HB 385

A bill to be entitled
2An act relating to nursing home facilities; amending s.
3400.118, F.S.; revising provisions relating to frequency
4of quality-of-care monitoring of specified facilities;
5amending s. 400.141, F.S.; authorizing facilities with a
6standard license to provide certified nursing assistant
7training; amending s. 400.147, F.S.; revising a
8definition; revising reporting requirements under facility
9internal risk management and quality assurance programs;
10amending s. 400.19, F.S.; providing conditions for
11scheduling surveys when certain deficiencies are
12overturned; amending s. 400.195, F.S.; correcting a cross-
13reference; amending s. 400.23, F.S.; revising conditions
14for documentation of compliance with staffing standards;
15directing the Agency for Health Care Administration to
16assign standard licensure status to a facility that has
17corrected specified deficiencies; revising provisions
18relating to classification of facility deficiencies;
19providing a definition; providing an effective date.
21Be It Enacted by the Legislature of the State of Florida:
23     Section 1.  Paragraph (a) of subsection (2) of section
24400.118, Florida Statutes, is amended to read:
25     400.118  Quality assurance; early warning system;
26monitoring; rapid response teams.--
27     (2)(a)  The agency shall establish within each district
28office one or more quality-of-care monitors, based on the number
29of nursing facilities in the district, to monitor all nursing
30facilities in the district on a regular, unannounced, aperiodic
31basis, including nights, evenings, weekends, and holidays.
32Quality-of-care monitors shall visit each nursing facility
33annually, shall visit each conditionally licensed nursing
34facility at least quarterly, and shall visit other nursing
35facilities as directed by the agency. Priority for additional
36monitoring visits shall be given to nursing facilities with a
37history of resident care deficiencies. Quality-of-care monitors
38shall be registered nurses who are trained and experienced in
39nursing facility regulation, standards of practice in long-term
40care, and evaluation of patient care. Individuals in these
41positions shall not be deployed by the agency as a part of the
42district survey team in the conduct of routine, scheduled
43surveys, but shall function solely and independently as quality-
44of-care monitors. Quality-of-care monitors shall assess the
45overall quality of life in the nursing facility and shall assess
46specific conditions in the facility directly related to resident
47care, including the operations of internal quality improvement
48and risk management programs and adverse incident reports. The
49quality-of-care monitor shall include in an assessment visit
50observation of the care and services rendered to residents and
51formal and informal interviews with residents, family members,
52facility staff, resident guests, volunteers, other regulatory
53staff, and representatives of a long-term care ombudsman council
54or Florida advocacy council.
55     Section 2.  Section 400.141, Florida Statutes, is amended
56to read:
57     400.141  Administration and management of nursing home
58facilities.--Every licensed facility shall comply with all
59applicable standards and rules of the agency and shall:
60     (1)  Be under the administrative direction and charge of a
61licensed administrator.
62     (2)  Appoint a medical director licensed pursuant to
63chapter 458 or chapter 459. The agency may establish by rule
64more specific criteria for the appointment of a medical
66     (3)  Have available the regular, consultative, and
67emergency services of physicians licensed by the state.
68     (4)  Provide for resident use of a community pharmacy as
69specified in s. 400.022(1)(q). Any other law to the contrary
70notwithstanding, a registered pharmacist licensed in Florida,
71that is under contract with a facility licensed under this
72chapter or chapter 429, shall repackage a nursing facility
73resident's bulk prescription medication which has been packaged
74by another pharmacist licensed in any state in the United States
75into a unit dose system compatible with the system used by the
76nursing facility, if the pharmacist is requested to offer such
77service. In order to be eligible for the repackaging, a resident
78or the resident's spouse must receive prescription medication
79benefits provided through a former employer as part of his or
80her retirement benefits, a qualified pension plan as specified
81in s. 4972 of the Internal Revenue Code, a federal retirement
82program as specified under 5 C.F.R. s. 831, or a long-term care
83policy as defined in s. 627.9404(1). A pharmacist who correctly
84repackages and relabels the medication and the nursing facility
85which correctly administers such repackaged medication under the
86provisions of this subsection shall not be held liable in any
87civil or administrative action arising from the repackaging. In
88order to be eligible for the repackaging, a nursing facility
89resident for whom the medication is to be repackaged shall sign
90an informed consent form provided by the facility which includes
91an explanation of the repackaging process and which notifies the
92resident of the immunities from liability provided herein. A
93pharmacist who repackages and relabels prescription medications,
94as authorized under this subsection, may charge a reasonable fee
95for costs resulting from the implementation of this provision.
96     (5)  Provide for the access of the facility residents to
97dental and other health-related services, recreational services,
98rehabilitative services, and social work services appropriate to
99their needs and conditions and not directly furnished by the
100licensee. When a geriatric outpatient nurse clinic is conducted
101in accordance with rules adopted by the agency, outpatients
102attending such clinic shall not be counted as part of the
103general resident population of the nursing home facility, nor
104shall the nursing staff of the geriatric outpatient clinic be
105counted as part of the nursing staff of the facility, until the
106outpatient clinic load exceeds 15 a day.
107     (6)  Be allowed and encouraged by the agency to provide
108other needed services under certain conditions. If the facility
109has a standard licensure status, and has had no class I or class
110II deficiencies during the past 2 years or has been awarded a
111Gold Seal under the program established in s. 400.235, it may be
112encouraged by the agency to provide services, including, but not
113limited to, respite and adult day services, which enable
114individuals to move in and out of the facility. A facility is
115not subject to any additional licensure requirements for
116providing these services. Respite care may be offered to persons
117in need of short-term or temporary nursing home services.
118Respite care must be provided in accordance with this part and
119rules adopted by the agency. However, the agency shall, by rule,
120adopt modified requirements for resident assessment, resident
121care plans, resident contracts, physician orders, and other
122provisions, as appropriate, for short-term or temporary nursing
123home services. The agency shall allow for shared programming and
124staff in a facility which meets minimum standards and offers
125services pursuant to this subsection, but, if the facility is
126cited for deficiencies in patient care, may require additional
127staff and programs appropriate to the needs of service
128recipients. A person who receives respite care may not be
129counted as a resident of the facility for purposes of the
130facility's licensed capacity unless that person receives 24-hour
131respite care. A person receiving either respite care for 24
132hours or longer or adult day services must be included when
133calculating minimum staffing for the facility. Any costs and
134revenues generated by a nursing home facility from
135nonresidential programs or services shall be excluded from the
136calculations of Medicaid per diems for nursing home
137institutional care reimbursement.
138     (7)  If the facility has a standard license or is a Gold
139Seal facility, exceeds the minimum required hours of licensed
140nursing and certified nursing assistant direct care per resident
141per day, and is part of a continuing care facility licensed
142under chapter 651 or a retirement community that offers other
143services pursuant to part III of this chapter or part I or part
144III of chapter 429 on a single campus, be allowed to share
145programming and staff. At the time of inspection and in the
146semiannual report required pursuant to subsection (15), a
147continuing care facility or retirement community that uses this
148option must demonstrate through staffing records that minimum
149staffing requirements for the facility were met. Licensed nurses
150and certified nursing assistants who work in the nursing home
151facility may be used to provide services elsewhere on campus if
152the facility exceeds the minimum number of direct care hours
153required per resident per day and the total number of residents
154receiving direct care services from a licensed nurse or a
155certified nursing assistant does not cause the facility to
156violate the staffing ratios required under s. 400.23(3)(a).
157Compliance with the minimum staffing ratios shall be based on
158total number of residents receiving direct care services,
159regardless of where they reside on campus. If the facility
160receives a conditional license, it may not share staff until the
161conditional license status ends. This subsection does not
162restrict the agency's authority under federal or state law to
163require additional staff if a facility is cited for deficiencies
164in care which are caused by an insufficient number of certified
165nursing assistants or licensed nurses. The agency may adopt
166rules for the documentation necessary to determine compliance
167with this provision.
168     (8)  Maintain the facility premises and equipment and
169conduct its operations in a safe and sanitary manner.
170     (9)  If the licensee furnishes food service, provide a
171wholesome and nourishing diet sufficient to meet generally
172accepted standards of proper nutrition for its residents and
173provide such therapeutic diets as may be prescribed by attending
174physicians. In making rules to implement this subsection, the
175agency shall be guided by standards recommended by nationally
176recognized professional groups and associations with knowledge
177of dietetics.
178     (10)  Keep full records of resident admissions and
179discharges; medical and general health status, including medical
180records, personal and social history, and identity and address
181of next of kin or other persons who may have responsibility for
182the affairs of the residents; and individual resident care plans
183including, but not limited to, prescribed services, service
184frequency and duration, and service goals. The records shall be
185open to inspection by the agency.
186     (11)  Keep such fiscal records of its operations and
187conditions as may be necessary to provide information pursuant
188to this part.
189     (12)  Furnish copies of personnel records for employees
190affiliated with such facility, to any other facility licensed by
191this state requesting this information pursuant to this part.
192Such information contained in the records may include, but is
193not limited to, disciplinary matters and any reason for
194termination. Any facility releasing such records pursuant to
195this part shall be considered to be acting in good faith and may
196not be held liable for information contained in such records,
197absent a showing that the facility maliciously falsified such
199     (13)  Publicly display a poster provided by the agency
200containing the names, addresses, and telephone numbers for the
201state's abuse hotline, the State Long-Term Care Ombudsman, the
202Agency for Health Care Administration consumer hotline, the
203Advocacy Center for Persons with Disabilities, the Florida
204Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
205with a clear description of the assistance to be expected from
207     (14)  Submit to the agency the information specified in s.
208400.071(2)(e) for a management company within 30 days after the
209effective date of the management agreement.
210     (15)  Submit semiannually to the agency, or more frequently
211if requested by the agency, information regarding facility
212staff-to-resident ratios, staff turnover, and staff stability,
213including information regarding certified nursing assistants,
214licensed nurses, the director of nursing, and the facility
215administrator. For purposes of this reporting:
216     (a)  Staff-to-resident ratios must be reported in the
217categories specified in s. 400.23(3)(a) and applicable rules.
218The ratio must be reported as an average for the most recent
219calendar quarter.
220     (b)  Staff turnover must be reported for the most recent
22112-month period ending on the last workday of the most recent
222calendar quarter prior to the date the information is submitted.
223The turnover rate must be computed quarterly, with the annual
224rate being the cumulative sum of the quarterly rates. The
225turnover rate is the total number of terminations or separations
226experienced during the quarter, excluding any employee
227terminated during a probationary period of 3 months or less,
228divided by the total number of staff employed at the end of the
229period for which the rate is computed, and expressed as a
231     (c)  The formula for determining staff stability is the
232total number of employees that have been employed for more than
23312 months, divided by the total number of employees employed at
234the end of the most recent calendar quarter, and expressed as a
236     (d)  A nursing facility that has failed to comply with
237state minimum-staffing requirements for 2 consecutive days is
238prohibited from accepting new admissions until the facility has
239achieved the minimum-staffing requirements for a period of 6
240consecutive days. For the purposes of this paragraph, any person
241who was a resident of the facility and was absent from the
242facility for the purpose of receiving medical care at a separate
243location or was on a leave of absence is not considered a new
244admission. Failure to impose such an admissions moratorium
245constitutes a class II deficiency.
246     (e)  A nursing facility which does not have a conditional
247license may be cited for failure to comply with the standards in
248s. 400.23(3)(a)1.a. only if it has failed to meet those
249standards on 2 consecutive days or if it has failed to meet at
250least 97 percent of those standards on any one day.
251     (f)  A facility which has a conditional license must be in
252compliance with the standards in s. 400.23(3)(a) at all times.
254Nothing in this section shall limit the agency's ability to
255impose a deficiency or take other actions if a facility does not
256have enough staff to meet the residents' needs.
257     (16)  Report monthly the number of vacant beds in the
258facility which are available for resident occupancy on the day
259the information is reported.
260     (17)  Notify a licensed physician when a resident exhibits
261signs of dementia or cognitive impairment or has a change of
262condition in order to rule out the presence of an underlying
263physiological condition that may be contributing to such
264dementia or impairment. The notification must occur within 30
265days after the acknowledgment of such signs by facility staff.
266If an underlying condition is determined to exist, the facility
267shall arrange, with the appropriate health care provider, the
268necessary care and services to treat the condition.
269     (18)  If the facility implements a dining and hospitality
270attendant program, ensure that the program is developed and
271implemented under the supervision of the facility director of
272nursing. A licensed nurse, licensed speech or occupational
273therapist, or a registered dietitian must conduct training of
274dining and hospitality attendants. A person employed by a
275facility as a dining and hospitality attendant must perform
276tasks under the direct supervision of a licensed nurse.
277     (19)  Report to the agency any filing for bankruptcy
278protection by the facility or its parent corporation,
279divestiture or spin-off of its assets, or corporate
280reorganization within 30 days after the completion of such
282     (20)  Maintain general and professional liability insurance
283coverage that is in force at all times. In lieu of general and
284professional liability insurance coverage, a state-designated
285teaching nursing home and its affiliated assisted living
286facilities created under s. 430.80 may demonstrate proof of
287financial responsibility as provided in s. 430.80(3)(h).
288     (21)  Maintain in the medical record for each resident a
289daily chart of certified nursing assistant services provided to
290the resident. The certified nursing assistant who is caring for
291the resident must complete this record by the end of his or her
292shift. This record must indicate assistance with activities of
293daily living, assistance with eating, and assistance with
294drinking, and must record each offering of nutrition and
295hydration for those residents whose plan of care or assessment
296indicates a risk for malnutrition or dehydration.
297     (22)  Before November 30 of each year, subject to the
298availability of an adequate supply of the necessary vaccine,
299provide for immunizations against influenza viruses to all its
300consenting residents in accordance with the recommendations of
301the United States Centers for Disease Control and Prevention,
302subject to exemptions for medical contraindications and
303religious or personal beliefs. Subject to these exemptions, any
304consenting person who becomes a resident of the facility after
305November 30 but before March 31 of the following year must be
306immunized within 5 working days after becoming a resident.
307Immunization shall not be provided to any resident who provides
308documentation that he or she has been immunized as required by
309this subsection. This subsection does not prohibit a resident
310from receiving the immunization from his or her personal
311physician if he or she so chooses. A resident who chooses to
312receive the immunization from his or her personal physician
313shall provide proof of immunization to the facility. The agency
314may adopt and enforce any rules necessary to comply with or
315implement this subsection.
316     (23)  Assess all residents for eligibility for pneumococcal
317polysaccharide vaccination (PPV) and vaccinate residents when
318indicated within 60 days after the effective date of this act in
319accordance with the recommendations of the United States Centers
320for Disease Control and Prevention, subject to exemptions for
321medical contraindications and religious or personal beliefs.
322Residents admitted after the effective date of this act shall be
323assessed within 5 working days of admission and, when indicated,
324vaccinated within 60 days in accordance with the recommendations
325of the United States Centers for Disease Control and Prevention,
326subject to exemptions for medical contraindications and
327religious or personal beliefs. Immunization shall not be
328provided to any resident who provides documentation that he or
329she has been immunized as required by this subsection. This
330subsection does not prohibit a resident from receiving the
331immunization from his or her personal physician if he or she so
332chooses. A resident who chooses to receive the immunization from
333his or her personal physician shall provide proof of
334immunization to the facility. The agency may adopt and enforce
335any rules necessary to comply with or implement this subsection.
336     (24)  Annually encourage and promote to its employees the
337benefits associated with immunizations against influenza viruses
338in accordance with the recommendations of the United States
339Centers for Disease Control and Prevention. The agency may adopt
340and enforce any rules necessary to comply with or implement this
343Every facility with a standard license Facilities that have been
344awarded a Gold Seal under the program established in s. 400.235
345may develop a plan to provide certified nursing assistant
346training as prescribed by federal regulations and state rules
347and may apply to the agency for approval of its their program.
348     Section 3.  Subsections (9) through (15) of section
349400.147, Florida Statutes, are renumbered as subsections (8)
350through (14), respectively, and paragraph (e) of subsection (5),
351subsection (7), and present subsection (8) of that section are
352amended to read:
353     400.147  Internal risk management and quality assurance
355     (5)  For purposes of reporting to the agency under this
356section, the term "adverse incident" means:
357     (e)  An event that is reported to law enforcement for
359     (7)(a)  The facility shall initiate an investigation and
360shall notify the agency within 1 business day after the risk
361manager or his or her designee has received a report pursuant to
362paragraph (1)(d). The notification must be made in writing and
363be provided electronically, by facsimile device or overnight
364mail delivery. The notification must include information
365regarding the identity of the affected resident, the type of
366adverse incident, the initiation of an investigation by the
367facility, and whether the events causing or resulting in the
368adverse incident represent a potential risk to any other
369resident. The notification is confidential as provided by law
370and is not discoverable or admissible in any civil or
371administrative action, except in disciplinary proceedings by the
372agency or the appropriate regulatory board. The agency may
373investigate, as it deems appropriate, any such incident and
374prescribe measures that must or may be taken in response to the
375incident. The agency shall review each incident and determine
376whether it potentially involved conduct by the health care
377professional who is subject to disciplinary action, in which
378case the provisions of s. 456.073 shall apply.
379     (b)(8)(a)  Each facility shall complete the investigation
380and submit an adverse incident report to the agency for each
381adverse incident within 15 calendar days after its occurrence.
382If, after a complete investigation, the risk manager determines
383that the incident was not an adverse incident as defined in
384subsection (5), the facility shall include this information in
385the report. The agency shall develop a form for reporting this
387     (c)(b)  The information reported to the agency pursuant to
388paragraph (b) that (a) which relates to persons licensed under
389chapter 458, chapter 459, chapter 461, or chapter 466 shall be
390reviewed by the agency. The agency shall determine whether any
391of the incidents potentially involved conduct by a health care
392professional who is subject to disciplinary action, in which
393case the provisions of s. 456.073 shall apply.
394     (d)(c)  The report submitted to the agency must also
395contain the name of the risk manager of the facility.
396     (e)(d)  The adverse incident report is confidential as
397provided by law and is not discoverable or admissible in any
398civil or administrative action, except in disciplinary
399proceedings by the agency or the appropriate regulatory board.
400     Section 4.  Subsection (3) of section 400.19, Florida
401Statutes, is amended to read:
402     400.19  Right of entry and inspection.--
403     (3)  The agency shall every 15 months conduct at least one
404unannounced inspection to determine compliance by the licensee
405with statutes, and with rules promulgated under the provisions
406of those statutes, governing minimum standards of construction,
407quality and adequacy of care, and rights of residents. The
408survey shall be conducted every 6 months for the next 2-year
409period if the facility has been cited for a class I deficiency,
410has been cited for two or more class II deficiencies arising
411from separate surveys or investigations within a 60-day period,
412or has had three or more substantiated complaints within a 6-
413month period, each resulting in at least one class I or class II
414deficiency. In addition to any other fees or fines in this part,
415the agency shall assess a fine for each facility that is subject
416to the 6-month survey cycle. The fine for the 2-year period
417shall be $6,000, one-half to be paid at the completion of each
418survey. The agency may adjust this fine by the change in the
419Consumer Price Index, based on the 12 months immediately
420preceding the increase, to cover the cost of the additional
421surveys. In the event such deficiencies are overturned as the
422result of administrative action but additional surveys have
423already been conducted pursuant to this section, the most recent
424survey shall be considered an annual survey for purposes of
425future survey scheduling. The agency shall verify through
426subsequent inspection that any deficiency identified during the
427annual inspection is corrected. However, the agency may verify
428the correction of a class III or class IV deficiency unrelated
429to resident rights or resident care without reinspecting the
430facility if adequate written documentation has been received
431from the facility, which provides assurance that the deficiency
432has been corrected. The giving or causing to be given of advance
433notice of such unannounced inspections by an employee of the
434agency to any unauthorized person shall constitute cause for
435suspension of not fewer than 5 working days according to the
436provisions of chapter 110.
437     Section 5.  Paragraph (d) of subsection (1) of section
438400.195, Florida Statutes, is amended to read:
439     400.195  Agency reporting requirements.--
440     (1)  For the period beginning June 30, 2001, and ending
441June 30, 2005, the Agency for Health Care Administration shall
442provide a report to the Governor, the President of the Senate,
443and the Speaker of the House of Representatives with respect to
444nursing homes. The first report shall be submitted no later than
445December 30, 2002, and subsequent reports shall be submitted
446every 6 months thereafter. The report shall identify facilities
447based on their ownership characteristics, size, business
448structure, for-profit or not-for-profit status, and any other
449characteristics the agency determines useful in analyzing the
450varied segments of the nursing home industry and shall report:
451     (d)  Information regarding deficiencies cited, including
452information used to develop the Nursing Home Guide WATCH LIST
453pursuant to s. 400.191, and applicable rules, a summary of data
454generated on nursing homes by Centers for Medicare and Medicaid
455Services Nursing Home Quality Information Project, and
456information collected pursuant to s. 400.147(8)(9), relating to
458     Section 6.  Paragraph (a) of subsection (3), paragraphs (b)
459and (e) of subsection (7), and subsection (8) of section 400.23,
460Florida Statutes, are amended to read:
461     400.23  Rules; evaluation and deficiencies; licensure
463     (3)(a)1.  The agency shall adopt rules providing minimum
464staffing requirements for nursing homes. These requirements
465shall include, for each nursing home facility:
466     a.  A minimum certified nursing assistant staffing of 2.6
467hours of direct care per resident per day beginning January 1,
4682003, and increasing to 2.7 hours of direct care per resident
469per day beginning January 1, 2007. Beginning January 1, 2002, no
470facility shall staff below one certified nursing assistant per
47120 residents, and a minimum licensed nursing staffing of 1.0
472hour of direct care per resident per day but never below one
473licensed nurse per 40 residents.
474     b.  Beginning January 1, 2007, a minimum weekly average
475certified nursing assistant staffing of 2.9 hours of direct care
476per resident per day. For the purpose of this sub-subparagraph,
477a week is defined as Sunday through Saturday.
478     2.  Nursing assistants employed under s. 400.211(2) may be
479included in computing the staffing ratio for certified nursing
480assistants only if their job responsibilities include only
481nursing-assistant-related duties.
482     3.  Each nursing home must document compliance with
483staffing standards as required under this paragraph and post
484daily the names of staff on duty for the benefit of facility
485residents and the public. Compliance with federal posting
486requirements shall satisfy the posting requirements of this
488     4.  The agency shall recognize the use of licensed nurses
489for compliance with minimum staffing requirements for certified
490nursing assistants, provided that the facility otherwise meets
491the minimum staffing requirements for licensed nurses and that
492the licensed nurses are performing the duties of a certified
493nursing assistant. Unless otherwise approved by the agency,
494licensed nurses counted toward the minimum staffing requirements
495for certified nursing assistants must exclusively perform the
496duties of a certified nursing assistant for the entire shift and
497not also be counted toward the minimum staffing requirements for
498licensed nurses. If the agency approved a facility's request to
499use a licensed nurse to perform both licensed nursing and
500certified nursing assistant duties, the facility must allocate
501the amount of staff time specifically spent on certified nursing
502assistant duties for the purpose of documenting compliance with
503minimum staffing requirements for certified and licensed nursing
504staff. In no event may the hours of a licensed nurse with dual
505job responsibilities be counted twice.
506     (7)  The agency shall, at least every 15 months, evaluate
507all nursing home facilities and make a determination as to the
508degree of compliance by each licensee with the established rules
509adopted under this part as a basis for assigning a licensure
510status to that facility. The agency shall base its evaluation on
511the most recent inspection report, taking into consideration
512findings from other official reports, surveys, interviews,
513investigations, and inspections. The agency shall assign a
514licensure status of standard or conditional to each nursing
516     (b)  A conditional licensure status means that a facility,
517due to the presence of one or more class I or class II
518deficiencies, or class III deficiencies not corrected within the
519time established by the agency, is not in substantial compliance
520at the time of the survey with criteria established under this
521part or with rules adopted by the agency. If the facility has no
522class I, class II, or uncorrected class III deficiencies at the
523time of the followup survey, a standard licensure status shall
524may be assigned.
525     (e)  Each licensee shall post its license issued pursuant
526to final agency action in a prominent place that is in clear and
527unobstructed public view at or near the place where residents
528are being admitted to the facility.
529     (8)  The agency shall adopt rules to provide that, when the
530criteria established under subsection (2) are not met, such
531deficiencies shall be classified according to the nature and the
532scope of the deficiency. The scope shall be cited as isolated,
533patterned, or widespread. An isolated deficiency is a deficiency
534affecting one or a very limited number of residents, or
535involving one or a very limited number of staff, or a situation
536that occurred only occasionally or in a very limited number of
537locations. A patterned deficiency is a deficiency where more
538than a very limited number of residents are affected, or more
539than a very limited number of staff are involved, or the
540situation has occurred in several locations, or the same
541resident or residents have been affected by repeated occurrences
542of the same deficient practice but the effect of the deficient
543practice is not found to be pervasive throughout the facility. A
544widespread deficiency is a deficiency in which the problems
545causing the deficiency are pervasive in the facility or
546represent systemic failure that has affected or has the
547potential to affect a large portion of the facility's residents.
548The agency shall indicate the classification on the face of the
549notice of deficiencies as follows:
550     (a)  A class I deficiency is a deficiency that the agency
551determines presents a situation in which immediate corrective
552action is necessary because the facility's noncompliance creates
553immediate jeopardy to the health or safety of a resident. For
554purposes of this subsection, "immediate jeopardy" means that the
555licensee's noncompliance has caused, or is likely to cause,
556serious injury, harm, impairment, or death to a resident
557receiving care in a facility. The condition or practice
558constituting a class I violation shall be abated or eliminated
559immediately, unless a fixed period of time, as determined by the
560agency, is required for correction. A class I deficiency is
561subject to a civil penalty of $10,000 for an isolated
562deficiency, $12,500 for a patterned deficiency, and $15,000 for
563a widespread deficiency. The fine amount shall be doubled for
564each deficiency if the facility was previously cited for one or
565more class I or class II deficiencies during the last annual
566inspection or any inspection or complaint investigation since
567the last annual inspection. A fine must be levied
568notwithstanding the correction of the deficiency.
569     (b)  A class II deficiency is a deficiency that the agency
570determines has caused actual harm to a resident but did not
571create immediate jeopardy compromised the resident's ability to
572maintain or reach his or her highest practicable physical,
573mental, and psychosocial well-being, as defined by an accurate
574and comprehensive resident assessment, plan of care, and
575provision of services. A class II deficiency is subject to a
576civil penalty of $2,500 for an isolated deficiency, $5,000 for a
577patterned deficiency, and $7,500 for a widespread deficiency.
578The fine amount shall be doubled for each deficiency if the
579facility was previously cited for one or more class I or class
580II deficiencies during the last annual inspection or any
581inspection or complaint investigation since the last annual
582inspection. A fine shall be levied notwithstanding the
583correction of the deficiency.
584     (c)  A class III deficiency is a deficiency that the agency
585determines has not caused actual harm to a resident and did not
586create immediate jeopardy but presents the potential for more
587than minimal harm will result in no more than minimal physical,
588mental, or psychosocial discomfort to the resident or has the
589potential to compromise the resident's ability to maintain or
590reach his or her highest practical physical, mental, or
591psychosocial well-being, as defined by an accurate and
592comprehensive resident assessment, plan of care, and provision
593of services. A class III deficiency is subject to a civil
594penalty of $1,000 for an isolated deficiency, $2,000 for a
595patterned deficiency, and $3,000 for a widespread deficiency.
596The fine amount shall be doubled for each deficiency if the
597facility was previously cited for one or more class I or class
598II deficiencies during the last annual inspection or any
599inspection or complaint investigation since the last annual
600inspection. A citation for a class III deficiency must specify
601the time within which the deficiency is required to be
602corrected. If a class III deficiency is corrected within the
603time specified, no civil penalty shall be imposed.
604     (d)  A class IV deficiency is a deficiency that the agency
605determines has the potential for causing no more than minimal
606harm to a minor negative impact on the resident. If the class IV
607deficiency is isolated, no plan of correction is required.
608     Section 7.  This act shall take effect July 1, 2007.

CODING: Words stricken are deletions; words underlined are additions.