HB 1143

1	A bill to be entitled
2	An act relating to the reduction and simplification of
3	health care provider regulation; amending s. 112.0455,
4	F.S., relating to the Drug-Free Workplace Act; deleting an
5	obsolete provision; amending s. 318.21, F.S.; revising
6	distribution of funds from civil penalties imposed for
7	traffic infractions by county courts; repealing s.
8	383.325, F.S., relating to confidentiality of inspection
9	reports of licensed birth center facilities; amending s.
10	395.002, F.S.; revising and deleting definitions
11	applicable to regulation of hospitals and other licensed
12	facilities; conforming a cross-reference; amending s.
13	395.003, F.S.; deleting an obsolete provision; amending s.
14	395.0193, F.S.; requiring a licensed facility to report
15	certain peer review information and final disciplinary
16	actions to the Division of Medical Quality Assurance of
17	the Department of Health rather than the Division of
18	Health Quality Assurance of the Agency for Health Care
19	Administration; amending s. 395.1023, F.S.; providing for
20	the Department of Children and Family Services rather than
21	the Department of Health to perform certain functions with
22	respect to child protection cases; requiring certain
23	hospitals to notify the Department of Children and Family
24	Services of compliance; amending s. 395.1041, F.S.,
25	relating to hospital emergency services and care; deleting
26	obsolete provisions; repealing s. 395.1046, F.S., relating
27	to complaint investigation procedures; amending s.
28	395.1055, F.S.; requiring licensed facility beds to
29	conform to standards specified by the Agency for Health
30	Care Administration, the Florida Building Code, and the
31	Florida Fire Prevention Code; amending s. 395.10972, F.S.;
32	revising a reference to the Florida Society of Healthcare
33	Risk Management to conform to the current designation;
34	amending s. 395.2050, F.S.; revising a reference to the
35	federal Health Care Financing Administration to conform to
36	the current designation; amending s. 395.3036, F.S.;
37	correcting a reference; repealing s. 395.3037, F.S.,
38	relating to redundant definitions; amending ss. 154.11,
39	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
40	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
41	F.S.; revising references to the Joint Commission on
42	Accreditation of Healthcare Organizations and the Council
43	on Accreditation of Children and Family Services to
44	conform to the current designation; amending s. 395.602,
45	F.S.; revising the definition of the term "rural hospital"
46	to delete an obsolete provision; amending s. 400.021,
47	F.S.; revising the definition of the term "geriatric
48	outpatient clinic"; amending s. 400.063, F.S.; deleting an
49	obsolete provision; amending ss. 400.071 and 400.0712,
50	F.S.; revising applicability of general licensure
51	requirements under pt. II of ch. 408, F.S., to
52	applications for nursing home licensure; revising
53	provisions governing inactive licenses; amending s.
54	400.111, F.S.; providing for disclosure of controlling
55	interest of a nursing home facility upon request by the
56	Agency for Health Care Administration; amending s.
57	400.1183, F.S.; revising grievance record maintenance and
58	reporting requirements for nursing homes; amending s.
59	400.141, F.S.; conforming a reference; requiring
60	facilities to maintain clinical records that meet
61	specified standards; providing a fine; deleting
62	requirement for facilities to submit certain information
63	related to management companies to the agency; amending s.
64	400.142, F.S.; deleting language relating to agency
65	adoption of rules; amending 400.147, F.S.; revising
66	reporting requirements for licensed nursing home
67	facilities relating to adverse incidents; repealing s.
68	400.148, F.S., relating to the Medicaid "Up-or-Out"
69	Quality of Care Contract Management Program; amending s.
70	400.162, F.S., requiring nursing homes to provide a
71	resident property statement annually and upon request;
72	amending s. 400.179, F.S.; revising requirements for
73	nursing home lease bond alternative fees; deleting an
74	obsolete provision; amending s. 400.19, F.S.; revising
75	inspection requirements; repealing s. 400.195, F.S.,
76	relating to agency reporting requirements; amending s.
77	400.23, F.S.; deleting an obsolete provision; clarifying a
78	reference; amending s. 400.275, F.S.; revising agency
79	duties with regard to training nursing home surveyor
80	teams; revising requirements for team members; amending s.
81	400.484, F.S.; revising the schedule of home health agency
82	inspection violations; amending s. 400.606, F.S.; revising
83	the content requirements of the plan accompanying an
84	initial or change-of-ownership application for licensure
85	of a hospice; revising requirements relating to
86	certificates of need for certain hospice facilities;
87	amending s. 400.607, F.S.; revising grounds for agency
88	action against a hospice; amending s. 400.931, F.S.;
89	deleting a requirement that an applicant for a home
90	medical equipment provider license submit a surety bond to
91	the agency; amending s. 400.932, F.S.; revising grounds
92	for the imposition of administrative penalties for certain
93	violations by an employee of a home medical equipment
94	provider; amending s. 400.967, F.S.; revising the schedule
95	of inspection violations for intermediate care facilities
96	for the developmentally disabled; providing a penalty for
97	certain violations; amending s. 400.9905, F.S.; revising
98	definitions under the Health Care Clinic Act; amending s.
99	400.991, F.S.; conforming terminology; revising
100	application requirements relating to documentation of
101	financial ability to operate a mobile clinic; amending s.
102	408.034, F.S.; revising agency authority relating to
103	licensing of intermediate care facilities for the
104	developmentally disabled; amending s. 408.036, F.S.;
105	deleting an exemption from certain certificate-of-need
106	review requirements for a hospice or a hospice inpatient
107	facility; amending s. 408.043, F.S.; revising requirements
108	for certain freestanding inpatient hospice care facilities
109	to obtain a certificate of need; amending s. 408.061,
110	F.S.; revising health care facility data reporting
111	requirements; amending s. 408.10, F.S.; removing agency
112	authority to investigate certain consumer complaints;
113	amending s. 408.802, F.S.; removing applicability of pt.
114	II of ch. 408, F.S., relating to general licensure
115	requirements, to private review agents; amending s.
116	408.804, F.S.; providing penalties for altering, defacing,
117	or falsifying a license certificate issued by the agency
118	or displaying such an altered, defaced, or falsified
119	certificate; amending s. 408.806, F.S.; revising agency
120	responsibilities for notification of licensees of
121	impending expiration of a license; removing an exception
122	from the imposition of a fee for late filing of an
123	application for renewal of a license; requiring payment of
124	a late fee for a license application to be considered
125	complete under certain circumstances; amending s. 408.810,
126	F.S.; revising provisions relating to information required
127	for licensure; requiring proof of submission of notice to
128	a mortgagor or landlord regarding provision of services
129	requiring licensure; requiring disclosure of information
130	by a controlling interest of certain court actions
131	relating to financial instability within a specified time
132	period; amending s. 408.813, F.S.; authorizing the agency
133	to impose fines for unclassified violations of pt. II of
134	ch. 408, F.S.; amending s. 408.815, F.S.; authorizing the
135	agency to extend a license expiration date under certain
136	circumstances; amending s. 409.221, F.S.; deleting a
137	reporting requirement relating to the consumer-directed
138	care program; amending s. 429.07, F.S.; deleting the
139	requirement for an assisted living facility to obtain an
140	additional license in order to provide limited nursing
141	services; deleting the requirement for the agency to
142	conduct quarterly monitoring visits of facilities that
143	hold a license to provide extended congregate care
144	services; deleting the requirement for the department to
145	report annually on the status of and recommendations
146	related to extended congregate care; deleting the
147	requirement for the agency to conduct monitoring visits at
148	least twice a year to facilities providing limited nursing
149	services; increasing the licensure fees and the maximum
150	fee required for the standard license; increasing the
151	licensure fees for the extended congregate care license;
152	eliminating the license fee for the limited nursing
153	services license; transferring from another provision of
154	law the requirement that a biennial survey of an assisted
155	living facility include specific actions to determine
156	whether the facility is adequately protecting residents'
157	rights; providing that an assisted living facility that
158	has a class I or class II violation is subject to
159	monitoring visits; requiring a registered nurse to
160	participate in certain monitoring visits; amending s.
161	429.11, F.S.; revising licensure application requirements
162	for assisted living facilities to eliminate provisional
163	licenses; amending s. 429.12, F.S.; revising notification
164	requirements for the sale or transfer of ownership of an
165	assisted living facility; amending s. 429.14, F.S.;
166	removing a ground for the imposition of an administrative
167	penalty; clarifying language relating to a facility's
168	request for a hearing under certain circumstances;
169	authorizing the agency to provide certain information
170	relating to the licensure status of assisted living
171	facilities electronically or through the agency's Internet
172	website; amending s. 429.17, F.S.; deleting provisions
173	relating to the limited nursing services license; revising
174	agency responsibilities regarding the issuance of
175	conditional licenses; amending s. 429.19, F.S.; clarifying
176	that a monitoring fee may be assessed in addition to an
177	administrative fine; amending s. 429.23, F.S.; deleting
178	reporting requirements for assisted living facilities
179	relating to liability claims; amending s. 429.255, F.S.;
180	eliminating provisions authorizing the use of volunteers
181	to provide certain health-care-related services in
182	assisted living facilities; authorizing assisted living
183	facilities to provide limited nursing services; requiring
184	an assisted living facility to be responsible for certain
185	recordkeeping and staff to be trained to monitor residents
186	receiving certain health-care-related services; amending
187	s. 429.28, F.S.; deleting a requirement for a biennial
188	survey of an assisted living facility, to conform to
189	changes made by the act; amending s. 429.35, F.S.;
190	authorizing the agency to provide certain information
191	relating to the inspections of assisted living facilities
192	electronically or through the agency's Internet website;
193	amending s. 429.41, F.S., relating to rulemaking;
194	conforming provisions to changes made by the act; amending
195	s. 429.53, F.S.; revising provisions relating to
196	consultation by the agency; revising a definition;
197	amending s. 429.54, F.S.; requiring licensed assisted
198	living facilities to electronically report certain data
199	semiannually to the agency in accordance with rules
200	adopted by the department; amending s. 429.71, F.S.;
201	revising schedule of inspection violations for adult
202	family-care homes; amending s. 429.911, F.S.; deleting a
203	ground for agency action against an adult day care center;
204	amending s. 429.915, F.S.; revising agency
205	responsibilities regarding the issuance of conditional
206	licenses; amending s. 483.294, F.S.; revising frequency of
207	agency inspections of multiphasic health testing centers;
208	amending ss. 394.4787, 400.0239, 408.07, 430.80, and
209	651.118, F.S.; conforming terminology and cross-
210	references; revising a reference; providing an effective
211	date.
212
213	Be It Enacted by the Legislature of the State of Florida:
214
215	Section 1.  Present paragraph (e) of subsection (10) and
216	paragraph (e) of subsection (14) of section 112.0455, Florida
217	Statutes, are amended, and paragraphs (f) through (k) of
218	subsection (10) of that section are redesignated as paragraphs
219	(e) through (j), respectively, to read:
220	112.0455  Drug-Free Workplace Act.-
221	(10)  EMPLOYER PROTECTION.-
222	(e)  Nothing in this section shall be construed to operate
223	retroactively, and nothing in this section shall abrogate the
224	right of an employer under state law to conduct drug tests prior
225	to January 1, 1990. A drug test conducted by an employer prior
226	to January 1, 1990, is not subject to this section.
227	(14)  DISCIPLINE REMEDIES.-
228	(e)  Upon resolving an appeal filed pursuant to paragraph
229	(c), and finding a violation of this section, the commission may
230	order the following relief:
231	1.  Rescind the disciplinary action, expunge related
232	records from the personnel file of the employee or job applicant
233	and reinstate the employee.
234	2.  Order compliance with paragraph (10)(f)(g).
235	3.  Award back pay and benefits.
236	4.  Award the prevailing employee or job applicant the
237	necessary costs of the appeal, reasonable attorney's fees, and
238	expert witness fees.
239	Section 2.  Paragraph (n) of subsection (1) of section
240	154.11, Florida Statutes, is amended to read:
241	154.11  Powers of board of trustees.-
242	(1)  The board of trustees of each public health trust
243	shall be deemed to exercise a public and essential governmental
244	function of both the state and the county and in furtherance
245	thereof it shall, subject to limitation by the governing body of
246	the county in which such board is located, have all of the
247	powers necessary or convenient to carry out the operation and
248	governance of designated health care facilities, including, but
249	without limiting the generality of, the foregoing:
250	(n)  To appoint originally the staff of physicians to
251	practice in any designated facility owned or operated by the
252	board and to approve the bylaws and rules to be adopted by the
253	medical staff of any designated facility owned and operated by
254	the board, such governing regulations to be in accordance with
255	the standards of The Joint Commission on the Accreditation of
256	Hospitals which provide, among other things, for the method of
257	appointing additional staff members and for the removal of staff
258	members.
259	Section 3.  Subsection (15) of section 318.21, Florida
260	Statutes, is amended to read:
261	318.21  Disposition of civil penalties by county courts.-
262	All civil penalties received by a county court pursuant to the
263	provisions of this chapter shall be distributed and paid monthly
264	as follows:
265	(15)  Of the additional fine assessed under s. 318.18(3)(e)
266	for a violation of s. 316.1893, 50 percent of the moneys
267	received from the fines shall be remitted to the Department of
268	Revenue and deposited into the Brain and Spinal Cord Injury
269	Trust Fund of Department of Health and shall be appropriated to
270	the Department of Health Agency for Health Care Administration
271	as general revenue to provide an enhanced Medicaid payment to
272	nursing homes that serve Medicaid recipients with spinal cord
273	injuries that are medically complex and who are technologically
274	and respiratory dependent with brain and spinal cord injuries.
275	The remaining 50 percent of the moneys received from the
276	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
277	the Department of Revenue and deposited into the Department of
278	Health Administrative Trust Fund to provide financial support to
279	certified trauma centers in the counties where enhanced penalty
280	zones are established to ensure the availability and
281	accessibility of trauma services. Funds deposited into the
282	Administrative Trust Fund under this subsection shall be
283	allocated as follows:
284	(a)  Fifty percent shall be allocated equally among all
285	Level I, Level II, and pediatric trauma centers in recognition
286	of readiness costs for maintaining trauma services.
287	(b)  Fifty percent shall be allocated among Level I, Level
288	II, and pediatric trauma centers based on each center's relative
289	volume of trauma cases as reported in the Department of Health
290	Trauma Registry.
291	Section 4.  Section 383.325, Florida Statutes, is repealed.
292	Section 5.  Subsection (2) of section 394.741, Florida
293	Statutes, is amended to read:
294	394.741  Accreditation requirements for providers of
295	behavioral health care services.-
296	(2)  Notwithstanding any provision of law to the contrary,
297	accreditation shall be accepted by the agency and department in
298	lieu of the agency's and department's facility licensure onsite
299	review requirements and shall be accepted as a substitute for
300	the department's administrative and program monitoring
301	requirements, except as required by subsections (3) and (4),
302	for:
303	(a)  Any organization from which the department purchases
304	behavioral health care services that is accredited by The Joint
305	Commission on Accreditation of Healthcare Organizations or the
306	Council on Accreditation for Children and Family Services, or
307	has those services that are being purchased by the department
308	accredited by CARF-the Rehabilitation Accreditation Commission.
309	(b)  Any mental health facility licensed by the agency or
310	any substance abuse component licensed by the department that is
311	accredited by The Joint Commission on Accreditation of
312	Healthcare Organizations, CARF-the Rehabilitation Accreditation
313	Commission, or the Council on Accreditation of Children and
314	Family Services.
315	(c)  Any network of providers from which the department or
316	the agency purchases behavioral health care services accredited
317	by The Joint Commission on Accreditation of Healthcare
318	Organizations, CARF-the Rehabilitation Accreditation Commission,
319	the Council on Accreditation of Children and Family Services, or
320	the National Committee for Quality Assurance. A provider
321	organization, which is part of an accredited network, is
322	afforded the same rights under this part.
323	Section 6.  Present subsections (15) through (32) of
324	section 395.002, Florida Statutes, are renumbered as subsections
325	(14) through (28), respectively, and present subsections (1),
326	(14), (24), (30), and (31), and paragraph (c) of present
327	subsection (28) of that section are amended to read:
328	395.002  Definitions.-As used in this chapter:
329	(1)  "Accrediting organizations" means nationally
330	recognized or approved accrediting organizations whose standards
331	incorporate comparable licensure requirements as determined by
332	the agency the Joint Commission on Accreditation of Healthcare
333	Organizations, the American Osteopathic Association, the
334	Commission on Accreditation of Rehabilitation Facilities, and
335	the Accreditation Association for Ambulatory Health Care, Inc.
336	(14)  "Initial denial determination" means a determination
337	by a private review agent that the health care services
338	furnished or proposed to be furnished to a patient are
339	inappropriate, not medically necessary, or not reasonable.
340	(24)  "Private review agent" means any person or entity
341	which performs utilization review services for third-party
342	payors on a contractual basis for outpatient or inpatient
343	services. However, the term shall not include full-time
344	employees, personnel, or staff of health insurers, health
345	maintenance organizations, or hospitals, or wholly owned
346	subsidiaries thereof or affiliates under common ownership, when
347	performing utilization review for their respective hospitals,
348	health maintenance organizations, or insureds of the same
349	insurance group. For this purpose, health insurers, health
350	maintenance organizations, and hospitals, or wholly owned
351	subsidiaries thereof or affiliates under common ownership,
352	include such entities engaged as administrators of self-
353	insurance as defined in s. 624.031.
354	(26)(28)  "Specialty hospital" means any facility which
355	meets the provisions of subsection (12), and which regularly
356	makes available either:
357	(c)  Intensive residential treatment programs for children
358	and adolescents as defined in subsection (14) (15).
359	(30)  "Utilization review" means a system for reviewing the
360	medical necessity or appropriateness in the allocation of health
361	care resources of hospital services given or proposed to be
362	given to a patient or group of patients.
363	(31)  "Utilization review plan" means a description of the
364	policies and procedures governing utilization review activities
365	performed by a private review agent.
366	Section 7.  Paragraph (c) of subsection (1) of section
367	395.003, Florida Statutes, is amended to read:
368	395.003  Licensure; denial, suspension, and revocation.-
369	(1)
370	(c)  Until July 1, 2006, additional emergency departments
371	located off the premises of licensed hospitals may not be
372	authorized by the agency.
373	Section 8.  Paragraph (e) of subsection (2) and subsection
374	(4) of section 395.0193, Florida Statutes, are amended to read:
375	395.0193  Licensed facilities; peer review; disciplinary
376	powers; agency or partnership with physicians.-
377	(2)  Each licensed facility, as a condition of licensure,
378	shall provide for peer review of physicians who deliver health
379	care services at the facility. Each licensed facility shall
380	develop written, binding procedures by which such peer review
381	shall be conducted. Such procedures shall include:
382	(e)  Recording of agendas and minutes which do not contain
383	confidential material, for review by the Division of Medical
384	Quality Assurance of the department Health Quality Assurance of
385	the agency.
386	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
387	actions taken under subsection (3) shall be reported in writing
388	to the Division of Medical Quality Assurance of the department
389	Health Quality Assurance of the agency within 30 working days
390	after its initial occurrence, regardless of the pendency of
391	appeals to the governing board of the hospital. The notification
392	shall identify the disciplined practitioner, the action taken,
393	and the reason for such action. All final disciplinary actions
394	taken under subsection (3), if different from those which were
395	reported to the department agency within 30 days after the
396	initial occurrence, shall be reported within 10 working days to
397	the Division of Medical Quality Assurance of the department
398	Health Quality Assurance of the agency in writing and shall
399	specify the disciplinary action taken and the specific grounds
400	therefor. The division shall review each report and determine
401	whether it potentially involved conduct by the licensee that is
402	subject to disciplinary action, in which case s. 456.073 shall
403	apply. The reports are not subject to inspection under s.
404	119.07(1) even if the division's investigation results in a
405	finding of probable cause.
406	Section 9.  Section 395.1023, Florida Statutes, is amended
407	to read:
408	395.1023  Child abuse and neglect cases; duties.-Each
409	licensed facility shall adopt a protocol that, at a minimum,
410	requires the facility to:
411	(1)  Incorporate a facility policy that every staff member
412	has an affirmative duty to report, pursuant to chapter 39, any
413	actual or suspected case of child abuse, abandonment, or
414	neglect; and
415	(2)  In any case involving suspected child abuse,
416	abandonment, or neglect, designate, at the request of the
417	Department of Children and Family Services, a staff physician to
418	act as a liaison between the hospital and the Department of
419	Children and Family Services office which is investigating the
420	suspected abuse, abandonment, or neglect, and the child
421	protection team, as defined in s. 39.01, when the case is
422	referred to such a team.
423
424	Each general hospital and appropriate specialty hospital shall
425	comply with the provisions of this section and shall notify the
426	agency and the Department of Children and Family Services of its
427	compliance by sending a copy of its policy to the agency and the
428	Department of Children and Family Services as required by rule.
429	The failure by a general hospital or appropriate specialty
430	hospital to comply shall be punished by a fine not exceeding
431	$1,000, to be fixed, imposed, and collected by the agency. Each
432	day in violation is considered a separate offense.
433	Section 10.  Subsection (2) and paragraph (d) of subsection
434	(3) of section 395.1041, Florida Statutes, are amended to read:
435	395.1041  Access to emergency services and care.-
436	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
437	shall establish and maintain an inventory of hospitals with
438	emergency services. The inventory shall list all services within
439	the service capability of the hospital, and such services shall
440	appear on the face of the hospital license. Each hospital having
441	emergency services shall notify the agency of its service
442	capability in the manner and form prescribed by the agency. The
443	agency shall use the inventory to assist emergency medical
444	services providers and others in locating appropriate emergency
445	medical care. The inventory shall also be made available to the
446	general public. On or before August 1, 1992, the agency shall
447	request that each hospital identify the services which are
448	within its service capability. On or before November 1, 1992,
449	the agency shall notify each hospital of the service capability
450	to be included in the inventory. The hospital has 15 days from
451	the date of receipt to respond to the notice. By December 1,
452	1992, the agency shall publish a final inventory. Each hospital
453	shall reaffirm its service capability when its license is
454	renewed and shall notify the agency of the addition of a new
455	service or the termination of a service prior to a change in its
456	service capability.
457	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
458	FACILITY OR HEALTH CARE PERSONNEL.-
459	(d)1.  Every hospital shall ensure the provision of
460	services within the service capability of the hospital, at all
461	times, either directly or indirectly through an arrangement with
462	another hospital, through an arrangement with one or more
463	physicians, or as otherwise made through prior arrangements. A
464	hospital may enter into an agreement with another hospital for
465	purposes of meeting its service capability requirement, and
466	appropriate compensation or other reasonable conditions may be
467	negotiated for these backup services.
468	2.  If any arrangement requires the provision of emergency
469	medical transportation, such arrangement must be made in
470	consultation with the applicable provider and may not require
471	the emergency medical service provider to provide transportation
472	that is outside the routine service area of that provider or in
473	a manner that impairs the ability of the emergency medical
474	service provider to timely respond to prehospital emergency
475	calls.
476	3.  A hospital shall not be required to ensure service
477	capability at all times as required in subparagraph 1. if, prior
478	to the receiving of any patient needing such service capability,
479	such hospital has demonstrated to the agency that it lacks the
480	ability to ensure such capability and it has exhausted all
481	reasonable efforts to ensure such capability through backup
482	arrangements. In reviewing a hospital's demonstration of lack of
483	ability to ensure service capability, the agency shall consider
484	factors relevant to the particular case, including the
485	following:
486	a.  Number and proximity of hospitals with the same service
487	capability.
488	b.  Number, type, credentials, and privileges of
489	specialists.
490	c.  Frequency of procedures.
491	d.  Size of hospital.
492	4.  The agency shall publish proposed rules implementing a
493	reasonable exemption procedure by November 1, 1992. Subparagraph
494	1. shall become effective upon the effective date of said rules
495	or January 31, 1993, whichever is earlier. For a period not to
496	exceed 1 year from the effective date of subparagraph 1., a
497	hospital requesting an exemption shall be deemed to be exempt
498	from offering the service until the agency initially acts to
499	deny or grant the original request. The agency has 45 days from
500	the date of receipt of the request to approve or deny the
501	request. After the first year from the effective date of
502	subparagraph 1., If the agency fails to initially act within the
503	time period, the hospital is deemed to be exempt from offering
504	the service until the agency initially acts to deny the request.
505	Section 11.  Section 395.1046, Florida Statutes, is
506	repealed.
507	Section 12.  Paragraph (e) of subsection (1) of section
508	395.1055, Florida Statutes, is amended to read:
509	395.1055  Rules and enforcement.-
510	(1)  The agency shall adopt rules pursuant to ss.
511	120.536(1) and 120.54 to implement the provisions of this part,
512	which shall include reasonable and fair minimum standards for
513	ensuring that:
514	(e)  Licensed facility beds conform to minimum space,
515	equipment, and furnishings standards as specified by the agency,
516	the Florida Building Code, and the Florida Fire Prevention Code
517	department.
518	Section 13.  Subsection (1) of section 395.10972, Florida
519	Statutes, is amended to read:
520	395.10972  Health Care Risk Manager Advisory Council.-The
521	Secretary of Health Care Administration may appoint a seven-
522	member advisory council to advise the agency on matters
523	pertaining to health care risk managers. The members of the
524	council shall serve at the pleasure of the secretary. The
525	council shall designate a chair. The council shall meet at the
526	call of the secretary or at those times as may be required by
527	rule of the agency. The members of the advisory council shall
528	receive no compensation for their services, but shall be
529	reimbursed for travel expenses as provided in s. 112.061. The
530	council shall consist of individuals representing the following
531	areas:
532	(1)  Two shall be active health care risk managers,
533	including one risk manager who is recommended by and a member of
534	the Florida Society for of Healthcare Risk Management and
535	Patient Safety.
536	Section 14.  Subsection (3) of section 395.2050, Florida
537	Statutes, is amended to read:
538	395.2050  Routine inquiry for organ and tissue donation;
539	certification for procurement activities; death records review.-
540	(3)  Each organ procurement organization designated by the
541	federal Centers for Medicare and Medicaid Services Health Care
542	Financing Administration and licensed by the state shall conduct
543	an annual death records review in the organ procurement
544	organization's affiliated donor hospitals. The organ procurement
545	organization shall enlist the services of every Florida licensed
546	tissue bank and eye bank affiliated with or providing service to
547	the donor hospital and operating in the same service area to
548	participate in the death records review.
549	Section 15.  Subsection (2) of section 395.3036, Florida
550	Statutes, is amended to read:
551	395.3036  Confidentiality of records and meetings of
552	corporations that lease public hospitals or other public health
553	care facilities.-The records of a private corporation that
554	leases a public hospital or other public health care facility
555	are confidential and exempt from the provisions of s. 119.07(1)
556	and s. 24(a), Art. I of the State Constitution, and the meetings
557	of the governing board of a private corporation are exempt from
558	s. 286.011 and s. 24(b), Art. I of the State Constitution when
559	the public lessor complies with the public finance
560	accountability provisions of s. 155.40(5) with respect to the
561	transfer of any public funds to the private lessee and when the
562	private lessee meets at least three of the five following
563	criteria:
564	(2)  The public lessor and the private lessee do not
565	commingle any of their funds in any account maintained by either
566	of them, other than the payment of the rent and administrative
567	fees or the transfer of funds pursuant to s. 155.40(2)
568	subsection (2).
569	Section 16.  Section 395.3037, Florida Statutes, is
570	repealed.
571	Section 17.  Subsections (1), (4), and (5) of section
572	395.3038, Florida Statutes, are amended to read:
573	395.3038  State-listed primary stroke centers and
574	comprehensive stroke centers; notification of hospitals.-
575	(1)  The agency shall make available on its website and to
576	the department a list of the name and address of each hospital
577	that meets the criteria for a primary stroke center and the name
578	and address of each hospital that meets the criteria for a
579	comprehensive stroke center. The list of primary and
580	comprehensive stroke centers shall include only those hospitals
581	that attest in an affidavit submitted to the agency that the
582	hospital meets the named criteria, or those hospitals that
583	attest in an affidavit submitted to the agency that the hospital
584	is certified as a primary or a comprehensive stroke center by
585	The Joint Commission on Accreditation of Healthcare
586	Organizations.
587	(4)  The agency shall adopt by rule criteria for a primary
588	stroke center which are substantially similar to the
589	certification standards for primary stroke centers of The Joint
590	Commission on Accreditation of Healthcare Organizations.
591	(5)  The agency shall adopt by rule criteria for a
592	comprehensive stroke center. However, if The Joint Commission on
593	Accreditation of Healthcare Organizations establishes criteria
594	for a comprehensive stroke center, the agency shall establish
595	criteria for a comprehensive stroke center which are
596	substantially similar to those criteria established by The Joint
597	Commission on Accreditation of Healthcare Organizations.
598	Section 18.  Paragraph (e) of subsection (2) of section
599	395.602, Florida Statutes, is amended to read:
600	395.602  Rural hospitals.-
601	(2)  DEFINITIONS.-As used in this part:
602	(e)  "Rural hospital" means an acute care hospital licensed
603	under this chapter, having 100 or fewer licensed beds and an
604	emergency room, which is:
605	1.  The sole provider within a county with a population
606	density of no greater than 100 persons per square mile;
607	2.  An acute care hospital, in a county with a population
608	density of no greater than 100 persons per square mile, which is
609	at least 30 minutes of travel time, on normally traveled roads
610	under normal traffic conditions, from any other acute care
611	hospital within the same county;
612	3.  A hospital supported by a tax district or subdistrict
613	whose boundaries encompass a population of 100 persons or fewer
614	per square mile;
615	4.  A hospital in a constitutional charter county with a
616	population of over 1 million persons that has imposed a local
617	option health service tax pursuant to law and in an area that
618	was directly impacted by a catastrophic event on August 24,
619	1992, for which the Governor of Florida declared a state of
620	emergency pursuant to chapter 125, and has 120 beds or less that
621	serves an agricultural community with an emergency room
622	utilization of no less than 20,000 visits and a Medicaid
623	inpatient utilization rate greater than 15 percent;
624	4.5.  A hospital with a service area that has a population
625	of 100 persons or fewer per square mile. As used in this
626	subparagraph, the term "service area" means the fewest number of
627	zip codes that account for 75 percent of the hospital's
628	discharges for the most recent 5-year period, based on
629	information available from the hospital inpatient discharge
630	database in the Florida Center for Health Information and Policy
631	Analysis at the Agency for Health Care Administration; or
632	5.6.  A hospital designated as a critical access hospital,
633	as defined in s. 408.07(15).
634
635	Population densities used in this paragraph must be based upon
636	the most recently completed United States census. A hospital
637	that received funds under s. 409.9116 for a quarter beginning no
638	later than July 1, 2002, is deemed to have been and shall
639	continue to be a rural hospital from that date through June 30,
640	2015, if the hospital continues to have 100 or fewer licensed
641	beds and an emergency room, or meets the criteria of
642	subparagraph 4. An acute care hospital that has not previously
643	been designated as a rural hospital and that meets the criteria
644	of this paragraph shall be granted such designation upon
645	application, including supporting documentation to the Agency
646	for Health Care Administration.
647	Section 19.  Subsection (8) of section 400.021, Florida
648	Statutes, is amended to read:
649	400.021  Definitions.-When used in this part, unless the
650	context otherwise requires, the term:
651	(8)  "Geriatric outpatient clinic" means a site for
652	providing outpatient health care to persons 60 years of age or
653	older, which is staffed by a registered nurse or a physician
654	assistant, or a licensed practical nurse under the direct
655	supervision of a registered nurse, advanced registered nurse
656	practitioner, or physician assistant.
657	Section 20.  Subsection (2) of section 400.063, Florida
658	Statutes, is amended to read:
659	400.063  Resident protection.-
660	(2)  The agency is authorized to establish for each
661	facility, subject to intervention by the agency, a separate bank
662	account for the deposit to the credit of the agency of any
663	moneys received from the Health Care Trust Fund or any other
664	moneys received for the maintenance and care of residents in the
665	facility, and the agency is authorized to disburse moneys from
666	such account to pay obligations incurred for the purposes of
667	this section. The agency is authorized to requisition moneys
668	from the Health Care Trust Fund in advance of an actual need for
669	cash on the basis of an estimate by the agency of moneys to be
670	spent under the authority of this section. Any bank account
671	established under this section need not be approved in advance
672	of its creation as required by s. 17.58, but shall be secured by
673	depository insurance equal to or greater than the balance of
674	such account or by the pledge of collateral security in
675	conformance with criteria established in s. 18.11. The agency
676	shall notify the Chief Financial Officer of any such account so
677	established and shall make a quarterly accounting to the Chief
678	Financial Officer for all moneys deposited in such account.
679	Section 21.  Subsections (1) and (5) of section 400.071,
680	Florida Statutes, are amended to read:
681	400.071  Application for license.-
682	(1)  In addition to the requirements of part II of chapter
683	408, the application for a license shall be under oath and must
684	contain the following:
685	(a)  The location of the facility for which a license is
686	sought and an indication, as in the original application, that
687	such location conforms to the local zoning ordinances.
688	(b)  A signed affidavit disclosing any financial or
689	ownership interest that a controlling interest as defined in
690	part II of chapter 408 has held in the last 5 years in any
691	entity licensed by this state or any other state to provide
692	health or residential care which has closed voluntarily or
693	involuntarily; has filed for bankruptcy; has had a receiver
694	appointed; has had a license denied, suspended, or revoked; or
695	has had an injunction issued against it which was initiated by a
696	regulatory agency. The affidavit must disclose the reason any
697	such entity was closed, whether voluntarily or involuntarily.
698	(c)  The total number of beds and the total number of
699	Medicare and Medicaid certified beds.
700	(b)(d)  Information relating to the applicant and employees
701	which the agency requires by rule. The applicant must
702	demonstrate that sufficient numbers of qualified staff, by
703	training or experience, will be employed to properly care for
704	the type and number of residents who will reside in the
705	facility.
706	(c)(e)  Copies of any civil verdict or judgment involving
707	the applicant rendered within the 10 years preceding the
708	application, relating to medical negligence, violation of
709	residents' rights, or wrongful death. As a condition of
710	licensure, the licensee agrees to provide to the agency copies
711	of any new verdict or judgment involving the applicant, relating
712	to such matters, within 30 days after filing with the clerk of
713	the court. The information required in this paragraph shall be
714	maintained in the facility's licensure file and in an agency
715	database which is available as a public record.
716	(5)  As a condition of licensure, each facility must
717	establish and submit with its application a plan for quality
718	assurance and for conducting risk management.
719	Section 22.  Section 400.0712, Florida Statutes, is amended
720	to read:
721	400.0712  Application for inactive license.-
722	(1)  As specified in this section, the agency may issue an
723	inactive license to a nursing home facility for all or a portion
724	of its beds. Any request by a licensee that a nursing home or
725	portion of a nursing home become inactive must be submitted to
726	the agency in the approved format. The facility may not initiate
727	any suspension of services, notify residents, or initiate
728	inactivity before receiving approval from the agency; and a
729	licensee that violates this provision may not be issued an
730	inactive license.
731	(1)(2)  In addition to the powers granted under part II of
732	chapter 408, the agency may issue an inactive license to a
733	nursing home that chooses to use an unoccupied contiguous
734	portion of the facility for an alternative use to meet the needs
735	of elderly persons through the use of less restrictive, less
736	institutional services.
737	(a)  An inactive license issued under this subsection may
738	be granted for a period not to exceed the current licensure
739	expiration date but may be renewed by the agency at the time of
740	licensure renewal.
741	(b)  A request to extend the inactive license must be
742	submitted to the agency in the approved format and approved by
743	the agency in writing.
744	(c)  Nursing homes that receive an inactive license to
745	provide alternative services shall not receive preference for
746	participation in the Assisted Living for the Elderly Medicaid
747	waiver.
748	(2)(3)  The agency shall adopt rules pursuant to ss.
749	120.536(1) and 120.54 necessary to implement this section.
750	Section 23.  Section 400.111, Florida Statutes, is amended
751	to read:
752	400.111  Disclosure of controlling interest.-In addition to
753	the requirements of part II of chapter 408, when requested by
754	the agency, the licensee shall submit a signed affidavit
755	disclosing any financial or ownership interest that a
756	controlling interest has held within the last 5 years in any
757	entity licensed by the state or any other state to provide
758	health or residential care which entity has closed voluntarily
759	or involuntarily; has filed for bankruptcy; has had a receiver
760	appointed; has had a license denied, suspended, or revoked; or
761	has had an injunction issued against it which was initiated by a
762	regulatory agency. The affidavit must disclose the reason such
763	entity was closed, whether voluntarily or involuntarily.
764	Section 24.  Subsection (2) of section 400.1183, Florida
765	Statutes, is amended to read:
766	400.1183  Resident grievance procedures.-
767	(2)  Each facility shall maintain records of all grievances
768	for agency inspection and shall report to the agency at the time
769	of relicensure the total number of grievances handled during the
770	prior licensure period, a categorization of the cases underlying
771	the grievances, and the final disposition of the grievances.
772	Section 25.  Paragraphs (o) through (w) of subsection (1)
773	of section 400.141, Florida Statutes, are redesignated as
774	paragraphs (n) through (u), respectively, and present paragraphs
775	(g), (j), (n), and (o) of that subsection are amended, to read:
776	400.141  Administration and management of nursing home
777	facilities.-
778	(1)  Every licensed facility shall comply with all
779	applicable standards and rules of the agency and shall:
780	(g)  If the facility has a standard license or is a Gold
781	Seal facility, exceeds the minimum required hours of licensed
782	nursing and certified nursing assistant direct care per resident
783	per day, and is part of a continuing care facility licensed
784	under chapter 651 or a retirement community that offers other
785	services pursuant to part III of this chapter or part I or part
786	III of chapter 429 on a single campus, be allowed to share
787	programming and staff. At the time of inspection and in the
788	semiannual report required pursuant to paragraph (n) (o), a
789	continuing care facility or retirement community that uses this
790	option must demonstrate through staffing records that minimum
791	staffing requirements for the facility were met. Licensed nurses
792	and certified nursing assistants who work in the nursing home
793	facility may be used to provide services elsewhere on campus if
794	the facility exceeds the minimum number of direct care hours
795	required per resident per day and the total number of residents
796	receiving direct care services from a licensed nurse or a
797	certified nursing assistant does not cause the facility to
798	violate the staffing ratios required under s. 400.23(3)(a).
799	Compliance with the minimum staffing ratios shall be based on
800	total number of residents receiving direct care services,
801	regardless of where they reside on campus. If the facility
802	receives a conditional license, it may not share staff until the
803	conditional license status ends. This paragraph does not
804	restrict the agency's authority under federal or state law to
805	require additional staff if a facility is cited for deficiencies
806	in care which are caused by an insufficient number of certified
807	nursing assistants or licensed nurses. The agency may adopt
808	rules for the documentation necessary to determine compliance
809	with this provision.
810	(j)  Keep full records of resident admissions and
811	discharges; medical and general health status, including medical
812	records, personal and social history, and identity and address
813	of next of kin or other persons who may have responsibility for
814	the affairs of the residents; and individual resident care plans
815	including, but not limited to, prescribed services, service
816	frequency and duration, and service goals. The records shall be
817	open to inspection by the agency. The facility must maintain
818	clinical records on each resident in accordance with accepted
819	professional standards and practices that are complete,
820	accurately documented, readily accessible, and systematically
821	organized.
822	(n)  Submit to the agency the information specified in s.
823	400.071(1)(b) for a management company within 30 days after the
824	effective date of the management agreement.
825	(n)(o)1.  Submit semiannually to the agency, or more
826	frequently if requested by the agency, information regarding
827	facility staff-to-resident ratios, staff turnover, and staff
828	stability, including information regarding certified nursing
829	assistants, licensed nurses, the director of nursing, and the
830	facility administrator. For purposes of this reporting:
831	a.  Staff-to-resident ratios must be reported in the
832	categories specified in s. 400.23(3)(a) and applicable rules.
833	The ratio must be reported as an average for the most recent
834	calendar quarter.
835	b.  Staff turnover must be reported for the most recent 12-
836	month period ending on the last workday of the most recent
837	calendar quarter prior to the date the information is submitted.
838	The turnover rate must be computed quarterly, with the annual
839	rate being the cumulative sum of the quarterly rates. The
840	turnover rate is the total number of terminations or separations
841	experienced during the quarter, excluding any employee
842	terminated during a probationary period of 3 months or less,
843	divided by the total number of staff employed at the end of the
844	period for which the rate is computed, and expressed as a
845	percentage.
846	c.  The formula for determining staff stability is the
847	total number of employees that have been employed for more than
848	12 months, divided by the total number of employees employed at
849	the end of the most recent calendar quarter, and expressed as a
850	percentage.
851	d.  A nursing facility that has failed to comply with state
852	minimum-staffing requirements for 2 consecutive days is
853	prohibited from accepting new admissions until the facility has
854	achieved the minimum-staffing requirements for a period of 6
855	consecutive days. For the purposes of this sub-subparagraph, any
856	person who was a resident of the facility and was absent from
857	the facility for the purpose of receiving medical care at a
858	separate location or was on a leave of absence is not considered
859	a new admission. Failure to impose such an admissions moratorium
860	is subject to a $1,000 fine constitutes a class II deficiency.
861	e.  A nursing facility which does not have a conditional
862	license may be cited for failure to comply with the standards in
863	s. 400.23(3)(a)1.a. only if it has failed to meet those
864	standards on 2 consecutive days or if it has failed to meet at
865	least 97 percent of those standards on any one day.
866	f.  A facility which has a conditional license must be in
867	compliance with the standards in s. 400.23(3)(a) at all times.
868	2.  This paragraph does not limit the agency's ability to
869	impose a deficiency or take other actions if a facility does not
870	have enough staff to meet the residents' needs.
871	Section 26.  Subsection (3) of section 400.142, Florida
872	Statutes, is amended to read:
873	400.142  Emergency medication kits; orders not to
874	resuscitate.-
875	(3)  Facility staff may withhold or withdraw
876	cardiopulmonary resuscitation if presented with an order not to
877	resuscitate executed pursuant to s. 401.45. The agency shall
878	adopt rules providing for the implementation of such orders.
879	Facility staff and facilities shall not be subject to criminal
880	prosecution or civil liability, nor be considered to have
881	engaged in negligent or unprofessional conduct, for withholding
882	or withdrawing cardiopulmonary resuscitation pursuant to such an
883	order and rules adopted by the agency. The absence of an order
884	not to resuscitate executed pursuant to s. 401.45 does not
885	preclude a physician from withholding or withdrawing
886	cardiopulmonary resuscitation as otherwise permitted by law.
887	Section 27.  Subsections (11) through (15) of section
888	400.147, Florida Statutes, are renumbered as subsections (10)
889	through (14), respectively, and present subsection (10) is
890	amended to read:
891	400.147  Internal risk management and quality assurance
892	program.-
893	(10)  By the 10th of each month, each facility subject to
894	this section shall report any notice received pursuant to s.
895	400.0233(2) and each initial complaint that was filed with the
896	clerk of the court and served on the facility during the
897	previous month by a resident or a resident's family member,
898	guardian, conservator, or personal legal representative. The
899	report must include the name of the resident, the resident's
900	date of birth and social security number, the Medicaid
901	identification number for Medicaid-eligible persons, the date or
902	dates of the incident leading to the claim or dates of
903	residency, if applicable, and the type of injury or violation of
904	rights alleged to have occurred. Each facility shall also submit
905	a copy of the notices received pursuant to s. 400.0233(2) and
906	complaints filed with the clerk of the court. This report is
907	confidential as provided by law and is not discoverable or
908	admissible in any civil or administrative action, except in such
909	actions brought by the agency to enforce the provisions of this
910	part.
911	Section 28.  Section 400.148, Florida Statutes, is
912	repealed.
913	Section 29.  Paragraph (f) of subsection (5) of section
914	400.162, Florida Statutes, is amended to read:
915	400.162  Property and personal affairs of residents.-
916	(5)
917	(f)  At least every 3 months, the licensee shall furnish
918	the resident and the guardian, trustee, or conservator, if any,
919	for the resident a complete and verified statement of all funds
920	and other property to which this subsection applies, detailing
921	the amounts and items received, together with their sources and
922	disposition. For resident property, the licensee shall furnish
923	such a statement annually and within 7 calendar days after a
924	request for a statement. In any event, the licensee shall
925	furnish such statements a statement annually and upon the
926	discharge or transfer of a resident. Any governmental agency or
927	private charitable agency contributing funds or other property
928	on account of a resident also shall be entitled to receive such
929	statements statement annually and upon discharge or transfer and
930	such other report as it may require pursuant to law.
931	Section 30.  Paragraphs (d) and (e) of subsection (2) of
932	section 400.179, Florida Statutes, are amended to read:
933	400.179  Liability for Medicaid underpayments and
934	overpayments.-
935	(2)  Because any transfer of a nursing facility may expose
936	the fact that Medicaid may have underpaid or overpaid the
937	transferor, and because in most instances, any such underpayment
938	or overpayment can only be determined following a formal field
939	audit, the liabilities for any such underpayments or
940	overpayments shall be as follows:
941	(d)  Where the transfer involves a facility that has been
942	leased by the transferor:
943	1.  The transferee shall, as a condition to being issued a
944	license by the agency, acquire, maintain, and provide proof to
945	the agency of a bond with a term of 30 months, renewable
946	annually, in an amount not less than the total of 3 months'
947	Medicaid payments to the facility computed on the basis of the
948	preceding 12-month average Medicaid payments to the facility.
949	2.  A leasehold licensee may meet the requirements of
950	subparagraph 1. by payment of a nonrefundable fee, paid at
951	initial licensure, paid at the time of any subsequent change of
952	ownership, and paid annually thereafter, in the amount of 1
953	percent of the total of 3 months' Medicaid payments to the
954	facility computed on the basis of the preceding 12-month average
955	Medicaid payments to the facility. If a preceding 12-month
956	average is not available, projected Medicaid payments may be
957	used. The fee shall be deposited into the Grants and Donations
958	Trust Fund and shall be accounted for separately as a Medicaid
959	nursing home overpayment account. These fees shall be used at
960	the sole discretion of the agency to repay nursing home Medicaid
961	overpayments. Payment of this fee shall not release the licensee
962	from any liability for any Medicaid overpayments, nor shall
963	payment bar the agency from seeking to recoup overpayments from
964	the licensee and any other liable party. As a condition of
965	exercising this lease bond alternative, licensees paying this
966	fee must maintain an existing lease bond through the end of the
967	30-month term period of that bond. The agency is herein granted
968	specific authority to promulgate all rules pertaining to the
969	administration and management of this account, including
970	withdrawals from the account, subject to federal review and
971	approval. This provision shall take effect upon becoming law and
972	shall apply to any leasehold license application. The financial
973	viability of the Medicaid nursing home overpayment account shall
974	be determined by the agency through annual review of the account
975	balance and the amount of total outstanding, unpaid Medicaid
976	overpayments owing from leasehold licensees to the agency as
977	determined by final agency audits. By March 31 of each year, the
978	agency shall assess the cumulative fees collected under this
979	subparagraph, minus any amounts used to repay nursing home
980	Medicaid overpayments. If the net cumulative collections, minus
981	amounts utilized to repay nursing home Medicaid overpayments,
982	exceed $25 million, the provisions of this paragraph shall not
983	apply for the subsequent fiscal year.
984	3.  The leasehold licensee may meet the bond requirement
985	through other arrangements acceptable to the agency. The agency
986	is herein granted specific authority to promulgate rules
987	pertaining to lease bond arrangements.
988	4.  All existing nursing facility licensees, operating the
989	facility as a leasehold, shall acquire, maintain, and provide
990	proof to the agency of the 30-month bond required in
991	subparagraph 1., above, on and after July 1, 1993, for each
992	license renewal.
993	5.  It shall be the responsibility of all nursing facility
994	operators, operating the facility as a leasehold, to renew the
995	30-month bond and to provide proof of such renewal to the agency
996	annually.
997	6.  Any failure of the nursing facility operator to
998	acquire, maintain, renew annually, or provide proof to the
999	agency shall be grounds for the agency to deny, revoke, and
1000	suspend the facility license to operate such facility and to
1001	take any further action, including, but not limited to,
1002	enjoining the facility, asserting a moratorium pursuant to part
1003	II of chapter 408, or applying for a receiver, deemed necessary
1004	to ensure compliance with this section and to safeguard and
1005	protect the health, safety, and welfare of the facility's
1006	residents. A lease agreement required as a condition of bond
1007	financing or refinancing under s. 154.213 by a health facilities
1008	authority or required under s. 159.30 by a county or
1009	municipality is not a leasehold for purposes of this paragraph
1010	and is not subject to the bond requirement of this paragraph.
1011	(e)  For the 2009-2010 fiscal year only, the provisions of
1012	paragraph (d) shall not apply. This paragraph expires July 1,
1013	2010.
1014	Section 31.  Subsection (3) of section 400.19, Florida
1015	Statutes, is amended to read:
1016	400.19  Right of entry and inspection.-
1017	(3)  The agency shall every 15 months conduct at least one
1018	unannounced inspection to determine compliance by the licensee
1019	with statutes, and with rules promulgated under the provisions
1020	of those statutes, governing minimum standards of construction,
1021	quality and adequacy of care, and rights of residents. The
1022	survey shall be conducted every 6 months for the next 2-year
1023	period if the facility has been cited for a class I deficiency,
1024	has been cited for two or more class II deficiencies arising
1025	from separate surveys or investigations within a 60-day period,
1026	or has had three or more substantiated complaints within a 6-
1027	month period, each resulting in at least one class I or class II
1028	deficiency. In addition to any other fees or fines in this part,
1029	the agency shall assess a fine for each facility that is subject
1030	to the 6-month survey cycle. The fine for the 2-year period
1031	shall be $6,000, one-half to be paid at the completion of each
1032	survey. The agency may adjust this fine by the change in the
1033	Consumer Price Index, based on the 12 months immediately
1034	preceding the increase, to cover the cost of the additional
1035	surveys. The agency shall verify through subsequent inspection
1036	that any deficiency identified during inspection is corrected.
1037	However, the agency may verify the correction of a class III or
1038	class IV deficiency unrelated to resident rights or resident
1039	care without reinspecting the facility if adequate written
1040	documentation has been received from the facility, which
1041	provides assurance that the deficiency has been corrected. The
1042	giving or causing to be given of advance notice of such
1043	unannounced inspections by an employee of the agency to any
1044	unauthorized person shall constitute cause for suspension of not
1045	fewer than 5 working days according to the provisions of chapter
1046	110.
1047	Section 32.  Section 400.195, Florida Statutes, is
1048	repealed.
1049	Section 33.  Subsection (5) of section 400.23, Florida
1050	Statutes, is amended to read:
1051	400.23  Rules; evaluation and deficiencies; licensure
1052	status.-
1053	(5)  The agency, in collaboration with the Division of
1054	Children's Medical Services Network of the Department of Health,
1055	must, no later than December 31, 1993, adopt rules for minimum
1056	standards of care for persons under 21 years of age who reside
1057	in nursing home facilities. The rules must include a methodology
1058	for reviewing a nursing home facility under ss. 408.031-408.045
1059	which serves only persons under 21 years of age. A facility may
1060	be exempt from these standards for specific persons between 18
1061	and 21 years of age, if the person's physician agrees that
1062	minimum standards of care based on age are not necessary.
1063	Section 34.  Subsection (1) of section 400.275, Florida
1064	Statutes, is amended to read:
1065	400.275  Agency duties.-
1066	(1)  The agency shall ensure that each newly hired nursing
1067	home surveyor, as a part of basic training, is assigned full-
1068	time to a licensed nursing home for at least 2 days within a 7-
1069	day period to observe facility operations outside of the survey
1070	process before the surveyor begins survey responsibilities. Such
1071	observations may not be the sole basis of a deficiency citation
1072	against the facility. The agency may not assign an individual to
1073	be a member of a survey team for purposes of a survey,
1074	evaluation, or consultation visit at a nursing home facility in
1075	which the surveyor was an employee within the preceding 2 5
1076	years.
1077	Section 35.  Subsection (2) of section 400.484, Florida
1078	Statutes, is amended to read:
1079	400.484  Right of inspection; violations deficiencies;
1080	fines.-
1081	(2)  The agency shall impose fines for various classes of
1082	violations deficiencies in accordance with the following
1083	schedule:
1084	(a)  Class I violations are defined in s. 408.813. A class
1085	I deficiency is any act, omission, or practice that results in a
1086	patient's death, disablement, or permanent injury, or places a
1087	patient at imminent risk of death, disablement, or permanent
1088	injury. Upon finding a class I violation deficiency, the agency
1089	shall impose an administrative fine in the amount of $15,000 for
1090	each occurrence and each day that the violation deficiency
1091	exists.
1092	(b)  Class II violations are defined in s. 408.813. A class
1093	II deficiency is any act, omission, or practice that has a
1094	direct adverse effect on the health, safety, or security of a
1095	patient. Upon finding a class II violation deficiency, the
1096	agency shall impose an administrative fine in the amount of
1097	$5,000 for each occurrence and each day that the violation
1098	deficiency exists.
1099	(c)  Class III violations are defined in s. 408.813. A
1100	class III deficiency is any act, omission, or practice that has
1101	an indirect, adverse effect on the health, safety, or security
1102	of a patient. Upon finding an uncorrected or repeated class III
1103	violation deficiency, the agency shall impose an administrative
1104	fine not to exceed $1,000 for each occurrence and each day that
1105	the uncorrected or repeated violation deficiency exists.
1106	(d)  Class IV violations are defined in s. 408.813. A class
1107	IV deficiency is any act, omission, or practice related to
1108	required reports, forms, or documents which does not have the
1109	potential of negatively affecting patients. These violations are
1110	of a type that the agency determines do not threaten the health,
1111	safety, or security of patients. Upon finding an uncorrected or
1112	repeated class IV violation deficiency, the agency shall impose
1113	an administrative fine not to exceed $500 for each occurrence
1114	and each day that the uncorrected or repeated violation
1115	deficiency exists.
1116	Section 36.  Paragraph (i) of subsection (1) and subsection
1117	(4) of section 400.606, Florida Statutes, are amended to read:
1118	400.606  License; application; renewal; conditional license
1119	or permit; certificate of need.-
1120	(1)  In addition to the requirements of part II of chapter
1121	408, the initial application and change of ownership application
1122	must be accompanied by a plan for the delivery of home,
1123	residential, and homelike inpatient hospice services to
1124	terminally ill persons and their families. Such plan must
1125	contain, but need not be limited to:
1126	(i)  The projected annual operating cost of the hospice.
1127
1128	If the applicant is an existing licensed health care provider,
1129	the application must be accompanied by a copy of the most recent
1130	profit-loss statement and, if applicable, the most recent
1131	licensure inspection report.
1132	(4)  A freestanding hospice facility that is primarily
1133	engaged in providing inpatient and related services and that is
1134	not otherwise licensed as a health care facility shall be
1135	required to obtain a certificate of need. However, a
1136	freestanding hospice facility with six or fewer beds shall not
1137	be required to comply with institutional standards such as, but
1138	not limited to, standards requiring sprinkler systems, emergency
1139	electrical systems, or special lavatory devices.
1140	Section 37.  Subsection (2) of section 400.607, Florida
1141	Statutes, is amended to read:
1142	400.607  Denial, suspension, revocation of license;
1143	emergency actions; imposition of administrative fine; grounds.-
1144	(2)  A violation of this part, part II of chapter 408, or
1145	applicable rules Any of the following actions by a licensed
1146	hospice or any of its employees shall be grounds for
1147	administrative action by the agency against a hospice.:
1148	(a)  A violation of the provisions of this part, part II of
1149	chapter 408, or applicable rules.
1150	(b)  An intentional or negligent act materially affecting
1151	the health or safety of a patient.
1152	Section 38.  Subsection (1) of section 400.925, Florida
1153	Statutes, is amended to read:
1154	400.925  Definitions.-As used in this part, the term:
1155	(1)  "Accrediting organizations" means The Joint Commission
1156	on Accreditation of Healthcare Organizations or other national
1157	accreditation agencies whose standards for accreditation are
1158	comparable to those required by this part for licensure.
1159	Section 39.  Subsections (3) through (6) of section
1160	400.931, Florida Statutes, are renumbered as subsections (2)
1161	through (5), respectively, and present subsection (2) of that
1162	section is amended to read:
1163	400.931  Application for license; fee; provisional license;
1164	temporary permit.-
1165	(2)  As an alternative to submitting proof of financial
1166	ability to operate as required in s. 408.810(8), the applicant
1167	may submit a $50,000 surety bond to the agency.
1168	Section 40.  Subsection (2) of section 400.932, Florida
1169	Statutes, is amended to read:
1170	400.932  Administrative penalties.-
1171	(2)  A violation of this part, part II of chapter 408, or
1172	applicable rules Any of the following actions by an employee of
1173	a home medical equipment provider shall be are grounds for
1174	administrative action or penalties by the agency.:
1175	(a)  Violation of this part, part II of chapter 408, or
1176	applicable rules.
1177	(b)  An intentional, reckless, or negligent act that
1178	materially affects the health or safety of a patient.
1179	Section 41.  Subsection (3) of section 400.967, Florida
1180	Statutes, is amended to read:
1181	400.967  Rules and classification of violations
1182	deficiencies.-
1183	(3)  The agency shall adopt rules to provide that, when the
1184	criteria established under this part and part II of chapter 408
1185	are not met, such violations deficiencies shall be classified
1186	according to the nature of the violation deficiency. The agency
1187	shall indicate the classification on the face of the notice of
1188	deficiencies as follows:
1189	(a)  Class I violations deficiencies are defined in s.
1190	408.813 those which the agency determines present an imminent
1191	danger to the residents or guests of the facility or a
1192	substantial probability that death or serious physical harm
1193	would result therefrom. The condition or practice constituting a
1194	class I violation must be abated or eliminated immediately,
1195	unless a fixed period of time, as determined by the agency, is
1196	required for correction. A class I violation deficiency is
1197	subject to a civil penalty in an amount not less than $5,000 and
1198	not exceeding $10,000 for each violation deficiency. A fine may
1199	be levied notwithstanding the correction of the violation
1200	deficiency.
1201	(b)  Class II violations deficiencies are defined in s.
1202	408.813 those which the agency determines have a direct or
1203	immediate relationship to the health, safety, or security of the
1204	facility residents, other than class I deficiencies. A class II
1205	violation deficiency is subject to a civil penalty in an amount
1206	not less than $1,000 and not exceeding $5,000 for each violation
1207	deficiency. A citation for a class II violation deficiency shall
1208	specify the time within which the violation deficiency must be
1209	corrected. If a class II violation deficiency is corrected
1210	within the time specified, no civil penalty shall be imposed,
1211	unless it is a repeated offense.
1212	(c)  Class III violations deficiencies are defined in s.
1213	408.813 those which the agency determines to have an indirect or
1214	potential relationship to the health, safety, or security of the
1215	facility residents, other than class I or class II deficiencies.
1216	A class III violation deficiency is subject to a civil penalty
1217	of not less than $500 and not exceeding $1,000 for each
1218	deficiency. A citation for a class III violation deficiency
1219	shall specify the time within which the violation deficiency
1220	must be corrected. If a class III violation deficiency is
1221	corrected within the time specified, no civil penalty shall be
1222	imposed, unless it is a repeated offense.
1223	(d)  Class IV violations are defined in s. 408.813. Upon
1224	finding an uncorrected or repeated class IV violation, the
1225	agency shall impose an administrative fine not to exceed $500
1226	for each occurrence and each day that the uncorrected or
1227	repeated violation exists.
1228	Section 42.  Subsections (4) and (7) of section 400.9905,
1229	Florida Statutes, are amended to read:
1230	400.9905  Definitions.-
1231	(4)  "Clinic" means an entity at which health care services
1232	are provided to individuals and which tenders charges for
1233	reimbursement for such services, including a mobile clinic and a
1234	portable health service or equipment provider. For purposes of
1235	this part, the term does not include and the licensure
1236	requirements of this part do not apply to:
1237	(a)  Entities licensed or registered by the state under
1238	chapter 395; or entities licensed or registered by the state and
1239	providing only health care services within the scope of services
1240	authorized under their respective licenses granted under ss.
1241	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1242	chapter except part X, chapter 429, chapter 463, chapter 465,
1243	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1244	chapter 651; end-stage renal disease providers authorized under
1245	42 C.F.R. part 405, subpart U; or providers certified under 42
1246	C.F.R. part 485, subpart B or subpart H; or any entity that
1247	provides neonatal or pediatric hospital-based health care
1248	services or other health care services by licensed practitioners
1249	solely within a hospital licensed under chapter 395.
1250	(b)  Entities that own, directly or indirectly, entities
1251	licensed or registered by the state pursuant to chapter 395; or
1252	entities that own, directly or indirectly, entities licensed or
1253	registered by the state and providing only health care services
1254	within the scope of services authorized pursuant to their
1255	respective licenses granted under ss. 383.30-383.335, chapter
1256	390, chapter 394, chapter 397, this chapter except part X,
1257	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1258	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1259	disease providers authorized under 42 C.F.R. part 405, subpart
1260	U; or providers certified under 42 C.F.R. part 485, subpart B or
1261	subpart H; or any entity that provides neonatal or pediatric
1262	hospital-based health care services by licensed practitioners
1263	solely within a hospital licensed under chapter 395.
1264	(c)  Entities that are owned, directly or indirectly, by an
1265	entity licensed or registered by the state pursuant to chapter
1266	395; or entities that are owned, directly or indirectly, by an
1267	entity licensed or registered by the state and providing only
1268	health care services within the scope of services authorized
1269	pursuant to their respective licenses granted under ss. 383.30-
1270	383.335, chapter 390, chapter 394, chapter 397, this chapter
1271	except part X, chapter 429, chapter 463, chapter 465, chapter
1272	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1273	651; end-stage renal disease providers authorized under 42
1274	C.F.R. part 405, subpart U; or providers certified under 42
1275	C.F.R. part 485, subpart B or subpart H; or any entity that
1276	provides neonatal or pediatric hospital-based health care
1277	services by licensed practitioners solely within a hospital
1278	under chapter 395.
1279	(d)  Entities that are under common ownership, directly or
1280	indirectly, with an entity licensed or registered by the state
1281	pursuant to chapter 395; or entities that are under common
1282	ownership, directly or indirectly, with an entity licensed or
1283	registered by the state and providing only health care services
1284	within the scope of services authorized pursuant to their
1285	respective licenses granted under ss. 383.30-383.335, chapter
1286	390, chapter 394, chapter 397, this chapter except part X,
1287	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1288	part I of chapter 483, chapter 484, or chapter 651; end-stage
1289	renal disease providers authorized under 42 C.F.R. part 405,
1290	subpart U; or providers certified under 42 C.F.R. part 485,
1291	subpart B or subpart H; or any entity that provides neonatal or
1292	pediatric hospital-based health care services by licensed
1293	practitioners solely within a hospital licensed under chapter
1294	395.
1295	(e)  An entity that is exempt from federal taxation under
1296	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1297	under 26 U.S.C. s. 409 that has a board of trustees not less
1298	than two-thirds of which are Florida-licensed health care
1299	practitioners and provides only physical therapy services under
1300	physician orders, any community college or university clinic,
1301	and any entity owned or operated by the federal or state
1302	government, including agencies, subdivisions, or municipalities
1303	thereof.
1304	(f)  A sole proprietorship, group practice, partnership, or
1305	corporation that provides health care services by physicians
1306	covered by s. 627.419, that is directly supervised by one or
1307	more of such physicians, and that is wholly owned by one or more
1308	of those physicians or by a physician and the spouse, parent,
1309	child, or sibling of that physician.
1310	(g)  A sole proprietorship, group practice, partnership, or
1311	corporation that provides health care services by licensed
1312	health care practitioners under chapter 457, chapter 458,
1313	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1314	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1315	chapter 490, chapter 491, or part I, part III, part X, part
1316	XIII, or part XIV of chapter 468, or s. 464.012, which are
1317	wholly owned by one or more licensed health care practitioners,
1318	or the licensed health care practitioners set forth in this
1319	paragraph and the spouse, parent, child, or sibling of a
1320	licensed health care practitioner, so long as one of the owners
1321	who is a licensed health care practitioner is supervising the
1322	business activities and is legally responsible for the entity's
1323	compliance with all federal and state laws. However, a health
1324	care practitioner may not supervise services beyond the scope of
1325	the practitioner's license, except that, for the purposes of
1326	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1327	provides only services authorized pursuant to s. 456.053(3)(b)
1328	may be supervised by a licensee specified in s. 456.053(3)(b).
1329	(h)  Clinical facilities affiliated with an accredited
1330	medical school at which training is provided for medical
1331	students, residents, or fellows.
1332	(i)  Entities that provide only oncology or radiation
1333	therapy services by physicians licensed under chapter 458 or
1334	chapter 459 or entities that provide oncology or radiation
1335	therapy services by physicians licensed under chapter 458 or
1336	chapter 459 which are owned by a corporation whose shares are
1337	publicly traded on a recognized stock exchange.
1338	(j)  Clinical facilities affiliated with a college of
1339	chiropractic accredited by the Council on Chiropractic Education
1340	at which training is provided for chiropractic students.
1341	(k)  Entities that provide licensed practitioners to staff
1342	emergency departments or to deliver anesthesia services in
1343	facilities licensed under chapter 395 and that derive at least
1344	90 percent of their gross annual revenues from the provision of
1345	such services. Entities claiming an exemption from licensure
1346	under this paragraph must provide documentation demonstrating
1347	compliance.
1348	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1349	perinatology clinical facilities that are a publicly traded
1350	corporation or that are wholly owned, directly or indirectly, by
1351	a publicly traded corporation. As used in this paragraph, a
1352	publicly traded corporation is a corporation that issues
1353	securities traded on an exchange registered with the United
1354	States Securities and Exchange Commission as a national
1355	securities exchange.
1356	(7)  "Portable health service or equipment provider" means
1357	an entity that contracts with or employs persons to provide
1358	portable health care services or equipment to multiple locations
1359	performing treatment or diagnostic testing of individuals, that
1360	bills third-party payors for those services, and that otherwise
1361	meets the definition of a clinic in subsection (4).
1362	Section 43.  Paragraph (b) of subsection (1) and paragraph
1363	(c) of subsection (4) of section 400.991, Florida Statutes, are
1364	amended to read:
1365	400.991  License requirements; background screenings;
1366	prohibitions.-
1367	(1)
1368	(b)  Each mobile clinic must obtain a separate health care
1369	clinic license and must provide to the agency, at least
1370	quarterly, its projected street location to enable the agency to
1371	locate and inspect such clinic. A portable health service or
1372	equipment provider must obtain a health care clinic license for
1373	a single administrative office and is not required to submit
1374	quarterly projected street locations.
1375	(4)  In addition to the requirements of part II of chapter
1376	408, the applicant must file with the application satisfactory
1377	proof that the clinic is in compliance with this part and
1378	applicable rules, including:
1379	(c)  Proof of financial ability to operate as required
1380	under ss. s. 408.810(8) and 408.8065. As an alternative to
1381	submitting proof of financial ability to operate as required
1382	under s. 408.810(8), the applicant may file a surety bond of at
1383	least $500,000 which guarantees that the clinic will act in full
1384	conformity with all legal requirements for operating a clinic,
1385	payable to the agency. The agency may adopt rules to specify
1386	related requirements for such surety bond.
1387	Section 44.  Paragraph (g) of subsection (1) and paragraph
1388	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1389	amended to read:
1390	400.9935  Clinic responsibilities.-
1391	(1)  Each clinic shall appoint a medical director or clinic
1392	director who shall agree in writing to accept legal
1393	responsibility for the following activities on behalf of the
1394	clinic. The medical director or the clinic director shall:
1395	(g)  Conduct systematic reviews of clinic billings to
1396	ensure that the billings are not fraudulent or unlawful. Upon
1397	discovery of an unlawful charge, the medical director or clinic
1398	director shall take immediate corrective action. If the clinic
1399	performs only the technical component of magnetic resonance
1400	imaging, static radiographs, computed tomography, or positron
1401	emission tomography, and provides the professional
1402	interpretation of such services, in a fixed facility that is
1403	accredited by The Joint Commission on Accreditation of
1404	Healthcare Organizations or the Accreditation Association for
1405	Ambulatory Health Care, and the American College of Radiology;
1406	and if, in the preceding quarter, the percentage of scans
1407	performed by that clinic which was billed to all personal injury
1408	protection insurance carriers was less than 15 percent, the
1409	chief financial officer of the clinic may, in a written
1410	acknowledgment provided to the agency, assume the responsibility
1411	for the conduct of the systematic reviews of clinic billings to
1412	ensure that the billings are not fraudulent or unlawful.
1413	(7)(a)  Each clinic engaged in magnetic resonance imaging
1414	services must be accredited by The Joint Commission on
1415	Accreditation of Healthcare Organizations, the American College
1416	of Radiology, or the Accreditation Association for Ambulatory
1417	Health Care, within 1 year after licensure. A clinic that is
1418	accredited by the American College of Radiology or is within the
1419	original 1-year period after licensure and replaces its core
1420	magnetic resonance imaging equipment shall be given 1 year after
1421	the date on which the equipment is replaced to attain
1422	accreditation. However, a clinic may request a single, 6-month
1423	extension if it provides evidence to the agency establishing
1424	that, for good cause shown, such clinic cannot be accredited
1425	within 1 year after licensure, and that such accreditation will
1426	be completed within the 6-month extension. After obtaining
1427	accreditation as required by this subsection, each such clinic
1428	must maintain accreditation as a condition of renewal of its
1429	license. A clinic that files a change of ownership application
1430	must comply with the original accreditation timeframe
1431	requirements of the transferor. The agency shall deny a change
1432	of ownership application if the clinic is not in compliance with
1433	the accreditation requirements. When a clinic adds, replaces, or
1434	modifies magnetic resonance imaging equipment and the
1435	accreditation agency requires new accreditation, the clinic must
1436	be accredited within 1 year after the date of the addition,
1437	replacement, or modification but may request a single, 6-month
1438	extension if the clinic provides evidence of good cause to the
1439	agency.
1440	Section 45.  Subsection (2) of section 408.034, Florida
1441	Statutes, is amended to read:
1442	408.034  Duties and responsibilities of agency; rules.-
1443	(2)  In the exercise of its authority to issue licenses to
1444	health care facilities and health service providers, as provided
1445	under chapters 393 and 395 and parts II, and IV, and VIII of
1446	chapter 400, the agency may not issue a license to any health
1447	care facility or health service provider that fails to receive a
1448	certificate of need or an exemption for the licensed facility or
1449	service.
1450	Section 46.  Paragraph (d) of subsection (1) of section
1451	408.036, Florida Statutes, is amended to read:
1452	408.036  Projects subject to review; exemptions.-
1453	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1454	health-care-related projects, as described in paragraphs (a)-
1455	(g), are subject to review and must file an application for a
1456	certificate of need with the agency. The agency is exclusively
1457	responsible for determining whether a health-care-related
1458	project is subject to review under ss. 408.031-408.045.
1459	(d)  The establishment of a hospice or hospice inpatient
1460	facility, except as provided in s. 408.043.
1461	Section 47.  Subsection (2) of section 408.043, Florida
1462	Statutes, is amended to read:
1463	408.043  Special provisions.-
1464	(2)  HOSPICES.-When an application is made for a
1465	certificate of need to establish or to expand a hospice, the
1466	need for such hospice shall be determined on the basis of the
1467	need for and availability of hospice services in the community.
1468	The formula on which the certificate of need is based shall
1469	discourage regional monopolies and promote competition. The
1470	inpatient hospice care component of a hospice which is a
1471	freestanding facility, or a part of a facility, which is
1472	primarily engaged in providing inpatient care and related
1473	services and is not licensed as a health care facility shall
1474	also be required to obtain a certificate of need. Provision of
1475	hospice care by any current provider of health care is a
1476	significant change in service and therefore requires a
1477	certificate of need for such services.
1478	Section 48.  Paragraph (k) of subsection (3) of section
1479	408.05, Florida Statutes, is amended to read:
1480	408.05  Florida Center for Health Information and Policy
1481	Analysis.-
1482	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1483	produce comparable and uniform health information and statistics
1484	for the development of policy recommendations, the agency shall
1485	perform the following functions:
1486	(k)  Develop, in conjunction with the State Consumer Health
1487	Information and Policy Advisory Council, and implement a long-
1488	range plan for making available health care quality measures and
1489	financial data that will allow consumers to compare health care
1490	services. The health care quality measures and financial data
1491	the agency must make available shall include, but is not limited
1492	to, pharmaceuticals, physicians, health care facilities, and
1493	health plans and managed care entities. The agency shall submit
1494	the initial plan to the Governor, the President of the Senate,
1495	and the Speaker of the House of Representatives by January 1,
1496	2006, and shall update the plan and report on the status of its
1497	implementation annually thereafter. The agency shall also make
1498	the plan and status report available to the public on its
1499	Internet website. As part of the plan, the agency shall identify
1500	the process and timeframes for implementation, any barriers to
1501	implementation, and recommendations of changes in the law that
1502	may be enacted by the Legislature to eliminate the barriers. As
1503	preliminary elements of the plan, the agency shall:
1504	1.  Make available patient-safety indicators, inpatient
1505	quality indicators, and performance outcome and patient charge
1506	data collected from health care facilities pursuant to s.
1507	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1508	"inpatient quality indicators" shall be as defined by the
1509	Centers for Medicare and Medicaid Services, the National Quality
1510	Forum, The Joint Commission on Accreditation of Healthcare
1511	Organizations, the Agency for Healthcare Research and Quality,
1512	the Centers for Disease Control and Prevention, or a similar
1513	national entity that establishes standards to measure the
1514	performance of health care providers, or by other states. The
1515	agency shall determine which conditions, procedures, health care
1516	quality measures, and patient charge data to disclose based upon
1517	input from the council. When determining which conditions and
1518	procedures are to be disclosed, the council and the agency shall
1519	consider variation in costs, variation in outcomes, and
1520	magnitude of variations and other relevant information. When
1521	determining which health care quality measures to disclose, the
1522	agency:
1523	a.  Shall consider such factors as volume of cases; average
1524	patient charges; average length of stay; complication rates;
1525	mortality rates; and infection rates, among others, which shall
1526	be adjusted for case mix and severity, if applicable.
1527	b.  May consider such additional measures that are adopted
1528	by the Centers for Medicare and Medicaid Studies, National
1529	Quality Forum, The Joint Commission on Accreditation of
1530	Healthcare Organizations, the Agency for Healthcare Research and
1531	Quality, Centers for Disease Control and Prevention, or a
1532	similar national entity that establishes standards to measure
1533	the performance of health care providers, or by other states.
1534
1535	When determining which patient charge data to disclose, the
1536	agency shall include such measures as the average of
1537	undiscounted charges on frequently performed procedures and
1538	preventive diagnostic procedures, the range of procedure charges
1539	from highest to lowest, average net revenue per adjusted patient
1540	day, average cost per adjusted patient day, and average cost per
1541	admission, among others.
1542	2.  Make available performance measures, benefit design,
1543	and premium cost data from health plans licensed pursuant to
1544	chapter 627 or chapter 641. The agency shall determine which
1545	health care quality measures and member and subscriber cost data
1546	to disclose, based upon input from the council. When determining
1547	which data to disclose, the agency shall consider information
1548	that may be required by either individual or group purchasers to
1549	assess the value of the product, which may include membership
1550	satisfaction, quality of care, current enrollment or membership,
1551	coverage areas, accreditation status, premium costs, plan costs,
1552	premium increases, range of benefits, copayments and
1553	deductibles, accuracy and speed of claims payment, credentials
1554	of physicians, number of providers, names of network providers,
1555	and hospitals in the network. Health plans shall make available
1556	to the agency any such data or information that is not currently
1557	reported to the agency or the office.
1558	3.  Determine the method and format for public disclosure
1559	of data reported pursuant to this paragraph. The agency shall
1560	make its determination based upon input from the State Consumer
1561	Health Information and Policy Advisory Council. At a minimum,
1562	the data shall be made available on the agency's Internet
1563	website in a manner that allows consumers to conduct an
1564	interactive search that allows them to view and compare the
1565	information for specific providers. The website must include
1566	such additional information as is determined necessary to ensure
1567	that the website enhances informed decisionmaking among
1568	consumers and health care purchasers, which shall include, at a
1569	minimum, appropriate guidance on how to use the data and an
1570	explanation of why the data may vary from provider to provider.
1571	The data specified in subparagraph 1. shall be released no later
1572	than January 1, 2006, for the reporting of infection rates, and
1573	no later than October 1, 2005, for mortality rates and
1574	complication rates. The data specified in subparagraph 2. shall
1575	be released no later than October 1, 2006.
1576	4.  Publish on its website undiscounted charges for no
1577	fewer than 150 of the most commonly performed adult and
1578	pediatric procedures, including outpatient, inpatient,
1579	diagnostic, and preventative procedures.
1580	Section 49.  Paragraph (a) of subsection (1) of section
1581	408.061, Florida Statutes, is amended to read:
1582	408.061  Data collection; uniform systems of financial
1583	reporting; information relating to physician charges;
1584	confidential information; immunity.-
1585	(1)  The agency shall require the submission by health care
1586	facilities, health care providers, and health insurers of data
1587	necessary to carry out the agency's duties. Specifications for
1588	data to be collected under this section shall be developed by
1589	the agency with the assistance of technical advisory panels
1590	including representatives of affected entities, consumers,
1591	purchasers, and such other interested parties as may be
1592	determined by the agency.
1593	(a)  Data submitted by health care facilities, including
1594	the facilities as defined in chapter 395, shall include, but are
1595	not limited to: case-mix data, patient admission and discharge
1596	data, hospital emergency department data which shall include the
1597	number of patients treated in the emergency department of a
1598	licensed hospital reported by patient acuity level, data on
1599	hospital-acquired infections as specified by rule, data on
1600	complications as specified by rule, data on readmissions as
1601	specified by rule, with patient and provider-specific
1602	identifiers included, actual charge data by diagnostic groups,
1603	financial data, accounting data, operating expenses, expenses
1604	incurred for rendering services to patients who cannot or do not
1605	pay, interest charges, depreciation expenses based on the
1606	expected useful life of the property and equipment involved, and
1607	demographic data. The agency shall adopt nationally recognized
1608	risk adjustment methodologies or software consistent with the
1609	standards of the Agency for Healthcare Research and Quality and
1610	as selected by the agency for all data submitted as required by
1611	this section. Data may be obtained from documents such as, but
1612	not limited to: leases, contracts, debt instruments, itemized
1613	patient bills, medical record abstracts, and related diagnostic
1614	information. Reported data elements shall be reported
1615	electronically and in accordance with rule 59E-7.012, Florida
1616	Administrative Code. Data submitted shall be certified
1617	chief executive officer or an appropriate and duly authorized
1618	representative or employee of the licensed facility that the
1619	information submitted is true and accurate.
1620	Section 50.  Section 408.10, Florida Statutes, is amended
1621	to read:
1622	408.10  Consumer complaints.-The agency shall:
1623	(1)  publish and make available to the public a toll-free
1624	telephone number for the purpose of handling consumer complaints
1625	and shall serve as a liaison between consumer entities and other
1626	private entities and governmental entities for the disposition
1627	of problems identified by consumers of health care.
1628	(2)  Be empowered to investigate consumer complaints
1629	relating to problems with health care facilities' billing
1630	practices and issue reports to be made public in any cases where
1631	the agency determines the health care facility has engaged in
1632	billing practices which are unreasonable and unfair to the
1633	consumer.
1634	Section 51.  Subsections (12) through (30) of section
1635	408.802, Florida Statutes, are renumbered as subsections (11)
1636	through (29), respectively, and present subsection (11) of that
1637	section is amended to read:
1638	408.802  Applicability.-The provisions of this part apply
1639	to the provision of services that require licensure as defined
1640	in this part and to the following entities licensed, registered,
1641	or certified by the agency, as described in chapters 112, 383,
1642	390, 394, 395, 400, 429, 440, 483, and 765:
1643	(11)  Private review agents, as provided under part I of
1644	chapter 395.
1645	Section 52.  Subsection (3) is added to section 408.804,
1646	Florida Statutes, to read:
1647	408.804  License required; display.-
1648	(3)  Any person who knowingly alters, defaces, or falsifies
1649	a license certificate issued by the agency, or causes or
1650	procures any person to commit such an offense, commits a
1651	misdemeanor of the second degree, punishable as provided in s.
1652	775.082 or s 775.083. Any licensee or provider who displays an
1653	altered, defaced, or falsified license certificate is subject to
1654	the penalties set forth in s. 408.815 and an administrative fine
1655	of $1,000 for each day of illegal display.
1656	Section 53.  Paragraph (d) of subsection (2) of section
1657	408.806, Florida Statutes, is amended, present subsections (3)
1658	through (8) are renumbered as subsections (4) through (9),
1659	respectively, and a new subsection (3) is added to that section,
1660	to read:
1661	408.806  License application process.-
1662	(2)
1663	(d)  The agency shall notify the licensee by mail or
1664	electronically at least 90 days before the expiration of a
1665	license that a renewal license is necessary to continue
1666	operation. The licensee's failure to timely file submit a
1667	renewal application and license application fee with the agency
1668	shall result in a $50 per day late fee charged to the licensee
1669	by the agency; however, the aggregate amount of the late fee may
1670	not exceed 50 percent of the licensure fee or $500, whichever is
1671	less. The agency shall provide a courtesy notice to the licensee
1672	by United States mail, electronically, or by any other manner at
1673	its address of record or mailing address, if provided, at least
1674	90 days prior to the expiration of a license informing the
1675	licensee of the expiration of the license. If the agency does
1676	not provide the courtesy notice or the licensee does not receive
1677	the courtesy notice, the licensee continues to be legally
1678	obligated to timely file the renewal application and license
1679	application fee with the agency and is not excused from the
1680	payment of a late fee. If an application is received after the
1681	required filing date and exhibits a hand-canceled postmark
1682	obtained from a United States post office dated on or before the
1683	required filing date, no fine will be levied.
1684	(3)  Payment of the late fee is required to consider any
1685	late application complete, and failure to pay the late fee is
1686	considered an omission from the application.
1687	Section 54.  Subsections (6) and (9) of section 408.810,
1688	Florida Statutes, are amended to read:
1689	408.810  Minimum licensure requirements.-In addition to the
1690	licensure requirements specified in this part, authorizing
1691	statutes, and applicable rules, each applicant and licensee must
1692	comply with the requirements of this section in order to obtain
1693	and maintain a license.
1694	(6)(a)  An applicant must provide the agency with proof of
1695	the applicant's legal right to occupy the property before a
1696	license may be issued. Proof may include, but need not be
1697	limited to, copies of warranty deeds, lease or rental
1698	agreements, contracts for deeds, quitclaim deeds, or other such
1699	documentation.
1700	(b)  In the event the property is encumbered by a mortgage
1701	or is leased, an applicant must provide the agency with proof
1702	that the mortgagor or landlord has been provided written notice
1703	of the applicant's intent as mortgagee or tenant to provide
1704	services that require licensure and instruct the mortgagor or
1705	landlord to serve the agency by certified mail with copies of
1706	any foreclosure or eviction actions initiated by the mortgagor
1707	or landlord against the applicant.
1708	(9)  A controlling interest may not withhold from the
1709	agency any evidence of financial instability, including, but not
1710	limited to, checks returned due to insufficient funds,
1711	delinquent accounts, nonpayment of withholding taxes, unpaid
1712	utility expenses, nonpayment for essential services, or adverse
1713	court action concerning the financial viability of the provider
1714	or any other provider licensed under this part that is under the
1715	control of the controlling interest. A controlling interest
1716	shall notify the agency within 10 days after a court action to
1717	initiate bankruptcy, foreclosure, or eviction proceedings
1718	concerning the provider, in which the controlling interest is a
1719	petitioner or defendant. Any person who violates this subsection
1720	commits a misdemeanor of the second degree, punishable as
1721	provided in s. 775.082 or s. 775.083. Each day of continuing
1722	violation is a separate offense.
1723	Section 55.  Subsection (3) is added to section 408.813,
1724	Florida Statutes, to read:
1725	408.813  Administrative fines; violations.-As a penalty for
1726	any violation of this part, authorizing statutes, or applicable
1727	rules, the agency may impose an administrative fine.
1728	(3)  The agency may impose an administrative fine for a
1729	violation that does not qualify as a class I, class II, class
1730	III, or class IV violation. The amount of the fine shall not
1731	exceed $500 for each violation. Unclassified violations may
1732	include:
1733	(a)  Violating any term or condition of a license.
1734	(b)  Violating any provision of this part, authorizing
1735	statutes, or applicable rules.
1736	(c)  Exceeding licensed capacity.
1737	(d)  Providing services beyond the scope of the license.
1738	(e)  Violating a moratorium imposed pursuant to s. 408.814.
1739	Section 56.  Subsection (5) is added to section 408.815,
1740	Florida Statutes, to read:
1741	408.815  License or application denial; revocation.-
1742	(5)  In order to ensure the health, safety, and welfare of
1743	clients when a license has been denied, revoked, or is set to
1744	terminate, the agency may extend the license expiration date for
1745	a period of up to 60 days for the sole purpose of allowing the
1746	safe and orderly discharge of clients. The agency may impose
1747	conditions on the extension, including, but not limited to,
1748	prohibiting or limiting admissions, expedited discharge
1749	planning, required status reports, and mandatory monitoring by
1750	the agency or third parties. In imposing these conditions, the
1751	agency shall take into consideration the nature and number of
1752	clients, the availability and location of acceptable alternative
1753	placements, and the ability of the licensee to continue
1754	providing care to the clients. The agency may terminate the
1755	extension or modify the conditions at any time. This authority
1756	is in addition to any other authority granted to the agency
1757	under chapter 120, this part, and authorizing statutes but
1758	creates no right or entitlement to an extension of a license
1759	expiration date.
1760	Section 57.  Paragraph (k) of subsection (4) of section
1761	409.221, Florida Statutes, is amended to read:
1762	409.221  Consumer-directed care program.-
1763	(4)  CONSUMER-DIRECTED CARE.-
1764	(k)  Reviews and reports.-The agency and the Departments of
1765	Elderly Affairs, Health, and Children and Family Services and
1766	the Agency for Persons with Disabilities shall each, on an
1767	ongoing basis, review and assess the implementation of the
1768	consumer-directed care program. By January 15 of each year, the
1769	agency shall submit a written report to the Legislature that
1770	includes each department's review of the program and contains
1771	recommendations for improvements to the program.
1772	Section 58.  Subsections (3) and (4) of section 429.07,
1773	Florida Statutes, are amended, and subsections (6) and (7) are
1774	added to that section, to read:
1775	429.07  License required; fee; inspections.-
1776	(3)  In addition to the requirements of s. 408.806, each
1777	license granted by the agency must state the type of care for
1778	which the license is granted. Licenses shall be issued for one
1779	or more of the following categories of care: standard, extended
1780	congregate care, limited nursing services, or limited mental
1781	health.
1782	(a)  A standard license shall be issued to a facility
1783	facilities providing one or more of the personal services
1784	identified in s. 429.02. Such licensee facilities may also
1785	employ or contract with a person licensed under part I of
1786	chapter 464 to administer medications and perform other tasks as
1787	specified in s. 429.255.
1788	(b)  An extended congregate care license shall be issued to
1789	a licensee facilities providing, directly or through contract,
1790	services beyond those authorized in paragraph (a), including
1791	acts performed pursuant to part I of chapter 464 by persons
1792	licensed thereunder, and supportive services defined by rule to
1793	persons who otherwise would be disqualified from continued
1794	residence in a facility licensed under this part.
1795	1.  In order for extended congregate care services to be
1796	provided in a facility licensed under this part, the agency must
1797	first determine that all requirements established in law and
1798	rule are met and must specifically designate, on the facility's
1799	license, that such services may be provided and whether the
1800	designation applies to all or part of a facility. Such
1801	designation may be made at the time of initial licensure or
1802	relicensure, or upon request in writing by a licensee under this
1803	part and part II of chapter 408. Notification of approval or
1804	denial of such request shall be made in accordance with part II
1805	of chapter 408. An existing licensee facilities qualifying to
1806	provide extended congregate care services must have maintained a
1807	standard license and may not have been subject to administrative
1808	sanctions during the previous 2 years, or since initial
1809	licensure if the facility has been licensed for less than 2
1810	years, for any of the following reasons:
1811	a.  A class I or class II violation;
1812	b.  Three or more repeat or recurring class III violations
1813	of identical or similar resident care standards as specified in
1814	rule from which a pattern of noncompliance is found by the
1815	agency;
1816	c.  Three or more class III violations that were not
1817	corrected in accordance with the corrective action plan approved
1818	by the agency;
1819	d.  Violation of resident care standards resulting in a
1820	requirement to employ the services of a consultant pharmacist or
1821	consultant dietitian;
1822	e.  Denial, suspension, or revocation of a license for
1823	another facility under this part in which the applicant for an
1824	extended congregate care license has at least 25 percent
1825	ownership interest; or
1826	f.  Imposition of a moratorium pursuant to this part or
1827	part II of chapter 408 or initiation of injunctive proceedings.
1828	2.  A licensee Facilities that is are licensed to provide
1829	extended congregate care services shall maintain a written
1830	progress report for on each person who receives such services,
1831	and the which report must describe describes the type, amount,
1832	duration, scope, and outcome of services that are rendered and
1833	the general status of the resident's health. A registered nurse,
1834	or appropriate designee, representing the agency shall visit
1835	such facilities at least quarterly to monitor residents who are
1836	receiving extended congregate care services and to determine if
1837	the facility is in compliance with this part, part II of chapter
1838	408, and rules that relate to extended congregate care. One of
1839	these visits may be in conjunction with the regular survey. The
1840	monitoring visits may be provided through contractual
1841	arrangements with appropriate community agencies. A registered
1842	nurse shall serve as part of the team that inspects such
1843	facility. The agency may waive one of the required yearly
1844	monitoring visits for a facility that has been licensed for at
1845	least 24 months to provide extended congregate care services,
1846	if, during the inspection, the registered nurse determines that
1847	extended congregate care services are being provided
1848	appropriately, and if the facility has no class I or class II
1849	violations and no uncorrected class III violations. Before such
1850	decision is made, the agency shall consult with the long-term
1851	care ombudsman council for the area in which the facility is
1852	located to determine if any complaints have been made and
1853	substantiated about the quality of services or care. The agency
1854	may not waive one of the required yearly monitoring visits if
1855	complaints have been made and substantiated.
1856	3.  Licensees Facilities that are licensed to provide
1857	extended congregate care services shall:
1858	a.  Demonstrate the capability to meet unanticipated
1859	resident service needs.
1860	b.  Offer a physical environment that promotes a homelike
1861	setting, provides for resident privacy, promotes resident
1862	independence, and allows sufficient congregate space as defined
1863	by rule.
1864	c.  Have sufficient staff available, taking into account
1865	the physical plant and firesafety features of the building, to
1866	assist with the evacuation of residents in an emergency, as
1867	necessary.
1868	d.  Adopt and follow policies and procedures that maximize
1869	resident independence, dignity, choice, and decisionmaking to
1870	permit residents to age in place to the extent possible, so that
1871	moves due to changes in functional status are minimized or
1872	avoided.
1873	e.  Allow residents or, if applicable, a resident's
1874	representative, designee, surrogate, guardian, or attorney in
1875	fact to make a variety of personal choices, participate in
1876	developing service plans, and share responsibility in
1877	decisionmaking.
1878	f.  Implement the concept of managed risk.
1879	g.  Provide, either directly or through contract, the
1880	services of a person licensed pursuant to part I of chapter 464.
1881	h.  In addition to the training mandated in s. 429.52,
1882	provide specialized training as defined by rule for facility
1883	staff.
1884	4.  Licensees Facilities licensed to provide extended
1885	congregate care services are exempt from the criteria for
1886	continued residency as set forth in rules adopted under s.
1887	429.41. Licensees Facilities so licensed shall adopt their own
1888	requirements within guidelines for continued residency set forth
1889	by rule. However, such licensees facilities may not serve
1890	residents who require 24-hour nursing supervision. Licensees
1891	Facilities licensed to provide extended congregate care services
1892	shall provide each resident with a written copy of facility
1893	policies governing admission and retention.
1894	5.  The primary purpose of extended congregate care
1895	services is to allow residents, as they become more impaired,
1896	the option of remaining in a familiar setting from which they
1897	would otherwise be disqualified for continued residency. A
1898	facility licensed to provide extended congregate care services
1899	may also admit an individual who exceeds the admission criteria
1900	for a facility with a standard license, if the individual is
1901	determined appropriate for admission to the extended congregate
1902	care facility.
1903	6.  Before admission of an individual to a facility
1904	licensed to provide extended congregate care services, the
1905	individual must undergo a medical examination as provided in s.
1906	429.26(4) and the facility must develop a preliminary service
1907	plan for the individual.
1908	7.  When a licensee facility can no longer provide or
1909	arrange for services in accordance with the resident's service
1910	plan and needs and the licensee's facility's policy, the
1911	licensee facility shall make arrangements for relocating the
1912	person in accordance with s. 429.28(1)(k).
1913	8.  Failure to provide extended congregate care services
1914	may result in denial of extended congregate care license
1915	renewal.
1916	9.  No later than January 1 of each year, the department,
1917	in consultation with the agency, shall prepare and submit to the
1918	Governor, the President of the Senate, the Speaker of the House
1919	of Representatives, and the chairs of appropriate legislative
1920	committees, a report on the status of, and recommendations
1921	related to, extended congregate care services. The status report
1922	must include, but need not be limited to, the following
1923	information:
1924	a.  A description of the facilities licensed to provide
1925	such services, including total number of beds licensed under
1926	this part.
1927	b.  The number and characteristics of residents receiving
1928	such services.
1929	c.  The types of services rendered that could not be
1930	provided through a standard license.
1931	d.  An analysis of deficiencies cited during licensure
1932	inspections.
1933	e.  The number of residents who required extended
1934	congregate care services at admission and the source of
1935	admission.
1936	f.  Recommendations for statutory or regulatory changes.
1937	g.  The availability of extended congregate care to state
1938	clients residing in facilities licensed under this part and in
1939	need of additional services, and recommendations for
1940	appropriations to subsidize extended congregate care services
1941	for such persons.
1942	h.  Such other information as the department considers
1943	appropriate.
1944	(c)  A limited nursing services license shall be issued to
1945	a facility that provides services beyond those authorized in
1946	paragraph (a) and as specified in this paragraph.
1947	1.  In order for limited nursing services to be provided in
1948	a facility licensed under this part, the agency must first
1949	determine that all requirements established in law and rule are
1950	met and must specifically designate, on the facility's license,
1951	that such services may be provided. Such designation may be made
1952	at the time of initial licensure or relicensure, or upon request
1953	in writing by a licensee under this part and part II of chapter
1954	408. Notification of approval or denial of such request shall be
1955	made in accordance with part II of chapter 408. Existing
1956	facilities qualifying to provide limited nursing services shall
1957	have maintained a standard license and may not have been subject
1958	to administrative sanctions that affect the health, safety, and
1959	welfare of residents for the previous 2 years or since initial
1960	licensure if the facility has been licensed for less than 2
1961	years.
1962	2.  Facilities that are licensed to provide limited nursing
1963	services shall maintain a written progress report on each person
1964	who receives such nursing services, which report describes the
1965	type, amount, duration, scope, and outcome of services that are
1966	rendered and the general status of the resident's health. A
1967	registered nurse representing the agency shall visit such
1968	facilities at least twice a year to monitor residents who are
1969	receiving limited nursing services and to determine if the
1970	facility is in compliance with applicable provisions of this
1971	part, part II of chapter 408, and related rules. The monitoring
1972	visits may be provided through contractual arrangements with
1973	appropriate community agencies. A registered nurse shall also
1974	serve as part of the team that inspects such facility.
1975	3.  A person who receives limited nursing services under
1976	this part must meet the admission criteria established by the
1977	agency for assisted living facilities. When a resident no longer
1978	meets the admission criteria for a facility licensed under this
1979	part, arrangements for relocating the person shall be made in
1980	accordance with s. 429.28(1)(k), unless the facility is licensed
1981	to provide extended congregate care services.
1982	(4)  In accordance with s. 408.805, an applicant or
1983	licensee shall pay a fee for each license application submitted
1984	under this part, part II of chapter 408, and applicable rules.
1985	The amount of the fee shall be established by rule.
1986	(a)  The biennial license fee required of a facility is
1987	$356 $300 per license, with an additional fee of $67.50 $50 per
1988	resident based on the total licensed resident capacity of the
1989	facility, except that no additional fee will be assessed for
1990	beds designated for recipients of optional state supplementation
1991	payments provided for in s. 409.212. The total fee may not
1992	exceed $18,000 $10,000.
1993	(b)  In addition to the total fee assessed under paragraph
1994	(a), the agency shall require facilities that are licensed to
1995	provide extended congregate care services under this part to pay
1996	an additional fee per licensed facility. The amount of the
1997	biennial fee shall be $501 $400 per license, with an additional
1998	fee of $10 per resident based on the total licensed resident
1999	capacity of the facility.
2000	(c)  In addition to the total fee assessed under paragraph
2001	(a), the agency shall require facilities that are licensed to
2002	provide limited nursing services under this part to pay an
2003	additional fee per licensed facility. The amount of the biennial
2004	fee shall be $250 per license, with an additional fee of $10 per
2005	resident based on the total licensed resident capacity of the
2006	facility.
2007	(6)  In order to determine whether the facility is
2008	adequately protecting residents' rights as provided in s.
2009	429.28, the biennial survey shall include private informal
2010	conversations with a sample of residents and consultation with
2011	the ombudsman council in the planning and service area in which
2012	the facility is located to discuss residents' experiences within
2013	the facility.
2014	(7)  An assisted living facility that has been cited within
2015	the previous 24-month period for a class I or class II
2016	violation, regardless of the status of any enforcement or
2017	disciplinary action, is subject to periodic unannounced
2018	monitoring to determine if the facility is in compliance with
2019	this part, part II of chapter 408, and applicable rules.
2020	Monitoring may occur through a desk review or an onsite
2021	assessment. If the class I or class II violation relates to
2022	providing or failing to provide nursing care, a registered nurse
2023	must participate in at least two onsite monitoring visits within
2024	a 12-month period.
2025	Section 59.  Subsection (7) of section 429.11, Florida
2026	Statutes, is renumbered as subsection (6), and present
2027	subsection (6) of that section is amended to read:
2028	429.11  Initial application for license; provisional
2029	license.-
2030	(6)  In addition to the license categories available in s.
2031	408.808, a provisional license may be issued to an applicant
2032	making initial application for licensure or making application
2033	for a change of ownership. A provisional license shall be
2034	limited in duration to a specific period of time not to exceed 6
2035	months, as determined by the agency.
2036	Section 60.  Section 429.12, Florida Statutes, is amended
2037	to read:
2038	429.12  Sale or transfer of ownership of a facility.-It is
2039	the intent of the Legislature to protect the rights of the
2040	residents of an assisted living facility when the facility is
2041	sold or the ownership thereof is transferred. Therefore, in
2042	addition to the requirements of part II of chapter 408, whenever
2043	a facility is sold or the ownership thereof is transferred,
2044	including leasing:.
2045	(1)  The transferee shall notify the residents, in writing,
2046	of the change of ownership within 7 days after receipt of the
2047	new license.
2048	(2)  The transferor of a facility the license of which is
2049	denied pending an administrative hearing shall, as a part of the
2050	written change-of-ownership contract, advise the transferee that
2051	a plan of correction must be submitted by the transferee and
2052	approved by the agency at least 7 days before the change of
2053	ownership and that failure to correct the condition which
2054	resulted in the moratorium pursuant to part II of chapter 408 or
2055	denial of licensure is grounds for denial of the transferee's
2056	license.
2057	Section 61.  Paragraphs (b) through (l) of subsection (1)
2058	of section 429.14, Florida Statutes, are redesignated as
2059	paragraphs (a) through (k), respectively, and present paragraph
2060	(a) of subsection (1) and subsections (5) and (6) of that
2061	section are amended to read:
2062	429.14  Administrative penalties.-
2063	(1)  In addition to the requirements of part II of chapter
2064	408, the agency may deny, revoke, and suspend any license issued
2065	under this part and impose an administrative fine in the manner
2066	provided in chapter 120 against a licensee of an assisted living
2067	facility for a violation of any provision of this part, part II
2068	of chapter 408, or applicable rules, or for any of the following
2069	actions by a licensee of an assisted living facility, for the
2070	actions of any person subject to level 2 background screening
2071	under s. 408.809, or for the actions of any facility employee:
2072	(a)  An intentional or negligent act seriously affecting
2073	the health, safety, or welfare of a resident of the facility.
2074	(5)  An action taken by the agency to suspend, deny, or
2075	revoke a facility's license under this part or part II of
2076	chapter 408, in which the agency claims that the facility owner
2077	or an employee of the facility has threatened the health,
2078	safety, or welfare of a resident of the facility shall be heard
2079	by the Division of Administrative Hearings of the Department of
2080	Management Services within 120 days after receipt of the
2081	facility's request for a hearing, unless that time limitation is
2082	waived by both parties. The administrative law judge must render
2083	a decision within 30 days after receipt of a proposed
2084	recommended order.
2085	(6)  The agency shall provide to the Division of Hotels and
2086	Restaurants of the Department of Business and Professional
2087	Regulation, on a monthly basis, a list of those assisted living
2088	facilities that have had their licenses denied, suspended, or
2089	revoked or that are involved in an appellate proceeding pursuant
2090	to s. 120.60 related to the denial, suspension, or revocation of
2091	a license. This information may be provided electronically or
2092	through the agency's Internet website.
2093	Section 62.  Subsections (1), (4), and (5) of section
2094	429.17, Florida Statutes, are amended to read:
2095	429.17  Expiration of license; renewal; conditional
2096	license.-
2097	(1)  Limited nursing, Extended congregate care, and limited
2098	mental health licenses shall expire at the same time as the
2099	facility's standard license, regardless of when issued.
2100	(4)  In addition to the license categories available in s.
2101	408.808, a conditional license may be issued to an applicant for
2102	license renewal if the applicant fails to meet all standards and
2103	requirements for licensure. A conditional license issued under
2104	this subsection shall be limited in duration to a specific
2105	period of time not to exceed 6 months, as determined by the
2106	agency, and shall be accompanied by an agency-approved plan of
2107	correction.
2108	(5)  When an extended congregate care or limited nursing
2109	license is requested during a facility's biennial license
2110	period, the fee shall be prorated in order to permit the
2111	additional license to expire at the end of the biennial license
2112	period. The fee shall be calculated as of the date the
2113	additional license application is received by the agency.
2114	Section 63.  Subsection (7) of section 429.19, Florida
2115	Statutes, is amended to read:
2116	429.19  Violations; imposition of administrative fines;
2117	grounds.-
2118	(7)  In addition to any administrative fines imposed, the
2119	agency may assess a survey or monitoring fee, equal to the
2120	lesser of one half of the facility's biennial license and bed
2121	fee or $500, to cover the cost of conducting initial complaint
2122	investigations that result in the finding of a violation that
2123	was the subject of the complaint or to monitor the health,
2124	safety, or security of residents under s. 429.07(7) monitoring
2125	visits conducted under s. 429.28(3)(c) to verify the correction
2126	of the violations.
2127	Section 64.  Subsections (6) through (10) of section
2128	429.23, Florida Statutes, are renumbered as subsections (5)
2129	through (9), respectively, and present subsection (5) of that
2130	section is amended to read:
2131	429.23  Internal risk management and quality assurance
2132	program; adverse incidents and reporting requirements.-
2133	(5)  Each facility shall report monthly to the agency any
2134	liability claim filed against it. The report must include the
2135	name of the resident, the dates of the incident leading to the
2136	claim, if applicable, and the type of injury or violation of
2137	rights alleged to have occurred. This report is not discoverable
2138	in any civil or administrative action, except in such actions
2139	brought by the agency to enforce the provisions of this part.
2140	Section 65.  Paragraph (a) of subsection (1) and subsection
2141	(2) of section 429.255, Florida Statutes, are amended to read:
2142	429.255  Use of personnel; emergency care.-
2143	(1)(a)  Persons under contract to the facility or, facility
2144	staff, or volunteers, who are licensed according to part I of
2145	chapter 464, or those persons exempt under s. 464.022(1), and
2146	others as defined by rule, may administer medications to
2147	residents, take residents' vital signs, manage individual weekly
2148	pill organizers for residents who self-administer medication,
2149	give prepackaged enemas ordered by a physician, observe
2150	residents, document observations on the appropriate resident's
2151	record, report observations to the resident's physician, and
2152	contract or allow residents or a resident's representative,
2153	designee, surrogate, guardian, or attorney in fact to contract
2154	with a third party, provided residents meet the criteria for
2155	appropriate placement as defined in s. 429.26. Persons under
2156	contract to the facility or facility staff who are licensed
2157	according to part I of chapter 464 may provide limited nursing
2158	services. Nursing assistants certified pursuant to part II of
2159	chapter 464 may take residents' vital signs as directed by a
2160	licensed nurse or physician. The facility is responsible for
2161	maintaining documentation of services provided under this
2162	paragraph as required by rule and ensuring that staff are
2163	adequately trained to monitor residents receiving these
2164	services.
2165	(2)  In facilities licensed to provide extended congregate
2166	care, persons under contract to the facility or, facility staff,
2167	or volunteers, who are licensed according to part I of chapter
2168	464, or those persons exempt under s. 464.022(1), or those
2169	persons certified as nursing assistants pursuant to part II of
2170	chapter 464, may also perform all duties within the scope of
2171	their license or certification, as approved by the facility
2172	administrator and pursuant to this part.
2173	Section 66.  Subsection (3) of section 429.28, Florida
2174	Statutes, is amended to read:
2175	429.28  Resident bill of rights.-
2176	(3)(a)  The agency shall conduct a survey to determine
2177	general compliance with facility standards and compliance with
2178	residents' rights as a prerequisite to initial licensure or
2179	licensure renewal.
2180	(b)  In order to determine whether the facility is
2181	adequately protecting residents' rights, the biennial survey
2182	shall include private informal conversations with a sample of
2183	residents and consultation with the ombudsman council in the
2184	planning and service area in which the facility is located to
2185	discuss residents' experiences within the facility.
2186	(c)  During any calendar year in which no survey is
2187	conducted, the agency shall conduct at least one monitoring
2188	visit of each facility cited in the previous year for a class I
2189	or class II violation, or more than three uncorrected class III
2190	violations.
2191	(d)  The agency may conduct periodic followup inspections
2192	as necessary to monitor the compliance of facilities with a
2193	history of any class I, class II, or class III violations that
2194	threaten the health, safety, or security of residents.
2195	(e)  The agency may conduct complaint investigations as
2196	warranted to investigate any allegations of noncompliance with
2197	requirements required under this part or rules adopted under
2198	this part.
2199	Section 67.  Subsection (2) of section 429.35, Florida
2200	Statutes, is amended to read:
2201	429.35  Maintenance of records; reports.-
2202	(2)  Within 60 days after the date of the biennial
2203	inspection visit required under s. 408.811 or within 30 days
2204	after the date of any interim visit, the agency shall forward
2205	the results of the inspection to the local ombudsman council in
2206	whose planning and service area, as defined in part II of
2207	chapter 400, the facility is located; to at least one public
2208	library or, in the absence of a public library, the county seat
2209	in the county in which the inspected assisted living facility is
2210	located; and, when appropriate, to the district Adult Services
2211	and Mental Health Program Offices. This information may be
2212	provided electronically or through the agency's Internet
2213	website.
2214	Section 68.  Paragraphs (i) and (j) of subsection (1) of
2215	section 429.41, Florida Statutes, are amended to read:
2216	429.41  Rules establishing standards.-
2217	(1)  It is the intent of the Legislature that rules
2218	published and enforced pursuant to this section shall include
2219	criteria by which a reasonable and consistent quality of
2220	resident care and quality of life may be ensured and the results
2221	of such resident care may be demonstrated. Such rules shall also
2222	ensure a safe and sanitary environment that is residential and
2223	noninstitutional in design or nature. It is further intended
2224	that reasonable efforts be made to accommodate the needs and
2225	preferences of residents to enhance the quality of life in a
2226	facility. The agency, in consultation with the department, may
2227	adopt rules to administer the requirements of part II of chapter
2228	408. In order to provide safe and sanitary facilities and the
2229	highest quality of resident care accommodating the needs and
2230	preferences of residents, the department, in consultation with
2231	the agency, the Department of Children and Family Services, and
2232	the Department of Health, shall adopt rules, policies, and
2233	procedures to administer this part, which must include
2234	reasonable and fair minimum standards in relation to:
2235	(i)  Facilities holding an a limited nursing, extended
2236	congregate care, or limited mental health license.
2237	(j)  The establishment of specific criteria to define
2238	appropriateness of resident admission and continued residency in
2239	a facility holding a standard, limited nursing, extended
2240	congregate care, and limited mental health license.
2241	Section 69.  Subsections (1) and (2) of section 429.53,
2242	Florida Statutes, are amended to read:
2243	429.53  Consultation by the agency.-
2244	(1)  The area offices of licensure and certification of the
2245	agency shall provide consultation to the following upon request:
2246	(a)  A licensee of a facility.
2247	(b)  A person interested in obtaining a license to operate
2248	a facility under this part.
2249	(2)  As used in this section, "consultation" includes:
2250	(a)  An explanation of the requirements of this part and
2251	rules adopted pursuant thereto;
2252	(b)  An explanation of the license application and renewal
2253	procedures;
2254	(c)  The provision of a checklist of general local and
2255	state approvals required prior to constructing or developing a
2256	facility and a listing of the types of agencies responsible for
2257	such approvals;
2258	(d)  An explanation of benefits and financial assistance
2259	available to a recipient of supplemental security income
2260	residing in a facility;
2261	(c)(e)  Any other information which the agency deems
2262	necessary to promote compliance with the requirements of this
2263	part; and
2264	(f)  A preconstruction review of a facility to ensure
2265	compliance with agency rules and this part.
2266	Section 70.  Subsections (1) and (2) of section 429.54,
2267	Florida Statutes, are renumbered as subsections (2) and (3),
2268	respectively, and a new subsection (1) is added to that section
2269	to read:
2270	429.54  Collection of information; local subsidy.-
2271	(1)  A facility that is licensed under this part must
2272	report electronically to the agency semiannually, or more
2273	frequently as determined by rule, data related to the facility,
2274	including, but not limited to, the total number of residents,
2275	the number of residents who are receiving limited mental health
2276	services, the number of residents who are receiving extended
2277	congregate care services, the number of residents who are
2278	receiving limited nursing services, funding sources of the
2279	residents, and professional staffing employed by or under
2280	contract with the licensee to provide resident services. The
2281	department, in consultation with the agency, shall adopt rules
2282	to administer this subsection.
2283	Section 71.  Subsections (1) and (5) of section 429.71,
2284	Florida Statutes, are amended to read:
2285	429.71  Classification of violations deficiencies;
2286	administrative fines.-
2287	(1)  In addition to the requirements of part II of chapter
2288	408 and in addition to any other liability or penalty provided
2289	by law, the agency may impose an administrative fine on a
2290	provider according to the following classification:
2291	(a)  Class I violations are defined in s. 408.813 those
2292	conditions or practices related to the operation and maintenance
2293	of an adult family-care home or to the care of residents which
2294	the agency determines present an imminent danger to the
2295	residents or guests of the facility or a substantial probability
2296	that death or serious physical or emotional harm would result
2297	therefrom. The condition or practice that constitutes a class I
2298	violation must be abated or eliminated within 24 hours, unless a
2299	fixed period, as determined by the agency, is required for
2300	correction. A class I violation deficiency is subject to an
2301	administrative fine in an amount not less than $500 and not
2302	exceeding $1,000 for each violation. A fine may be levied
2303	notwithstanding the correction of the deficiency.
2304	(b)  Class II violations are defined in s. 408.813 those
2305	conditions or practices related to the operation and maintenance
2306	of an adult family-care home or to the care of residents which
2307	the agency determines directly threaten the physical or
2308	emotional health, safety, or security of the residents, other
2309	than class I violations. A class II violation is subject to an
2310	administrative fine in an amount not less than $250 and not
2311	exceeding $500 for each violation. A citation for a class II
2312	violation must specify the time within which the violation is
2313	required to be corrected. If a class II violation is corrected
2314	within the time specified, no civil penalty shall be imposed,
2315	unless it is a repeated offense.
2316	(c)  Class III violations are defined in s. 408.813 those
2317	conditions or practices related to the operation and maintenance
2318	of an adult family-care home or to the care of residents which
2319	the agency determines indirectly or potentially threaten the
2320	physical or emotional health, safety, or security of residents,
2321	other than class I or class II violations. A class III violation
2322	is subject to an administrative fine in an amount not less than
2323	$100 and not exceeding $250 for each violation. A citation for a
2324	class III violation shall specify the time within which the
2325	violation is required to be corrected. If a class III violation
2326	is corrected within the time specified, no civil penalty shall
2327	be imposed, unless it is a repeated violation offense.
2328	(d)  Class IV violations are defined in s. 408.813 those
2329	conditions or occurrences related to the operation and
2330	maintenance of an adult family-care home, or related to the
2331	required reports, forms, or documents, which do not have the
2332	potential of negatively affecting the residents. A provider that
2333	does not correct A class IV violation within the time limit
2334	specified by the agency is subject to an administrative fine in
2335	an amount not less than $50 and not exceeding $100 for each
2336	violation. Any class IV violation that is corrected during the
2337	time the agency survey is conducted will be identified as an
2338	agency finding and not as a violation, unless it is a repeat
2339	violation.
2340	(5)  As an alternative to or in conjunction with an
2341	administrative action against a provider, the agency may request
2342	a plan of corrective action that demonstrates a good faith
2343	effort to remedy each violation by a specific date, subject to
2344	the approval of the agency.
2345	Section 72.  Paragraphs (b) through (e) of subsection (2)
2346	of section 429.911, Florida Statutes, are redesignated as
2347	paragraphs (a) through (d), respectively, and present paragraph
2348	(a) of that subsection is amended to read:
2349	429.911  Denial, suspension, revocation of license;
2350	emergency action; administrative fines; investigations and
2351	inspections.-
2352	(2)  Each of the following actions by the owner of an adult
2353	day care center or by its operator or employee is a ground for
2354	action by the agency against the owner of the center or its
2355	operator or employee:
2356	(a)  An intentional or negligent act materially affecting
2357	the health or safety of center participants.
2358	Section 73.  Section 429.915, Florida Statutes, is amended
2359	to read:
2360	429.915  Conditional license.-In addition to the license
2361	categories available in part II of chapter 408, the agency may
2362	issue a conditional license to an applicant for license renewal
2363	or change of ownership if the applicant fails to meet all
2364	standards and requirements for licensure. A conditional license
2365	issued under this subsection must be limited to a specific
2366	period not exceeding 6 months, as determined by the agency, and
2367	must be accompanied by an approved plan of correction.
2368	Section 74.  Subsection (7) of section 394.4787, Florida
2369	Statutes, is amended to read:
2370	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
2371	and 394.4789.-As used in this section and ss. 394.4786,
2372	394.4788, and 394.4789:
2373	(7)  "Specialty psychiatric hospital" means a hospital
2374	licensed by the agency pursuant to s. 395.002(26)(28) and part
2375	II of chapter 408 as a specialty psychiatric hospital.
2376	Section 75.  Paragraph (g) of subsection (2) of section
2377	400.0239, Florida Statutes, is amended to read:
2378	400.0239  Quality of Long-Term Care Facility Improvement
2379	Trust Fund.-
2380	(2)  Expenditures from the trust fund shall be allowable
2381	for direct support of the following:
2382	(g)  Other initiatives authorized by the Centers for
2383	Medicare and Medicaid Services for the use of federal civil
2384	monetary penalties, including projects recommended through the
2385	Medicaid "Up-or-Out" Quality of Care Contract Management Program
2386	pursuant to s. 400.148.
2387	Section 76.  Subsection (43) of section 408.07, Florida
2388	Statutes, is amended to read:
2389	408.07  Definitions.-As used in this chapter, with the
2390	exception of ss. 408.031-408.045, the term:
2391	(43)  "Rural hospital" means an acute care hospital
2392	licensed under chapter 395, having 100 or fewer licensed beds
2393	and an emergency room, and which is:
2394	(a)  The sole provider within a county with a population
2395	density of no greater than 100 persons per square mile;
2396	(b)  An acute care hospital, in a county with a population
2397	density of no greater than 100 persons per square mile, which is
2398	at least 30 minutes of travel time, on normally traveled roads
2399	under normal traffic conditions, from another acute care
2400	hospital within the same county;
2401	(c)  A hospital supported by a tax district or subdistrict
2402	whose boundaries encompass a population of 100 persons or fewer
2403	per square mile;
2404	(d)  A hospital with a service area that has a population
2405	of 100 persons or fewer per square mile. As used in this
2406	paragraph, the term "service area" means the fewest number of
2407	zip codes that account for 75 percent of the hospital's
2408	discharges for the most recent 5-year period, based on
2409	information available from the hospital inpatient discharge
2410	database in the Florida Center for Health Information and Policy
2411	Analysis at the Agency for Health Care Administration; or
2412	(e)  A critical access hospital.
2413
2414	Population densities used in this subsection must be based upon
2415	the most recently completed United States census. A hospital
2416	that received funds under s. 409.9116 for a quarter beginning no
2417	later than July 1, 2002, is deemed to have been and shall
2418	continue to be a rural hospital from that date through June 30,
2419	2015, if the hospital continues to have 100 or fewer licensed
2420	beds and an emergency room, or meets the criteria of s.
2421	395.602(2)(e)4. An acute care hospital that has not previously
2422	been designated as a rural hospital and that meets the criteria
2423	of this subsection shall be granted such designation upon
2424	application, including supporting documentation, to the Agency
2425	for Health Care Administration.
2426	Section 77.  Paragraphs (b) and (h) of subsection (3) of
2427	section 430.80, Florida Statutes, are amended to read:
2428	430.80  Implementation of a teaching nursing home pilot
2429	project.-
2430	(3)  To be designated as a teaching nursing home, a nursing
2431	home licensee must, at a minimum:
2432	(b)  Participate in a nationally recognized accreditation
2433	program and hold a valid accreditation, such as the
2434	accreditation awarded by The Joint Commission on Accreditation
2435	of Healthcare Organizations;
2436	(h)  Maintain insurance coverage pursuant to s.
2437	400.141(1)(r)(s) or proof of financial responsibility in a
2438	minimum amount of $750,000. Such proof of financial
2439	responsibility may include:
2440	1.  Maintaining an escrow account consisting of cash or
2441	assets eligible for deposit in accordance with s. 625.52; or
2442	2.  Obtaining and maintaining pursuant to chapter 675 an
2443	unexpired, irrevocable, nontransferable and nonassignable letter
2444	of credit issued by any bank or savings association organized
2445	and existing under the laws of this state or any bank or savings
2446	association organized under the laws of the United States that
2447	has its principal place of business in this state or has a
2448	branch office which is authorized to receive deposits in this
2449	state. The letter of credit shall be used to satisfy the
2450	obligation of the facility to the claimant upon presentment of a
2451	final judgment indicating liability and awarding damages to be
2452	paid by the facility or upon presentment of a settlement
2453	agreement signed by all parties to the agreement when such final
2454	judgment or settlement is a result of a liability claim against
2455	the facility.
2456	Section 78.  Paragraph (a) of subsection (2) of section
2457	440.13, Florida Statutes, is amended to read:
2458	440.13  Medical services and supplies; penalty for
2459	violations; limitations.-
2460	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
2461	(a)  Subject to the limitations specified elsewhere in this
2462	chapter, the employer shall furnish to the employee such
2463	medically necessary remedial treatment, care, and attendance for
2464	such period as the nature of the injury or the process of
2465	recovery may require, which is in accordance with established
2466	practice parameters and protocols of treatment as provided for
2467	in this chapter, including medicines, medical supplies, durable
2468	medical equipment, orthoses, prostheses, and other medically
2469	necessary apparatus. Remedial treatment, care, and attendance,
2470	including work-hardening programs or pain-management programs
2471	accredited by the Commission on Accreditation of Rehabilitation
2472	Facilities or The Joint Commission on the Accreditation of
2473	Health Organizations or pain-management programs affiliated with
2474	medical schools, shall be considered as covered treatment only
2475	when such care is given based on a referral by a physician as
2476	defined in this chapter. Medically necessary treatment, care,
2477	and attendance does not include chiropractic services in excess
2478	of 24 treatments or rendered 12 weeks beyond the date of the
2479	initial chiropractic treatment, whichever comes first, unless
2480	the carrier authorizes additional treatment or the employee is
2481	catastrophically injured.
2482
2483	Failure of the carrier to timely comply with this subsection
2484	shall be a violation of this chapter and the carrier shall be
2485	subject to penalties as provided for in s. 440.525.
2486	Section 79.  Section 483.294, Florida Statutes, is amended
2487	to read:
2488	483.294  Inspection of centers.-In accordance with s.
2489	408.811, the agency shall biennially, at least once annually,
2490	inspect the premises and operations of all centers subject to
2491	licensure under this part.
2492	Section 80.  Subsection (1) of section 627.645, Florida
2493	Statutes, is amended to read:
2494	627.645  Denial of health insurance claims restricted.-
2495	(1)  No claim for payment under a health insurance policy
2496	or self-insured program of health benefits for treatment, care,
2497	or services in a licensed hospital which is accredited by The
2498	Joint Commission on the Accreditation of Hospitals, the American
2499	Osteopathic Association, or the Commission on the Accreditation
2500	of Rehabilitative Facilities shall be denied because such
2501	hospital lacks major surgical facilities and is primarily of a
2502	rehabilitative nature, if such rehabilitation is specifically
2503	for treatment of physical disability.
2504	Section 81.  Paragraph (c) of subsection (2) of section
2505	627.668, Florida Statutes, is amended to read:
2506	627.668  Optional coverage for mental and nervous disorders
2507	required; exception.-
2508	(2)  Under group policies or contracts, inpatient hospital
2509	benefits, partial hospitalization benefits, and outpatient
2510	benefits consisting of durational limits, dollar amounts,
2511	deductibles, and coinsurance factors shall not be less favorable
2512	than for physical illness generally, except that:
2513	(c)  Partial hospitalization benefits shall be provided
2514	under the direction of a licensed physician. For purposes of
2515	this part, the term "partial hospitalization services" is
2516	defined as those services offered by a program accredited by The
2517	Joint Commission on Accreditation of Hospitals (JCAH) or in
2518	compliance with equivalent standards. Alcohol rehabilitation
2519	programs accredited by The Joint Commission on Accreditation of
2520	Hospitals or approved by the state and licensed drug abuse
2521	rehabilitation programs shall also be qualified providers under
2522	this section. In any benefit year, if partial hospitalization
2523	services or a combination of inpatient and partial
2524	hospitalization are utilized, the total benefits paid for all
2525	such services shall not exceed the cost of 30 days of inpatient
2526	hospitalization for psychiatric services, including physician
2527	fees, which prevail in the community in which the partial
2528	hospitalization services are rendered. If partial
2529	hospitalization services benefits are provided beyond the limits
2530	set forth in this paragraph, the durational limits, dollar
2531	amounts, and coinsurance factors thereof need not be the same as
2532	those applicable to physical illness generally.
2533	Section 82.  Subsection (3) of section 627.669, Florida
2534	Statutes, is amended to read:
2535	627.669  Optional coverage required for substance abuse
2536	impaired persons; exception.-
2537	(3)  The benefits provided under this section shall be
2538	applicable only if treatment is provided by, or under the
2539	supervision of, or is prescribed by, a licensed physician or
2540	licensed psychologist and if services are provided in a program
2541	accredited by The Joint Commission on Accreditation of Hospitals
2542	or approved by the state.
2543	Section 83.  Paragraph (a) of subsection (1) of section
2544	627.736, Florida Statutes, is amended to read:
2545	627.736  Required personal injury protection benefits;
2546	exclusions; priority; claims.-
2547	(1)  REQUIRED BENEFITS.-Every insurance policy complying
2548	with the security requirements of s. 627.733 shall provide
2549	personal injury protection to the named insured, relatives
2550	residing in the same household, persons operating the insured
2551	motor vehicle, passengers in such motor vehicle, and other
2552	persons struck by such motor vehicle and suffering bodily injury
2553	while not an occupant of a self-propelled vehicle, subject to
2554	the provisions of subsection (2) and paragraph (4)(e), to a
2555	limit of $10,000 for loss sustained by any such person as a
2556	result of bodily injury, sickness, disease, or death arising out
2557	of the ownership, maintenance, or use of a motor vehicle as
2558	follows:
2559	(a)  Medical benefits.-Eighty percent of all reasonable
2560	expenses for medically necessary medical, surgical, X-ray,
2561	dental, and rehabilitative services, including prosthetic
2562	devices, and medically necessary ambulance, hospital, and
2563	nursing services. However, the medical benefits shall provide
2564	reimbursement only for such services and care that are lawfully
2565	provided, supervised, ordered, or prescribed by a physician
2566	licensed under chapter 458 or chapter 459, a dentist licensed
2567	under chapter 466, or a chiropractic physician licensed under
2568	chapter 460 or that are provided by any of the following persons
2569	or entities:
2570	1.  A hospital or ambulatory surgical center licensed under
2571	chapter 395.
2572	2.  A person or entity licensed under ss. 401.2101-401.45
2573	that provides emergency transportation and treatment.
2574	3.  An entity wholly owned by one or more physicians
2575	licensed under chapter 458 or chapter 459, chiropractic
2576	physicians licensed under chapter 460, or dentists licensed
2577	under chapter 466 or by such practitioner or practitioners and
2578	the spouse, parent, child, or sibling of that practitioner or
2579	those practitioners.
2580	4.  An entity wholly owned, directly or indirectly, by a
2581	hospital or hospitals.
2582	5.  A health care clinic licensed under ss. 400.990-400.995
2583	that is:
2584	a.  Accredited by The Joint Commission on Accreditation of
2585	Healthcare Organizations, the American Osteopathic Association,
2586	the Commission on Accreditation of Rehabilitation Facilities, or
2587	the Accreditation Association for Ambulatory Health Care, Inc.;
2588	or
2589	b.  A health care clinic that:
2590	(I)  Has a medical director licensed under chapter 458,
2591	chapter 459, or chapter 460;
2592	(II)  Has been continuously licensed for more than 3 years
2593	or is a publicly traded corporation that issues securities
2594	traded on an exchange registered with the United States
2595	Securities and Exchange Commission as a national securities
2596	exchange; and
2597	(III)  Provides at least four of the following medical
2598	specialties:
2599	(A)  General medicine.
2600	(B)  Radiography.
2601	(C)  Orthopedic medicine.
2602	(D)  Physical medicine.
2603	(E)  Physical therapy.
2604	(F)  Physical rehabilitation.
2605	(G)  Prescribing or dispensing outpatient prescription
2606	medication.
2607	(H)  Laboratory services.
2608
2609	The Financial Services Commission shall adopt by rule the form
2610	that must be used by an insurer and a health care provider
2611	specified in subparagraph 3., subparagraph 4., or subparagraph
2612	5. to document that the health care provider meets the criteria
2613	of this paragraph, which rule must include a requirement for a
2614	sworn statement or affidavit.
2615
2616	Only insurers writing motor vehicle liability insurance in this
2617	state may provide the required benefits of this section, and no
2618	such insurer shall require the purchase of any other motor
2619	vehicle coverage other than the purchase of property damage
2620	liability coverage as required by s. 627.7275 as a condition for
2621	providing such required benefits. Insurers may not require that
2622	property damage liability insurance in an amount greater than
2623	$10,000 be purchased in conjunction with personal injury
2624	protection. Such insurers shall make benefits and required
2625	property damage liability insurance coverage available through
2626	normal marketing channels. Any insurer writing motor vehicle
2627	liability insurance in this state who fails to comply with such
2628	availability requirement as a general business practice shall be
2629	deemed to have violated part IX of chapter 626, and such
2630	violation shall constitute an unfair method of competition or an
2631	unfair or deceptive act or practice involving the business of
2632	insurance; and any such insurer committing such violation shall
2633	be subject to the penalties afforded in such part, as well as
2634	those which may be afforded elsewhere in the insurance code.
2635	Section 84.  Subsection (12) of section 641.495, Florida
2636	Statutes, is amended to read:
2637	641.495  Requirements for issuance and maintenance of
2638	certificate.-
2639	(12)  The provisions of part I of chapter 395 do not apply
2640	to a health maintenance organization that, on or before January
2641	1, 1991, provides not more than 10 outpatient holding beds for
2642	short-term and hospice-type patients in an ambulatory care
2643	facility for its members, provided that such health maintenance
2644	organization maintains current accreditation by The Joint
2645	Commission on Accreditation of Health Care Organizations, the
2646	Accreditation Association for Ambulatory Health Care, or the
2647	National Committee for Quality Assurance.
2648	Section 85.  Subsection (13) of section 651.118, Florida
2649	Statutes, is amended to read:
2650	651.118  Agency for Health Care Administration;
2651	certificates of need; sheltered beds; community beds.-
2652	(13)  Residents, as defined in this chapter, are not
2653	considered new admissions for the purpose of s.
2654	400.141(1)(n)(o)1.d.
2655	Section 86.  Subsection (2) of section 766.1015, Florida
2656	Statutes, is amended to read:
2657	766.1015  Civil immunity for members of or consultants to
2658	certain boards, committees, or other entities.-
2659	(2)  Such committee, board, group, commission, or other
2660	entity must be established in accordance with state law or in
2661	accordance with requirements of The Joint Commission on
2662	Accreditation of Healthcare Organizations, established and duly
2663	constituted by one or more public or licensed private hospitals
2664	or behavioral health agencies, or established by a governmental
2665	agency. To be protected by this section, the act, decision,
2666	omission, or utterance may not be made or done in bad faith or
2667	with malicious intent.
2668	Section 87.  This act shall take effect July 1, 2010.

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