HB 651

1	A bill to be entitled
2	An act relating to the Agency for Health Care
3	Administration; repealing s. 395.0199, F.S., relating to
4	private utilization review of health care services;
5	amending ss. 395.405 and 400.0712, F.S.; conforming cross-
6	references; amending s. 400.118, F.S.; removing provisions
7	requiring quality-of-care monitors for nursing facilities
8	in agency district offices; amending s. 400.141, F.S.;
9	revising reporting requirements for facility staff-to-
10	resident ratios; deleting a requirement that licensed
11	nursing home facilities provide the agency with a monthly
12	report on the number of vacant beds in the facility;
13	amending s. 400.147, F.S.; revising reporting requirements
14	under facility internal risk management and quality
15	assurance programs; revising the definition of the term
16	"adverse incident" for reporting purposes; requiring
17	abuse, neglect, and exploitation to be reported to the
18	agency and the Department of Children and Family Services;
19	deleting a requirement that the agency submit an annual
20	report on nursing home adverse incidents to the
21	Legislature; amending s. 400.195, F.S.; conforming a
22	cross-reference; amending s. 400.464, F.S.; revising
23	grounds for imposition of penalties with regard to home
24	health agencies under certain circumstances; amending s.
25	400.497, F.S.; conforming a cross-reference; repealing s.
26	400.509, F.S., relating to the registration and regulation
27	of providers that offer companion or homemaker services
28	and are exempt from licensure; amending ss. 400.506 and
29	400.512, F.S.; deleting references to companion and
30	homemaker services to conform to changes made by the act;
31	amending s. 400.9935, F.S.; revising responsibilities of
32	medical and health care clinic directors relating to
33	referral of patients; deleting a penalty; revising
34	accreditation requirements for clinics providing magnetic
35	resonance imaging services; amending s. 400.995, F.S.;
36	revising agency responsibilities with respect to personnel
37	and operations in certain injunctive proceedings; amending
38	s. 408.803, F.S.; revising definitions applicable to pt.
39	II of ch. 408, F.S., the "Health Care Licensing Procedures
40	Act"; amending s. 408.806, F.S.; revising contents of and
41	procedures relating to health care provider applications
42	for licensure; providing an exception from certain
43	licensure inspections for adult family-care homes;
44	authorizing the agency to provide electronic access to
45	certain information and documents; amending s. 408.807,
46	F.S.; providing procedure and time limits for transfer of
47	ownership and applications for licensure; amending s.
48	408.808, F.S.; providing for a provisional license to be
49	issued to applicants applying for a change of ownership;
50	providing a time limit on provisional licenses; amending
51	s. 408.809, F.S.; revising provisions relating to
52	background screening of specified employees; requiring
53	health care providers to submit to the agency an affidavit
54	of compliance with background screening requirements at
55	the time of license renewal; deleting a provision to
56	conform to changes made by the act; amending s. 408.810,
57	F.S.; revising provisions relating to information required
58	for licensure; amending s. 408.811, F.S.; providing for
59	certain inspections to be accepted in lieu of complete
60	licensure inspections; granting agency access to records
61	requested during an offsite review; providing timeframes
62	for correction of certain deficiencies and submission of
63	plans to correct such deficiencies; amending s. 408.813,
64	F.S.; providing classifications of violations of pt. II of
65	ch. 408, F.S.; providing for fines; amending s. 408.820,
66	F.S.; revising applicability of exemptions from specified
67	requirements of pt. II of ch. 408, F.S.; creating s.
68	408.821, F.S.; requiring entities regulated or licensed by
69	the agency to designate a safety officer for emergency
70	operations; providing that entities regulated or licensed
71	by the agency may temporarily exceed their licensed
72	capacity to act as receiving providers under specified
73	circumstances; providing requirements while such entities
74	are in an overcapacity status; providing for issuance of
75	an inactive license to such licensees under specified
76	conditions; providing requirements and procedures with
77	respect to the issuance and reactivation of an inactive
78	license; authorizing the agency to adopt rules; amending
79	s. 408.831, F.S.; deleting provisions relating to
80	authorization for entities regulated or licensed by the
81	agency to exceed their licensed capacity to act as
82	receiving facilities and issuance and reactivation of
83	inactive licenses; amending s. 409.221, F.S.; conforming a
84	cross-reference; amending s. 409.901, F.S.; revising a
85	definition applicable to Medicaid providers; repealing s.
86	429.071, F.S., relating to the intergenerational respite
87	care assisted living facility pilot program; amending s.
88	429.08, F.S.; authorizing the agency to provide
89	information regarding licensed assisted living facilities
90	on its Internet website; abolishing local coordinating
91	workgroups established by agency field offices; amending
92	s. 429.14, F.S.; conforming a reference; amending s.
93	429.19, F.S.; revising agency procedures for imposition of
94	fines for violations of pt. I of ch. 429, F.S., the
95	"Assisted Living Facilities Act"; amending s. 429.23,
96	F.S.; revising the definition of the term "adverse
97	incident" for reporting purposes; requiring abuse,
98	neglect, and exploitation to be reported to the agency and
99	the Department of Children and Family Services; deleting a
100	requirement that the agency submit an annual report on
101	assisted living facility adverse incidents to the
102	Legislature; amending s. 429.26, F.S.; removing
103	requirement for a resident of an assisted living facility
104	to undergo examinations and evaluations under certain
105	circumstances; amending s. 430.80, F.S.; conforming a
106	cross-reference; amending ss. 435.04 and 435.05, F.S.;
107	requiring employers of certain employees to submit an
108	affidavit of compliance with level 2 screening
109	requirements at the time of license renewal; amending s.
110	483.031, F.S.; conforming a reference; amending s.
111	483.041, F.S.; revising a definition applicable to pt. I
112	of ch. 483, F.S., the "Florida Clinical Laboratory Law";
113	repealing s. 483.106, F.S., relating to applications for
114	certificates of exemption by clinical laboratories that
115	perform certain tests; amending s. 483.172, F.S.;
116	conforming a reference; amending s. 483.23, F.S.; revising
117	provisions relating to exemptions from penalties imposed
118	for the performance of certain clinical laboratory
119	procedures; amending s. 651.118, F.S.; conforming a cross-
120	reference; providing an effective date.
121
122	Be It Enacted by the Legislature of the State of Florida:
123
124	Section 1.  Section 395.0199, Florida Statutes, is
125	repealed.
126	Section 2.  Section 395.405, Florida Statutes, is amended
127	to read:
128	395.405  Rulemaking.--The department shall adopt and
129	enforce all rules necessary to administer ss. 395.0199, 395.401,
130	395.4015, 395.402, 395.4025, 395.403, 395.404, and 395.4045.
131	Section 3.  Subsection (1) of section 400.0712, Florida
132	Statutes, is amended to read:
133	400.0712  Application for inactive license.--
134	(1)  As specified in s. 408.831(4) and this section, the
135	agency may issue an inactive license to a nursing home facility
136	for all or a portion of its beds. Any request by a licensee that
137	a nursing home or portion of a nursing home become inactive must
138	be submitted to the agency in the approved format. The facility
139	may not initiate any suspension of services, notify residents,
140	or initiate inactivity before receiving approval from the
141	agency; and a licensee that violates this provision may not be
142	issued an inactive license.
143	Section 4.  Subsection (3) of section 400.118, Florida
144	Statutes, is renumbered as subsection (2), and present
145	subsection (2) of that section is amended to read:
146	400.118  Quality assurance; early warning system;
147	monitoring; rapid response teams.--
148	(2)(a)  The agency shall establish within each district
149	office one or more quality-of-care monitors, based on the number
150	of nursing facilities in the district, to monitor all nursing
151	facilities in the district on a regular, unannounced, aperiodic
152	basis, including nights, evenings, weekends, and holidays.
153	Quality-of-care monitors shall visit each nursing facility at
154	least quarterly. Priority for additional monitoring visits shall
155	be given to nursing facilities with a history of resident care
156	deficiencies. Quality-of-care monitors shall be registered
157	nurses who are trained and experienced in nursing facility
158	regulation, standards of practice in long-term care, and
159	evaluation of patient care. Individuals in these positions shall
160	not be deployed by the agency as a part of the district survey
161	team in the conduct of routine, scheduled surveys, but shall
162	function solely and independently as quality-of-care monitors.
163	Quality-of-care monitors shall assess the overall quality of
164	life in the nursing facility and shall assess specific
165	conditions in the facility directly related to resident care,
166	including the operations of internal quality improvement and
167	risk management programs and adverse incident reports. The
168	quality-of-care monitor shall include in an assessment visit
169	observation of the care and services rendered to residents and
170	formal and informal interviews with residents, family members,
171	facility staff, resident guests, volunteers, other regulatory
172	staff, and representatives of a long-term care ombudsman council
173	or Florida advocacy council.
174	(b)  Findings of a monitoring visit, both positive and
175	negative, shall be provided orally and in writing to the
176	facility administrator or, in the absence of the facility
177	administrator, to the administrator on duty or the director of
178	nursing. The quality-of-care monitor may recommend to the
179	facility administrator procedural and policy changes and staff
180	training, as needed, to improve the care or quality of life of
181	facility residents. Conditions observed by the quality-of-care
182	monitor which threaten the health or safety of a resident shall
183	be reported immediately to the agency area office supervisor for
184	appropriate regulatory action and, as appropriate or as required
185	by law, to law enforcement, adult protective services, or other
186	responsible agencies.
187	(c)  Any record, whether written or oral, or any written or
188	oral communication generated pursuant to paragraph (a) or
189	paragraph (b) shall not be subject to discovery or introduction
190	into evidence in any civil or administrative action against a
191	nursing facility arising out of matters which are the subject of
192	quality-of-care monitoring, and a person who was in attendance
193	at a monitoring visit or evaluation may not be permitted or
194	required to testify in any such civil or administrative action
195	as to any evidence or other matters produced or presented during
196	the monitoring visits or evaluations. However, information,
197	documents, or records otherwise available from original sources
198	are not to be construed as immune from discovery or use in any
199	such civil or administrative action merely because they were
200	presented during monitoring visits or evaluations, and any
201	person who participates in such activities may not be prevented
202	from testifying as to matters within his or her knowledge, but
203	such witness may not be asked about his or her participation in
204	such activities. The exclusion from the discovery or
205	introduction of evidence in any civil or administrative action
206	provided for herein shall not apply when the quality-of-care
207	monitor makes a report to the appropriate authorities regarding
208	a threat to the health or safety of a resident.
209	Section 5.  Section 400.141, Florida Statutes, is amended
210	to read:
211	400.141  Administration and management of nursing home
212	facilities.--
213	(1)  Every licensed facility shall comply with all
214	applicable standards and rules of the agency and shall:
215	(a)(1)  Be under the administrative direction and charge of
216	a licensed administrator.
217	(b)(2)  Appoint a medical director licensed pursuant to
218	chapter 458 or chapter 459. The agency may establish by rule
219	more specific criteria for the appointment of a medical
220	director.
221	(c)(3)  Have available the regular, consultative, and
222	emergency services of physicians licensed by the state.
223	(d)(4)  Provide for resident use of a community pharmacy as
224	specified in s. 400.022(1)(q). Any other law to the contrary
225	notwithstanding, a registered pharmacist licensed in Florida,
226	that is under contract with a facility licensed under this
227	chapter or chapter 429, shall repackage a nursing facility
228	resident's bulk prescription medication which has been packaged
229	by another pharmacist licensed in any state in the United States
230	into a unit dose system compatible with the system used by the
231	nursing facility, if the pharmacist is requested to offer such
232	service. In order to be eligible for the repackaging, a resident
233	or the resident's spouse must receive prescription medication
234	benefits provided through a former employer as part of his or
235	her retirement benefits, a qualified pension plan as specified
236	in s. 4972 of the Internal Revenue Code, a federal retirement
237	program as specified under 5 C.F.R. s. 831, or a long-term care
238	policy as defined in s. 627.9404(1). A pharmacist who correctly
239	repackages and relabels the medication and the nursing facility
240	which correctly administers such repackaged medication under the
241	provisions of this paragraph may subsection shall not be held
242	liable in any civil or administrative action arising from the
243	repackaging. In order to be eligible for the repackaging, a
244	nursing facility resident for whom the medication is to be
245	repackaged shall sign an informed consent form provided by the
246	facility which includes an explanation of the repackaging
247	process and which notifies the resident of the immunities from
248	liability provided in this paragraph herein. A pharmacist who
249	repackages and relabels prescription medications, as authorized
250	under this paragraph subsection, may charge a reasonable fee for
251	costs resulting from the implementation of this provision.
252	(e)(5)  Provide for the access of the facility residents to
253	dental and other health-related services, recreational services,
254	rehabilitative services, and social work services appropriate to
255	their needs and conditions and not directly furnished by the
256	licensee. When a geriatric outpatient nurse clinic is conducted
257	in accordance with rules adopted by the agency, outpatients
258	attending such clinic shall not be counted as part of the
259	general resident population of the nursing home facility, nor
260	shall the nursing staff of the geriatric outpatient clinic be
261	counted as part of the nursing staff of the facility, until the
262	outpatient clinic load exceeds 15 a day.
263	(f)(6)  Be allowed and encouraged by the agency to provide
264	other needed services under certain conditions. If the facility
265	has a standard licensure status, and has had no class I or class
266	II deficiencies during the past 2 years or has been awarded a
267	Gold Seal under the program established in s. 400.235, it may be
268	encouraged by the agency to provide services, including, but not
269	limited to, respite and adult day services, which enable
270	individuals to move in and out of the facility. A facility is
271	not subject to any additional licensure requirements for
272	providing these services. Respite care may be offered to persons
273	in need of short-term or temporary nursing home services.
274	Respite care must be provided in accordance with this part and
275	rules adopted by the agency. However, the agency shall, by rule,
276	adopt modified requirements for resident assessment, resident
277	care plans, resident contracts, physician orders, and other
278	provisions, as appropriate, for short-term or temporary nursing
279	home services. The agency shall allow for shared programming and
280	staff in a facility which meets minimum standards and offers
281	services pursuant to this paragraph subsection, but, if the
282	facility is cited for deficiencies in patient care, may require
283	additional staff and programs appropriate to the needs of
284	service recipients. A person who receives respite care may not
285	be counted as a resident of the facility for purposes of the
286	facility's licensed capacity unless that person receives 24-hour
287	respite care. A person receiving either respite care for 24
288	hours or longer or adult day services must be included when
289	calculating minimum staffing for the facility. Any costs and
290	revenues generated by a nursing home facility from
291	nonresidential programs or services shall be excluded from the
292	calculations of Medicaid per diems for nursing home
293	institutional care reimbursement.
294	(g)(7)  If the facility has a standard license or is a Gold
295	Seal facility, exceeds the minimum required hours of licensed
296	nursing and certified nursing assistant direct care per resident
297	per day, and is part of a continuing care facility licensed
298	under chapter 651 or a retirement community that offers other
299	services pursuant to part III of this chapter or part I or part
300	III of chapter 429 on a single campus, be allowed to share
301	programming and staff. At the time of inspection and in the
302	semiannual report required pursuant to paragraph (o) subsection
303	(15), a continuing care facility or retirement community that
304	uses this option must demonstrate through staffing records that
305	minimum staffing requirements for the facility were met.
306	Licensed nurses and certified nursing assistants who work in the
307	nursing home facility may be used to provide services elsewhere
308	on campus if the facility exceeds the minimum number of direct
309	care hours required per resident per day and the total number of
310	residents receiving direct care services from a licensed nurse
311	or a certified nursing assistant does not cause the facility to
312	violate the staffing ratios required under s. 400.23(3)(a).
313	Compliance with the minimum staffing ratios shall be based on
314	total number of residents receiving direct care services,
315	regardless of where they reside on campus. If the facility
316	receives a conditional license, it may not share staff until the
317	conditional license status ends. This paragraph subsection does
318	not restrict the agency's authority under federal or state law
319	to require additional staff if a facility is cited for
320	deficiencies in care which are caused by an insufficient number
321	of certified nursing assistants or licensed nurses. The agency
322	may adopt rules for the documentation necessary to determine
323	compliance with this provision.
324	(h)(8)  Maintain the facility premises and equipment and
325	conduct its operations in a safe and sanitary manner.
326	(i)(9)  If the licensee furnishes food service, provide a
327	wholesome and nourishing diet sufficient to meet generally
328	accepted standards of proper nutrition for its residents and
329	provide such therapeutic diets as may be prescribed by attending
330	physicians. In making rules to implement this paragraph
331	subsection, the agency shall be guided by standards recommended
332	by nationally recognized professional groups and associations
333	with knowledge of dietetics.
334	(j)(10)  Keep full records of resident admissions and
335	discharges; medical and general health status, including medical
336	records, personal and social history, and identity and address
337	of next of kin or other persons who may have responsibility for
338	the affairs of the residents; and individual resident care plans
339	including, but not limited to, prescribed services, service
340	frequency and duration, and service goals. The records shall be
341	open to inspection by the agency.
342	(k)(11)  Keep such fiscal records of its operations and
343	conditions as may be necessary to provide information pursuant
344	to this part.
345	(l)(12)  Furnish copies of personnel records for employees
346	affiliated with such facility, to any other facility licensed by
347	this state requesting this information pursuant to this part.
348	Such information contained in the records may include, but is
349	not limited to, disciplinary matters and any reason for
350	termination. Any facility releasing such records pursuant to
351	this part shall be considered to be acting in good faith and may
352	not be held liable for information contained in such records,
353	absent a showing that the facility maliciously falsified such
354	records.
355	(m)(13)  Publicly display a poster provided by the agency
356	containing the names, addresses, and telephone numbers for the
357	state's abuse hotline, the State Long-Term Care Ombudsman, the
358	Agency for Health Care Administration consumer hotline, the
359	Advocacy Center for Persons with Disabilities, the Florida
360	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
361	with a clear description of the assistance to be expected from
362	each.
363	(n)(14)  Submit to the agency the information specified in
364	s. 400.071(1)(b) for a management company within 30 days after
365	the effective date of the management agreement.
366	(o)1.(15)  In addition to the requirements of s.
367	400.23(3)(a) and applicable rules, submit semiannually to the
368	agency, or more frequently if requested by the agency,
369	information regarding facility staff-to-resident ratios, staff
370	turnover, and staff stability, including information regarding
371	certified nursing assistants, licensed nurses, the director of
372	nursing, and the facility administrator. For purposes of this
373	reporting:
374	a.(a)  Staff-to-resident ratios must be reported in the
375	categories specified in s. 400.23(3)(a) and applicable rules.
376	The ratio must be reported as an average for the most recent
377	calendar quarter.
378	b.(b)  Staff turnover must be reported for the most recent
379	12-month period ending on the last workday of the most recent
380	calendar quarter prior to the date the information is submitted.
381	The turnover rate must be computed quarterly, with the annual
382	rate being the cumulative sum of the quarterly rates. The
383	turnover rate is the total number of terminations or separations
384	experienced during the quarter, excluding any employee
385	terminated during a probationary period of 3 months or less,
386	divided by the total number of staff employed at the end of the
387	period for which the rate is computed, and expressed as a
388	percentage.
389	c.(c)  The formula for determining staff stability is the
390	total number of employees that have been employed for more than
391	12 months, divided by the total number of employees employed at
392	the end of the most recent calendar quarter, and expressed as a
393	percentage.
394	d.(d)  A nursing facility that has failed to comply with
395	state minimum-staffing requirements for 2 consecutive days is
396	prohibited from accepting new admissions until the facility has
397	achieved the minimum-staffing requirements for a period of 6
398	consecutive days. For the purposes of this sub-subparagraph
399	paragraph, any person who was a resident of the facility and was
400	absent from the facility for the purpose of receiving medical
401	care at a separate location or was on a leave of absence is not
402	considered a new admission. Failure to impose such an admissions
403	moratorium constitutes a class II deficiency.
404	e.(e)  A nursing facility which does not have a conditional
405	license may be cited for failure to comply with the standards in
406	s. 400.23(3)(a)1.a. only if it has failed to meet those
407	standards on 2 consecutive days or if it has failed to meet at
408	least 97 percent of those standards on any one day.
409	f.(f)  A facility which has a conditional license must be
410	in compliance with the standards in s. 400.23(3)(a) at all
411	times.
412	2.  Nothing in This paragraph does not section shall limit
413	the agency's ability to impose a deficiency or take other
414	actions if a facility does not have enough staff to meet the
415	residents' needs.
416	(16)  Report monthly the number of vacant beds in the
417	facility which are available for resident occupancy on the day
418	the information is reported.
419	(p)(17)  Notify a licensed physician when a resident
420	exhibits signs of dementia or cognitive impairment or has a
421	change of condition in order to rule out the presence of an
422	underlying physiological condition that may be contributing to
423	such dementia or impairment. The notification must occur within
424	30 days after the acknowledgment of such signs by facility
425	staff. If an underlying condition is determined to exist, the
426	facility shall arrange, with the appropriate health care
427	provider, the necessary care and services to treat the
428	condition.
429	(q)(18)  If the facility implements a dining and
430	hospitality attendant program, ensure that the program is
431	developed and implemented under the supervision of the facility
432	director of nursing. A licensed nurse, licensed speech or
433	occupational therapist, or a registered dietitian must conduct
434	training of dining and hospitality attendants. A person employed
435	by a facility as a dining and hospitality attendant must perform
436	tasks under the direct supervision of a licensed nurse.
437	(r)(19)  Report to the agency any filing for bankruptcy
438	protection by the facility or its parent corporation,
439	divestiture or spin-off of its assets, or corporate
440	reorganization within 30 days after the completion of such
441	activity.
442	(s)(20)  Maintain general and professional liability
443	insurance coverage that is in force at all times. In lieu of
444	general and professional liability insurance coverage, a state-
445	designated teaching nursing home and its affiliated assisted
446	living facilities created under s. 430.80 may demonstrate proof
447	of financial responsibility as provided in s. 430.80(3)(h).
448	(t)(21)  Maintain in the medical record for each resident a
449	daily chart of certified nursing assistant services provided to
450	the resident. The certified nursing assistant who is caring for
451	the resident must complete this record by the end of his or her
452	shift. This record must indicate assistance with activities of
453	daily living, assistance with eating, and assistance with
454	drinking, and must record each offering of nutrition and
455	hydration for those residents whose plan of care or assessment
456	indicates a risk for malnutrition or dehydration.
457	(u)(22)  Before November 30 of each year, subject to the
458	availability of an adequate supply of the necessary vaccine,
459	provide for immunizations against influenza viruses to all its
460	consenting residents in accordance with the recommendations of
461	the United States Centers for Disease Control and Prevention,
462	subject to exemptions for medical contraindications and
463	religious or personal beliefs. Subject to these exemptions, any
464	consenting person who becomes a resident of the facility after
465	November 30 but before March 31 of the following year must be
466	immunized within 5 working days after becoming a resident.
467	Immunization shall not be provided to any resident who provides
468	documentation that he or she has been immunized as required by
469	this paragraph subsection. This paragraph subsection does not
470	prohibit a resident from receiving the immunization from his or
471	her personal physician if he or she so chooses. A resident who
472	chooses to receive the immunization from his or her personal
473	physician shall provide proof of immunization to the facility.
474	The agency may adopt and enforce any rules necessary to comply
475	with or implement this paragraph subsection.
476	(v)(23)  Assess all residents for eligibility for
477	pneumococcal polysaccharide vaccination (PPV) and vaccinate
478	residents when indicated within 60 days after the effective date
479	of this act in accordance with the recommendations of the United
480	States Centers for Disease Control and Prevention, subject to
481	exemptions for medical contraindications and religious or
482	personal beliefs. Residents admitted after the effective date of
483	this act shall be assessed within 5 working days of admission
484	and, when indicated, vaccinated within 60 days in accordance
485	with the recommendations of the United States Centers for
486	Disease Control and Prevention, subject to exemptions for
487	medical contraindications and religious or personal beliefs.
488	Immunization shall not be provided to any resident who provides
489	documentation that he or she has been immunized as required by
490	this paragraph subsection. This paragraph subsection does not
491	prohibit a resident from receiving the immunization from his or
492	her personal physician if he or she so chooses. A resident who
493	chooses to receive the immunization from his or her personal
494	physician shall provide proof of immunization to the facility.
495	The agency may adopt and enforce any rules necessary to comply
496	with or implement this paragraph subsection.
497	(w)(24)  Annually encourage and promote to its employees
498	the benefits associated with immunizations against influenza
499	viruses in accordance with the recommendations of the United
500	States Centers for Disease Control and Prevention. The agency
501	may adopt and enforce any rules necessary to comply with or
502	implement this paragraph subsection.
503	(2)  Facilities that have been awarded a Gold Seal under
504	the program established in s. 400.235 may develop a plan to
505	provide certified nursing assistant training as prescribed by
506	federal regulations and state rules and may apply to the agency
507	for approval of their program.
508	Section 6.  Present subsections (9) through (13) of section
509	400.147, Florida Statutes, are renumbered as subsections (10)
510	through (14), respectively, subsection (5) and present
511	subsection (14) are amended, and a new subsection (9) is added
512	to that section, to read:
513	400.147  Internal risk management and quality assurance
514	program.--
515	(5)  For purposes of reporting to the agency under this
516	section, the term "adverse incident" means:
517	(a)  An event over which facility personnel could exercise
518	control and which is associated in whole or in part with the
519	facility's intervention, rather than the condition for which
520	such intervention occurred, and which results in one of the
521	following:
522	1.  Death;
523	2.  Brain or spinal damage;
524	3.  Permanent disfigurement;
525	4.  Fracture or dislocation of bones or joints;
526	5.  A limitation of neurological, physical, or sensory
527	function;
528	6.  Any condition that required medical attention to which
529	the resident has not given his or her informed consent,
530	including failure to honor advanced directives; or
531	7.  Any condition that required the transfer of the
532	resident, within or outside the facility, to a unit providing a
533	more acute level of care due to the adverse incident, rather
534	than the resident's condition prior to the adverse incident; or
535	8.  An event that is reported to law enforcement; or
536	(b)  Abuse, neglect, or exploitation as defined in s.
537	415.102;
538	(c)  Abuse, neglect and harm as defined in s. 39.01;
539	(b)(d)  Resident elopement, if the elopement places the
540	resident at risk of harm or injury.; or
541	(e)  An event that is reported to law enforcement.
542	(9)  Abuse, neglect, or exploitation must be reported to
543	the agency as required by 42 C.F.R. s. 483.13(c) and to the
544	department as required by chapters 39 and 415.
545	(14)  The agency shall annually submit to the Legislature a
546	report on nursing home adverse incidents. The report must
547	include the following information arranged by county:
548	(a)  The total number of adverse incidents.
549	(b)  A listing, by category, of the types of adverse
550	incidents, the number of incidents occurring within each
551	category, and the type of staff involved.
552	(c)  A listing, by category, of the types of injury caused
553	and the number of injuries occurring within each category.
554	(d)  Types of liability claims filed based on an adverse
555	incident or reportable injury.
556	(e)  Disciplinary action taken against staff, categorized
557	by type of staff involved.
558	Section 7.  Paragraph (d) of subsection (1) of section
559	400.195, Florida Statutes, is amended to read:
560	400.195  Agency reporting requirements.--
561	(1)  For the period beginning June 30, 2001, and ending
562	June 30, 2005, the Agency for Health Care Administration shall
563	provide a report to the Governor, the President of the Senate,
564	and the Speaker of the House of Representatives with respect to
565	nursing homes. The first report shall be submitted no later than
566	December 30, 2002, and subsequent reports shall be submitted
567	every 6 months thereafter. The report shall identify facilities
568	based on their ownership characteristics, size, business
569	structure, for-profit or not-for-profit status, and any other
570	characteristics the agency determines useful in analyzing the
571	varied segments of the nursing home industry and shall report:
572	(d)  Information regarding deficiencies cited, including
573	information used to develop the Nursing Home Guide WATCH LIST
574	pursuant to s. 400.191, and applicable rules, a summary of data
575	generated on nursing homes by Centers for Medicare and Medicaid
576	Services Nursing Home Quality Information Project, and
577	information collected pursuant to s. 400.147(10)(9), relating to
578	litigation.
579	Section 8.  Paragraph (a) of subsection (4) of section
580	400.464, Florida Statutes, is amended to read:
581	400.464  Home health agencies to be licensed; expiration of
582	license; exemptions; unlawful acts; penalties.--
583	(4)(a)  An organization that offers or advertises to the
584	public any service for which licensure or registration is
585	required under this part must include in the advertisement the
586	license number or registration number issued to the organization
587	by the agency. The agency shall assess a fine of not less than
588	$100 to any licensee or registrant who fails to include the
589	license or registration number when submitting the advertisement
590	for publication, broadcast, or printing. The fine for a second
591	or subsequent offense is $500. The holder of a license issued
592	under this part may not advertise or indicate to the public that
593	it holds a home health agency or nurse registry license other
594	than the one it has been issued.
595	Section 9.  Section 400.497, Florida Statutes, is amended
596	to read:
597	400.497  Rules establishing minimum standards.--The agency
598	shall adopt, publish, and enforce rules to implement part II of
599	chapter 408 and this part, including, as applicable, s. ss.
600	400.506 and 400.509, which must provide reasonable and fair
601	minimum standards relating to:
602	(1)  The home health aide competency test and home health
603	aide training. The agency shall create the home health aide
604	competency test and establish the curriculum and instructor
605	qualifications for home health aide training. Licensed home
606	health agencies may provide this training and shall furnish
607	documentation of such training to other licensed home health
608	agencies upon request. Successful passage of the competency test
609	by home health aides may be substituted for the training
610	required under this section and any rule adopted pursuant
611	thereto.
612	(2)  Shared staffing. The agency shall allow shared
613	staffing if the home health agency is part of a retirement
614	community that provides multiple levels of care, is located on
615	one campus, is licensed under this chapter or chapter 429, and
616	otherwise meets the requirements of law and rule.
617	(3)  The criteria for the frequency of onsite licensure
618	surveys.
619	(4)  Licensure application and renewal.
620	(5)  Oversight by the director of nursing. The agency shall
621	develop rules related to:
622	(a)  Standards that address oversight responsibilities by
623	the director of nursing of skilled nursing and personal care
624	services provided by the home health agency's staff;
625	(b)  Requirements for a director of nursing to provide to
626	the agency, upon request, a certified daily report of the home
627	health services provided by a specified direct employee or
628	contracted staff member on behalf of the home health agency. The
629	agency may request a certified daily report only for a period
630	not to exceed 2 years prior to the date of the request; and
631	(c)  A quality assurance program for home health services
632	provided by the home health agency.
633	(6)  Conditions for using a recent unannounced licensure
634	inspection for the inspection required in s. 408.806 related to
635	a licensure application associated with a change in ownership of
636	a licensed home health agency.
637	(7)  The requirements for onsite and electronic
638	accessibility of supervisory personnel of home health agencies.
639	(8)  Information to be included in patients' records.
640	(9)  Geographic service areas.
641	(10)  Preparation of a comprehensive emergency management
642	plan pursuant to s. 400.492.
643	(a)  The Agency for Health Care Administration shall adopt
644	rules establishing minimum criteria for the plan and plan
645	updates, with the concurrence of the Department of Health and in
646	consultation with the Department of Community Affairs.
647	(b)  The rules must address the requirements in s. 400.492.
648	In addition, the rules shall provide for the maintenance of
649	patient-specific medication lists that can accompany patients
650	who are transported from their homes.
651	(c)  The plan is subject to review and approval by the
652	county health department. During its review, the county health
653	department shall contact state and local health and medical
654	stakeholders when necessary. The county health department shall
655	complete its review to ensure that the plan is in accordance
656	with the criteria in the Agency for Health Care Administration
657	rules within 90 days after receipt of the plan and shall approve
658	the plan or advise the home health agency of necessary
659	revisions. If the home health agency fails to submit a plan or
660	fails to submit the requested information or revisions to the
661	county health department within 30 days after written
662	notification from the county health department, the county
663	health department shall notify the Agency for Health Care
664	Administration. The agency shall notify the home health agency
665	that its failure constitutes a deficiency, subject to a fine of
666	$5,000 per occurrence. If the plan is not submitted, information
667	is not provided, or revisions are not made as requested, the
668	agency may impose the fine.
669	(d)  For any home health agency that operates in more than
670	one county, the Department of Health shall review the plan,
671	after consulting with state and local health and medical
672	stakeholders when necessary. The department shall complete its
673	review within 90 days after receipt of the plan and shall
674	approve the plan or advise the home health agency of necessary
675	revisions. The department shall make every effort to avoid
676	imposing differing requirements on a home health agency that
677	operates in more than one county as a result of differing or
678	conflicting comprehensive plan requirements of the counties in
679	which the home health agency operates.
680	(e)  The requirements in this subsection do not apply to:
681	1.  A facility that is certified under chapter 651 and has
682	a licensed home health agency used exclusively by residents of
683	the facility; or
684	2.  A retirement community that consists of residential
685	units for independent living and either a licensed nursing home
686	or an assisted living facility, and has a licensed home health
687	agency used exclusively by the residents of the retirement
688	community, provided the comprehensive emergency management plan
689	for the facility or retirement community provides for continuous
690	care of all residents with special needs during an emergency.
691	Section 10.  Paragraph (a) of subsection (6) of section
692	400.506, Florida Statutes, is amended to read:
693	400.506  Licensure of nurse registries; requirements;
694	penalties.--
695	(6)(a)  A nurse registry may refer for contract in private
696	residences registered nurses and licensed practical nurses
697	registered and licensed under part I of chapter 464, certified
698	nursing assistants certified under part II of chapter 464, and
699	home health aides who present documented proof of successful
700	completion of the training required by rule of the agency, and
701	companions or homemakers for the purposes of providing those
702	services authorized under s. 400.509(1). A licensed nurse
703	registry shall ensure that each certified nursing assistant
704	referred for contract by the nurse registry and each home health
705	aide referred for contract by the nurse registry is adequately
706	trained to perform the tasks of a home health aide in the home
707	setting. Each person referred by a nurse registry must provide
708	current documentation that he or she is free from communicable
709	diseases.
710	Section 11.  Section 400.509, Florida Statutes, is
711	repealed.
712	Section 12.  Section 400.512, Florida Statutes, is amended
713	to read:
714	400.512  Screening of home health agency personnel and;
715	nurse registry personnel; and companions and homemakers.--The
716	agency shall require employment or contractor screening as
717	provided in chapter 435, using the level 1 standards for
718	screening set forth in that chapter, for home health agency
719	personnel and; persons referred for employment by nurse
720	registries; and persons employed by companion or homemaker
721	services registered under s. 400.509.
722	(1)(a)  The Agency for Health Care Administration may, upon
723	request, grant exemptions from disqualification from employment
724	or contracting under this section as provided in s. 435.07,
725	except for health care practitioners licensed by the Department
726	of Health or a regulatory board within that department.
727	(b)  The appropriate regulatory board within the Department
728	of Health, or that department itself when there is no board,
729	may, upon request of the licensed health care practitioner,
730	grant exemptions from disqualification from employment or
731	contracting under this section as provided in s. 435.07.
732	(2)  The administrator of each home health agency and, the
733	managing employee of each nurse registry, and the managing
734	employee of each companion or homemaker service registered under
735	s. 400.509 must sign an affidavit annually, under penalty of
736	perjury, stating that all personnel hired or contracted with or
737	registered on or after October 1, 2000, who enter the home of a
738	patient or client in their service capacity have been screened.
739	(3)  As a prerequisite to operating as a home health agency
740	or, nurse registry, or companion or homemaker service under s.
741	400.509, the administrator or managing employee, respectively,
742	must submit to the agency his or her name and any other
743	information necessary to conduct a complete screening according
744	to this section. The agency shall submit the information to the
745	Department of Law Enforcement for state processing. The agency
746	shall review the record of the administrator or manager with
747	respect to the offenses specified in this section and shall
748	notify the owner of its findings. If disposition information is
749	missing on a criminal record, the administrator or manager, upon
750	request of the agency, must obtain and supply within 30 days the
751	missing disposition information to the agency. Failure to supply
752	missing information within 30 days or to show reasonable efforts
753	to obtain such information will result in automatic
754	disqualification.
755	(4)  Proof of compliance with the screening requirements of
756	chapter 435 shall be accepted in lieu of the requirements of
757	this section if the person has been continuously employed or
758	registered without a breach in service that exceeds 180 days,
759	the proof of compliance is not more than 2 years old, and the
760	person has been screened by the Department of Law Enforcement. A
761	home health agency or, nurse registry, or companion or homemaker
762	service registered under s. 400.509 shall directly provide proof
763	of compliance to another home health agency or, nurse registry,
764	or companion or homemaker service registered under s. 400.509.
765	The recipient home health agency or, nurse registry, or
766	companion or homemaker service registered under s. 400.509 may
767	not accept any proof of compliance directly from the person who
768	requires screening. Proof of compliance with the screening
769	requirements of this section shall be provided upon request to
770	the person screened by the home health agencies or; nurse
771	registries; or companion or homemaker services registered under
772	s. 400.509.
773	(5)  There is no monetary liability on the part of, and no
774	cause of action for damages arises against, a licensed home
775	health agency or, licensed nurse registry, or companion or
776	homemaker service registered under s. 400.509, that, upon notice
777	that the employee or contractor has been found guilty of,
778	regardless of adjudication, or entered a plea of nolo contendere
779	or guilty to, any offense prohibited under s. 435.03 or under
780	any similar statute of another jurisdiction, terminates the
781	employee or contractor, whether or not the employee or
782	contractor has filed for an exemption with the agency in
783	accordance with chapter 435 and whether or not the time for
784	filing has expired.
785	(6)  The costs of processing the statewide correspondence
786	criminal records checks must be borne by the home health agency
787	or; the nurse registry; or the companion or homemaker service
788	registered under s. 400.509, or by the person being screened, at
789	the discretion of the home health agency or, nurse registry, or
790	s. 400.509 registrant.
791	Section 13.  Paragraph (h) of subsection (1) and paragraph
792	(a) of subsection (7) of section 400.9935, Florida Statutes, are
793	amended to read:
794	400.9935  Clinic responsibilities.--
795	(1)  Each clinic shall appoint a medical director or clinic
796	director who shall agree in writing to accept legal
797	responsibility for the following activities on behalf of the
798	clinic. The medical director or the clinic director shall:
799	(h)  Not refer a patient to the clinic if the clinic
800	performs magnetic resonance imaging, static radiographs,
801	computed tomography, or positron emission tomography. The term
802	"refer a patient" means the referral of one or more patients of
803	the medical or clinical director or a member of the medical or
804	clinical director's group practice to the clinic for magnetic
805	resonance imaging, static radiographs, computed tomography, or
806	positron emission tomography. A medical director who is found to
807	violate this paragraph commits a felony of the third degree,
808	punishable as provided in s. 775.082, s. 775.083, or s. 775.084.
809	(7)(a)  Each clinic engaged in magnetic resonance imaging
810	services must be accredited by the Joint Commission on
811	Accreditation of Healthcare Organizations, the American College
812	of Radiology, or the Accreditation Association for Ambulatory
813	Health Care, within 1 year after licensure. A clinic that is
814	accredited by the American College of Radiology or is within the
815	original 1-year period after licensure and replaces its core
816	magnetic resonance imaging equipment shall be given 1 year after
817	the date on which the equipment is replaced to attain
818	accreditation. However, a clinic may request a single, 6-month
819	extension if it provides evidence to the agency establishing
820	that, for good cause shown, such clinic cannot can not be
821	accredited within 1 year after licensure, and that such
822	accreditation will be completed within the 6-month extension.
823	After obtaining accreditation as required by this subsection,
824	each such clinic must maintain accreditation as a condition of
825	renewal of its license. A clinic that files a change of
826	ownership application must comply with the original timeframe
827	accreditation requirements of the transferor. The agency shall
828	deny a change of ownership application if the clinic is not in
829	compliance with the accreditation requirements. When a clinic
830	adds, replaces, or modifies magnetic resonance imaging equipment
831	and the agency requires new accreditation, the clinic must be
832	accredited within 1 year after the date of the addition,
833	replacement, or modification but may request a single, 6-month
834	extension if the clinic provides evidence of good cause to the
835	agency.
836	Section 14.  Subsection (6) of section 400.995, Florida
837	Statutes, is amended to read:
838	400.995  Agency administrative penalties.--
839	(6)  The agency, as an alternative to or in conjunction
840	with an administrative action against a clinic for violations of
841	this part and adopted rules, shall make a reasonable attempt to
842	discuss each violation and recommended corrective action with
843	the owner, medical director, or clinic director of the clinic,
844	prior to written notification. The agency, instead of fixing a
845	period within which the clinic shall enter into compliance with
846	standards, may request a plan of corrective action from the
847	clinic which demonstrates a good faith effort to remedy each
848	violation by a specific date, subject to the approval of the
849	agency.
850	Section 15.  Subsections (5) and (9) of section 408.803,
851	Florida Statutes, are amended to read:
852	408.803  Definitions.--As used in this part, the term:
853	(5)  "Change of ownership" means:
854	(a)  An event in which the licensee sells or otherwise
855	transfers its ownership changes to a different individual or
856	other legal entity;
857	(b)  An event in which an individual or other entity
858	purchases or in good faith intends to purchase the licensed
859	provider; or
860	(c)  An event in which 51 45 percent or more of the
861	ownership, voting shares, membership, or controlling interest of
862	a licensee is in any manner transferred or otherwise assigned.
863	This paragraph does not apply to a licensee that is publicly
864	traded on a recognized stock exchange. In a corporation whose
865	shares are not publicly traded on a recognized stock exchange is
866	transferred or assigned, including the final transfer or
867	assignment of multiple transfers or assignments over a 2-year
868	period that cumulatively total 45 percent or greater.
869
870	A change solely in the management company or board of directors
871	is not a change of ownership.
872	(9)  "Licensee" means an individual, corporation,
873	partnership, firm, association, or governmental entity, or other
874	entity that is issued a permit, registration, certificate, or
875	license by the agency. The licensee is legally responsible for
876	all aspects of the provider operation.
877	Section 16.  Paragraph (a) of subsection (1), subsection
878	(2), paragraph (c) of subsection (7), and subsection (8) of
879	section 408.806, Florida Statutes, are amended to read:
880	408.806  License application process.--
881	(1)  An application for licensure must be made to the
882	agency on forms furnished by the agency, submitted under oath,
883	and accompanied by the appropriate fee in order to be accepted
884	and considered timely. The application must contain information
885	required by authorizing statutes and applicable rules and must
886	include:
887	(a)  The name, address, and social security number of:
888	1.  The applicant;
889	2.  The administrator or a similarly titled person who is
890	responsible for the day-to-day operation of the provider;
891	3.  The financial officer or similarly titled person who is
892	responsible for the financial operation of the licensee or
893	provider; and
894	4.  Each controlling interest if the applicant or
895	controlling interest is an individual.
896	(2)(a)  The applicant for a renewal license must submit an
897	application that must be received by the agency at least 60 days
898	but no more than 120 days prior to the expiration of the current
899	license. An application received more than 120 days prior to the
900	expiration of the current license shall be returned to the
901	applicant. If the renewal application and fee are received prior
902	to the license expiration date, the license shall not be deemed
903	to have expired if the license expiration date occurs during the
904	agency's review of the renewal application.
905	(b)  The applicant for initial licensure due to a change of
906	ownership must submit an application that must be received by
907	the agency at least 60 days prior to the date of change of
908	ownership.
909	(c)  For any other application or request, the applicant
910	must submit an application or request that must be received by
911	the agency at least 60 days but no more than 120 days prior to
912	the requested effective date, unless otherwise specified in
913	authorizing statutes or applicable rules. An application
914	received more than 120 days prior to the expiration of the
915	current license shall be returned to the applicant.
916	(d)  The agency shall notify the licensee by mail or
917	electronically at least 90 days prior to the expiration of a
918	license that a renewal license is necessary to continue
919	operation. The failure to timely submit a renewal application
920	and license fee shall result in a $50 per day late fee charged
921	to the licensee by the agency; however, the aggregate amount of
922	the late fee may not exceed 50 percent of the licensure fee or
923	$500, whichever is less. If an application is received after the
924	required filing date and exhibits a hand-canceled postmark
925	obtained from a United States post office dated on or before the
926	required filing date, no fine will be levied.
927	(7)
928	(c)  If an inspection is required by the authorizing
929	statute for a license application other than an initial
930	application, the inspection must be unannounced. This paragraph
931	does not apply to inspections required pursuant to ss. 383.324,
932	395.0161(4), 429.67(6), and 483.061(2).
933	(8)  The agency may establish procedures for the electronic
934	notification and submission of required information, including,
935	but not limited to:
936	(a)  Licensure applications.
937	(b)  Required signatures.
938	(c)  Payment of fees.
939	(d)  Notarization of applications.
940
941	Requirements for electronic submission of any documents required
942	by this part or authorizing statutes may be established by rule.
943	As an alternative to sending documents as required by
944	authorizing statutes, the agency may provide electronic access
945	to information or documents.
946	Section 17.  Subsection (2) of section 408.807, Florida
947	Statutes, is amended to read:
948	408.807  Change of ownership.--Whenever a change of
949	ownership occurs:
950	(2)  The transferee shall make application to the agency
951	for a license within the timeframes required in s. 408.806. The
952	effective date of the transfer must be submitted with the
953	application. The effective date of licensure may not be prior to
954	the date of application. Final closing documents must be
955	provided within 10 calendar days after the effective date of the
956	transfer.
957	Section 18.  Subsection (2) of section 408.808, Florida
958	Statutes, is amended to read:
959	408.808  License categories.--
960	(2)  PROVISIONAL LICENSE.--A provisional license may be
961	issued to an applicant pursuant to s. 408.809(3). An applicant
962	against whom a proceeding denying or revoking a license is
963	pending at the time of license renewal may be issued a
964	provisional license effective until final action not subject to
965	further appeal. A provisional license may also be issued to an
966	applicant applying for a change of ownership. A provisional
967	license shall be limited in duration to a specific period of
968	time, not to exceed 6 months, as determined by the agency.
969	Section 19.  Subsection (5) of section 408.809, Florida
970	Statutes, is amended, and new subsections (5) and (6) are added
971	to that section, to read:
972	408.809  Background screening; prohibited offenses.--
973	(5)  Effective October 1, 2009, in addition to the offenses
974	listed in ss. 435.03 and 435.04, all persons required to undergo
975	background screening pursuant to this part or authorizing
976	statutes must not have been found guilty of, regardless of
977	adjudication, or entered a plea of nolo contendere or guilty to,
978	any of the following offenses or any similar offense of another
979	jurisdiction:
980	(a)  Any authorizing statutes, if the offense was a felony.
981	(b)  This chapter, if the offense was a felony.
982	(c)  Section 409.920, relating to Medicaid provider fraud,
983	if the offense was a felony.
984	(d)  Section 741.28, relating to domestic violence.
985	(e)  Chapter 784, relating to assault, battery, and
986	culpable negligence, if the offense was a felony.
987	(f)  Section 810.02, relating to burglary.
988	(g)  Section 817.034, relating to fraudulent acts through
989	mail, wire, radio, electromagnetic, photoelectronic, or
990	photooptical systems.
991	(h)  Section 817.234, relating to false and fraudulent
992	insurance claims.
993	(i)  Section 817.505, relating to patient brokering.
994	(j)  Section 817.568, relating to criminal use of personal
995	identification information.
996	(k)  Section 817.60, relating to obtaining a credit card
997	through fraudulent means.
998	(l)  Section 817.61, relating to fraudulent use of credit
999	cards, if the offense was a felony.
1000	(m)  Section 831.01, relating to forgery.
1001	(n)  Section 831.02, relating to uttering forged
1002	instruments.
1003	(o)  Section 831.07, relating to forging bank bills,
1004	checks, drafts, or promissory notes.
1005	(p)  Section 831.09, relating to uttering forged bank
1006	bills, checks, drafts, or promissory notes.
1007	(q)  Section 831.30, relating to fraud in obtaining
1008	medicinal drugs.
1009	(r)  Section 831.31, relating to the sale, manufacture,
1010	delivery, or possession with the intent to sell, manufacture, or
1011	deliver any counterfeit controlled substance, if the offense was
1012	a felony.
1013
1014	A person employed or affiliated with a licensee on September 30,
1015	2009, may not be required by law to submit to rescreening if
1016	that licensee has in its possession written evidence that the
1017	person has been screened and qualified according to the
1018	standards specified in s. 435.03 or s. 435.04. Exemptions from
1019	disqualification may be granted pursuant to s. 435.07.
1020	(6)  The attestations required under ss. 435.04(5) and
1021	435.05(3) must be submitted at the time of license renewal,
1022	notwithstanding the provisions of ss. 435.04(5) and 435.05(3)
1023	which require annual submission of an affidavit of compliance
1024	with background screening requirements.
1025	(5)  Background screening is not required to obtain a
1026	certificate of exemption issued under s. 483.106.
1027	Section 20.  Subsection (3) of section 408.810, Florida
1028	Statutes, is amended to read:
1029	408.810  Minimum licensure requirements.--In addition to
1030	the licensure requirements specified in this part, authorizing
1031	statutes, and applicable rules, each applicant and licensee must
1032	comply with the requirements of this section in order to obtain
1033	and maintain a license.
1034	(3)  Unless otherwise specified in this part, authorizing
1035	statutes, or applicable rules, any information required to be
1036	reported to the agency must be submitted within 21 calendar days
1037	after the report period or effective date of the information,
1038	whichever is earlier, including, but not limited to, any change
1039	of:
1040	(a)  Information contained in the most recent application
1041	for licensure.
1042	(b)  Required insurance or bonds.
1043	Section 21.  Present subsection (4) of section 408.811,
1044	Florida Statutes, is renumbered as subsection (6), subsections
1045	(2) and (3) are amended, and new subsections (4) and (5) are
1046	added to that section, to read:
1047	408.811  Right of inspection; copies; inspection reports;
1048	plan for correction of deficiencies.--
1049	(2)  Inspections conducted in conjunction with
1050	certification, comparable licensure requirements, or a
1051	recognized or approved accreditation organization may be
1052	accepted in lieu of a complete licensure inspection. However, a
1053	licensure inspection may also be conducted to review any
1054	licensure requirements that are not also requirements for
1055	certification.
1056	(3)  The agency shall have access to and the licensee shall
1057	provide, or if requested send, copies of all provider records
1058	required during an inspection or other review at no cost to the
1059	agency, including records requested during an offsite review.
1060	(4)  Deficiencies must be corrected within 30 calendar days
1061	after the last day of an inspection unless an alternative
1062	timeframe is required or approved by the agency.
1063	(5)  The agency may require an applicant or licensee to
1064	submit a plan of correction for deficiencies. If required, the
1065	plan of correction must be filed with the agency within 10
1066	calendar days after notification unless an alternative timeframe
1067	is required.
1068	Section 22.  Section 408.813, Florida Statutes, is amended
1069	to read:
1070	408.813  Administrative fines; violations.--As a penalty
1071	for any violation of this part, authorizing statutes, or
1072	applicable rules, the agency may impose an administrative fine.
1073	(1)  Unless the amount or aggregate limitation of the fine
1074	is prescribed by authorizing statutes or applicable rules, the
1075	agency may establish criteria by rule for the amount or
1076	aggregate limitation of administrative fines applicable to this
1077	part, authorizing statutes, and applicable rules. Each day of
1078	violation constitutes a separate violation and is subject to a
1079	separate fine. For fines imposed by final order of the agency
1080	and not subject to further appeal, the violator shall pay the
1081	fine plus interest at the rate specified in s. 55.03 for each
1082	day beyond the date set by the agency for payment of the fine.
1083	(2)  Violations of this part, authorizing statutes, or
1084	applicable rules may be classified according to the nature of
1085	the violation and the gravity of its probable effect on clients.
1086	The scope of a violation may be cited as an isolated, patterned,
1087	or widespread deficiency. An isolated deficiency is a deficiency
1088	affecting one or a very limited number of clients, or involving
1089	one or a very limited number of staff, or a situation that
1090	occurred only occasionally or in a very limited number of
1091	locations. A patterned deficiency is a deficiency in which more
1092	than a very limited number of clients are affected, or more than
1093	a very limited number of staff are involved, or the situation
1094	has occurred in several locations, or the same client or clients
1095	have been affected by repeated occurrences of the same deficient
1096	practice but the effect of the deficient practice is not found
1097	to be pervasive throughout the provider. A widespread deficiency
1098	is a deficiency in which the problems causing the deficiency are
1099	pervasive in the provider or represent systemic failure that has
1100	affected or has the potential to affect a large portion of the
1101	provider's clients. The definitions of classifications in this
1102	subsection control over conflicting definitions in authorizing
1103	statutes. This subsection does not affect the legislative
1104	determination of the amount of a fine imposed under authorizing
1105	statutes. Violations shall be classified on the written notice
1106	as follows:
1107	(a)  Class "I" violations are those conditions or
1108	occurrences related to the operation and maintenance of a
1109	provider or to the care of clients which the agency determines
1110	present an imminent danger to the clients of the provider or a
1111	substantial probability that death or serious physical or
1112	emotional harm would result therefrom. The condition or practice
1113	constituting a class I violation shall be abated or eliminated
1114	within 24 hours, unless a fixed period, as determined by the
1115	agency, is required for correction. The agency shall impose an
1116	administrative fine as provided in this section for a cited
1117	class I violation. A fine shall be levied notwithstanding the
1118	correction of the violation.
1119	(b)  Class "II" violations are those conditions or
1120	occurrences related to the operation and maintenance of a
1121	provider or to the care of clients which the agency determines
1122	directly threaten the physical or emotional health, safety, or
1123	security of the clients, other than class I violations. The
1124	agency shall impose an administrative fine as provided in this
1125	section for a cited class II violation. A fine shall be levied
1126	notwithstanding the correction of the violation.
1127	(c)  Class "III" violations are those conditions or
1128	occurrences related to the operation and maintenance of a
1129	provider or to the care of clients which the agency determines
1130	indirectly or potentially threaten the physical or emotional
1131	health, safety, or security of clients, other than class I or
1132	class II violations. The agency shall impose an administrative
1133	fine as provided in this section for a cited class III
1134	violation. A citation for a class III violation must specify the
1135	time within which the violation is required to be corrected. If
1136	a class III violation is corrected within the time specified, a
1137	fine may not be imposed.
1138	(d)  Class "IV" violations are those conditions or
1139	occurrences related to the operation and maintenance of a
1140	provider or to required reports, forms, or documents that do not
1141	have the potential of negatively affecting clients. These
1142	violations are of a type that the agency determines do not
1143	threaten the health, safety, or security of clients. The agency
1144	shall impose an administrative fine as provided in this section
1145	for a cited class IV violation. A citation for a class IV
1146	violation must specify the time within which the violation is
1147	required to be corrected. If a class IV violation is corrected
1148	within the time specified, a fine may not be imposed.
1149	Section 23.  Subsections (12), (21), and (26) of section
1150	408.820, Florida Statutes, are amended to read:
1151	408.820  Exemptions.--Except as prescribed in authorizing
1152	statutes, the following exemptions shall apply to specified
1153	requirements of this part:
1154	(12)  Health care risk managers, as provided under part I
1155	of chapter 395, are exempt from ss. 408.806(7), 408.810(4)-(10),
1156	and 408.811.
1157	(21)  Transitional living facilities, as provided under
1158	part V of chapter 400, are exempt from s. 408.810(7)-(10).
1159	(26)  Health care clinics, as provided under part X of
1160	chapter 400, are exempt from s. ss. 408.809 and 408.810(1), (6),
1161	(7), and (10).
1162	Section 24.  Section 408.821, Florida Statutes, is created
1163	to read:
1164	408.821  Emergency management planning; emergency
1165	operations; inactive license.--
1166	(1)  Licensees required by authorizing statutes to have an
1167	emergency operations plan must designate a safety officer to
1168	serve as the primary contact for emergency operations.
1169	(2)  An entity subject to this part may temporarily exceed
1170	its licensed capacity to act as a receiving provider in
1171	accordance with an approved emergency operations plan. While in
1172	an overcapacity status, each provider must furnish or arrange
1173	for appropriate care and services to all clients. In addition,
1174	the agency may approve requests for overcapacity beyond 15 days,
1175	which approvals may be based upon satisfactory justification and
1176	need as provided by the receiving and sending providers.
1177	(3)(a)  An inactive license may be issued to a licensee
1178	subject to this section when the provider is located in a
1179	geographic area in which a state of emergency was declared by
1180	the Governor if the provider:
1181	1.  Suffered damage to its operation during the state of
1182	emergency.
1183	2.  Is currently licensed.
1184	3.  Does not have a provisional license.
1185	4.  Will be temporarily unable to provide services but is
1186	reasonably expected to resume services within 12 months.
1187	(b)  An inactive license may be issued for a period not to
1188	exceed 12 months but may be renewed by the agency for up to 12
1189	additional months upon demonstration to the agency of progress
1190	toward reopening. A request by a licensee for an inactive
1191	license or to extend the previously approved inactive period
1192	must be submitted in writing to the agency, accompanied by
1193	written justification for the inactive license, which states the
1194	beginning and ending dates of inactivity and includes a plan for
1195	the transfer of any clients to other providers and appropriate
1196	licensure fees. Upon agency approval, the licensee shall notify
1197	clients of any necessary discharge or transfer as required by
1198	authorizing statutes or applicable rules. The beginning of the
1199	inactive licensure period shall be the date the provider ceases
1200	operations. The end of the inactive period shall become the
1201	licensee expiration date, and all licensure fees must be
1202	current, must be paid in full, and may be prorated. Reactivation
1203	of an inactive license requires the prior approval by the agency
1204	of a renewal application, including payment of licensure fees
1205	and agency inspections indicating compliance with all
1206	requirements of this part and applicable rules and statutes.
1207	(4)  The agency may adopt rules pursuant to ss. 120.536(1)
1208	and 120.54 relating to emergency management planning,
1209	communications, and operations in conjunction with the
1210	Department of Community Affairs. Licensees providing residential
1211	or inpatient services must utilize an online database approved
1212	by the agency to report information to the agency regarding the
1213	provider's emergency status, planning, or operations.
1214	Section 25.  Subsections (3), (4), and (5) of section
1215	408.831, Florida Statutes, are amended to read:
1216	408.831  Denial, suspension, or revocation of a license,
1217	registration, certificate, or application.--
1218	(3)  An entity subject to this section may exceed its
1219	licensed capacity to act as a receiving facility in accordance
1220	with an emergency operations plan for clients of evacuating
1221	providers from a geographic area where an evacuation order has
1222	been issued by a local authority having jurisdiction. While in
1223	an overcapacity status, each provider must furnish or arrange
1224	for appropriate care and services to all clients. In addition,
1225	the agency may approve requests for overcapacity beyond 15 days,
1226	which approvals may be based upon satisfactory justification and
1227	need as provided by the receiving and sending facilities.
1228	(4)(a)  An inactive license may be issued to a licensee
1229	subject to this section when the provider is located in a
1230	geographic area where a state of emergency was declared by the
1231	Governor if the provider:
1232	1.  Suffered damage to its operation during that state of
1233	emergency.
1234	2.  Is currently licensed.
1235	3.  Does not have a provisional license.
1236	4.  Will be temporarily unable to provide services but is
1237	reasonably expected to resume services within 12 months.
1238	(b)  An inactive license may be issued for a period not to
1239	exceed 12 months but may be renewed by the agency for up to 12
1240	additional months upon demonstration to the agency of progress
1241	toward reopening. A request by a licensee for an inactive
1242	license or to extend the previously approved inactive period
1243	must be submitted in writing to the agency, accompanied by
1244	written justification for the inactive license, which states the
1245	beginning and ending dates of inactivity and includes a plan for
1246	the transfer of any clients to other providers and appropriate
1247	licensure fees. Upon agency approval, the licensee shall notify
1248	clients of any necessary discharge or transfer as required by
1249	authorizing statutes or applicable rules. The beginning of the
1250	inactive licensure period shall be the date the provider ceases
1251	operations. The end of the inactive period shall become the
1252	licensee expiration date, and all licensure fees must be
1253	current, paid in full, and may be prorated. Reactivation of an
1254	inactive license requires the prior approval by the agency of a
1255	renewal application, including payment of licensure fees and
1256	agency inspections indicating compliance with all requirements
1257	of this part and applicable rules and statutes.
1258	(3)(5)  This section provides standards of enforcement
1259	applicable to all entities licensed or regulated by the Agency
1260	for Health Care Administration. This section controls over any
1261	conflicting provisions of chapters 39, 383, 390, 391, 394, 395,
1262	400, 408, 429, 468, 483, and 765 or rules adopted pursuant to
1263	those chapters.
1264	Section 26.  Paragraph (e) of subsection (4) of section
1265	409.221, Florida Statutes, is amended to read:
1266	409.221  Consumer-directed care program.--
1267	(4)  CONSUMER-DIRECTED CARE.--
1268	(e)  Services.--Consumers shall use the budget allowance
1269	only to pay for home and community-based services that meet the
1270	consumer's long-term care needs and are a cost-efficient use of
1271	funds. Such services may include, but are not limited to, the
1272	following:
1273	1.  Personal care.
1274	2.  Homemaking and chores, including housework, meals,
1275	shopping, and transportation.
1276	3.  Home modifications and assistive devices which may
1277	increase the consumer's independence or make it possible to
1278	avoid institutional placement.
1279	4.  Assistance in taking self-administered medication.
1280	5.  Day care and respite care services, including those
1281	provided by nursing home facilities pursuant to s.
1282	400.141(1)(f)(6) or by adult day care facilities licensed
1283	pursuant to s. 429.907.
1284	6.  Personal care and support services provided in an
1285	assisted living facility.
1286	Section 27.  Subsection (5) of section 409.901, Florida
1287	Statutes, is amended to read:
1288	409.901  Definitions; ss. 409.901-409.920.--As used in ss.
1289	409.901-409.920, except as otherwise specifically provided, the
1290	term:
1291	(5)  "Change of ownership" means:
1292	(a)  An event in which the provider ownership changes or
1293	intends to change to a different individual or other legal
1294	entity; or
1295	(b)  An event in which 51 45 percent or more of the
1296	ownership, voting shares, membership, or controlling interest of
1297	a provider is in any manner transferred or otherwise assigned.
1298	This paragraph does not apply to a licensee that is publicly
1299	traded on a recognized stock exchange; or
1300	(c)  When the provider is licensed or registered by the
1301	agency, an event considered a change of ownership for licensure
1302	as defined in s. 408.803 in a corporation whose shares are not
1303	publicly traded on a recognized stock exchange is transferred or
1304	assigned, including the final transfer or assignment of multiple
1305	transfers or assignments over a 2-year period that cumulatively
1306	total 45 percent or more.
1307
1308	A change solely in the management company or board of directors
1309	is not a change of ownership.
1310	Section 28.  Section 429.071, Florida Statutes, is
1311	repealed.
1312	Section 29.  Paragraph (e) of subsection (1) and
1313	subsections (2) and (3) of section 429.08, Florida Statutes, are
1314	amended to read:
1315	429.08  Unlicensed facilities; referral of person for
1316	residency to unlicensed facility; penalties; verification of
1317	licensure status.--
1318	(1)
1319	(e)  The agency shall provide to the department's elder
1320	information and referral providers a list, by county, of
1321	licensed assisted living facilities, to assist persons who are
1322	considering an assisted living facility placement in locating a
1323	licensed facility. This information may be provided through the
1324	agency's Internet site.
1325	(2)  Each field office of the Agency for Health Care
1326	Administration shall establish a local coordinating workgroup
1327	which includes representatives of local law enforcement
1328	agencies, state attorneys, the Medicaid Fraud Control Unit of
1329	the Department of Legal Affairs, local fire authorities, the
1330	Department of Children and Family Services, the district long-
1331	term care ombudsman council, and the district human rights
1332	advocacy committee to assist in identifying the operation of
1333	unlicensed facilities and to develop and implement a plan to
1334	ensure effective enforcement of state laws relating to such
1335	facilities. The workgroup shall report its findings, actions,
1336	and recommendations semiannually to the Director of Health
1337	Quality Assurance of the agency.
1338	(2)(3)  It is unlawful to knowingly refer a person for
1339	residency to an unlicensed assisted living facility; to an
1340	assisted living facility the license of which is under denial or
1341	has been suspended or revoked; or to an assisted living facility
1342	that has a moratorium pursuant to part II of chapter 408. Any
1343	person who violates this subsection commits a noncriminal
1344	violation, punishable by a fine not exceeding $500 as provided
1345	in s. 775.083.
1346	(a)  Any health care practitioner, as defined in s.
1347	456.001, who is aware of the operation of an unlicensed facility
1348	shall report that facility to the agency. Failure to report a
1349	facility that the practitioner knows or has reasonable cause to
1350	suspect is unlicensed shall be reported to the practitioner's
1351	licensing board.
1352	(b)  Any hospital or community mental health center
1353	licensed under chapter 395 or chapter 394 which knowingly
1354	discharges a patient or client to an unlicensed facility is
1355	subject to sanction by the agency.
1356	(c)  Any employee of the agency or department, or the
1357	Department of Children and Family Services, who knowingly refers
1358	a person for residency to an unlicensed facility; to a facility
1359	the license of which is under denial or has been suspended or
1360	revoked; or to a facility that has a moratorium pursuant to part
1361	II of chapter 408 is subject to disciplinary action by the
1362	agency or department, or the Department of Children and Family
1363	Services.
1364	(d)  The employer of any person who is under contract with
1365	the agency or department, or the Department of Children and
1366	Family Services, and who knowingly refers a person for residency
1367	to an unlicensed facility; to a facility the license of which is
1368	under denial or has been suspended or revoked; or to a facility
1369	that has a moratorium pursuant to part II of chapter 408 shall
1370	be fined and required to prepare a corrective action plan
1371	designed to prevent such referrals.
1372	(e)  The agency shall provide the department and the
1373	Department of Children and Family Services with a list of
1374	licensed facilities within each county and shall update the list
1375	at least quarterly. This information may be provided through the
1376	agency's Internet site.
1377	(f)  At least annually, the agency shall notify, in
1378	appropriate trade publications, physicians licensed under
1379	chapter 458 or chapter 459, hospitals licensed under chapter
1380	395, nursing home facilities licensed under part II of chapter
1381	400, and employees of the agency or the department, or the
1382	Department of Children and Family Services, who are responsible
1383	for referring persons for residency, that it is unlawful to
1384	knowingly refer a person for residency to an unlicensed assisted
1385	living facility and shall notify them of the penalty for
1386	violating such prohibition. The department and the Department of
1387	Children and Family Services shall, in turn, notify service
1388	providers under contract to the respective departments who have
1389	responsibility for resident referrals to facilities. Further,
1390	the notice must direct each noticed facility and individual to
1391	contact the appropriate agency office in order to verify the
1392	licensure status of any facility prior to referring any person
1393	for residency. Each notice must include the name, telephone
1394	number, and mailing address of the appropriate office to
1395	contact.
1396	Section 30.  Paragraph (e) of subsection (1) of section
1397	429.14, Florida Statutes, is amended to read:
1398	429.14  Administrative penalties.--
1399	(1)  In addition to the requirements of part II of chapter
1400	408, the agency may deny, revoke, and suspend any license issued
1401	under this part and impose an administrative fine in the manner
1402	provided in chapter 120 against a licensee of an assisted living
1403	facility for a violation of any provision of this part, part II
1404	of chapter 408, or applicable rules, or for any of the following
1405	actions by a licensee of an assisted living facility, for the
1406	actions of any person subject to level 2 background screening
1407	under s. 408.809, or for the actions of any facility employee:
1408	(e)  A citation of any of the following deficiencies as
1409	specified defined in s. 429.19:
1410	1.  One or more cited class I deficiencies.
1411	2.  Three or more cited class II deficiencies.
1412	3.  Five or more cited class III deficiencies that have
1413	been cited on a single survey and have not been corrected within
1414	the times specified.
1415	Section 31.  Section 429.19, Florida Statutes, is amended
1416	to read:
1417	429.19  Violations; imposition of administrative fines;
1418	grounds.--
1419	(1)  In addition to the requirements of part II of chapter
1420	408, the agency shall impose an administrative fine in the
1421	manner provided in chapter 120 for the violation of any
1422	provision of this part, part II of chapter 408, and applicable
1423	rules by an assisted living facility, for the actions of any
1424	person subject to level 2 background screening under s. 408.809,
1425	for the actions of any facility employee, or for an intentional
1426	or negligent act seriously affecting the health, safety, or
1427	welfare of a resident of the facility.
1428	(2)  Each violation of this part and adopted rules shall be
1429	classified according to the nature of the violation and the
1430	gravity of its probable effect on facility residents. The agency
1431	shall indicate the classification on the written notice of the
1432	violation as follows:
1433	(a)  Class "I" violations are defined in s. 408.813 those
1434	conditions or occurrences related to the operation and
1435	maintenance of a facility or to the personal care of residents
1436	which the agency determines present an imminent danger to the
1437	residents or guests of the facility or a substantial probability
1438	that death or serious physical or emotional harm would result
1439	therefrom. The condition or practice constituting a class I
1440	violation shall be abated or eliminated within 24 hours, unless
1441	a fixed period, as determined by the agency, is required for
1442	correction. The agency shall impose an administrative fine for a
1443	cited class I violation in an amount of not less than $5,000 for
1444	an isolated deficiency, $7,500 for a patterned deficiency, and
1445	not exceeding $10,000 for a widespread deficiency each
1446	violation. A fine may be levied notwithstanding the correction
1447	of the violation.
1448	(b)  Class "II" violations are defined in s. 408.813 those
1449	conditions or occurrences related to the operation and
1450	maintenance of a facility or to the personal care of residents
1451	which the agency determines directly threaten the physical or
1452	emotional health, safety, or security of the facility residents,
1453	other than class I violations. The agency shall impose an
1454	administrative fine for a cited class II violation in an amount
1455	of not less than $1,000 for an isolated deficiency, $3,000 for a
1456	patterned deficiency, and not exceeding $5,000 for a widespread
1457	deficiency each violation. A fine shall be levied
1458	notwithstanding the correction of the violation.
1459	(c)  Class "III" violations are defined in s. 408.813 those
1460	conditions or occurrences related to the operation and
1461	maintenance of a facility or to the personal care of residents
1462	which the agency determines indirectly or potentially threaten
1463	the physical or emotional health, safety, or security of
1464	facility residents, other than class I or class II violations.
1465	The agency shall impose an administrative fine for a cited class
1466	III violation in an amount of not less than $500 for an isolated
1467	deficiency, $750 for a patterned deficiency, and not exceeding
1468	$1,000 for a widespread deficiency each violation. A citation
1469	for a class III violation must specify the time within which the
1470	violation is required to be corrected. If a class III violation
1471	is corrected within the time specified, no fine may be imposed,
1472	unless it is a repeated offense.
1473	(d)  Class "IV" violations are defined in s. 408.813 those
1474	conditions or occurrences related to the operation and
1475	maintenance of a building or to required reports, forms, or
1476	documents that do not have the potential of negatively affecting
1477	residents. These violations are of a type that the agency
1478	determines do not threaten the health, safety, or security of
1479	residents of the facility. The agency shall impose an
1480	administrative fine for a cited class IV violation in an amount
1481	of not less than $100 for an isolated deficiency, $150 for a
1482	patterned deficiency, and not exceeding $200 for a widespread
1483	deficiency each violation. A citation for a class IV violation
1484	must specify the time within which the violation is required to
1485	be corrected. If a class IV violation is corrected within the
1486	time specified, no fine shall be imposed. Any class IV violation
1487	that is corrected during the time an agency survey is being
1488	conducted will be identified as an agency finding and not as a
1489	violation.
1490	(3)  For purposes of this section, in determining if a
1491	penalty is to be imposed and in fixing the amount of the fine,
1492	the agency shall consider the following factors:
1493	(a)  The gravity of the violation, including the
1494	probability that death or serious physical or emotional harm to
1495	a resident will result or has resulted, the severity of the
1496	action or potential harm, and the extent to which the provisions
1497	of the applicable laws or rules were violated.
1498	(b)  Actions taken by the owner or administrator to correct
1499	violations.
1500	(c)  Any previous violations.
1501	(d)  The financial benefit to the facility of committing or
1502	continuing the violation.
1503	(e)  The licensed capacity of the facility.
1504	(3)(4)  Each day of continuing violation after the date
1505	fixed for termination of the violation, as ordered by the
1506	agency, constitutes an additional, separate, and distinct
1507	violation.
1508	(4)(5)  Any action taken to correct a violation shall be
1509	documented in writing by the owner or administrator of the
1510	facility and verified through followup visits by agency
1511	personnel. The agency may impose a fine and, in the case of an
1512	owner-operated facility, revoke or deny a facility's license
1513	when a facility administrator fraudulently misrepresents action
1514	taken to correct a violation.
1515	(5)(6)  Any facility whose owner fails to apply for a
1516	change-of-ownership license in accordance with part II of
1517	chapter 408 and operates the facility under the new ownership is
1518	subject to a fine of $5,000.
1519	(6)(7)  In addition to any administrative fines imposed,
1520	the agency may assess a survey fee, equal to the lesser of one
1521	half of the facility's biennial license and bed fee or $500, to
1522	cover the cost of conducting initial complaint investigations
1523	that result in the finding of a violation that was the subject
1524	of the complaint or monitoring visits conducted under s.
1525	429.28(3)(c) to verify the correction of the violations.
1526	(8)  The agency, as an alternative to or in conjunction
1527	with an administrative action against a facility for violations
1528	of this part and adopted rules, shall make a reasonable attempt
1529	to discuss each violation and recommended corrective action with
1530	the owner or administrator of the facility, prior to written
1531	notification. The agency, instead of fixing a period within
1532	which the facility shall enter into compliance with standards,
1533	may request a plan of corrective action from the facility which
1534	demonstrates a good faith effort to remedy each violation by a
1535	specific date, subject to the approval of the agency.
1536	(7)(9)  The agency shall develop and disseminate an annual
1537	list of all facilities sanctioned or fined $5,000 or more for
1538	violations of state standards, the number and class of
1539	violations involved, the penalties imposed, and the current
1540	status of cases. The list shall be disseminated, at no charge,
1541	to the Department of Elderly Affairs, the Department of Health,
1542	the Department of Children and Family Services, the Agency for
1543	Persons with Disabilities, the area agencies on aging, the
1544	Florida Statewide Advocacy Council, and the state and local
1545	ombudsman councils. The Department of Children and Family
1546	Services shall disseminate the list to service providers under
1547	contract to the department who are responsible for referring
1548	persons to a facility for residency. The agency may charge a fee
1549	commensurate with the cost of printing and postage to other
1550	interested parties requesting a copy of this list. This
1551	information may be provided electronically.
1552	Section 32.  Subsections (2) and (6) of section 429.23,
1553	Florida Statutes, are amended to read:
1554	429.23  Internal risk management and quality assurance
1555	program; adverse incidents and reporting requirements.--
1556	(2)  Every facility licensed under this part is required to
1557	maintain adverse incident reports. For purposes of this section,
1558	the term, "adverse incident" means:
1559	(a)  An event over which facility personnel could exercise
1560	control rather than as a result of the resident's condition and
1561	results in:
1562	1.  Death;
1563	2.  Brain or spinal damage;
1564	3.  Permanent disfigurement;
1565	4.  Fracture or dislocation of bones or joints;
1566	5.  Any condition that required medical attention to which
1567	the resident has not given his or her consent, including failure
1568	to honor advanced directives;
1569	6.  Any condition that requires the transfer of the
1570	resident from the facility to a unit providing more acute care
1571	due to the incident rather than the resident's condition before
1572	the incident; or.
1573	7.  An event that is reported to law enforcement; or
1574	(b)  Abuse, neglect, or exploitation as defined in s.
1575	415.102;
1576	(c)  Events reported to law enforcement; or
1577	(b)(d)  Resident elopement, if the elopement places the
1578	resident at risk of harm or injury.
1579	(6)  Abuse, neglect, or exploitation must be reported to
1580	the Department of Children and Family Services as required under
1581	chapter 415. The agency shall annually submit to the Legislature
1582	a report on assisted living facility adverse incident reports.
1583	The report must include the following information arranged by
1584	county:
1585	(a)  A total number of adverse incidents;
1586	(b)  A listing, by category, of the type of adverse
1587	incidents occurring within each category and the type of staff
1588	involved;
1589	(c)  A listing, by category, of the types of injuries, if
1590	any, and the number of injuries occurring within each category;
1591	(d)  Types of liability claims filed based on an adverse
1592	incident report or reportable injury; and
1593	(e)  Disciplinary action taken against staff, categorized
1594	by the type of staff involved.
1595	Section 33.  Subsections (10) through (12) of section
1596	429.26, Florida Statutes, are renumbered as subsections (9)
1597	through (11), respectively, and present subsection (9) of that
1598	section is amended to read:
1599	429.26  Appropriateness of placements; examinations of
1600	residents.--
1601	(9)  If, at any time after admission to a facility, a
1602	resident appears to need care beyond that which the facility is
1603	licensed to provide, the agency shall require the resident to be
1604	physically examined by a licensed physician, physician
1605	assistant, or licensed nurse practitioner. This examination
1606	shall, to the extent possible, be performed by the resident's
1607	preferred physician or nurse practitioner and shall be paid for
1608	by the resident with personal funds, except as provided in s.
1609	429.18(2). Following this examination, the examining physician,
1610	physician assistant, or licensed nurse practitioner shall
1611	complete and sign a medical form provided by the agency. The
1612	completed medical form shall be submitted to the agency within
1613	30 days after the date the facility owner or administrator is
1614	notified by the agency that the physical examination is
1615	required. After consultation with the physician, physician
1616	assistant, or licensed nurse practitioner who performed the
1617	examination, a medical review team designated by the agency
1618	shall then determine whether the resident is appropriately
1619	residing in the facility. The medical review team shall base its
1620	decision on a comprehensive review of the resident's physical
1621	and functional status, including the resident's preferences, and
1622	not on an isolated health-related problem. In the case of a
1623	mental health resident, if the resident appears to have needs in
1624	addition to those identified in the community living support
1625	plan, the agency may require an evaluation by a mental health
1626	professional, as determined by the Department of Children and
1627	Family Services. A facility may not be required to retain a
1628	resident who requires more services or care than the facility is
1629	able to provide in accordance with its policies and criteria for
1630	admission and continued residency. Members of the medical review
1631	team making the final determination may not include the agency
1632	personnel who initially questioned the appropriateness of a
1633	resident's placement. Such determination is final and binding
1634	upon the facility and the resident. Any resident who is
1635	determined by the medical review team to be inappropriately
1636	residing in a facility shall be given 30 days' written notice to
1637	relocate by the owner or administrator, unless the resident's
1638	continued residence in the facility presents an imminent danger
1639	to the health, safety, or welfare of the resident or a
1640	substantial probability exists that death or serious physical
1641	harm would result to the resident if allowed to remain in the
1642	facility.
1643	Section 34.  Paragraph (h) of subsection (3) of section
1644	430.80, Florida Statutes, is amended to read:
1645	430.80  Implementation of a teaching nursing home pilot
1646	project.--
1647	(3)  To be designated as a teaching nursing home, a nursing
1648	home licensee must, at a minimum:
1649	(h)  Maintain insurance coverage pursuant to s.
1650	400.141(1)(s)(20) or proof of financial responsibility in a
1651	minimum amount of $750,000. Such proof of financial
1652	responsibility may include:
1653	1.  Maintaining an escrow account consisting of cash or
1654	assets eligible for deposit in accordance with s. 625.52; or
1655	2.  Obtaining and maintaining pursuant to chapter 675 an
1656	unexpired, irrevocable, nontransferable and nonassignable letter
1657	of credit issued by any bank or savings association organized
1658	and existing under the laws of this state or any bank or savings
1659	association organized under the laws of the United States that
1660	has its principal place of business in this state or has a
1661	branch office which is authorized to receive deposits in this
1662	state. The letter of credit shall be used to satisfy the
1663	obligation of the facility to the claimant upon presentment of a
1664	final judgment indicating liability and awarding damages to be
1665	paid by the facility or upon presentment of a settlement
1666	agreement signed by all parties to the agreement when such final
1667	judgment or settlement is a result of a liability claim against
1668	the facility.
1669	Section 35.  Subsection (5) of section 435.04, Florida
1670	Statutes, is amended to read:
1671	435.04  Level 2 screening standards.--
1672	(5)  Under penalty of perjury, all employees in such
1673	positions of trust or responsibility shall attest to meeting the
1674	requirements for qualifying for employment and agreeing to
1675	inform the employer immediately if convicted of any of the
1676	disqualifying offenses while employed by the employer. Each
1677	employer of employees in such positions of trust or
1678	responsibilities which is licensed or registered by a state
1679	agency shall submit to the licensing agency annually or at the
1680	time of license renewal, under penalty of perjury, an affidavit
1681	of compliance with the provisions of this section.
1682	Section 36.  Subsection (3) of section 435.05, Florida
1683	Statutes, is amended to read:
1684	435.05  Requirements for covered employees.--Except as
1685	otherwise provided by law, the following requirements shall
1686	apply to covered employees:
1687	(3)  Each employer required to conduct level 2 background
1688	screening must sign an affidavit annually or at the time of
1689	license renewal, under penalty of perjury, stating that all
1690	covered employees have been screened or are newly hired and are
1691	awaiting the results of the required screening checks.
1692	Section 37.  Subsection (2) of section 483.031, Florida
1693	Statutes, is amended to read:
1694	483.031  Application of part; exemptions.--This part
1695	applies to all clinical laboratories within this state, except:
1696	(2)  A clinical laboratory that performs only waived tests
1697	and has received a certificate of exemption from the agency
1698	under s. 483.106.
1699	Section 38.  Subsection (10) of section 483.041, Florida
1700	Statutes, is amended to read:
1701	483.041  Definitions.--As used in this part, the term:
1702	(10)  "Waived test" means a test that the federal Centers
1703	for Medicare and Medicaid Services Health Care Financing
1704	Administration has determined qualifies for a certificate of
1705	waiver under the federal Clinical Laboratory Improvement
1706	Amendments of 1988, and the federal rules adopted thereunder.
1707	Section 39.  Section 483.106, Florida Statutes, is
1708	repealed.
1709	Section 40.  Subsection (3) of section 483.172, Florida
1710	Statutes, is amended to read:
1711	483.172  License fees.--
1712	(3)  The agency shall assess a biennial fee of $100 for a
1713	certificate of exemption and a $100 license fee for facilities
1714	surveyed by an approved accrediting organization.
1715	Section 41.  Subsection (1) of section 483.23, Florida
1716	Statutes, is amended to read:
1717	483.23  Offenses; criminal penalties.--
1718	(1)(a)  It is unlawful for any person to:
1719	1.  Operate, maintain, direct, or engage in the business of
1720	operating a clinical laboratory unless she or he has obtained a
1721	clinical laboratory license from the agency or is exempt under
1722	s. 483.031.
1723	2.  Conduct, maintain, or operate a clinical laboratory,
1724	other than an exempt laboratory or a laboratory operated under
1725	s. 483.035, unless the clinical laboratory is under the direct
1726	and responsible supervision and direction of a person licensed
1727	under part III of this chapter.
1728	3.  Allow any person other than an individual licensed
1729	under part III of this chapter to perform clinical laboratory
1730	procedures, except in the operation of a laboratory exempt under
1731	s. 483.031 or a laboratory operated under s. 483.035.
1732	4.  Violate or aid and abet in the violation of any
1733	provision of this part or the rules adopted under this part.
1734	(b)  The performance of any act specified in paragraph (a)
1735	constitutes a misdemeanor of the second degree, punishable as
1736	provided in s. 775.082 or s. 775.083.
1737	Section 42.  Subsection (13) of section 651.118, Florida
1738	Statutes, is amended to read:
1739	651.118  Agency for Health Care Administration;
1740	certificates of need; sheltered beds; community beds.--
1741	(13)  Residents, as defined in this chapter, are not
1742	considered new admissions for the purpose of s.
1743	400.141(1)(o)1.d.(15)(d).
1744	Section 43.  This act shall take effect upon becoming a
1745	law.

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