CS/CS/CS/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; amending s.
8	381.00315, F.S.; directing the Department of Health to
9	accept funds from counties, municipalities, and certain
10	other entities for the purchase of certain products made
11	available under a contract of the United States Department
12	of Health and Human Services for the manufacture and
13	delivery of such products in response to a public health
14	emergency; amending s. 381.0072, F.S.; limiting Department
15	of Health food service inspections in nursing homes;
16	requiring the department to coordinate inspections with
17	the Agency for Health Care Administration; repealing s.
18	383.325, F.S., relating to confidentiality of inspection
19	reports of licensed birth center facilities; amending s.
20	395.002, F.S.; revising and deleting definitions
21	applicable to regulation of hospitals and other licensed
22	facilities; conforming a cross-reference; amending s.
23	395.003, F.S.; deleting an obsolete provision; conforming
24	a cross-reference; amending s. 395.0193, F.S.; requiring a
25	licensed facility to report certain peer review
26	information and final disciplinary actions to the Division
27	of Medical Quality Assurance of the Department of Health
28	rather than the Division of Health Quality Assurance of
29	the Agency for Health Care Administration; amending s.
30	395.1023, F.S.; providing for the Department of Children
31	and Family Services rather than the Department of Health
32	to perform certain functions with respect to child
33	protection cases; requiring certain hospitals to notify
34	the Department of Children and Family Services of
35	compliance; amending s. 395.1041, F.S., relating to
36	hospital emergency services and care; deleting obsolete
37	provisions; repealing s. 395.1046, F.S., relating to
38	complaint investigation procedures; amending s. 395.1055,
39	F.S.; requiring licensed facility beds to conform to
40	standards specified by the Agency for Health Care
41	Administration, the Florida Building Code, and the Florida
42	Fire Prevention Code; amending s. 395.10972, F.S.;
43	revising a reference to the Florida Society of Healthcare
44	Risk Management to conform to the current designation;
45	amending s. 395.2050, F.S.; revising a reference to the
46	federal Health Care Financing Administration to conform to
47	the current designation; amending s. 395.3036, F.S.;
48	correcting a reference; repealing s. 395.3037, F.S.,
49	relating to redundant definitions; amending ss. 154.11,
50	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
51	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
52	F.S.; revising references to the Joint Commission on
53	Accreditation of Healthcare Organizations, the Commission
54	on Accreditation of Rehabilitation Facilities, and the
55	Council on Accreditation to conform to their current
56	designations; amending s. 395.602, F.S.; revising the
57	definition of the term "rural hospital" to delete an
58	obsolete provision; amending s. 400.021, F.S.; revising
59	the definition of the term "geriatric outpatient clinic";
60	amending s. 400.063, F.S.; deleting an obsolete provision;
61	amending ss. 400.071 and 400.0712, F.S.; revising
62	applicability of general licensure requirements under pt.
63	II of ch. 408, F.S., to applications for nursing home
64	licensure; revising provisions governing inactive
65	licenses; amending s. 400.111, F.S.; providing for
66	disclosure of controlling interest of a nursing home
67	facility upon request by the Agency for Health Care
68	Administration; amending s. 400.1183, F.S.; revising
69	grievance record maintenance and reporting requirements
70	for nursing homes; amending s. 400.141, F.S.; providing
71	criteria for the provision of respite services by nursing
72	homes; requiring a written plan of care; requiring a
73	contract for services; requiring resident release to
74	caregivers to be designated in writing; providing an
75	exemption to the application of discharge planning rules;
76	providing for residents' rights; providing for use of
77	personal medications; providing terms of respite stay;
78	providing for communication of patient information;
79	requiring a physician order for care and proof of a
80	physical examination; providing for services for respite
81	patients and duties of facilities with respect to such
82	patients; conforming a cross-reference; requiring
83	facilities to maintain clinical records that meet
84	specified standards; providing a fine relating to an
85	admissions moratorium; deleting requirement for facilities
86	to submit certain information related to management
87	companies to the agency; deleting a requirement for
88	facilities to notify the agency of certain bankruptcy
89	filings to conform to changes made by the act; amending s.
90	400.142, F.S.; deleting language relating to agency
91	adoption of rules; amending 400.147, F.S.; revising
92	reporting requirements for licensed nursing home
93	facilities relating to adverse incidents; repealing s.
94	400.148, F.S., relating to the Medicaid "Up-or-Out"
95	Quality of Care Contract Management Program; amending s.
96	400.162, F.S., requiring nursing homes to provide a
97	resident property statement annually and upon request;
98	amending s. 400.179, F.S.; revising requirements for
99	nursing home lease bond alternative fees; deleting an
100	obsolete provision; amending s. 400.19, F.S.; revising
101	inspection requirements; repealing s. 400.195, F.S.,
102	relating to agency reporting requirements; amending s.
103	400.23, F.S.; deleting an obsolete provision; correcting a
104	reference; directing the agency to adopt rules for minimum
105	staffing standards in nursing homes that serve persons
106	under 21 years of age; providing minimum staffing
107	standards; amending s. 400.275, F.S.; revising agency
108	duties with regard to training nursing home surveyor
109	teams; revising requirements for team members; amending s.
110	400.484, F.S.; revising the schedule of home health agency
111	inspection violations; amending s. 400.606, F.S.; revising
112	the content requirements of the plan accompanying an
113	initial or change-of-ownership application for licensure
114	of a hospice; revising requirements relating to
115	certificates of need for certain hospice facilities;
116	amending s. 400.607, F.S.; revising grounds for agency
117	action against a hospice; amending s. 400.931, F.S.;
118	deleting a requirement that an applicant for a home
119	medical equipment provider license submit a surety bond to
120	the agency; amending s. 400.932, F.S.; revising grounds
121	for the imposition of administrative penalties for certain
122	violations by an employee of a home medical equipment
123	provider; amending s. 400.967, F.S.; revising the schedule
124	of inspection violations for intermediate care facilities
125	for the developmentally disabled; providing a penalty for
126	certain violations; amending s. 400.9905, F.S.; providing
127	that pt. X of ch, 400, F.S., the Health Care Clinic Act,
128	does not apply to an entity owned by a corporation with a
129	specified amount of annual sales of health care services
130	under certain circumstances or to an entity owned or
131	controlled by a publicly traded entity with a specified
132	amount of annual revenues; amending s. 400.991, F.S.;
133	conforming terminology; revising application requirements
134	relating to documentation of financial ability to operate
135	a mobile clinic; amending s. 408.034, F.S.; revising
136	agency authority relating to licensing of intermediate
137	care facilities for the developmentally disabled; amending
138	s. 408.036, F.S.; deleting an exemption from certain
139	certificate-of-need review requirements for a hospice or a
140	hospice inpatient facility; amending s. 408.043, F.S.;
141	revising requirements for certain freestanding inpatient
142	hospice care facilities to obtain a certificate of need;
143	amending s. 408.061, F.S.; revising health care facility
144	data reporting requirements; amending s. 408.10, F.S.;
145	removing agency authority to investigate certain consumer
146	complaints; amending s. 408.802, F.S.; removing
147	applicability of pt. II of ch. 408, F.S., relating to
148	general licensure requirements, to private review agents;
149	amending s. 408.804, F.S.; providing penalties for
150	altering, defacing, or falsifying a license certificate
151	issued by the agency or displaying such an altered,
152	defaced, or falsified certificate; amending s. 408.806,
153	F.S.; revising agency responsibilities for notification of
154	licensees of impending expiration of a license; requiring
155	payment of a late fee for a license application to be
156	considered complete under certain circumstances; amending
157	s. 408.810, F.S.; revising provisions relating to
158	information required for licensure; requiring proof of
159	submission of notice to a mortgagor or landlord regarding
160	provision of services requiring licensure; requiring
161	disclosure of information by a controlling interest of
162	certain court actions relating to financial instability
163	within a specified time period; amending s. 408.813, F.S.;
164	authorizing the agency to impose fines for unclassified
165	violations of pt. II of ch. 408, F.S.; amending s.
166	408.815, F.S.; authorizing the agency to extend a license
167	expiration date under certain circumstances; amending s.
168	409.221, F.S.; deleting a reporting requirement relating
169	to the consumer-directed care program; amending s.
170	409.91196, F.S.; conforming a cross-reference; amending s.
171	409.912, F.S.; revising procedures for implementation of a
172	Medicaid prescribed-drug spending-control program;
173	amending s. 429.07, F.S.; deleting the requirement for an
174	assisted living facility to obtain an additional license
175	in order to provide limited nursing services; deleting the
176	requirement for the agency to conduct quarterly monitoring
177	visits of facilities that hold a license to provide
178	extended congregate care services; deleting the
179	requirement for the department to report annually on the
180	status of and recommendations related to extended
181	congregate care; deleting the requirement for the agency
182	to conduct monitoring visits at least twice a year to
183	facilities providing limited nursing services; increasing
184	the licensure fees and the maximum fee required for the
185	standard license; increasing the licensure fees for the
186	extended congregate care license; eliminating the license
187	fee for the limited nursing services license; transferring
188	from another provision of law the requirement that a
189	biennial survey of an assisted living facility include
190	specific actions to determine whether the facility is
191	adequately protecting residents' rights; providing that an
192	assisted living facility that has a class I or class II
193	violation is subject to monitoring visits; requiring a
194	registered nurse to participate in certain monitoring
195	visits; amending s. 429.11, F.S.; revising licensure
196	application requirements for assisted living facilities to
197	eliminate provisional licenses; amending s. 429.12, F.S.;
198	revising notification requirements for the sale or
199	transfer of ownership of an assisted living facility;
200	amending s. 429.14, F.S.; removing a ground for the
201	imposition of an administrative penalty; clarifying
202	language relating to a facility's request for a hearing
203	under certain circumstances; authorizing the agency to
204	provide certain information relating to the licensure
205	status of assisted living facilities electronically or
206	through the agency's Internet website; amending s. 429.17,
207	F.S.; deleting provisions relating to the limited nursing
208	services license; revising agency responsibilities
209	regarding the issuance of conditional licenses; amending
210	s. 429.19, F.S.; clarifying that a monitoring fee may be
211	assessed in addition to an administrative fine; amending
212	s. 429.23, F.S.; deleting reporting requirements for
213	assisted living facilities relating to liability claims;
214	amending s. 429.255, F.S.; eliminating provisions
215	authorizing the use of volunteers to provide certain
216	health-care-related services in assisted living
217	facilities; authorizing assisted living facilities to
218	provide limited nursing services; requiring an assisted
219	living facility to be responsible for certain
220	recordkeeping and staff to be trained to monitor residents
221	receiving certain health-care-related services; amending
222	s. 429.28, F.S.; deleting a requirement for a biennial
223	survey of an assisted living facility, to conform to
224	changes made by the act; amending s. 429.35, F.S.;
225	authorizing the agency to provide certain information
226	relating to the inspections of assisted living facilities
227	electronically or through the agency's Internet website;
228	amending s. 429.41, F.S., relating to rulemaking;
229	conforming provisions to changes made by the act; amending
230	s. 429.53, F.S.; revising provisions relating to
231	consultation by the agency; revising a definition;
232	amending s. 429.54, F.S.; requiring licensed assisted
233	living facilities to electronically report certain data
234	semiannually to the agency in accordance with rules
235	adopted by the department; amending s. 429.71, F.S.;
236	revising schedule of inspection violations for adult
237	family-care homes; amending s. 429.911, F.S.; deleting a
238	ground for agency action against an adult day care center;
239	amending s. 429.915, F.S.; revising agency
240	responsibilities regarding the issuance of conditional
241	licenses; amending s. 483.294, F.S.; revising frequency of
242	agency inspections of multiphasic health testing centers;
243	amending s. 499.003, F.S.; removing a requirement that
244	certain prescription drug purchasers maintain a separate
245	inventory of certain prescription drugs; amending s.
246	499.01212, F.S.; exempting prescription drugs contained in
247	sealed medical convenience kits from the pedigree paper
248	requirements under specified circumstances; amending s.
249	633.081, F.S.; limiting Fire Marshal inspections of
250	nursing homes to once a year; providing for additional
251	inspections based on complaints and violations identified
252	in the course of orientation or training activities;
253	amending s. 766.202, F.S.; adding persons licensed under
254	pt. XIV of ch. 468, F.S., to the definition of "health
255	care provider"; amending ss. 394.4787, 400.0239, 408.07,
256	430.80, and 651.118, F.S.; conforming terminology and
257	cross-references; revising a reference; providing an
258	effective date.
259
260	Be It Enacted by the Legislature of the State of Florida:
261
262	Section 1.  Present paragraph (e) of subsection (10) and
263	paragraph (e) of subsection (14) of section 112.0455, Florida
264	Statutes, are amended, and paragraphs (f) through (k) of
265	subsection (10) of that section are redesignated as paragraphs
266	(e) through (j), respectively, to read:
267	112.0455  Drug-Free Workplace Act.-
268	(10)  EMPLOYER PROTECTION.-
269	(e)  Nothing in this section shall be construed to operate
270	retroactively, and nothing in this section shall abrogate the
271	right of an employer under state law to conduct drug tests prior
272	to January 1, 1990. A drug test conducted by an employer prior
273	to January 1, 1990, is not subject to this section.
274	(14)  DISCIPLINE REMEDIES.-
275	(e)  Upon resolving an appeal filed pursuant to paragraph
276	(c), and finding a violation of this section, the commission may
277	order the following relief:
278	1.  Rescind the disciplinary action, expunge related
279	records from the personnel file of the employee or job applicant
280	and reinstate the employee.
281	2.  Order compliance with paragraph (10)(f)(g).
282	3.  Award back pay and benefits.
283	4.  Award the prevailing employee or job applicant the
284	necessary costs of the appeal, reasonable attorney's fees, and
285	expert witness fees.
286	Section 2.  Paragraph (n) of subsection (1) of section
287	154.11, Florida Statutes, is amended to read:
288	154.11  Powers of board of trustees.-
289	(1)  The board of trustees of each public health trust
290	shall be deemed to exercise a public and essential governmental
291	function of both the state and the county and in furtherance
292	thereof it shall, subject to limitation by the governing body of
293	the county in which such board is located, have all of the
294	powers necessary or convenient to carry out the operation and
295	governance of designated health care facilities, including, but
296	without limiting the generality of, the foregoing:
297	(n)  To appoint originally the staff of physicians to
298	practice in any designated facility owned or operated by the
299	board and to approve the bylaws and rules to be adopted by the
300	medical staff of any designated facility owned and operated by
301	the board, such governing regulations to be in accordance with
302	the standards of The Joint Commission on the Accreditation of
303	Hospitals which provide, among other things, for the method of
304	appointing additional staff members and for the removal of staff
305	members.
306	Section 3.  Subsection (15) of section 318.21, Florida
307	Statutes, is amended to read:
308	318.21  Disposition of civil penalties by county courts.-
309	All civil penalties received by a county court pursuant to the
310	provisions of this chapter shall be distributed and paid monthly
311	as follows:
312	(15)  Of the additional fine assessed under s. 318.18(3)(e)
313	for a violation of s. 316.1893, 50 percent of the moneys
314	received from the fines shall be remitted to the Department of
315	Revenue and deposited into the Brain and Spinal Cord Injury
316	Trust Fund of Department of Health and shall be appropriated to
317	the Department of Health Agency for Health Care Administration
318	as general revenue to provide an enhanced Medicaid payment to
319	nursing homes that serve Medicaid recipients with spinal cord
320	injuries that are medically complex and who are technologically
321	and respiratory dependent with brain and spinal cord injuries.
322	The remaining 50 percent of the moneys received from the
323	enhanced fine imposed under s. 318.18(3)(e) shall be remitted to
324	the Department of Revenue and deposited into the Department of
325	Health Administrative Trust Fund to provide financial support to
326	certified trauma centers in the counties where enhanced penalty
327	zones are established to ensure the availability and
328	accessibility of trauma services. Funds deposited into the
329	Administrative Trust Fund under this subsection shall be
330	allocated as follows:
331	(a)  Fifty percent shall be allocated equally among all
332	Level I, Level II, and pediatric trauma centers in recognition
333	of readiness costs for maintaining trauma services.
334	(b)  Fifty percent shall be allocated among Level I, Level
335	II, and pediatric trauma centers based on each center's relative
336	volume of trauma cases as reported in the Department of Health
337	Trauma Registry.
338	Section 4.  Subsection (3) is added to section 381.00315,
339	Florida Statutes, to read:
340	381.00315  Public health advisories; public health
341	emergencies.-The State Health Officer is responsible for
342	declaring public health emergencies and issuing public health
343	advisories.
344	(3)  To facilitate effective emergency management, when the
345	United States Department of Health and Human Services contracts
346	for the manufacture and delivery of licensable products in
347	response to a public health emergency and the terms of those
348	contracts are made available to the states, the department shall
349	accept funds provided by counties, municipalities, and other
350	entities designated in the state emergency management plan
351	required under s. 252.35(2)(a) for the purpose of participation
352	in such contracts. The department shall deposit the funds into
353	the Grants and Donations Trust Fund and expend the funds on
354	behalf of the donor county, municipality, or other entity for
355	the purchase the licensable products made available under the
356	contract.
357	Section 5.  Paragraph (e) is added to subsection (2) of
358	section 381.0072, Florida Statutes, to read:
359	381.0072  Food service protection.-It shall be the duty of
360	the Department of Health to adopt and enforce sanitation rules
361	consistent with law to ensure the protection of the public from
362	food-borne illness. These rules shall provide the standards and
363	requirements for the storage, preparation, serving, or display
364	of food in food service establishments as defined in this
365	section and which are not permitted or licensed under chapter
366	500 or chapter 509.
367	(2)  DUTIES.-
368	(e)  The department shall inspect food service
369	establishments in nursing homes licensed under part II of
370	chapter 400 twice each year. The department may make additional
371	inspections only in response to complaints. The department shall
372	coordinate inspections with the Agency for Health Care
373	Administration, such that the department's inspection is at
374	least 60 days after a recertification visit by the Agency for
375	Health Care Administration.
376	Section 6.  Section 383.325, Florida Statutes, is repealed.
377	Section 7.  Subsection (7) of section 394.4787, Florida
378	Statutes, is amended to read:
379	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
380	and 394.4789.-As used in this section and ss. 394.4786,
381	394.4788, and 394.4789:
382	(7)  "Specialty psychiatric hospital" means a hospital
383	licensed by the agency pursuant to s. 395.002(26)(28) and part
384	II of chapter 408 as a specialty psychiatric hospital.
385	Section 8.  Subsection (2) of section 394.741, Florida
386	Statutes, is amended to read:
387	394.741  Accreditation requirements for providers of
388	behavioral health care services.-
389	(2)  Notwithstanding any provision of law to the contrary,
390	accreditation shall be accepted by the agency and department in
391	lieu of the agency's and department's facility licensure onsite
392	review requirements and shall be accepted as a substitute for
393	the department's administrative and program monitoring
394	requirements, except as required by subsections (3) and (4),
395	for:
396	(a)  Any organization from which the department purchases
397	behavioral health care services that is accredited by The Joint
398	Commission on Accreditation of Healthcare Organizations or the
399	Council on Accreditation for Children and Family Services, or
400	has those services that are being purchased by the department
401	accredited by the Commission on Accreditation of Rehabilitation
402	Facilities CARF-the Rehabilitation Accreditation Commission.
403	(b)  Any mental health facility licensed by the agency or
404	any substance abuse component licensed by the department that is
405	accredited by The Joint Commission on Accreditation of
406	Healthcare Organizations, the Commission on Accreditation of
407	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
408	Commission, or the Council on Accreditation of Children and
409	Family Services.
410	(c)  Any network of providers from which the department or
411	the agency purchases behavioral health care services accredited
412	by The Joint Commission on Accreditation of Healthcare
413	Organizations, the Commission on Accreditation of Rehabilitation
414	Facilities CARF-the Rehabilitation Accreditation Commission, the
415	Council on Accreditation of Children and Family Services, or the
416	National Committee for Quality Assurance. A provider
417	organization, which is part of an accredited network, is
418	afforded the same rights under this part.
419	Section 9.  Present subsections (15) through (32) of
420	section 395.002, Florida Statutes, are renumbered as subsections
421	(14) through (28), respectively, and present subsections (1),
422	(14), (24), (30), and (31), and paragraph (c) of present
423	subsection (28) of that section are amended to read:
424	395.002  Definitions.-As used in this chapter:
425	(1)  "Accrediting organizations" means nationally
426	recognized or approved accrediting organizations whose standards
427	incorporate comparable licensure requirements as determined by
428	the agency the Joint Commission on Accreditation of Healthcare
429	Organizations, the American Osteopathic Association, the
430	Commission on Accreditation of Rehabilitation Facilities, and
431	the Accreditation Association for Ambulatory Health Care, Inc.
432	(14)  "Initial denial determination" means a determination
433	by a private review agent that the health care services
434	furnished or proposed to be furnished to a patient are
435	inappropriate, not medically necessary, or not reasonable.
436	(24)  "Private review agent" means any person or entity
437	which performs utilization review services for third-party
438	payors on a contractual basis for outpatient or inpatient
439	services. However, the term shall not include full-time
440	employees, personnel, or staff of health insurers, health
441	maintenance organizations, or hospitals, or wholly owned
442	subsidiaries thereof or affiliates under common ownership, when
443	performing utilization review for their respective hospitals,
444	health maintenance organizations, or insureds of the same
445	insurance group. For this purpose, health insurers, health
446	maintenance organizations, and hospitals, or wholly owned
447	subsidiaries thereof or affiliates under common ownership,
448	include such entities engaged as administrators of self-
449	insurance as defined in s. 624.031.
450	(26)(28)  "Specialty hospital" means any facility which
451	meets the provisions of subsection (12), and which regularly
452	makes available either:
453	(c)  Intensive residential treatment programs for children
454	and adolescents as defined in subsection (14) (15).
455	(30)  "Utilization review" means a system for reviewing the
456	medical necessity or appropriateness in the allocation of health
457	care resources of hospital services given or proposed to be
458	given to a patient or group of patients.
459	(31)  "Utilization review plan" means a description of the
460	policies and procedures governing utilization review activities
461	performed by a private review agent.
462	Section 10.  Paragraph (c) of subsection (1) and paragraph
463	(b) of subsection (2) of section 395.003, Florida Statutes, are
464	amended to read:
465	395.003  Licensure; denial, suspension, and revocation.-
466	(1)
467	(c)  Until July 1, 2006, additional emergency departments
468	located off the premises of licensed hospitals may not be
469	authorized by the agency.
470	(2)
471	(b)  The agency shall, at the request of a licensee that is
472	a teaching hospital as defined in s. 408.07(45), issue a single
473	license to a licensee for facilities that have been previously
474	licensed as separate premises, provided such separately licensed
475	facilities, taken together, constitute the same premises as
476	defined in s. 395.002(22)(23). Such license for the single
477	premises shall include all of the beds, services, and programs
478	that were previously included on the licenses for the separate
479	premises. The granting of a single license under this paragraph
480	shall not in any manner reduce the number of beds, services, or
481	programs operated by the licensee.
482	Section 11.  Paragraph (e) of subsection (2) and subsection
483	(4) of section 395.0193, Florida Statutes, are amended to read:
484	395.0193  Licensed facilities; peer review; disciplinary
485	powers; agency or partnership with physicians.-
486	(2)  Each licensed facility, as a condition of licensure,
487	shall provide for peer review of physicians who deliver health
488	care services at the facility. Each licensed facility shall
489	develop written, binding procedures by which such peer review
490	shall be conducted. Such procedures shall include:
491	(e)  Recording of agendas and minutes which do not contain
492	confidential material, for review by the Division of Medical
493	Quality Assurance of the department Health Quality Assurance of
494	the agency.
495	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
496	actions taken under subsection (3) shall be reported in writing
497	to the Division of Medical Quality Assurance of the department
498	Health Quality Assurance of the agency within 30 working days
499	after its initial occurrence, regardless of the pendency of
500	appeals to the governing board of the hospital. The notification
501	shall identify the disciplined practitioner, the action taken,
502	and the reason for such action. All final disciplinary actions
503	taken under subsection (3), if different from those which were
504	reported to the department agency within 30 days after the
505	initial occurrence, shall be reported within 10 working days to
506	the Division of Medical Quality Assurance of the department
507	Health Quality Assurance of the agency in writing and shall
508	specify the disciplinary action taken and the specific grounds
509	therefor. The division shall review each report and determine
510	whether it potentially involved conduct by the licensee that is
511	subject to disciplinary action, in which case s. 456.073 shall
512	apply. The reports are not subject to inspection under s.
513	119.07(1) even if the division's investigation results in a
514	finding of probable cause.
515	Section 12.  Section 395.1023, Florida Statutes, is amended
516	to read:
517	395.1023  Child abuse and neglect cases; duties.-Each
518	licensed facility shall adopt a protocol that, at a minimum,
519	requires the facility to:
520	(1)  Incorporate a facility policy that every staff member
521	has an affirmative duty to report, pursuant to chapter 39, any
522	actual or suspected case of child abuse, abandonment, or
523	neglect; and
524	(2)  In any case involving suspected child abuse,
525	abandonment, or neglect, designate, at the request of the
526	Department of Children and Family Services, a staff physician to
527	act as a liaison between the hospital and the Department of
528	Children and Family Services office which is investigating the
529	suspected abuse, abandonment, or neglect, and the child
530	protection team, as defined in s. 39.01, when the case is
531	referred to such a team.
532
533	Each general hospital and appropriate specialty hospital shall
534	comply with the provisions of this section and shall notify the
535	agency and the Department of Children and Family Services of its
536	compliance by sending a copy of its policy to the agency and the
537	Department of Children and Family Services as required by rule.
538	The failure by a general hospital or appropriate specialty
539	hospital to comply shall be punished by a fine not exceeding
540	$1,000, to be fixed, imposed, and collected by the agency. Each
541	day in violation is considered a separate offense.
542	Section 13.  Subsection (2) and paragraph (d) of subsection
543	(3) of section 395.1041, Florida Statutes, are amended to read:
544	395.1041  Access to emergency services and care.-
545	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
546	shall establish and maintain an inventory of hospitals with
547	emergency services. The inventory shall list all services within
548	the service capability of the hospital, and such services shall
549	appear on the face of the hospital license. Each hospital having
550	emergency services shall notify the agency of its service
551	capability in the manner and form prescribed by the agency. The
552	agency shall use the inventory to assist emergency medical
553	services providers and others in locating appropriate emergency
554	medical care. The inventory shall also be made available to the
555	general public. On or before August 1, 1992, the agency shall
556	request that each hospital identify the services which are
557	within its service capability. On or before November 1, 1992,
558	the agency shall notify each hospital of the service capability
559	to be included in the inventory. The hospital has 15 days from
560	the date of receipt to respond to the notice. By December 1,
561	1992, the agency shall publish a final inventory. Each hospital
562	shall reaffirm its service capability when its license is
563	renewed and shall notify the agency of the addition of a new
564	service or the termination of a service prior to a change in its
565	service capability.
566	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
567	FACILITY OR HEALTH CARE PERSONNEL.-
568	(d)1.  Every hospital shall ensure the provision of
569	services within the service capability of the hospital, at all
570	times, either directly or indirectly through an arrangement with
571	another hospital, through an arrangement with one or more
572	physicians, or as otherwise made through prior arrangements. A
573	hospital may enter into an agreement with another hospital for
574	purposes of meeting its service capability requirement, and
575	appropriate compensation or other reasonable conditions may be
576	negotiated for these backup services.
577	2.  If any arrangement requires the provision of emergency
578	medical transportation, such arrangement must be made in
579	consultation with the applicable provider and may not require
580	the emergency medical service provider to provide transportation
581	that is outside the routine service area of that provider or in
582	a manner that impairs the ability of the emergency medical
583	service provider to timely respond to prehospital emergency
584	calls.
585	3.  A hospital shall not be required to ensure service
586	capability at all times as required in subparagraph 1. if, prior
587	to the receiving of any patient needing such service capability,
588	such hospital has demonstrated to the agency that it lacks the
589	ability to ensure such capability and it has exhausted all
590	reasonable efforts to ensure such capability through backup
591	arrangements. In reviewing a hospital's demonstration of lack of
592	ability to ensure service capability, the agency shall consider
593	factors relevant to the particular case, including the
594	following:
595	a.  Number and proximity of hospitals with the same service
596	capability.
597	b.  Number, type, credentials, and privileges of
598	specialists.
599	c.  Frequency of procedures.
600	d.  Size of hospital.
601	4.  The agency shall publish proposed rules implementing a
602	reasonable exemption procedure by November 1, 1992. Subparagraph
603	1. shall become effective upon the effective date of said rules
604	or January 31, 1993, whichever is earlier. For a period not to
605	exceed 1 year from the effective date of subparagraph 1., a
606	hospital requesting an exemption shall be deemed to be exempt
607	from offering the service until the agency initially acts to
608	deny or grant the original request. The agency has 45 days from
609	the date of receipt of the request to approve or deny the
610	request. After the first year from the effective date of
611	subparagraph 1., If the agency fails to initially act within the
612	time period, the hospital is deemed to be exempt from offering
613	the service until the agency initially acts to deny the request.
614	Section 14.  Section 395.1046, Florida Statutes, is
615	repealed.
616	Section 15.  Paragraph (e) of subsection (1) of section
617	395.1055, Florida Statutes, is amended to read:
618	395.1055  Rules and enforcement.-
619	(1)  The agency shall adopt rules pursuant to ss.
620	120.536(1) and 120.54 to implement the provisions of this part,
621	which shall include reasonable and fair minimum standards for
622	ensuring that:
623	(e)  Licensed facility beds conform to minimum space,
624	equipment, and furnishings standards as specified by the agency,
625	the Florida Building Code, and the Florida Fire Prevention Code
626	department.
627	Section 16.  Subsection (1) of section 395.10972, Florida
628	Statutes, is amended to read:
629	395.10972  Health Care Risk Manager Advisory Council.-The
630	Secretary of Health Care Administration may appoint a seven-
631	member advisory council to advise the agency on matters
632	pertaining to health care risk managers. The members of the
633	council shall serve at the pleasure of the secretary. The
634	council shall designate a chair. The council shall meet at the
635	call of the secretary or at those times as may be required by
636	rule of the agency. The members of the advisory council shall
637	receive no compensation for their services, but shall be
638	reimbursed for travel expenses as provided in s. 112.061. The
639	council shall consist of individuals representing the following
640	areas:
641	(1)  Two shall be active health care risk managers,
642	including one risk manager who is recommended by and a member of
643	the Florida Society for of Healthcare Risk Management and
644	Patient Safety.
645	Section 17.  Subsection (3) of section 395.2050, Florida
646	Statutes, is amended to read:
647	395.2050  Routine inquiry for organ and tissue donation;
648	certification for procurement activities; death records review.-
649	(3)  Each organ procurement organization designated by the
650	federal Centers for Medicare and Medicaid Services Health Care
651	Financing Administration and licensed by the state shall conduct
652	an annual death records review in the organ procurement
653	organization's affiliated donor hospitals. The organ procurement
654	organization shall enlist the services of every Florida licensed
655	tissue bank and eye bank affiliated with or providing service to
656	the donor hospital and operating in the same service area to
657	participate in the death records review.
658	Section 18.  Subsection (2) of section 395.3036, Florida
659	Statutes, is amended to read:
660	395.3036  Confidentiality of records and meetings of
661	corporations that lease public hospitals or other public health
662	care facilities.-The records of a private corporation that
663	leases a public hospital or other public health care facility
664	are confidential and exempt from the provisions of s. 119.07(1)
665	and s. 24(a), Art. I of the State Constitution, and the meetings
666	of the governing board of a private corporation are exempt from
667	s. 286.011 and s. 24(b), Art. I of the State Constitution when
668	the public lessor complies with the public finance
669	accountability provisions of s. 155.40(5) with respect to the
670	transfer of any public funds to the private lessee and when the
671	private lessee meets at least three of the five following
672	criteria:
673	(2)  The public lessor and the private lessee do not
674	commingle any of their funds in any account maintained by either
675	of them, other than the payment of the rent and administrative
676	fees or the transfer of funds pursuant to s. 155.40(2)
677	subsection (2).
678	Section 19.  Section 395.3037, Florida Statutes, is
679	repealed.
680	Section 20.  Subsections (1), (4), and (5) of section
681	395.3038, Florida Statutes, are amended to read:
682	395.3038  State-listed primary stroke centers and
683	comprehensive stroke centers; notification of hospitals.-
684	(1)  The agency shall make available on its website and to
685	the department a list of the name and address of each hospital
686	that meets the criteria for a primary stroke center and the name
687	and address of each hospital that meets the criteria for a
688	comprehensive stroke center. The list of primary and
689	comprehensive stroke centers shall include only those hospitals
690	that attest in an affidavit submitted to the agency that the
691	hospital meets the named criteria, or those hospitals that
692	attest in an affidavit submitted to the agency that the hospital
693	is certified as a primary or a comprehensive stroke center by
694	The Joint Commission on Accreditation of Healthcare
695	Organizations.
696	(4)  The agency shall adopt by rule criteria for a primary
697	stroke center which are substantially similar to the
698	certification standards for primary stroke centers of The Joint
699	Commission on Accreditation of Healthcare Organizations.
700	(5)  The agency shall adopt by rule criteria for a
701	comprehensive stroke center. However, if The Joint Commission on
702	Accreditation of Healthcare Organizations establishes criteria
703	for a comprehensive stroke center, the agency shall establish
704	criteria for a comprehensive stroke center which are
705	substantially similar to those criteria established by The Joint
706	Commission on Accreditation of Healthcare Organizations.
707	Section 21.  Paragraph (e) of subsection (2) of section
708	395.602, Florida Statutes, is amended to read:
709	395.602  Rural hospitals.-
710	(2)  DEFINITIONS.-As used in this part:
711	(e)  "Rural hospital" means an acute care hospital licensed
712	under this chapter, having 100 or fewer licensed beds and an
713	emergency room, which is:
714	1.  The sole provider within a county with a population
715	density of no greater than 100 persons per square mile;
716	2.  An acute care hospital, in a county with a population
717	density of no greater than 100 persons per square mile, which is
718	at least 30 minutes of travel time, on normally traveled roads
719	under normal traffic conditions, from any other acute care
720	hospital within the same county;
721	3.  A hospital supported by a tax district or subdistrict
722	whose boundaries encompass a population of 100 persons or fewer
723	per square mile;
724	4.  A hospital in a constitutional charter county with a
725	population of over 1 million persons that has imposed a local
726	option health service tax pursuant to law and in an area that
727	was directly impacted by a catastrophic event on August 24,
728	1992, for which the Governor of Florida declared a state of
729	emergency pursuant to chapter 125, and has 120 beds or less that
730	serves an agricultural community with an emergency room
731	utilization of no less than 20,000 visits and a Medicaid
732	inpatient utilization rate greater than 15 percent;
733	4.5.  A hospital with a service area that has a population
734	of 100 persons or fewer per square mile. As used in this
735	subparagraph, the term "service area" means the fewest number of
736	zip codes that account for 75 percent of the hospital's
737	discharges for the most recent 5-year period, based on
738	information available from the hospital inpatient discharge
739	database in the Florida Center for Health Information and Policy
740	Analysis at the Agency for Health Care Administration; or
741	5.6.  A hospital designated as a critical access hospital,
742	as defined in s. 408.07(15).
743
744	Population densities used in this paragraph must be based upon
745	the most recently completed United States census. A hospital
746	that received funds under s. 409.9116 for a quarter beginning no
747	later than July 1, 2002, is deemed to have been and shall
748	continue to be a rural hospital from that date through June 30,
749	2015, if the hospital continues to have 100 or fewer licensed
750	beds and an emergency room, or meets the criteria of
751	subparagraph 4. An acute care hospital that has not previously
752	been designated as a rural hospital and that meets the criteria
753	of this paragraph shall be granted such designation upon
754	application, including supporting documentation to the Agency
755	for Health Care Administration.
756	Section 22.  Subsection (8) of section 400.021, Florida
757	Statutes, is amended to read:
758	400.021  Definitions.-When used in this part, unless the
759	context otherwise requires, the term:
760	(8)  "Geriatric outpatient clinic" means a site for
761	providing outpatient health care to persons 60 years of age or
762	older, which is staffed by a registered nurse or a physician
763	assistant, or a licensed practical nurse under the direct
764	supervision of a registered nurse, advanced registered nurse
765	practitioner, or physician.
766	Section 23.  Paragraph (g) of subsection (2) of section
767	400.0239, Florida Statutes, is amended to read:
768	400.0239  Quality of Long-Term Care Facility Improvement
769	Trust Fund.-
770	(2)  Expenditures from the trust fund shall be allowable
771	for direct support of the following:
772	(g)  Other initiatives authorized by the Centers for
773	Medicare and Medicaid Services for the use of federal civil
774	monetary penalties, including projects recommended through the
775	Medicaid "Up-or-Out" Quality of Care Contract Management Program
776	pursuant to s. 400.148.
777	Section 24.  Subsection (2) of section 400.063, Florida
778	Statutes, is amended to read:
779	400.063  Resident protection.-
780	(2)  The agency is authorized to establish for each
781	facility, subject to intervention by the agency, a separate bank
782	account for the deposit to the credit of the agency of any
783	moneys received from the Health Care Trust Fund or any other
784	moneys received for the maintenance and care of residents in the
785	facility, and the agency is authorized to disburse moneys from
786	such account to pay obligations incurred for the purposes of
787	this section. The agency is authorized to requisition moneys
788	from the Health Care Trust Fund in advance of an actual need for
789	cash on the basis of an estimate by the agency of moneys to be
790	spent under the authority of this section. Any bank account
791	established under this section need not be approved in advance
792	of its creation as required by s. 17.58, but shall be secured by
793	depository insurance equal to or greater than the balance of
794	such account or by the pledge of collateral security in
795	conformance with criteria established in s. 18.11. The agency
796	shall notify the Chief Financial Officer of any such account so
797	established and shall make a quarterly accounting to the Chief
798	Financial Officer for all moneys deposited in such account.
799	Section 25.  Subsections (1) and (5) of section 400.071,
800	Florida Statutes, are amended to read:
801	400.071  Application for license.-
802	(1)  In addition to the requirements of part II of chapter
803	408, the application for a license shall be under oath and must
804	contain the following:
805	(a)  The location of the facility for which a license is
806	sought and an indication, as in the original application, that
807	such location conforms to the local zoning ordinances.
808	(b)  A signed affidavit disclosing any financial or
809	ownership interest that a controlling interest as defined in
810	part II of chapter 408 has held in the last 5 years in any
811	entity licensed by this state or any other state to provide
812	health or residential care which has closed voluntarily or
813	involuntarily; has filed for bankruptcy; has had a receiver
814	appointed; has had a license denied, suspended, or revoked; or
815	has had an injunction issued against it which was initiated by a
816	regulatory agency. The affidavit must disclose the reason any
817	such entity was closed, whether voluntarily or involuntarily.
818	(c)  The total number of beds and the total number of
819	Medicare and Medicaid certified beds.
820	(b)(d)  Information relating to the applicant and employees
821	which the agency requires by rule. The applicant must
822	demonstrate that sufficient numbers of qualified staff, by
823	training or experience, will be employed to properly care for
824	the type and number of residents who will reside in the
825	facility.
826	(c)(e)  Copies of any civil verdict or judgment involving
827	the applicant rendered within the 10 years preceding the
828	application, relating to medical negligence, violation of
829	residents' rights, or wrongful death. As a condition of
830	licensure, the licensee agrees to provide to the agency copies
831	of any new verdict or judgment involving the applicant, relating
832	to such matters, within 30 days after filing with the clerk of
833	the court. The information required in this paragraph shall be
834	maintained in the facility's licensure file and in an agency
835	database which is available as a public record.
836	(5)  As a condition of licensure, each facility must
837	establish and submit with its application a plan for quality
838	assurance and for conducting risk management.
839	Section 26.  Section 400.0712, Florida Statutes, is amended
840	to read:
841	400.0712  Application for inactive license.-
842	(1)  As specified in this section, the agency may issue an
843	inactive license to a nursing home facility for all or a portion
844	of its beds. Any request by a licensee that a nursing home or
845	portion of a nursing home become inactive must be submitted to
846	the agency in the approved format. The facility may not initiate
847	any suspension of services, notify residents, or initiate
848	inactivity before receiving approval from the agency; and a
849	licensee that violates this provision may not be issued an
850	inactive license.
851	(1)(2)  In addition to the powers granted under part II of
852	chapter 408, the agency may issue an inactive license to a
853	nursing home that chooses to use an unoccupied contiguous
854	portion of the facility for an alternative use to meet the needs
855	of elderly persons through the use of less restrictive, less
856	institutional services.
857	(a)  An inactive license issued under this subsection may
858	be granted for a period not to exceed the current licensure
859	expiration date but may be renewed by the agency at the time of
860	licensure renewal.
861	(b)  A request to extend the inactive license must be
862	submitted to the agency in the approved format and approved by
863	the agency in writing.
864	(c)  Nursing homes that receive an inactive license to
865	provide alternative services shall not receive preference for
866	participation in the Assisted Living for the Elderly Medicaid
867	waiver.
868	(2)(3)  The agency shall adopt rules pursuant to ss.
869	120.536(1) and 120.54 necessary to implement this section.
870	Section 27.  Section 400.111, Florida Statutes, is amended
871	to read:
872	400.111  Disclosure of controlling interest.-In addition to
873	the requirements of part II of chapter 408, when requested by
874	the agency, the licensee shall submit a signed affidavit
875	disclosing any financial or ownership interest that a
876	controlling interest has held within the last 5 years in any
877	entity licensed by the state or any other state to provide
878	health or residential care which entity has closed voluntarily
879	or involuntarily; has filed for bankruptcy; has had a receiver
880	appointed; has had a license denied, suspended, or revoked; or
881	has had an injunction issued against it which was initiated by a
882	regulatory agency. The affidavit must disclose the reason such
883	entity was closed, whether voluntarily or involuntarily.
884	Section 28.  Subsection (2) of section 400.1183, Florida
885	Statutes, is amended to read:
886	400.1183  Resident grievance procedures.-
887	(2)  Each facility shall maintain records of all grievances
888	for agency inspection and shall report to the agency at the time
889	of relicensure the total number of grievances handled during the
890	prior licensure period, a categorization of the cases underlying
891	the grievances, and the final disposition of the grievances.
892	Section 29.  Paragraphs (o) through (w) of subsection (1)
893	of section 400.141, Florida Statutes, are redesignated as
894	paragraphs (n) through (u), respectively, and present paragraphs
895	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
896	to read:
897	400.141  Administration and management of nursing home
898	facilities.-
899	(1)  Every licensed facility shall comply with all
900	applicable standards and rules of the agency and shall:
901	(f)  Be allowed and encouraged by the agency to provide
902	other needed services under certain conditions. If the facility
903	has a standard licensure status, and has had no class I or class
904	II deficiencies during the past 2 years or has been awarded a
905	Gold Seal under the program established in s. 400.235, it may be
906	encouraged by the agency to provide services, including, but not
907	limited to, respite and adult day services, which enable
908	individuals to move in and out of the facility. A facility is
909	not subject to any additional licensure requirements for
910	providing these services.
911	1.  Respite care may be offered to persons in need of
912	short-term or temporary nursing home services. For each person
913	admitted under the respite care program, the facility licensee
914	must:
915	a.  Have a written abbreviated plan of care that, at a
916	minimum, includes nutritional requirements, medication orders,
917	physician orders, nursing assessments, and dietary preferences.
918	The nursing or physician assessments may take the place of all
919	other assessments required for full-time residents.
920	b.  Have a contract that, at a minimum, specifies the
921	services to be provided to the respite resident, including
922	charges for services, activities, equipment, emergency medical
923	services, and the administration of medications. If multiple
924	respite admissions for a single person are anticipated, the
925	original contract is valid for 1 year after the date of
926	execution.
927	c.  Ensure that each resident is released to his or her
928	caregiver or an individual designated in writing by the
929	caregiver.
930	2.  A person admitted under the respite care program is:
931	a.  Exempt from requirements in rule related to discharge
932	planning.
933	b.  Covered by the resident's rights set forth in s.
934	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
935	shall not be considered trust funds subject to the requirements
936	of s. 400.022(1)(h) until the resident has been in the facility
937	for more than 14 consecutive days.
938	c.  Allowed to use his or her personal medications for the
939	respite stay if permitted by facility policy. The facility must
940	obtain a physician's orders for the medications. The caregiver
941	may provide information regarding the medications as part of the
942	nursing assessment, which must agree with the physician's
943	orders. Medications shall be released with the resident upon
944	discharge in accordance with current orders.
945	3.  A person receiving respite care is entitled to a total
946	of 60 days in the facility within a contract year or a calendar
947	year if the contract is for less than 12 months. However, each
948	single stay may not exceed 14 days. If a stay exceeds 14
949	consecutive days, the facility must comply with all assessment
950	and care planning requirements applicable to nursing home
951	residents.
952	4.  A person receiving respite care must reside in a
953	licensed nursing home bed.
954	5.  A prospective respite resident must provide medical
955	information from a physician, a physician assistant, or a nurse
956	practitioner and other information from the primary caregiver as
957	may be required by the facility prior to or at the time of
958	admission to receive respite care. The medical information must
959	include a physician's order for respite care and proof of a
960	physical examination by a licensed physician, physician
961	assistant, or nurse practitioner. The physician's order and
962	physical examination may be used to provide intermittent respite
963	care for up to 12 months after the date the order is written.
964	6.  The facility must assume the duties of the primary
965	caregiver. To ensure continuity of care and services, the
966	resident is entitled to retain his or her personal physician and
967	must have access to medically necessary services such as
968	physical therapy, occupational therapy, or speech therapy, as
969	needed. The facility must arrange for transportation to these
970	services if necessary. Respite care must be provided in
971	accordance with this part and rules adopted by the agency.
972	However, the agency shall, by rule, adopt modified requirements
973	for resident assessment, resident care plans, resident
974	contracts, physician orders, and other provisions, as
975	appropriate, for short-term or temporary nursing home services.
976	7.  The agency shall allow for shared programming and staff
977	in a facility which meets minimum standards and offers services
978	pursuant to this paragraph, but, if the facility is cited for
979	deficiencies in patient care, may require additional staff and
980	programs appropriate to the needs of service recipients. A
981	person who receives respite care may not be counted as a
982	resident of the facility for purposes of the facility's licensed
983	capacity unless that person receives 24-hour respite care. A
984	person receiving either respite care for 24 hours or longer or
985	adult day services must be included when calculating minimum
986	staffing for the facility. Any costs and revenues generated by a
987	nursing home facility from nonresidential programs or services
988	shall be excluded from the calculations of Medicaid per diems
989	for nursing home institutional care reimbursement.
990	(g)  If the facility has a standard license or is a Gold
991	Seal facility, exceeds the minimum required hours of licensed
992	nursing and certified nursing assistant direct care per resident
993	per day, and is part of a continuing care facility licensed
994	under chapter 651 or a retirement community that offers other
995	services pursuant to part III of this chapter or part I or part
996	III of chapter 429 on a single campus, be allowed to share
997	programming and staff. At the time of inspection and in the
998	semiannual report required pursuant to paragraph (n) (o), a
999	continuing care facility or retirement community that uses this
1000	option must demonstrate through staffing records that minimum
1001	staffing requirements for the facility were met. Licensed nurses
1002	and certified nursing assistants who work in the nursing home
1003	facility may be used to provide services elsewhere on campus if
1004	the facility exceeds the minimum number of direct care hours
1005	required per resident per day and the total number of residents
1006	receiving direct care services from a licensed nurse or a
1007	certified nursing assistant does not cause the facility to
1008	violate the staffing ratios required under s. 400.23(3)(a).
1009	Compliance with the minimum staffing ratios shall be based on
1010	total number of residents receiving direct care services,
1011	regardless of where they reside on campus. If the facility
1012	receives a conditional license, it may not share staff until the
1013	conditional license status ends. This paragraph does not
1014	restrict the agency's authority under federal or state law to
1015	require additional staff if a facility is cited for deficiencies
1016	in care which are caused by an insufficient number of certified
1017	nursing assistants or licensed nurses. The agency may adopt
1018	rules for the documentation necessary to determine compliance
1019	with this provision.
1020	(j)  Keep full records of resident admissions and
1021	discharges; medical and general health status, including medical
1022	records, personal and social history, and identity and address
1023	of next of kin or other persons who may have responsibility for
1024	the affairs of the residents; and individual resident care plans
1025	including, but not limited to, prescribed services, service
1026	frequency and duration, and service goals. The records shall be
1027	open to inspection by the agency. The facility must maintain
1028	clinical records on each resident in accordance with accepted
1029	professional standards and practices that are complete,
1030	accurately documented, readily accessible, and systematically
1031	organized.
1032	(n)  Submit to the agency the information specified in s.
1033	400.071(1)(b) for a management company within 30 days after the
1034	effective date of the management agreement.
1035	(n)(o)1.  Submit semiannually to the agency, or more
1036	frequently if requested by the agency, information regarding
1037	facility staff-to-resident ratios, staff turnover, and staff
1038	stability, including information regarding certified nursing
1039	assistants, licensed nurses, the director of nursing, and the
1040	facility administrator. For purposes of this reporting:
1041	a.  Staff-to-resident ratios must be reported in the
1042	categories specified in s. 400.23(3)(a) and applicable rules.
1043	The ratio must be reported as an average for the most recent
1044	calendar quarter.
1045	b.  Staff turnover must be reported for the most recent 12-
1046	month period ending on the last workday of the most recent
1047	calendar quarter prior to the date the information is submitted.
1048	The turnover rate must be computed quarterly, with the annual
1049	rate being the cumulative sum of the quarterly rates. The
1050	turnover rate is the total number of terminations or separations
1051	experienced during the quarter, excluding any employee
1052	terminated during a probationary period of 3 months or less,
1053	divided by the total number of staff employed at the end of the
1054	period for which the rate is computed, and expressed as a
1055	percentage.
1056	c.  The formula for determining staff stability is the
1057	total number of employees that have been employed for more than
1058	12 months, divided by the total number of employees employed at
1059	the end of the most recent calendar quarter, and expressed as a
1060	percentage.
1061	d.  A nursing facility that has failed to comply with state
1062	minimum-staffing requirements for 2 consecutive days is
1063	prohibited from accepting new admissions until the facility has
1064	achieved the minimum-staffing requirements for a period of 6
1065	consecutive days. For the purposes of this sub-subparagraph, any
1066	person who was a resident of the facility and was absent from
1067	the facility for the purpose of receiving medical care at a
1068	separate location or was on a leave of absence is not considered
1069	a new admission. Failure to impose such an admissions moratorium
1070	is subject to a $1,000 fine constitutes a class II deficiency.
1071	e.  A nursing facility which does not have a conditional
1072	license may be cited for failure to comply with the standards in
1073	s. 400.23(3)(a)1.a. only if it has failed to meet those
1074	standards on 2 consecutive days or if it has failed to meet at
1075	least 97 percent of those standards on any one day.
1076	f.  A facility which has a conditional license must be in
1077	compliance with the standards in s. 400.23(3)(a) at all times.
1078	2.  This paragraph does not limit the agency's ability to
1079	impose a deficiency or take other actions if a facility does not
1080	have enough staff to meet the residents' needs.
1081	(r)  Report to the agency any filing for bankruptcy
1082	protection by the facility or its parent corporation,
1083	divestiture or spin-off of its assets, or corporate
1084	reorganization within 30 days after the completion of such
1085	activity.
1086	Section 30.  Subsection (3) of section 400.142, Florida
1087	Statutes, is amended to read:
1088	400.142  Emergency medication kits; orders not to
1089	resuscitate.-
1090	(3)  Facility staff may withhold or withdraw
1091	cardiopulmonary resuscitation if presented with an order not to
1092	resuscitate executed pursuant to s. 401.45. The agency shall
1093	adopt rules providing for the implementation of such orders.
1094	Facility staff and facilities shall not be subject to criminal
1095	prosecution or civil liability, nor be considered to have
1096	engaged in negligent or unprofessional conduct, for withholding
1097	or withdrawing cardiopulmonary resuscitation pursuant to such an
1098	order and rules adopted by the agency. The absence of an order
1099	not to resuscitate executed pursuant to s. 401.45 does not
1100	preclude a physician from withholding or withdrawing
1101	cardiopulmonary resuscitation as otherwise permitted by law.
1102	Section 31.  Subsections (11) through (15) of section
1103	400.147, Florida Statutes, are renumbered as subsections (10)
1104	through (14), respectively, and present subsection (10) is
1105	amended to read:
1106	400.147  Internal risk management and quality assurance
1107	program.-
1108	(10)  By the 10th of each month, each facility subject to
1109	this section shall report any notice received pursuant to s.
1110	400.0233(2) and each initial complaint that was filed with the
1111	clerk of the court and served on the facility during the
1112	previous month by a resident or a resident's family member,
1113	guardian, conservator, or personal legal representative. The
1114	report must include the name of the resident, the resident's
1115	date of birth and social security number, the Medicaid
1116	identification number for Medicaid-eligible persons, the date or
1117	dates of the incident leading to the claim or dates of
1118	residency, if applicable, and the type of injury or violation of
1119	rights alleged to have occurred. Each facility shall also submit
1120	a copy of the notices received pursuant to s. 400.0233(2) and
1121	complaints filed with the clerk of the court. This report is
1122	confidential as provided by law and is not discoverable or
1123	admissible in any civil or administrative action, except in such
1124	actions brought by the agency to enforce the provisions of this
1125	part.
1126	Section 32.  Section 400.148, Florida Statutes, is
1127	repealed.
1128	Section 33.  Paragraph (f) of subsection (5) of section
1129	400.162, Florida Statutes, is amended to read:
1130	400.162  Property and personal affairs of residents.-
1131	(5)
1132	(f)  At least every 3 months, the licensee shall furnish
1133	the resident and the guardian, trustee, or conservator, if any,
1134	for the resident a complete and verified statement of all funds
1135	and other property to which this subsection applies, detailing
1136	the amounts and items received, together with their sources and
1137	disposition. For resident property, the licensee shall furnish
1138	such a statement annually and within 7 calendar days after a
1139	request for a statement. In any event, the licensee shall
1140	furnish such statements a statement annually and upon the
1141	discharge or transfer of a resident. Any governmental agency or
1142	private charitable agency contributing funds or other property
1143	on account of a resident also shall be entitled to receive such
1144	statements statement annually and upon discharge or transfer and
1145	such other report as it may require pursuant to law.
1146	Section 34.  Paragraphs (d) and (e) of subsection (2) of
1147	section 400.179, Florida Statutes, are amended to read:
1148	400.179  Liability for Medicaid underpayments and
1149	overpayments.-
1150	(2)  Because any transfer of a nursing facility may expose
1151	the fact that Medicaid may have underpaid or overpaid the
1152	transferor, and because in most instances, any such underpayment
1153	or overpayment can only be determined following a formal field
1154	audit, the liabilities for any such underpayments or
1155	overpayments shall be as follows:
1156	(d)  Where the transfer involves a facility that has been
1157	leased by the transferor:
1158	1.  The transferee shall, as a condition to being issued a
1159	license by the agency, acquire, maintain, and provide proof to
1160	the agency of a bond with a term of 30 months, renewable
1161	annually, in an amount not less than the total of 3 months'
1162	Medicaid payments to the facility computed on the basis of the
1163	preceding 12-month average Medicaid payments to the facility.
1164	2.  A leasehold licensee may meet the requirements of
1165	subparagraph 1. by payment of a nonrefundable fee, paid at
1166	initial licensure, paid at the time of any subsequent change of
1167	ownership, and paid annually thereafter, in the amount of 1
1168	percent of the total of 3 months' Medicaid payments to the
1169	facility computed on the basis of the preceding 12-month average
1170	Medicaid payments to the facility. If a preceding 12-month
1171	average is not available, projected Medicaid payments may be
1172	used. The fee shall be deposited into the Grants and Donations
1173	Trust Fund and shall be accounted for separately as a Medicaid
1174	nursing home overpayment account. These fees shall be used at
1175	the sole discretion of the agency to repay nursing home Medicaid
1176	overpayments. Payment of this fee shall not release the licensee
1177	from any liability for any Medicaid overpayments, nor shall
1178	payment bar the agency from seeking to recoup overpayments from
1179	the licensee and any other liable party. As a condition of
1180	exercising this lease bond alternative, licensees paying this
1181	fee must maintain an existing lease bond through the end of the
1182	30-month term period of that bond. The agency is herein granted
1183	specific authority to promulgate all rules pertaining to the
1184	administration and management of this account, including
1185	withdrawals from the account, subject to federal review and
1186	approval. This provision shall take effect upon becoming law and
1187	shall apply to any leasehold license application. The financial
1188	viability of the Medicaid nursing home overpayment account shall
1189	be determined by the agency through annual review of the account
1190	balance and the amount of total outstanding, unpaid Medicaid
1191	overpayments owing from leasehold licensees to the agency as
1192	determined by final agency audits. By March 31 of each year, the
1193	agency shall assess the cumulative fees collected under this
1194	subparagraph, minus any amounts used to repay nursing home
1195	Medicaid overpayments and amounts transferred to contribute to
1196	the General Revenue Fund pursuant to s. 215.20. If the net
1197	cumulative collections, minus amounts utilized to repay nursing
1198	home Medicaid overpayments, exceed $25 million, the provisions
1199	of this paragraph shall not apply for the subsequent fiscal
1200	year.
1201	3.  The leasehold licensee may meet the bond requirement
1202	through other arrangements acceptable to the agency. The agency
1203	is herein granted specific authority to promulgate rules
1204	pertaining to lease bond arrangements.
1205	4.  All existing nursing facility licensees, operating the
1206	facility as a leasehold, shall acquire, maintain, and provide
1207	proof to the agency of the 30-month bond required in
1208	subparagraph 1., above, on and after July 1, 1993, for each
1209	license renewal.
1210	5.  It shall be the responsibility of all nursing facility
1211	operators, operating the facility as a leasehold, to renew the
1212	30-month bond and to provide proof of such renewal to the agency
1213	annually.
1214	6.  Any failure of the nursing facility operator to
1215	acquire, maintain, renew annually, or provide proof to the
1216	agency shall be grounds for the agency to deny, revoke, and
1217	suspend the facility license to operate such facility and to
1218	take any further action, including, but not limited to,
1219	enjoining the facility, asserting a moratorium pursuant to part
1220	II of chapter 408, or applying for a receiver, deemed necessary
1221	to ensure compliance with this section and to safeguard and
1222	protect the health, safety, and welfare of the facility's
1223	residents. A lease agreement required as a condition of bond
1224	financing or refinancing under s. 154.213 by a health facilities
1225	authority or required under s. 159.30 by a county or
1226	municipality is not a leasehold for purposes of this paragraph
1227	and is not subject to the bond requirement of this paragraph.
1228	(e)  For the 2009-2010 fiscal year only, the provisions of
1229	paragraph (d) shall not apply. This paragraph expires July 1,
1230	2010.
1231	Section 35.  Subsection (3) of section 400.19, Florida
1232	Statutes, is amended to read:
1233	400.19  Right of entry and inspection.-
1234	(3)  The agency shall every 15 months conduct at least one
1235	unannounced inspection to determine compliance by the licensee
1236	with statutes, and with rules promulgated under the provisions
1237	of those statutes, governing minimum standards of construction,
1238	quality and adequacy of care, and rights of residents. The
1239	survey shall be conducted every 6 months for the next 2-year
1240	period if the facility has been cited for a class I deficiency,
1241	has been cited for two or more class II deficiencies arising
1242	from separate surveys or investigations within a 60-day period,
1243	or has had three or more substantiated complaints within a 6-
1244	month period, each resulting in at least one class I or class II
1245	deficiency. In addition to any other fees or fines in this part,
1246	the agency shall assess a fine for each facility that is subject
1247	to the 6-month survey cycle. The fine for the 2-year period
1248	shall be $6,000, one-half to be paid at the completion of each
1249	survey. The agency may adjust this fine by the change in the
1250	Consumer Price Index, based on the 12 months immediately
1251	preceding the increase, to cover the cost of the additional
1252	surveys. The agency shall verify through subsequent inspection
1253	that any deficiency identified during inspection is corrected.
1254	However, the agency may verify the correction of a class III or
1255	class IV deficiency unrelated to resident rights or resident
1256	care without reinspecting the facility if adequate written
1257	documentation has been received from the facility, which
1258	provides assurance that the deficiency has been corrected. The
1259	giving or causing to be given of advance notice of such
1260	unannounced inspections by an employee of the agency to any
1261	unauthorized person shall constitute cause for suspension of not
1262	fewer than 5 working days according to the provisions of chapter
1263	110.
1264	Section 36.  Section 400.195, Florida Statutes, is
1265	repealed.
1266	Section 37.  Subsection (5) of section 400.23, Florida
1267	Statutes, is amended to read:
1268	400.23  Rules; evaluation and deficiencies; licensure
1269	status.-
1270	(5)(a)  The agency, in collaboration with the Division of
1271	Children's Medical Services Network of the Department of Health,
1272	must, no later than December 31, 1993, adopt rules for minimum
1273	standards of care for persons under 21 years of age who reside
1274	in nursing home facilities. The rules must include a methodology
1275	for reviewing a nursing home facility under ss. 408.031-408.045
1276	which serves only persons under 21 years of age. A facility may
1277	be exempt from these standards for specific persons between 18
1278	and 21 years of age, if the person's physician agrees that
1279	minimum standards of care based on age are not necessary.
1280	(b)  The agency, in collaboration with the Division of
1281	Children's Medical Services Network, shall adopt rules for
1282	minimum staffing requirements for nursing home facilities that
1283	serve persons under 21 years of age, which shall apply in lieu
1284	of the standards contained in subsection (3).
1285	1.  For persons under 21 years of age who require skilled
1286	care, the requirements shall include a minimum combined average
1287	of licensed nurses, respiratory therapists, and certified
1288	nursing assistants of 3.9 hours of direct care per resident per
1289	day for each nursing home facility.
1290	2.  For persons under 21 years of age who are fragile, the
1291	requirements shall include a minimum combined average of
1292	licensed nurses, respiratory therapists, respiratory care
1293	practitioners, and certified nursing assistants of 5 hours of
1294	direct care per resident per day for each nursing home facility.
1295	Section 38.  Subsection (1) of section 400.275, Florida
1296	Statutes, is amended to read:
1297	400.275  Agency duties.-
1298	(1)  The agency shall ensure that each newly hired nursing
1299	home surveyor, as a part of basic training, is assigned full-
1300	time to a licensed nursing home for at least 2 days within a 7-
1301	day period to observe facility operations outside of the survey
1302	process before the surveyor begins survey responsibilities. Such
1303	observations may not be the sole basis of a deficiency citation
1304	against the facility. The agency may not assign an individual to
1305	be a member of a survey team for purposes of a survey,
1306	evaluation, or consultation visit at a nursing home facility in
1307	which the surveyor was an employee within the preceding 2 5
1308	years.
1309	Section 39.  Subsection (2) of section 400.484, Florida
1310	Statutes, is amended to read:
1311	400.484  Right of inspection; violations deficiencies;
1312	fines.-
1313	(2)  The agency shall impose fines for various classes of
1314	violations deficiencies in accordance with the following
1315	schedule:
1316	(a)  Class I violations are defined in s. 408.813. A class
1317	I deficiency is any act, omission, or practice that results in a
1318	patient's death, disablement, or permanent injury, or places a
1319	patient at imminent risk of death, disablement, or permanent
1320	injury. Upon finding a class I violation deficiency, the agency
1321	shall impose an administrative fine in the amount of $15,000 for
1322	each occurrence and each day that the violation deficiency
1323	exists.
1324	(b)  Class II violations are defined in s. 408.813. A class
1325	II deficiency is any act, omission, or practice that has a
1326	direct adverse effect on the health, safety, or security of a
1327	patient. Upon finding a class II violation deficiency, the
1328	agency shall impose an administrative fine in the amount of
1329	$5,000 for each occurrence and each day that the violation
1330	deficiency exists.
1331	(c)  Class III violations are defined in s. 408.813. A
1332	class III deficiency is any act, omission, or practice that has
1333	an indirect, adverse effect on the health, safety, or security
1334	of a patient. Upon finding an uncorrected or repeated class III
1335	violation deficiency, the agency shall impose an administrative
1336	fine not to exceed $1,000 for each occurrence and each day that
1337	the uncorrected or repeated violation deficiency exists.
1338	(d)  Class IV violations are defined in s. 408.813. A class
1339	IV deficiency is any act, omission, or practice related to
1340	required reports, forms, or documents which does not have the
1341	potential of negatively affecting patients. These violations are
1342	of a type that the agency determines do not threaten the health,
1343	safety, or security of patients. Upon finding an uncorrected or
1344	repeated class IV violation deficiency, the agency shall impose
1345	an administrative fine not to exceed $500 for each occurrence
1346	and each day that the uncorrected or repeated violation
1347	deficiency exists.
1348	Section 40.  Paragraph (i) of subsection (1) and subsection
1349	(4) of section 400.606, Florida Statutes, are amended to read:
1350	400.606  License; application; renewal; conditional license
1351	or permit; certificate of need.-
1352	(1)  In addition to the requirements of part II of chapter
1353	408, the initial application and change of ownership application
1354	must be accompanied by a plan for the delivery of home,
1355	residential, and homelike inpatient hospice services to
1356	terminally ill persons and their families. Such plan must
1357	contain, but need not be limited to:
1358	(i)  The projected annual operating cost of the hospice.
1359
1360	If the applicant is an existing licensed health care provider,
1361	the application must be accompanied by a copy of the most recent
1362	profit-loss statement and, if applicable, the most recent
1363	licensure inspection report.
1364	(4)  A freestanding hospice facility that is primarily
1365	engaged in providing inpatient and related services and that is
1366	not otherwise licensed as a health care facility shall be
1367	required to obtain a certificate of need. However, a
1368	freestanding hospice facility with six or fewer beds shall not
1369	be required to comply with institutional standards such as, but
1370	not limited to, standards requiring sprinkler systems, emergency
1371	electrical systems, or special lavatory devices.
1372	Section 41.  Subsection (2) of section 400.607, Florida
1373	Statutes, is amended to read:
1374	400.607  Denial, suspension, revocation of license;
1375	emergency actions; imposition of administrative fine; grounds.-
1376	(2)  A violation of this part, part II of chapter 408, or
1377	applicable rules Any of the following actions by a licensed
1378	hospice or any of its employees shall be grounds for
1379	administrative action by the agency against a hospice.:
1380	(a)  A violation of the provisions of this part, part II of
1381	chapter 408, or applicable rules.
1382	(b)  An intentional or negligent act materially affecting
1383	the health or safety of a patient.
1384	Section 42.  Subsection (1) of section 400.925, Florida
1385	Statutes, is amended to read:
1386	400.925  Definitions.-As used in this part, the term:
1387	(1)  "Accrediting organizations" means The Joint Commission
1388	on Accreditation of Healthcare Organizations or other national
1389	accreditation agencies whose standards for accreditation are
1390	comparable to those required by this part for licensure.
1391	Section 43.  Subsections (3) through (6) of section
1392	400.931, Florida Statutes, are renumbered as subsections (2)
1393	through (5), respectively, and present subsection (2) of that
1394	section is amended to read:
1395	400.931  Application for license; fee; provisional license;
1396	temporary permit.-
1397	(2)  As an alternative to submitting proof of financial
1398	ability to operate as required in s. 408.810(8), the applicant
1399	may submit a $50,000 surety bond to the agency.
1400	Section 44.  Subsection (2) of section 400.932, Florida
1401	Statutes, is amended to read:
1402	400.932  Administrative penalties.-
1403	(2)  A violation of this part, part II of chapter 408, or
1404	applicable rules Any of the following actions by an employee of
1405	a home medical equipment provider shall be are grounds for
1406	administrative action or penalties by the agency.:
1407	(a)  Violation of this part, part II of chapter 408, or
1408	applicable rules.
1409	(b)  An intentional, reckless, or negligent act that
1410	materially affects the health or safety of a patient.
1411	Section 45.  Subsection (3) of section 400.967, Florida
1412	Statutes, is amended to read:
1413	400.967  Rules and classification of violations
1414	deficiencies.-
1415	(3)  The agency shall adopt rules to provide that, when the
1416	criteria established under this part and part II of chapter 408
1417	are not met, such violations deficiencies shall be classified
1418	according to the nature of the violation deficiency. The agency
1419	shall indicate the classification on the face of the notice of
1420	deficiencies as follows:
1421	(a)  Class I violations deficiencies are defined in s.
1422	408.813 those which the agency determines present an imminent
1423	danger to the residents or guests of the facility or a
1424	substantial probability that death or serious physical harm
1425	would result therefrom. The condition or practice constituting a
1426	class I violation must be abated or eliminated immediately,
1427	unless a fixed period of time, as determined by the agency, is
1428	required for correction. A class I violation deficiency is
1429	subject to a civil penalty in an amount not less than $5,000 and
1430	not exceeding $10,000 for each violation deficiency. A fine may
1431	be levied notwithstanding the correction of the violation
1432	deficiency.
1433	(b)  Class II violations deficiencies are defined in s.
1434	408.813 those which the agency determines have a direct or
1435	immediate relationship to the health, safety, or security of the
1436	facility residents, other than class I deficiencies. A class II
1437	violation deficiency is subject to a civil penalty in an amount
1438	not less than $1,000 and not exceeding $5,000 for each violation
1439	deficiency. A citation for a class II violation deficiency shall
1440	specify the time within which the violation deficiency must be
1441	corrected. If a class II violation deficiency is corrected
1442	within the time specified, no civil penalty shall be imposed,
1443	unless it is a repeated offense.
1444	(c)  Class III violations deficiencies are defined in s.
1445	408.813 those which the agency determines to have an indirect or
1446	potential relationship to the health, safety, or security of the
1447	facility residents, other than class I or class II deficiencies.
1448	A class III violation deficiency is subject to a civil penalty
1449	of not less than $500 and not exceeding $1,000 for each
1450	deficiency. A citation for a class III violation deficiency
1451	shall specify the time within which the violation deficiency
1452	must be corrected. If a class III violation deficiency is
1453	corrected within the time specified, no civil penalty shall be
1454	imposed, unless it is a repeated offense.
1455	(d)  Class IV violations are defined in s. 408.813. Upon
1456	finding an uncorrected or repeated class IV violation, the
1457	agency shall impose an administrative fine not to exceed $500
1458	for each occurrence and each day that the uncorrected or
1459	repeated violation exists.
1460	Section 46.  Subsections (4) and (7) of section 400.9905,
1461	Florida Statutes, are amended to read:
1462	400.9905  Definitions.-
1463	(4)  "Clinic" means an entity at which health care services
1464	are provided to individuals and which tenders charges for
1465	reimbursement for such services, including a mobile clinic and a
1466	portable health service or equipment provider. For purposes of
1467	this part, the term does not include and the licensure
1468	requirements of this part do not apply to:
1469	(a)  Entities licensed or registered by the state under
1470	chapter 395; or entities licensed or registered by the state and
1471	providing only health care services within the scope of services
1472	authorized under their respective licenses granted under ss.
1473	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1474	chapter except part X, chapter 429, chapter 463, chapter 465,
1475	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1476	chapter 651; end-stage renal disease providers authorized under
1477	42 C.F.R. part 405, subpart U; or providers certified under 42
1478	C.F.R. part 485, subpart B or subpart H; or any entity that
1479	provides neonatal or pediatric hospital-based health care
1480	services or other health care services by licensed practitioners
1481	solely within a hospital licensed under chapter 395.
1482	(b)  Entities that own, directly or indirectly, entities
1483	licensed or registered by the state pursuant to chapter 395; or
1484	entities that own, directly or indirectly, entities licensed or
1485	registered by the state and providing only health care services
1486	within the scope of services authorized pursuant to their
1487	respective licenses granted under ss. 383.30-383.335, chapter
1488	390, chapter 394, chapter 397, this chapter except part X,
1489	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1490	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1491	disease providers authorized under 42 C.F.R. part 405, subpart
1492	U; or providers certified under 42 C.F.R. part 485, subpart B or
1493	subpart H; or any entity that provides neonatal or pediatric
1494	hospital-based health care services by licensed practitioners
1495	solely within a hospital licensed under chapter 395.
1496	(c)  Entities that are owned, directly or indirectly, by an
1497	entity licensed or registered by the state pursuant to chapter
1498	395; or entities that are owned, directly or indirectly, by an
1499	entity licensed or registered by the state and providing only
1500	health care services within the scope of services authorized
1501	pursuant to their respective licenses granted under ss. 383.30-
1502	383.335, chapter 390, chapter 394, chapter 397, this chapter
1503	except part X, chapter 429, chapter 463, chapter 465, chapter
1504	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1505	651; end-stage renal disease providers authorized under 42
1506	C.F.R. part 405, subpart U; or providers certified under 42
1507	C.F.R. part 485, subpart B or subpart H; or any entity that
1508	provides neonatal or pediatric hospital-based health care
1509	services by licensed practitioners solely within a hospital
1510	under chapter 395.
1511	(d)  Entities that are under common ownership, directly or
1512	indirectly, with an entity licensed or registered by the state
1513	pursuant to chapter 395; or entities that are under common
1514	ownership, directly or indirectly, with an entity licensed or
1515	registered by the state and providing only health care services
1516	within the scope of services authorized pursuant to their
1517	respective licenses granted under ss. 383.30-383.335, chapter
1518	390, chapter 394, chapter 397, this chapter except part X,
1519	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1520	part I of chapter 483, chapter 484, or chapter 651; end-stage
1521	renal disease providers authorized under 42 C.F.R. part 405,
1522	subpart U; or providers certified under 42 C.F.R. part 485,
1523	subpart B or subpart H; or any entity that provides neonatal or
1524	pediatric hospital-based health care services by licensed
1525	practitioners solely within a hospital licensed under chapter
1526	395.
1527	(e)  An entity that is exempt from federal taxation under
1528	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1529	under 26 U.S.C. s. 409 that has a board of trustees not less
1530	than two-thirds of which are Florida-licensed health care
1531	practitioners and provides only physical therapy services under
1532	physician orders, any community college or university clinic,
1533	and any entity owned or operated by the federal or state
1534	government, including agencies, subdivisions, or municipalities
1535	thereof.
1536	(f)  A sole proprietorship, group practice, partnership, or
1537	corporation that provides health care services by physicians
1538	covered by s. 627.419, that is directly supervised by one or
1539	more of such physicians, and that is wholly owned by one or more
1540	of those physicians or by a physician and the spouse, parent,
1541	child, or sibling of that physician.
1542	(g)  A sole proprietorship, group practice, partnership, or
1543	corporation that provides health care services by licensed
1544	health care practitioners under chapter 457, chapter 458,
1545	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1546	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1547	chapter 490, chapter 491, or part I, part III, part X, part
1548	XIII, or part XIV of chapter 468, or s. 464.012, which are
1549	wholly owned by one or more licensed health care practitioners,
1550	or the licensed health care practitioners set forth in this
1551	paragraph and the spouse, parent, child, or sibling of a
1552	licensed health care practitioner, so long as one of the owners
1553	who is a licensed health care practitioner is supervising the
1554	business activities and is legally responsible for the entity's
1555	compliance with all federal and state laws. However, a health
1556	care practitioner may not supervise services beyond the scope of
1557	the practitioner's license, except that, for the purposes of
1558	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1559	provides only services authorized pursuant to s. 456.053(3)(b)
1560	may be supervised by a licensee specified in s. 456.053(3)(b).
1561	(h)  Clinical facilities affiliated with an accredited
1562	medical school at which training is provided for medical
1563	students, residents, or fellows.
1564	(i)  Entities that provide only oncology or radiation
1565	therapy services by physicians licensed under chapter 458 or
1566	chapter 459 or entities that provide oncology or radiation
1567	therapy services by physicians licensed under chapter 458 or
1568	chapter 459 which are owned by a corporation whose shares are
1569	publicly traded on a recognized stock exchange.
1570	(j)  Clinical facilities affiliated with a college of
1571	chiropractic accredited by the Council on Chiropractic Education
1572	at which training is provided for chiropractic students.
1573	(k)  Entities that provide licensed practitioners to staff
1574	emergency departments or to deliver anesthesia services in
1575	facilities licensed under chapter 395 and that derive at least
1576	90 percent of their gross annual revenues from the provision of
1577	such services. Entities claiming an exemption from licensure
1578	under this paragraph must provide documentation demonstrating
1579	compliance.
1580	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1581	perinatology clinical facilities that are a publicly traded
1582	corporation or that are wholly owned, directly or indirectly, by
1583	a publicly traded corporation. As used in this paragraph, a
1584	publicly traded corporation is a corporation that issues
1585	securities traded on an exchange registered with the United
1586	States Securities and Exchange Commission as a national
1587	securities exchange.
1588	(m)  Entities that are owned by a corporation that has $250
1589	million or more in total annual sales of health care services
1590	provided by licensed health care practitioners if one or more of
1591	the owners of the entity is a health care practitioner who is
1592	licensed in this state, is responsible for supervising the
1593	business activities of the entity, and is legally responsible
1594	for the entity's compliance with state law for purposes of this
1595	section.
1596	(n)  Entities that are owned or controlled, directly or
1597	indirectly, by a publicly traded entity with $100 million or
1598	more, in the aggregate, in total annual revenues derived from
1599	providing health care services by licensed health care
1600	practitioners that are employed or contracted by an entity
1601	described in this paragraph.
1602	(7)  "Portable health service or equipment provider" means
1603	an entity that contracts with or employs persons to provide
1604	portable health care services or equipment to multiple locations
1605	performing treatment or diagnostic testing of individuals, that
1606	bills third-party payors for those services, and that otherwise
1607	meets the definition of a clinic in subsection (4).
1608	Section 47.  Paragraph (b) of subsection (1) and paragraph
1609	(c) of subsection (4) of section 400.991, Florida Statutes, are
1610	amended to read:
1611	400.991  License requirements; background screenings;
1612	prohibitions.-
1613	(1)
1614	(b)  Each mobile clinic must obtain a separate health care
1615	clinic license and must provide to the agency, at least
1616	quarterly, its projected street location to enable the agency to
1617	locate and inspect such clinic. A portable health service or
1618	equipment provider must obtain a health care clinic license for
1619	a single administrative office and is not required to submit
1620	quarterly projected street locations.
1621	(4)  In addition to the requirements of part II of chapter
1622	408, the applicant must file with the application satisfactory
1623	proof that the clinic is in compliance with this part and
1624	applicable rules, including:
1625	(c)  Proof of financial ability to operate as required
1626	under ss. s. 408.810(8) and 408.8065. As an alternative to
1627	submitting proof of financial ability to operate as required
1628	under s. 408.810(8), the applicant may file a surety bond of at
1629	least $500,000 which guarantees that the clinic will act in full
1630	conformity with all legal requirements for operating a clinic,
1631	payable to the agency. The agency may adopt rules to specify
1632	related requirements for such surety bond.
1633	Section 48.  Paragraph (g) of subsection (1) and paragraph
1634	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1635	amended to read:
1636	400.9935  Clinic responsibilities.-
1637	(1)  Each clinic shall appoint a medical director or clinic
1638	director who shall agree in writing to accept legal
1639	responsibility for the following activities on behalf of the
1640	clinic. The medical director or the clinic director shall:
1641	(g)  Conduct systematic reviews of clinic billings to
1642	ensure that the billings are not fraudulent or unlawful. Upon
1643	discovery of an unlawful charge, the medical director or clinic
1644	director shall take immediate corrective action. If the clinic
1645	performs only the technical component of magnetic resonance
1646	imaging, static radiographs, computed tomography, or positron
1647	emission tomography, and provides the professional
1648	interpretation of such services, in a fixed facility that is
1649	accredited by The Joint Commission on Accreditation of
1650	Healthcare Organizations or the Accreditation Association for
1651	Ambulatory Health Care, and the American College of Radiology;
1652	and if, in the preceding quarter, the percentage of scans
1653	performed by that clinic which was billed to all personal injury
1654	protection insurance carriers was less than 15 percent, the
1655	chief financial officer of the clinic may, in a written
1656	acknowledgment provided to the agency, assume the responsibility
1657	for the conduct of the systematic reviews of clinic billings to
1658	ensure that the billings are not fraudulent or unlawful.
1659	(7)(a)  Each clinic engaged in magnetic resonance imaging
1660	services must be accredited by The Joint Commission on
1661	Accreditation of Healthcare Organizations, the American College
1662	of Radiology, or the Accreditation Association for Ambulatory
1663	Health Care, within 1 year after licensure. A clinic that is
1664	accredited by the American College of Radiology or is within the
1665	original 1-year period after licensure and replaces its core
1666	magnetic resonance imaging equipment shall be given 1 year after
1667	the date on which the equipment is replaced to attain
1668	accreditation. However, a clinic may request a single, 6-month
1669	extension if it provides evidence to the agency establishing
1670	that, for good cause shown, such clinic cannot be accredited
1671	within 1 year after licensure, and that such accreditation will
1672	be completed within the 6-month extension. After obtaining
1673	accreditation as required by this subsection, each such clinic
1674	must maintain accreditation as a condition of renewal of its
1675	license. A clinic that files a change of ownership application
1676	must comply with the original accreditation timeframe
1677	requirements of the transferor. The agency shall deny a change
1678	of ownership application if the clinic is not in compliance with
1679	the accreditation requirements. When a clinic adds, replaces, or
1680	modifies magnetic resonance imaging equipment and the
1681	accreditation agency requires new accreditation, the clinic must
1682	be accredited within 1 year after the date of the addition,
1683	replacement, or modification but may request a single, 6-month
1684	extension if the clinic provides evidence of good cause to the
1685	agency.
1686	Section 49.  Subsection (2) of section 408.034, Florida
1687	Statutes, is amended to read:
1688	408.034  Duties and responsibilities of agency; rules.-
1689	(2)  In the exercise of its authority to issue licenses to
1690	health care facilities and health service providers, as provided
1691	under chapters 393 and 395 and parts II, and IV, and VIII of
1692	chapter 400, the agency may not issue a license to any health
1693	care facility or health service provider that fails to receive a
1694	certificate of need or an exemption for the licensed facility or
1695	service.
1696	Section 50.  Paragraph (d) of subsection (1) of section
1697	408.036, Florida Statutes, is amended to read:
1698	408.036  Projects subject to review; exemptions.-
1699	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1700	health-care-related projects, as described in paragraphs (a)-
1701	(g), are subject to review and must file an application for a
1702	certificate of need with the agency. The agency is exclusively
1703	responsible for determining whether a health-care-related
1704	project is subject to review under ss. 408.031-408.045.
1705	(d)  The establishment of a hospice or hospice inpatient
1706	facility, except as provided in s. 408.043.
1707	Section 51.  Subsection (2) of section 408.043, Florida
1708	Statutes, is amended to read:
1709	408.043  Special provisions.-
1710	(2)  HOSPICES.-When an application is made for a
1711	certificate of need to establish or to expand a hospice, the
1712	need for such hospice shall be determined on the basis of the
1713	need for and availability of hospice services in the community.
1714	The formula on which the certificate of need is based shall
1715	discourage regional monopolies and promote competition. The
1716	inpatient hospice care component of a hospice which is a
1717	freestanding facility, or a part of a facility, which is
1718	primarily engaged in providing inpatient care and related
1719	services and is not licensed as a health care facility shall
1720	also be required to obtain a certificate of need. Provision of
1721	hospice care by any current provider of health care is a
1722	significant change in service and therefore requires a
1723	certificate of need for such services.
1724	Section 52.  Paragraph (k) of subsection (3) of section
1725	408.05, Florida Statutes, is amended to read:
1726	408.05  Florida Center for Health Information and Policy
1727	Analysis.-
1728	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1729	produce comparable and uniform health information and statistics
1730	for the development of policy recommendations, the agency shall
1731	perform the following functions:
1732	(k)  Develop, in conjunction with the State Consumer Health
1733	Information and Policy Advisory Council, and implement a long-
1734	range plan for making available health care quality measures and
1735	financial data that will allow consumers to compare health care
1736	services. The health care quality measures and financial data
1737	the agency must make available shall include, but is not limited
1738	to, pharmaceuticals, physicians, health care facilities, and
1739	health plans and managed care entities. The agency shall submit
1740	the initial plan to the Governor, the President of the Senate,
1741	and the Speaker of the House of Representatives by January 1,
1742	2006, and shall update the plan and report on the status of its
1743	implementation annually thereafter. The agency shall also make
1744	the plan and status report available to the public on its
1745	Internet website. As part of the plan, the agency shall identify
1746	the process and timeframes for implementation, any barriers to
1747	implementation, and recommendations of changes in the law that
1748	may be enacted by the Legislature to eliminate the barriers. As
1749	preliminary elements of the plan, the agency shall:
1750	1.  Make available patient-safety indicators, inpatient
1751	quality indicators, and performance outcome and patient charge
1752	data collected from health care facilities pursuant to s.
1753	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1754	"inpatient quality indicators" shall be as defined by the
1755	Centers for Medicare and Medicaid Services, the National Quality
1756	Forum, The Joint Commission on Accreditation of Healthcare
1757	Organizations, the Agency for Healthcare Research and Quality,
1758	the Centers for Disease Control and Prevention, or a similar
1759	national entity that establishes standards to measure the
1760	performance of health care providers, or by other states. The
1761	agency shall determine which conditions, procedures, health care
1762	quality measures, and patient charge data to disclose based upon
1763	input from the council. When determining which conditions and
1764	procedures are to be disclosed, the council and the agency shall
1765	consider variation in costs, variation in outcomes, and
1766	magnitude of variations and other relevant information. When
1767	determining which health care quality measures to disclose, the
1768	agency:
1769	a.  Shall consider such factors as volume of cases; average
1770	patient charges; average length of stay; complication rates;
1771	mortality rates; and infection rates, among others, which shall
1772	be adjusted for case mix and severity, if applicable.
1773	b.  May consider such additional measures that are adopted
1774	by the Centers for Medicare and Medicaid Studies, National
1775	Quality Forum, The Joint Commission on Accreditation of
1776	Healthcare Organizations, the Agency for Healthcare Research and
1777	Quality, Centers for Disease Control and Prevention, or a
1778	similar national entity that establishes standards to measure
1779	the performance of health care providers, or by other states.
1780
1781	When determining which patient charge data to disclose, the
1782	agency shall include such measures as the average of
1783	undiscounted charges on frequently performed procedures and
1784	preventive diagnostic procedures, the range of procedure charges
1785	from highest to lowest, average net revenue per adjusted patient
1786	day, average cost per adjusted patient day, and average cost per
1787	admission, among others.
1788	2.  Make available performance measures, benefit design,
1789	and premium cost data from health plans licensed pursuant to
1790	chapter 627 or chapter 641. The agency shall determine which
1791	health care quality measures and member and subscriber cost data
1792	to disclose, based upon input from the council. When determining
1793	which data to disclose, the agency shall consider information
1794	that may be required by either individual or group purchasers to
1795	assess the value of the product, which may include membership
1796	satisfaction, quality of care, current enrollment or membership,
1797	coverage areas, accreditation status, premium costs, plan costs,
1798	premium increases, range of benefits, copayments and
1799	deductibles, accuracy and speed of claims payment, credentials
1800	of physicians, number of providers, names of network providers,
1801	and hospitals in the network. Health plans shall make available
1802	to the agency any such data or information that is not currently
1803	reported to the agency or the office.
1804	3.  Determine the method and format for public disclosure
1805	of data reported pursuant to this paragraph. The agency shall
1806	make its determination based upon input from the State Consumer
1807	Health Information and Policy Advisory Council. At a minimum,
1808	the data shall be made available on the agency's Internet
1809	website in a manner that allows consumers to conduct an
1810	interactive search that allows them to view and compare the
1811	information for specific providers. The website must include
1812	such additional information as is determined necessary to ensure
1813	that the website enhances informed decisionmaking among
1814	consumers and health care purchasers, which shall include, at a
1815	minimum, appropriate guidance on how to use the data and an
1816	explanation of why the data may vary from provider to provider.
1817	The data specified in subparagraph 1. shall be released no later
1818	than January 1, 2006, for the reporting of infection rates, and
1819	no later than October 1, 2005, for mortality rates and
1820	complication rates. The data specified in subparagraph 2. shall
1821	be released no later than October 1, 2006.
1822	4.  Publish on its website undiscounted charges for no
1823	fewer than 150 of the most commonly performed adult and
1824	pediatric procedures, including outpatient, inpatient,
1825	diagnostic, and preventative procedures.
1826	Section 53.  Paragraph (a) of subsection (1) of section
1827	408.061, Florida Statutes, is amended to read:
1828	408.061  Data collection; uniform systems of financial
1829	reporting; information relating to physician charges;
1830	confidential information; immunity.-
1831	(1)  The agency shall require the submission by health care
1832	facilities, health care providers, and health insurers of data
1833	necessary to carry out the agency's duties. Specifications for
1834	data to be collected under this section shall be developed by
1835	the agency with the assistance of technical advisory panels
1836	including representatives of affected entities, consumers,
1837	purchasers, and such other interested parties as may be
1838	determined by the agency.
1839	(a)  Data submitted by health care facilities, including
1840	the facilities as defined in chapter 395, shall include, but are
1841	not limited to: case-mix data, patient admission and discharge
1842	data, hospital emergency department data which shall include the
1843	number of patients treated in the emergency department of a
1844	licensed hospital reported by patient acuity level, data on
1845	hospital-acquired infections as specified by rule, data on
1846	complications as specified by rule, data on readmissions as
1847	specified by rule, with patient and provider-specific
1848	identifiers included, actual charge data by diagnostic groups,
1849	financial data, accounting data, operating expenses, expenses
1850	incurred for rendering services to patients who cannot or do not
1851	pay, interest charges, depreciation expenses based on the
1852	expected useful life of the property and equipment involved, and
1853	demographic data. The agency shall adopt nationally recognized
1854	risk adjustment methodologies or software consistent with the
1855	standards of the Agency for Healthcare Research and Quality and
1856	as selected by the agency for all data submitted as required by
1857	this section. Data may be obtained from documents such as, but
1858	not limited to: leases, contracts, debt instruments, itemized
1859	patient bills, medical record abstracts, and related diagnostic
1860	information. Reported data elements shall be reported
1861	electronically and in accordance with rule 59E-7.012, Florida
1862	Administrative Code. Data submitted shall be certified by the
1863	chief executive officer or an appropriate and duly authorized
1864	representative or employee of the licensed facility that the
1865	information submitted is true and accurate.
1866	Section 54.  Subsection (43) of section 408.07, Florida
1867	Statutes, is amended to read:
1868	408.07  Definitions.-As used in this chapter, with the
1869	exception of ss. 408.031-408.045, the term:
1870	(43)  "Rural hospital" means an acute care hospital
1871	licensed under chapter 395, having 100 or fewer licensed beds
1872	and an emergency room, and which is:
1873	(a)  The sole provider within a county with a population
1874	density of no greater than 100 persons per square mile;
1875	(b)  An acute care hospital, in a county with a population
1876	density of no greater than 100 persons per square mile, which is
1877	at least 30 minutes of travel time, on normally traveled roads
1878	under normal traffic conditions, from another acute care
1879	hospital within the same county;
1880	(c)  A hospital supported by a tax district or subdistrict
1881	whose boundaries encompass a population of 100 persons or fewer
1882	per square mile;
1883	(d)  A hospital with a service area that has a population
1884	of 100 persons or fewer per square mile. As used in this
1885	paragraph, the term "service area" means the fewest number of
1886	zip codes that account for 75 percent of the hospital's
1887	discharges for the most recent 5-year period, based on
1888	information available from the hospital inpatient discharge
1889	database in the Florida Center for Health Information and Policy
1890	Analysis at the Agency for Health Care Administration; or
1891	(e)  A critical access hospital.
1892
1893	Population densities used in this subsection must be based upon
1894	the most recently completed United States census. A hospital
1895	that received funds under s. 409.9116 for a quarter beginning no
1896	later than July 1, 2002, is deemed to have been and shall
1897	continue to be a rural hospital from that date through June 30,
1898	2015, if the hospital continues to have 100 or fewer licensed
1899	beds and an emergency room, or meets the criteria of s.
1900	395.602(2)(e)4. An acute care hospital that has not previously
1901	been designated as a rural hospital and that meets the criteria
1902	of this subsection shall be granted such designation upon
1903	application, including supporting documentation, to the Agency
1904	for Health Care Administration.
1905	Section 55.  Section 408.10, Florida Statutes, is amended
1906	to read:
1907	408.10  Consumer complaints.-The agency shall:
1908	(1)  publish and make available to the public a toll-free
1909	telephone number for the purpose of handling consumer complaints
1910	and shall serve as a liaison between consumer entities and other
1911	private entities and governmental entities for the disposition
1912	of problems identified by consumers of health care.
1913	(2)  Be empowered to investigate consumer complaints
1914	relating to problems with health care facilities' billing
1915	practices and issue reports to be made public in any cases where
1916	the agency determines the health care facility has engaged in
1917	billing practices which are unreasonable and unfair to the
1918	consumer.
1919	Section 56.  Subsections (12) through (30) of section
1920	408.802, Florida Statutes, are renumbered as subsections (11)
1921	through (29), respectively, and present subsection (11) of that
1922	section is amended to read:
1923	408.802  Applicability.-The provisions of this part apply
1924	to the provision of services that require licensure as defined
1925	in this part and to the following entities licensed, registered,
1926	or certified by the agency, as described in chapters 112, 383,
1927	390, 394, 395, 400, 429, 440, 483, and 765:
1928	(11)  Private review agents, as provided under part I of
1929	chapter 395.
1930	Section 57.  Subsection (3) is added to section 408.804,
1931	Florida Statutes, to read:
1932	408.804  License required; display.-
1933	(3)  Any person who knowingly alters, defaces, or falsifies
1934	a license certificate issued by the agency, or causes or
1935	procures any person to commit such an offense, commits a
1936	misdemeanor of the second degree, punishable as provided in s.
1937	775.082 or s 775.083. Any licensee or provider who displays an
1938	altered, defaced, or falsified license certificate is subject to
1939	the penalties set forth in s. 408.815 and an administrative fine
1940	of $1,000 for each day of illegal display.
1941	Section 58.  Paragraph (d) of subsection (2) of section
1942	408.806, Florida Statutes, is amended, present subsections (3)
1943	through (8) are renumbered as subsections (4) through (9),
1944	respectively, and a new subsection (3) is added to that section,
1945	to read:
1946	408.806  License application process.-
1947	(2)
1948	(d)  The agency shall notify the licensee by mail or
1949	electronically at least 90 days before the expiration of a
1950	license that a renewal license is necessary to continue
1951	operation. The licensee's failure to timely file submit a
1952	renewal application and license application fee with the agency
1953	shall result in a $50 per day late fee charged to the licensee
1954	by the agency; however, the aggregate amount of the late fee may
1955	not exceed 50 percent of the licensure fee or $500, whichever is
1956	less. The agency shall provide a courtesy notice to the licensee
1957	by United States mail, electronically, or by any other manner at
1958	its address of record or mailing address, if provided, at least
1959	90 days prior to the expiration of a license informing the
1960	licensee of the expiration of the license. If the agency does
1961	not provide the courtesy notice or the licensee does not receive
1962	the courtesy notice, the licensee continues to be legally
1963	obligated to timely file the renewal application and license
1964	application fee with the agency and is not excused from the
1965	payment of a late fee. If an application is received after the
1966	required filing date and exhibits a hand-canceled postmark
1967	obtained from a United States post office dated on or before the
1968	required filing date, no fine will be levied.
1969	(3)  Payment of the late fee is required to consider any
1970	late application complete, and failure to pay the late fee is
1971	considered an omission from the application.
1972	Section 59.  Subsections (6) and (9) of section 408.810,
1973	Florida Statutes, are amended to read:
1974	408.810  Minimum licensure requirements.-In addition to the
1975	licensure requirements specified in this part, authorizing
1976	statutes, and applicable rules, each applicant and licensee must
1977	comply with the requirements of this section in order to obtain
1978	and maintain a license.
1979	(6)(a)  An applicant must provide the agency with proof of
1980	the applicant's legal right to occupy the property before a
1981	license may be issued. Proof may include, but need not be
1982	limited to, copies of warranty deeds, lease or rental
1983	agreements, contracts for deeds, quitclaim deeds, or other such
1984	documentation.
1985	(b)  In the event the property is encumbered by a mortgage
1986	or is leased, an applicant must provide the agency with proof
1987	that the mortgagor or landlord has been provided written notice
1988	of the applicant's intent as mortgagee or tenant to provide
1989	services that require licensure and instruct the mortgagor or
1990	landlord to serve the agency by certified mail with copies of
1991	any foreclosure or eviction actions initiated by the mortgagor
1992	or landlord against the applicant.
1993	(9)  A controlling interest may not withhold from the
1994	agency any evidence of financial instability, including, but not
1995	limited to, checks returned due to insufficient funds,
1996	delinquent accounts, nonpayment of withholding taxes, unpaid
1997	utility expenses, nonpayment for essential services, or adverse
1998	court action concerning the financial viability of the provider
1999	or any other provider licensed under this part that is under the
2000	control of the controlling interest. A controlling interest
2001	shall notify the agency within 10 days after a court action to
2002	initiate bankruptcy, foreclosure, or eviction proceedings
2003	concerning the provider, in which the controlling interest is a
2004	petitioner or defendant. Any person who violates this subsection
2005	commits a misdemeanor of the second degree, punishable as
2006	provided in s. 775.082 or s. 775.083. Each day of continuing
2007	violation is a separate offense.
2008	Section 60.  Subsection (3) is added to section 408.813,
2009	Florida Statutes, to read:
2010	408.813  Administrative fines; violations.-As a penalty for
2011	any violation of this part, authorizing statutes, or applicable
2012	rules, the agency may impose an administrative fine.
2013	(3)  The agency may impose an administrative fine for a
2014	violation that does not qualify as a class I, class II, class
2015	III, or class IV violation. Unless otherwise specified by law,
2016	the amount of the fine shall not exceed $500 for each violation.
2017	Unclassified violations may include:
2018	(a)  Violating any term or condition of a license.
2019	(b)  Violating any provision of this part, authorizing
2020	statutes, or applicable rules.
2021	(c)  Exceeding licensed capacity.
2022	(d)  Providing services beyond the scope of the license.
2023	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2024	Section 61.  Subsection (5) is added to section 408.815,
2025	Florida Statutes, to read:
2026	408.815  License or application denial; revocation.-
2027	(5)  In order to ensure the health, safety, and welfare of
2028	clients when a license has been denied, revoked, or is set to
2029	terminate, the agency may extend the license expiration date for
2030	a period of up to 30 days for the sole purpose of allowing the
2031	safe and orderly discharge of clients. The agency may impose
2032	conditions on the extension, including, but not limited to,
2033	prohibiting or limiting admissions, expedited discharge
2034	planning, required status reports, and mandatory monitoring by
2035	the agency or third parties. In imposing these conditions, the
2036	agency shall take into consideration the nature and number of
2037	clients, the availability and location of acceptable alternative
2038	placements, and the ability of the licensee to continue
2039	providing care to the clients. The agency may terminate the
2040	extension or modify the conditions at any time. This authority
2041	is in addition to any other authority granted to the agency
2042	under chapter 120, this part, and authorizing statutes but
2043	creates no right or entitlement to an extension of a license
2044	expiration date.
2045	Section 62.  Paragraph (k) of subsection (4) of section
2046	409.221, Florida Statutes, is amended to read:
2047	409.221  Consumer-directed care program.-
2048	(4)  CONSUMER-DIRECTED CARE.-
2049	(k)  Reviews and reports.-The agency and the Departments of
2050	Elderly Affairs, Health, and Children and Family Services and
2051	the Agency for Persons with Disabilities shall each, on an
2052	ongoing basis, review and assess the implementation of the
2053	consumer-directed care program. By January 15 of each year, the
2054	agency shall submit a written report to the Legislature that
2055	includes each department's review of the program and contains
2056	recommendations for improvements to the program.
2057	Section 63.  Subsection (1) of section 409.91196, Florida
2058	Statutes, is amended to read:
2059	409.91196  Supplemental rebate agreements; public records
2060	and public meetings exemption.-
2061	(1)  The rebate amount, percent of rebate, manufacturer's
2062	pricing, and supplemental rebate, and other trade secrets as
2063	defined in s. 688.002 that the agency has identified for use in
2064	negotiations, held by the Agency for Health Care Administration
2065	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2066	119.07(1) and s. 24(a), Art. I of the State Constitution.
2067	Section 64.  Paragraph (a) of subsection (39) of section
2068	409.912, Florida Statutes, is amended to read:
2069	409.912  Cost-effective purchasing of health care.-The
2070	agency shall purchase goods and services for Medicaid recipients
2071	in the most cost-effective manner consistent with the delivery
2072	of quality medical care. To ensure that medical services are
2073	effectively utilized, the agency may, in any case, require a
2074	confirmation or second physician's opinion of the correct
2075	diagnosis for purposes of authorizing future services under the
2076	Medicaid program. This section does not restrict access to
2077	emergency services or poststabilization care services as defined
2078	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2079	shall be rendered in a manner approved by the agency. The agency
2080	shall maximize the use of prepaid per capita and prepaid
2081	aggregate fixed-sum basis services when appropriate and other
2082	alternative service delivery and reimbursement methodologies,
2083	including competitive bidding pursuant to s. 287.057, designed
2084	to facilitate the cost-effective purchase of a case-managed
2085	continuum of care. The agency shall also require providers to
2086	minimize the exposure of recipients to the need for acute
2087	inpatient, custodial, and other institutional care and the
2088	inappropriate or unnecessary use of high-cost services. The
2089	agency shall contract with a vendor to monitor and evaluate the
2090	clinical practice patterns of providers in order to identify
2091	trends that are outside the normal practice patterns of a
2092	provider's professional peers or the national guidelines of a
2093	provider's professional association. The vendor must be able to
2094	provide information and counseling to a provider whose practice
2095	patterns are outside the norms, in consultation with the agency,
2096	to improve patient care and reduce inappropriate utilization.
2097	The agency may mandate prior authorization, drug therapy
2098	management, or disease management participation for certain
2099	populations of Medicaid beneficiaries, certain drug classes, or
2100	particular drugs to prevent fraud, abuse, overuse, and possible
2101	dangerous drug interactions. The Pharmaceutical and Therapeutics
2102	Committee shall make recommendations to the agency on drugs for
2103	which prior authorization is required. The agency shall inform
2104	the Pharmaceutical and Therapeutics Committee of its decisions
2105	regarding drugs subject to prior authorization. The agency is
2106	authorized to limit the entities it contracts with or enrolls as
2107	Medicaid providers by developing a provider network through
2108	provider credentialing. The agency may competitively bid single-
2109	source-provider contracts if procurement of goods or services
2110	results in demonstrated cost savings to the state without
2111	limiting access to care. The agency may limit its network based
2112	on the assessment of beneficiary access to care, provider
2113	availability, provider quality standards, time and distance
2114	standards for access to care, the cultural competence of the
2115	provider network, demographic characteristics of Medicaid
2116	beneficiaries, practice and provider-to-beneficiary standards,
2117	appointment wait times, beneficiary use of services, provider
2118	turnover, provider profiling, provider licensure history,
2119	previous program integrity investigations and findings, peer
2120	review, provider Medicaid policy and billing compliance records,
2121	clinical and medical record audits, and other factors. Providers
2122	shall not be entitled to enrollment in the Medicaid provider
2123	network. The agency shall determine instances in which allowing
2124	Medicaid beneficiaries to purchase durable medical equipment and
2125	other goods is less expensive to the Medicaid program than long-
2126	term rental of the equipment or goods. The agency may establish
2127	rules to facilitate purchases in lieu of long-term rentals in
2128	order to protect against fraud and abuse in the Medicaid program
2129	as defined in s. 409.913. The agency may seek federal waivers
2130	necessary to administer these policies.
2131	(39)(a)  The agency shall implement a Medicaid prescribed-
2132	drug spending-control program that includes the following
2133	components:
2134	1.  A Medicaid preferred drug list, which shall be a
2135	listing of cost-effective therapeutic options recommended by the
2136	Medicaid Pharmacy and Therapeutics Committee established
2137	pursuant to s. 409.91195 and adopted by the agency for each
2138	therapeutic class on the preferred drug list. At the discretion
2139	of the committee, and when feasible, the preferred drug list
2140	should include at least two products in a therapeutic class. The
2141	agency may post the preferred drug list and updates to the
2142	preferred drug list on an Internet website without following the
2143	rulemaking procedures of chapter 120. Antiretroviral agents are
2144	excluded from the preferred drug list. The agency shall also
2145	limit the amount of a prescribed drug dispensed to no more than
2146	a 34-day supply unless the drug products' smallest marketed
2147	package is greater than a 34-day supply, or the drug is
2148	determined by the agency to be a maintenance drug in which case
2149	a 100-day maximum supply may be authorized. The agency is
2150	authorized to seek any federal waivers necessary to implement
2151	these cost-control programs and to continue participation in the
2152	federal Medicaid rebate program, or alternatively to negotiate
2153	state-only manufacturer rebates. The agency may adopt rules to
2154	implement this subparagraph. The agency shall continue to
2155	provide unlimited contraceptive drugs and items. The agency must
2156	establish procedures to ensure that:
2157	a.  There is a response to a request for prior consultation
2158	by telephone or other telecommunication device within 24 hours
2159	after receipt of a request for prior consultation; and
2160	b.  A 72-hour supply of the drug prescribed is provided in
2161	an emergency or when the agency does not provide a response
2162	within 24 hours as required by sub-subparagraph a.
2163	2.  Reimbursement to pharmacies for Medicaid prescribed
2164	drugs shall be set at the lesser of: the average wholesale price
2165	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2166	plus 4.75 percent, the federal upper limit (FUL), the state
2167	maximum allowable cost (SMAC), or the usual and customary (UAC)
2168	charge billed by the provider.
2169	3.  For a prescribed drug billed as a 340B prescribed
2170	medication, the claim must meet the requirements of the Deficit
2171	Reduction Act of 2005 and the federal 340B program, contain a
2172	national drug code, and be billed at the actual acquisition cost
2173	or payment shall be denied.
2174	4.3.  The agency shall develop and implement a process for
2175	managing the drug therapies of Medicaid recipients who are using
2176	significant numbers of prescribed drugs each month. The
2177	management process may include, but is not limited to,
2178	comprehensive, physician-directed medical-record reviews, claims
2179	analyses, and case evaluations to determine the medical
2180	necessity and appropriateness of a patient's treatment plan and
2181	drug therapies. The agency may contract with a private
2182	organization to provide drug-program-management services. The
2183	Medicaid drug benefit management program shall include
2184	initiatives to manage drug therapies for HIV/AIDS patients,
2185	patients using 20 or more unique prescriptions in a 180-day
2186	period, and the top 1,000 patients in annual spending. The
2187	agency shall enroll any Medicaid recipient in the drug benefit
2188	management program if he or she meets the specifications of this
2189	provision and is not enrolled in a Medicaid health maintenance
2190	organization.
2191	5.4.  The agency may limit the size of its pharmacy network
2192	based on need, competitive bidding, price negotiations,
2193	credentialing, or similar criteria. The agency shall give
2194	special consideration to rural areas in determining the size and
2195	location of pharmacies included in the Medicaid pharmacy
2196	network. A pharmacy credentialing process may include criteria
2197	such as a pharmacy's full-service status, location, size,
2198	patient educational programs, patient consultation, disease
2199	management services, and other characteristics. The agency may
2200	impose a moratorium on Medicaid pharmacy enrollment when it is
2201	determined that it has a sufficient number of Medicaid-
2202	participating providers. The agency must allow dispensing
2203	practitioners to participate as a part of the Medicaid pharmacy
2204	network regardless of the practitioner's proximity to any other
2205	entity that is dispensing prescription drugs under the Medicaid
2206	program. A dispensing practitioner must meet all credentialing
2207	requirements applicable to his or her practice, as determined by
2208	the agency.
2209	6.5.  The agency shall develop and implement a program that
2210	requires Medicaid practitioners who prescribe drugs to use a
2211	counterfeit-proof prescription pad for Medicaid prescriptions.
2212	The agency shall require the use of standardized counterfeit-
2213	proof prescription pads by Medicaid-participating prescribers or
2214	prescribers who write prescriptions for Medicaid recipients. The
2215	agency may implement the program in targeted geographic areas or
2216	statewide.
2217	7.6.  The agency may enter into arrangements that require
2218	manufacturers of generic drugs prescribed to Medicaid recipients
2219	to provide rebates of at least 15.1 percent of the average
2220	manufacturer price for the manufacturer's generic products.
2221	These arrangements shall require that if a generic-drug
2222	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2223	at a level below 15.1 percent, the manufacturer must provide a
2224	supplemental rebate to the state in an amount necessary to
2225	achieve a 15.1-percent rebate level.
2226	8.7.  The agency may establish a preferred drug list as
2227	described in this subsection, and, pursuant to the establishment
2228	of such preferred drug list, it is authorized to negotiate
2229	supplemental rebates from manufacturers that are in addition to
2230	those required by Title XIX of the Social Security Act and at no
2231	less than 14 percent of the average manufacturer price as
2232	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2233	the federal or supplemental rebate, or both, equals or exceeds
2234	29 percent. There is no upper limit on the supplemental rebates
2235	the agency may negotiate. The agency may determine that specific
2236	products, brand-name or generic, are competitive at lower rebate
2237	percentages. Agreement to pay the minimum supplemental rebate
2238	percentage will guarantee a manufacturer that the Medicaid
2239	Pharmaceutical and Therapeutics Committee will consider a
2240	product for inclusion on the preferred drug list. However, a
2241	pharmaceutical manufacturer is not guaranteed placement on the
2242	preferred drug list by simply paying the minimum supplemental
2243	rebate. Agency decisions will be made on the clinical efficacy
2244	of a drug and recommendations of the Medicaid Pharmaceutical and
2245	Therapeutics Committee, as well as the price of competing
2246	products minus federal and state rebates. The agency is
2247	authorized to contract with an outside agency or contractor to
2248	conduct negotiations for supplemental rebates. For the purposes
2249	of this section, the term "supplemental rebates" means cash
2250	rebates. Effective July 1, 2004, value-added programs as a
2251	substitution for supplemental rebates are prohibited. The agency
2252	is authorized to seek any federal waivers to implement this
2253	initiative.
2254	9.8.  The Agency for Health Care Administration shall
2255	expand home delivery of pharmacy products. To assist Medicaid
2256	patients in securing their prescriptions and reduce program
2257	costs, the agency shall expand its current mail-order-pharmacy
2258	diabetes-supply program to include all generic and brand-name
2259	drugs used by Medicaid patients with diabetes. Medicaid
2260	recipients in the current program may obtain nondiabetes drugs
2261	on a voluntary basis. This initiative is limited to the
2262	geographic area covered by the current contract. The agency may
2263	seek and implement any federal waivers necessary to implement
2264	this subparagraph.
2265	10.9.  The agency shall limit to one dose per month any
2266	drug prescribed to treat erectile dysfunction.
2267	11.10.a.  The agency may implement a Medicaid behavioral
2268	drug management system. The agency may contract with a vendor
2269	that has experience in operating behavioral drug management
2270	systems to implement this program. The agency is authorized to
2271	seek federal waivers to implement this program.
2272	b.  The agency, in conjunction with the Department of
2273	Children and Family Services, may implement the Medicaid
2274	behavioral drug management system that is designed to improve
2275	the quality of care and behavioral health prescribing practices
2276	based on best practice guidelines, improve patient adherence to
2277	medication plans, reduce clinical risk, and lower prescribed
2278	drug costs and the rate of inappropriate spending on Medicaid
2279	behavioral drugs. The program may include the following
2280	elements:
2281	(I)  Provide for the development and adoption of best
2282	practice guidelines for behavioral health-related drugs such as
2283	antipsychotics, antidepressants, and medications for treating
2284	bipolar disorders and other behavioral conditions; translate
2285	them into practice; review behavioral health prescribers and
2286	compare their prescribing patterns to a number of indicators
2287	that are based on national standards; and determine deviations
2288	from best practice guidelines.
2289	(II)  Implement processes for providing feedback to and
2290	educating prescribers using best practice educational materials
2291	and peer-to-peer consultation.
2292	(III)  Assess Medicaid beneficiaries who are outliers in
2293	their use of behavioral health drugs with regard to the numbers
2294	and types of drugs taken, drug dosages, combination drug
2295	therapies, and other indicators of improper use of behavioral
2296	health drugs.
2297	(IV)  Alert prescribers to patients who fail to refill
2298	prescriptions in a timely fashion, are prescribed multiple same-
2299	class behavioral health drugs, and may have other potential
2300	medication problems.
2301	(V)  Track spending trends for behavioral health drugs and
2302	deviation from best practice guidelines.
2303	(VI)  Use educational and technological approaches to
2304	promote best practices, educate consumers, and train prescribers
2305	in the use of practice guidelines.
2306	(VII)  Disseminate electronic and published materials.
2307	(VIII)  Hold statewide and regional conferences.
2308	(IX)  Implement a disease management program with a model
2309	quality-based medication component for severely mentally ill
2310	individuals and emotionally disturbed children who are high
2311	users of care.
2312	12.11.a.  The agency shall implement a Medicaid
2313	prescription drug management system. The agency may contract
2314	with a vendor that has experience in operating prescription drug
2315	management systems in order to implement this system. Any
2316	management system that is implemented in accordance with this
2317	subparagraph must rely on cooperation between physicians and
2318	pharmacists to determine appropriate practice patterns and
2319	clinical guidelines to improve the prescribing, dispensing, and
2320	use of drugs in the Medicaid program. The agency may seek
2321	federal waivers to implement this program.
2322	b.  The drug management system must be designed to improve
2323	the quality of care and prescribing practices based on best
2324	practice guidelines, improve patient adherence to medication
2325	plans, reduce clinical risk, and lower prescribed drug costs and
2326	the rate of inappropriate spending on Medicaid prescription
2327	drugs. The program must:
2328	(I)  Provide for the development and adoption of best
2329	practice guidelines for the prescribing and use of drugs in the
2330	Medicaid program, including translating best practice guidelines
2331	into practice; reviewing prescriber patterns and comparing them
2332	to indicators that are based on national standards and practice
2333	patterns of clinical peers in their community, statewide, and
2334	nationally; and determine deviations from best practice
2335	guidelines.
2336	(II)  Implement processes for providing feedback to and
2337	educating prescribers using best practice educational materials
2338	and peer-to-peer consultation.
2339	(III)  Assess Medicaid recipients who are outliers in their
2340	use of a single or multiple prescription drugs with regard to
2341	the numbers and types of drugs taken, drug dosages, combination
2342	drug therapies, and other indicators of improper use of
2343	prescription drugs.
2344	(IV)  Alert prescribers to patients who fail to refill
2345	prescriptions in a timely fashion, are prescribed multiple drugs
2346	that may be redundant or contraindicated, or may have other
2347	potential medication problems.
2348	(V)  Track spending trends for prescription drugs and
2349	deviation from best practice guidelines.
2350	(VI)  Use educational and technological approaches to
2351	promote best practices, educate consumers, and train prescribers
2352	in the use of practice guidelines.
2353	(VII)  Disseminate electronic and published materials.
2354	(VIII)  Hold statewide and regional conferences.
2355	(IX)  Implement disease management programs in cooperation
2356	with physicians and pharmacists, along with a model quality-
2357	based medication component for individuals having chronic
2358	medical conditions.
2359	13.12.  The agency is authorized to contract for drug
2360	rebate administration, including, but not limited to,
2361	calculating rebate amounts, invoicing manufacturers, negotiating
2362	disputes with manufacturers, and maintaining a database of
2363	rebate collections.
2364	14.13.  The agency may specify the preferred daily dosing
2365	form or strength for the purpose of promoting best practices
2366	with regard to the prescribing of certain drugs as specified in
2367	the General Appropriations Act and ensuring cost-effective
2368	prescribing practices.
2369	15.14.  The agency may require prior authorization for
2370	Medicaid-covered prescribed drugs. The agency may, but is not
2371	required to, prior-authorize the use of a product:
2372	a.  For an indication not approved in labeling;
2373	b.  To comply with certain clinical guidelines; or
2374	c.  If the product has the potential for overuse, misuse,
2375	or abuse.
2376
2377	The agency may require the prescribing professional to provide
2378	information about the rationale and supporting medical evidence
2379	for the use of a drug. The agency may post prior authorization
2380	criteria and protocol and updates to the list of drugs that are
2381	subject to prior authorization on an Internet website without
2382	amending its rule or engaging in additional rulemaking.
2383	16.15.  The agency, in conjunction with the Pharmaceutical
2384	and Therapeutics Committee, may require age-related prior
2385	authorizations for certain prescribed drugs. The agency may
2386	preauthorize the use of a drug for a recipient who may not meet
2387	the age requirement or may exceed the length of therapy for use
2388	of this product as recommended by the manufacturer and approved
2389	by the Food and Drug Administration. Prior authorization may
2390	require the prescribing professional to provide information
2391	about the rationale and supporting medical evidence for the use
2392	of a drug.
2393	17.16.  The agency shall implement a step-therapy prior
2394	authorization approval process for medications excluded from the
2395	preferred drug list. Medications listed on the preferred drug
2396	list must be used within the previous 12 months prior to the
2397	alternative medications that are not listed. The step-therapy
2398	prior authorization may require the prescriber to use the
2399	medications of a similar drug class or for a similar medical
2400	indication unless contraindicated in the Food and Drug
2401	Administration labeling. The trial period between the specified
2402	steps may vary according to the medical indication. The step-
2403	therapy approval process shall be developed in accordance with
2404	the committee as stated in s. 409.91195(7) and (8). A drug
2405	product may be approved without meeting the step-therapy prior
2406	authorization criteria if the prescribing physician provides the
2407	agency with additional written medical or clinical documentation
2408	that the product is medically necessary because:
2409	a.  There is not a drug on the preferred drug list to treat
2410	the disease or medical condition which is an acceptable clinical
2411	alternative;
2412	b.  The alternatives have been ineffective in the treatment
2413	of the beneficiary's disease; or
2414	c.  Based on historic evidence and known characteristics of
2415	the patient and the drug, the drug is likely to be ineffective,
2416	or the number of doses have been ineffective.
2417
2418	The agency shall work with the physician to determine the best
2419	alternative for the patient. The agency may adopt rules waiving
2420	the requirements for written clinical documentation for specific
2421	drugs in limited clinical situations.
2422	18.17.  The agency shall implement a return and reuse
2423	program for drugs dispensed by pharmacies to institutional
2424	recipients, which includes payment of a $5 restocking fee for
2425	the implementation and operation of the program. The return and
2426	reuse program shall be implemented electronically and in a
2427	manner that promotes efficiency. The program must permit a
2428	pharmacy to exclude drugs from the program if it is not
2429	practical or cost-effective for the drug to be included and must
2430	provide for the return to inventory of drugs that cannot be
2431	credited or returned in a cost-effective manner. The agency
2432	shall determine if the program has reduced the amount of
2433	Medicaid prescription drugs which are destroyed on an annual
2434	basis and if there are additional ways to ensure more
2435	prescription drugs are not destroyed which could safely be
2436	reused. The agency's conclusion and recommendations shall be
2437	reported to the Legislature by December 1, 2005.
2438	Section 65.  Subsections (3) and (4) of section 429.07,
2439	Florida Statutes, are amended, and subsections (6) and (7) are
2440	added to that section, to read:
2441	429.07  License required; fee; inspections.-
2442	(3)  In addition to the requirements of s. 408.806, each
2443	license granted by the agency must state the type of care for
2444	which the license is granted. Licenses shall be issued for one
2445	or more of the following categories of care: standard, extended
2446	congregate care, limited nursing services, or limited mental
2447	health.
2448	(a)  A standard license shall be issued to a facility
2449	facilities providing one or more of the personal services
2450	identified in s. 429.02. Such licensee facilities may also
2451	employ or contract with a person licensed under part I of
2452	chapter 464 to administer medications and perform other tasks as
2453	specified in s. 429.255.
2454	(b)  An extended congregate care license shall be issued to
2455	a licensee facilities providing, directly or through contract,
2456	services beyond those authorized in paragraph (a), including
2457	acts performed pursuant to part I of chapter 464 by persons
2458	licensed thereunder, and supportive services defined by rule to
2459	persons who otherwise would be disqualified from continued
2460	residence in a facility licensed under this part.
2461	1.  In order for extended congregate care services to be
2462	provided in a facility licensed under this part, the agency must
2463	first determine that all requirements established in law and
2464	rule are met and must specifically designate, on the facility's
2465	license, that such services may be provided and whether the
2466	designation applies to all or part of a facility. Such
2467	designation may be made at the time of initial licensure or
2468	relicensure, or upon request in writing by a licensee under this
2469	part and part II of chapter 408. Notification of approval or
2470	denial of such request shall be made in accordance with part II
2471	of chapter 408. An existing licensee facilities qualifying to
2472	provide extended congregate care services must have maintained a
2473	standard license and may not have been subject to administrative
2474	sanctions during the previous 2 years, or since initial
2475	licensure if the facility has been licensed for less than 2
2476	years, for any of the following reasons:
2477	a.  A class I or class II violation;
2478	b.  Three or more repeat or recurring class III violations
2479	of identical or similar resident care standards as specified in
2480	rule from which a pattern of noncompliance is found by the
2481	agency;
2482	c.  Three or more class III violations that were not
2483	corrected in accordance with the corrective action plan approved
2484	by the agency;
2485	d.  Violation of resident care standards resulting in a
2486	requirement to employ the services of a consultant pharmacist or
2487	consultant dietitian;
2488	e.  Denial, suspension, or revocation of a license for
2489	another facility under this part in which the applicant for an
2490	extended congregate care license has at least 25 percent
2491	ownership interest; or
2492	f.  Imposition of a moratorium pursuant to this part or
2493	part II of chapter 408 or initiation of injunctive proceedings.
2494	2.  A licensee Facilities that is are licensed to provide
2495	extended congregate care services shall maintain a written
2496	progress report for on each person who receives such services,
2497	and the which report must describe describes the type, amount,
2498	duration, scope, and outcome of services that are rendered and
2499	the general status of the resident's health. A registered nurse,
2500	or appropriate designee, representing the agency shall visit
2501	such facilities at least quarterly to monitor residents who are
2502	receiving extended congregate care services and to determine if
2503	the facility is in compliance with this part, part II of chapter
2504	408, and rules that relate to extended congregate care. One of
2505	these visits may be in conjunction with the regular survey. The
2506	monitoring visits may be provided through contractual
2507	arrangements with appropriate community agencies. A registered
2508	nurse shall serve as part of the team that inspects such
2509	facility. The agency may waive one of the required yearly
2510	monitoring visits for a facility that has been licensed for at
2511	least 24 months to provide extended congregate care services,
2512	if, during the inspection, the registered nurse determines that
2513	extended congregate care services are being provided
2514	appropriately, and if the facility has no class I or class II
2515	violations and no uncorrected class III violations. Before such
2516	decision is made, the agency shall consult with the long-term
2517	care ombudsman council for the area in which the facility is
2518	located to determine if any complaints have been made and
2519	substantiated about the quality of services or care. The agency
2520	may not waive one of the required yearly monitoring visits if
2521	complaints have been made and substantiated.
2522	3.  Licensees Facilities that are licensed to provide
2523	extended congregate care services shall:
2524	a.  Demonstrate the capability to meet unanticipated
2525	resident service needs.
2526	b.  Offer a physical environment that promotes a homelike
2527	setting, provides for resident privacy, promotes resident
2528	independence, and allows sufficient congregate space as defined
2529	by rule.
2530	c.  Have sufficient staff available, taking into account
2531	the physical plant and firesafety features of the building, to
2532	assist with the evacuation of residents in an emergency, as
2533	necessary.
2534	d.  Adopt and follow policies and procedures that maximize
2535	resident independence, dignity, choice, and decisionmaking to
2536	permit residents to age in place to the extent possible, so that
2537	moves due to changes in functional status are minimized or
2538	avoided.
2539	e.  Allow residents or, if applicable, a resident's
2540	representative, designee, surrogate, guardian, or attorney in
2541	fact to make a variety of personal choices, participate in
2542	developing service plans, and share responsibility in
2543	decisionmaking.
2544	f.  Implement the concept of managed risk.
2545	g.  Provide, either directly or through contract, the
2546	services of a person licensed pursuant to part I of chapter 464.
2547	h.  In addition to the training mandated in s. 429.52,
2548	provide specialized training as defined by rule for facility
2549	staff.
2550	4.  Licensees Facilities licensed to provide extended
2551	congregate care services are exempt from the criteria for
2552	continued residency as set forth in rules adopted under s.
2553	429.41. Licensees Facilities so licensed shall adopt their own
2554	requirements within guidelines for continued residency set forth
2555	by rule. However, such licensees facilities may not serve
2556	residents who require 24-hour nursing supervision. Licensees
2557	Facilities licensed to provide extended congregate care services
2558	shall provide each resident with a written copy of facility
2559	policies governing admission and retention.
2560	5.  The primary purpose of extended congregate care
2561	services is to allow residents, as they become more impaired,
2562	the option of remaining in a familiar setting from which they
2563	would otherwise be disqualified for continued residency. A
2564	facility licensed to provide extended congregate care services
2565	may also admit an individual who exceeds the admission criteria
2566	for a facility with a standard license, if the individual is
2567	determined appropriate for admission to the extended congregate
2568	care facility.
2569	6.  Before admission of an individual to a facility
2570	licensed to provide extended congregate care services, the
2571	individual must undergo a medical examination as provided in s.
2572	429.26(4) and the facility must develop a preliminary service
2573	plan for the individual.
2574	7.  When a licensee facility can no longer provide or
2575	arrange for services in accordance with the resident's service
2576	plan and needs and the licensee's facility's policy, the
2577	licensee facility shall make arrangements for relocating the
2578	person in accordance with s. 429.28(1)(k).
2579	8.  Failure to provide extended congregate care services
2580	may result in denial of extended congregate care license
2581	renewal.
2582	9.  No later than January 1 of each year, the department,
2583	in consultation with the agency, shall prepare and submit to the
2584	Governor, the President of the Senate, the Speaker of the House
2585	of Representatives, and the chairs of appropriate legislative
2586	committees, a report on the status of, and recommendations
2587	related to, extended congregate care services. The status report
2588	must include, but need not be limited to, the following
2589	information:
2590	a.  A description of the facilities licensed to provide
2591	such services, including total number of beds licensed under
2592	this part.
2593	b.  The number and characteristics of residents receiving
2594	such services.
2595	c.  The types of services rendered that could not be
2596	provided through a standard license.
2597	d.  An analysis of deficiencies cited during licensure
2598	inspections.
2599	e.  The number of residents who required extended
2600	congregate care services at admission and the source of
2601	admission.
2602	f.  Recommendations for statutory or regulatory changes.
2603	g.  The availability of extended congregate care to state
2604	clients residing in facilities licensed under this part and in
2605	need of additional services, and recommendations for
2606	appropriations to subsidize extended congregate care services
2607	for such persons.
2608	h.  Such other information as the department considers
2609	appropriate.
2610	(c)  A limited nursing services license shall be issued to
2611	a facility that provides services beyond those authorized in
2612	paragraph (a) and as specified in this paragraph.
2613	1.  In order for limited nursing services to be provided in
2614	a facility licensed under this part, the agency must first
2615	determine that all requirements established in law and rule are
2616	met and must specifically designate, on the facility's license,
2617	that such services may be provided. Such designation may be made
2618	at the time of initial licensure or relicensure, or upon request
2619	in writing by a licensee under this part and part II of chapter
2620	408. Notification of approval or denial of such request shall be
2621	made in accordance with part II of chapter 408. Existing
2622	facilities qualifying to provide limited nursing services shall
2623	have maintained a standard license and may not have been subject
2624	to administrative sanctions that affect the health, safety, and
2625	welfare of residents for the previous 2 years or since initial
2626	licensure if the facility has been licensed for less than 2
2627	years.
2628	2.  Facilities that are licensed to provide limited nursing
2629	services shall maintain a written progress report on each person
2630	who receives such nursing services, which report describes the
2631	type, amount, duration, scope, and outcome of services that are
2632	rendered and the general status of the resident's health. A
2633	registered nurse representing the agency shall visit such
2634	facilities at least twice a year to monitor residents who are
2635	receiving limited nursing services and to determine if the
2636	facility is in compliance with applicable provisions of this
2637	part, part II of chapter 408, and related rules. The monitoring
2638	visits may be provided through contractual arrangements with
2639	appropriate community agencies. A registered nurse shall also
2640	serve as part of the team that inspects such facility.
2641	3.  A person who receives limited nursing services under
2642	this part must meet the admission criteria established by the
2643	agency for assisted living facilities. When a resident no longer
2644	meets the admission criteria for a facility licensed under this
2645	part, arrangements for relocating the person shall be made in
2646	accordance with s. 429.28(1)(k), unless the facility is licensed
2647	to provide extended congregate care services.
2648	(4)  In accordance with s. 408.805, an applicant or
2649	licensee shall pay a fee for each license application submitted
2650	under this part, part II of chapter 408, and applicable rules.
2651	The amount of the fee shall be established by rule.
2652	(a)  The biennial license fee required of a facility is
2653	$356 $300 per license, with an additional fee of $67.50 $50 per
2654	resident based on the total licensed resident capacity of the
2655	facility, except that no additional fee will be assessed for
2656	beds designated for recipients of optional state supplementation
2657	payments provided for in s. 409.212. The total fee may not
2658	exceed $18,000 $10,000.
2659	(b)  In addition to the total fee assessed under paragraph
2660	(a), the agency shall require facilities that are licensed to
2661	provide extended congregate care services under this part to pay
2662	an additional fee per licensed facility. The amount of the
2663	biennial fee shall be $501 $400 per license, with an additional
2664	fee of $10 per resident based on the total licensed resident
2665	capacity of the facility.
2666	(c)  In addition to the total fee assessed under paragraph
2667	(a), the agency shall require facilities that are licensed to
2668	provide limited nursing services under this part to pay an
2669	additional fee per licensed facility. The amount of the biennial
2670	fee shall be $250 per license, with an additional fee of $10 per
2671	resident based on the total licensed resident capacity of the
2672	facility.
2673	(6)  In order to determine whether the facility is
2674	adequately protecting residents' rights as provided in s.
2675	429.28, the biennial survey shall include private informal
2676	conversations with a sample of residents and consultation with
2677	the ombudsman council in the planning and service area in which
2678	the facility is located to discuss residents' experiences within
2679	the facility.
2680	(7)  An assisted living facility that has been cited within
2681	the previous 24-month period for a class I or class II
2682	violation, regardless of the status of any enforcement or
2683	disciplinary action, is subject to periodic unannounced
2684	monitoring to determine if the facility is in compliance with
2685	this part, part II of chapter 408, and applicable rules.
2686	Monitoring may occur through a desk review or an onsite
2687	assessment. If the class I or class II violation relates to
2688	providing or failing to provide nursing care, a registered nurse
2689	must participate in at least two onsite monitoring visits within
2690	a 12-month period.
2691	Section 66.  Subsection (7) of section 429.11, Florida
2692	Statutes, is renumbered as subsection (6), and present
2693	subsection (6) of that section is amended to read:
2694	429.11  Initial application for license; provisional
2695	license.-
2696	(6)  In addition to the license categories available in s.
2697	408.808, a provisional license may be issued to an applicant
2698	making initial application for licensure or making application
2699	for a change of ownership. A provisional license shall be
2700	limited in duration to a specific period of time not to exceed 6
2701	months, as determined by the agency.
2702	Section 67.  Section 429.12, Florida Statutes, is amended
2703	to read:
2704	429.12  Sale or transfer of ownership of a facility.-It is
2705	the intent of the Legislature to protect the rights of the
2706	residents of an assisted living facility when the facility is
2707	sold or the ownership thereof is transferred. Therefore, in
2708	addition to the requirements of part II of chapter 408, whenever
2709	a facility is sold or the ownership thereof is transferred,
2710	including leasing:.
2711	(1)  The transferee shall notify the residents, in writing,
2712	of the change of ownership within 7 days after receipt of the
2713	new license.
2714	(2)  The transferor of a facility the license of which is
2715	denied pending an administrative hearing shall, as a part of the
2716	written change-of-ownership contract, advise the transferee that
2717	a plan of correction must be submitted by the transferee and
2718	approved by the agency at least 7 days before the change of
2719	ownership and that failure to correct the condition which
2720	resulted in the moratorium pursuant to part II of chapter 408 or
2721	denial of licensure is grounds for denial of the transferee's
2722	license.
2723	Section 68.  Paragraphs (b) through (l) of subsection (1)
2724	of section 429.14, Florida Statutes, are redesignated as
2725	paragraphs (a) through (k), respectively, and present paragraph
2726	(a) of subsection (1) and subsections (5) and (6) of that
2727	section are amended to read:
2728	429.14  Administrative penalties.-
2729	(1)  In addition to the requirements of part II of chapter
2730	408, the agency may deny, revoke, and suspend any license issued
2731	under this part and impose an administrative fine in the manner
2732	provided in chapter 120 against a licensee of an assisted living
2733	facility for a violation of any provision of this part, part II
2734	of chapter 408, or applicable rules, or for any of the following
2735	actions by a licensee of an assisted living facility, for the
2736	actions of any person subject to level 2 background screening
2737	under s. 408.809, or for the actions of any facility employee:
2738	(a)  An intentional or negligent act seriously affecting
2739	the health, safety, or welfare of a resident of the facility.
2740	(5)  An action taken by the agency to suspend, deny, or
2741	revoke a facility's license under this part or part II of
2742	chapter 408, in which the agency claims that the facility owner
2743	or an employee of the facility has threatened the health,
2744	safety, or welfare of a resident of the facility shall be heard
2745	by the Division of Administrative Hearings of the Department of
2746	Management Services within 120 days after receipt of the
2747	facility's request for a hearing, unless that time limitation is
2748	waived by both parties. The administrative law judge must render
2749	a decision within 30 days after receipt of a proposed
2750	recommended order.
2751	(6)  The agency shall provide to the Division of Hotels and
2752	Restaurants of the Department of Business and Professional
2753	Regulation, on a monthly basis, a list of those assisted living
2754	facilities that have had their licenses denied, suspended, or
2755	revoked or that are involved in an appellate proceeding pursuant
2756	to s. 120.60 related to the denial, suspension, or revocation of
2757	a license. This information may be provided electronically or
2758	through the agency's Internet website.
2759	Section 69.  Subsections (1), (4), and (5) of section
2760	429.17, Florida Statutes, are amended to read:
2761	429.17  Expiration of license; renewal; conditional
2762	license.-
2763	(1)  Limited nursing, Extended congregate care, and limited
2764	mental health licenses shall expire at the same time as the
2765	facility's standard license, regardless of when issued.
2766	(4)  In addition to the license categories available in s.
2767	408.808, a conditional license may be issued to an applicant for
2768	license renewal if the applicant fails to meet all standards and
2769	requirements for licensure. A conditional license issued under
2770	this subsection shall be limited in duration to a specific
2771	period of time not to exceed 6 months, as determined by the
2772	agency, and shall be accompanied by an agency-approved plan of
2773	correction.
2774	(5)  When an extended congregate care or limited nursing
2775	license is requested during a facility's biennial license
2776	period, the fee shall be prorated in order to permit the
2777	additional license to expire at the end of the biennial license
2778	period. The fee shall be calculated as of the date the
2779	additional license application is received by the agency.
2780	Section 70.  Subsection (7) of section 429.19, Florida
2781	Statutes, is amended to read:
2782	429.19  Violations; imposition of administrative fines;
2783	grounds.-
2784	(7)  In addition to any administrative fines imposed, the
2785	agency may assess a survey or monitoring fee, equal to the
2786	lesser of one half of the facility's biennial license and bed
2787	fee or $500, to cover the cost of conducting initial complaint
2788	investigations that result in the finding of a violation that
2789	was the subject of the complaint or to monitor the health,
2790	safety, or security of residents under s. 429.07(7) monitoring
2791	visits conducted under s. 429.28(3)(c) to verify the correction
2792	of the violations.
2793	Section 71.  Subsections (6) through (10) of section
2794	429.23, Florida Statutes, are renumbered as subsections (5)
2795	through (9), respectively, and present subsection (5) of that
2796	section is amended to read:
2797	429.23  Internal risk management and quality assurance
2798	program; adverse incidents and reporting requirements.-
2799	(5)  Each facility shall report monthly to the agency any
2800	liability claim filed against it. The report must include the
2801	name of the resident, the dates of the incident leading to the
2802	claim, if applicable, and the type of injury or violation of
2803	rights alleged to have occurred. This report is not discoverable
2804	in any civil or administrative action, except in such actions
2805	brought by the agency to enforce the provisions of this part.
2806	Section 72.  Paragraph (a) of subsection (1) and subsection
2807	(2) of section 429.255, Florida Statutes, are amended to read:
2808	429.255  Use of personnel; emergency care.-
2809	(1)(a)  Persons under contract to the facility or, facility
2810	staff, or volunteers, who are licensed according to part I of
2811	chapter 464, or those persons exempt under s. 464.022(1), and
2812	others as defined by rule, may administer medications to
2813	residents, take residents' vital signs, manage individual weekly
2814	pill organizers for residents who self-administer medication,
2815	give prepackaged enemas ordered by a physician, observe
2816	residents, document observations on the appropriate resident's
2817	record, report observations to the resident's physician, and
2818	contract or allow residents or a resident's representative,
2819	designee, surrogate, guardian, or attorney in fact to contract
2820	with a third party, provided residents meet the criteria for
2821	appropriate placement as defined in s. 429.26. Persons under
2822	contract to the facility or facility staff who are licensed
2823	according to part I of chapter 464 may provide limited nursing
2824	services. Nursing assistants certified pursuant to part II of
2825	chapter 464 may take residents' vital signs as directed by a
2826	licensed nurse or physician. The facility is responsible for
2827	maintaining documentation of services provided under this
2828	paragraph as required by rule and ensuring that staff are
2829	adequately trained to monitor residents receiving these
2830	services.
2831	(2)  In facilities licensed to provide extended congregate
2832	care, persons under contract to the facility or, facility staff,
2833	or volunteers, who are licensed according to part I of chapter
2834	464, or those persons exempt under s. 464.022(1), or those
2835	persons certified as nursing assistants pursuant to part II of
2836	chapter 464, may also perform all duties within the scope of
2837	their license or certification, as approved by the facility
2838	administrator and pursuant to this part.
2839	Section 73.  Subsection (3) of section 429.28, Florida
2840	Statutes, is amended to read:
2841	429.28  Resident bill of rights.-
2842	(3)(a)  The agency shall conduct a survey to determine
2843	general compliance with facility standards and compliance with
2844	residents' rights as a prerequisite to initial licensure or
2845	licensure renewal.
2846	(b)  In order to determine whether the facility is
2847	adequately protecting residents' rights, the biennial survey
2848	shall include private informal conversations with a sample of
2849	residents and consultation with the ombudsman council in the
2850	planning and service area in which the facility is located to
2851	discuss residents' experiences within the facility.
2852	(c)  During any calendar year in which no survey is
2853	conducted, the agency shall conduct at least one monitoring
2854	visit of each facility cited in the previous year for a class I
2855	or class II violation, or more than three uncorrected class III
2856	violations.
2857	(d)  The agency may conduct periodic followup inspections
2858	as necessary to monitor the compliance of facilities with a
2859	history of any class I, class II, or class III violations that
2860	threaten the health, safety, or security of residents.
2861	(e)  The agency may conduct complaint investigations as
2862	warranted to investigate any allegations of noncompliance with
2863	requirements required under this part or rules adopted under
2864	this part.
2865	Section 74.  Subsection (2) of section 429.35, Florida
2866	Statutes, is amended to read:
2867	429.35  Maintenance of records; reports.-
2868	(2)  Within 60 days after the date of the biennial
2869	inspection visit required under s. 408.811 or within 30 days
2870	after the date of any interim visit, the agency shall forward
2871	the results of the inspection to the local ombudsman council in
2872	whose planning and service area, as defined in part II of
2873	chapter 400, the facility is located; to at least one public
2874	library or, in the absence of a public library, the county seat
2875	in the county in which the inspected assisted living facility is
2876	located; and, when appropriate, to the district Adult Services
2877	and Mental Health Program Offices. This information may be
2878	provided electronically or through the agency's Internet
2879	website.
2880	Section 75.  Paragraphs (i) and (j) of subsection (1) of
2881	section 429.41, Florida Statutes, are amended to read:
2882	429.41  Rules establishing standards.-
2883	(1)  It is the intent of the Legislature that rules
2884	published and enforced pursuant to this section shall include
2885	criteria by which a reasonable and consistent quality of
2886	resident care and quality of life may be ensured and the results
2887	of such resident care may be demonstrated. Such rules shall also
2888	ensure a safe and sanitary environment that is residential and
2889	noninstitutional in design or nature. It is further intended
2890	that reasonable efforts be made to accommodate the needs and
2891	preferences of residents to enhance the quality of life in a
2892	facility. The agency, in consultation with the department, may
2893	adopt rules to administer the requirements of part II of chapter
2894	408. In order to provide safe and sanitary facilities and the
2895	highest quality of resident care accommodating the needs and
2896	preferences of residents, the department, in consultation with
2897	the agency, the Department of Children and Family Services, and
2898	the Department of Health, shall adopt rules, policies, and
2899	procedures to administer this part, which must include
2900	reasonable and fair minimum standards in relation to:
2901	(i)  Facilities holding an a limited nursing, extended
2902	congregate care, or limited mental health license.
2903	(j)  The establishment of specific criteria to define
2904	appropriateness of resident admission and continued residency in
2905	a facility holding a standard, limited nursing, extended
2906	congregate care, and limited mental health license.
2907	Section 76.  Subsections (1) and (2) of section 429.53,
2908	Florida Statutes, are amended to read:
2909	429.53  Consultation by the agency.-
2910	(1)  The area offices of licensure and certification of the
2911	agency shall provide consultation to the following upon request:
2912	(a)  A licensee of a facility.
2913	(b)  A person interested in obtaining a license to operate
2914	a facility under this part.
2915	(2)  As used in this section, "consultation" includes:
2916	(a)  An explanation of the requirements of this part and
2917	rules adopted pursuant thereto;
2918	(b)  An explanation of the license application and renewal
2919	procedures;
2920	(c)  The provision of a checklist of general local and
2921	state approvals required prior to constructing or developing a
2922	facility and a listing of the types of agencies responsible for
2923	such approvals;
2924	(d)  An explanation of benefits and financial assistance
2925	available to a recipient of supplemental security income
2926	residing in a facility;
2927	(c)(e)  Any other information which the agency deems
2928	necessary to promote compliance with the requirements of this
2929	part; and
2930	(f)  A preconstruction review of a facility to ensure
2931	compliance with agency rules and this part.
2932	Section 77.  Subsections (1) and (2) of section 429.54,
2933	Florida Statutes, are renumbered as subsections (2) and (3),
2934	respectively, and a new subsection (1) is added to that section
2935	to read:
2936	429.54  Collection of information; local subsidy.-
2937	(1)  A facility that is licensed under this part must
2938	report electronically to the agency semiannually data related to
2939	the facility, including, but not limited to, the total number of
2940	residents, the number of residents who are receiving limited
2941	mental health services, the number of residents who are
2942	receiving extended congregate care services, the number of
2943	residents who are receiving limited nursing services, and
2944	professional staffing employed by or under contract with the
2945	licensee to provide resident services. The department, in
2946	consultation with the agency, shall adopt rules to administer
2947	this subsection.
2948	Section 78.  Subsections (1) and (5) of section 429.71,
2949	Florida Statutes, are amended to read:
2950	429.71  Classification of violations deficiencies;
2951	administrative fines.-
2952	(1)  In addition to the requirements of part II of chapter
2953	408 and in addition to any other liability or penalty provided
2954	by law, the agency may impose an administrative fine on a
2955	provider according to the following classification:
2956	(a)  Class I violations are defined in s. 408.813 those
2957	conditions or practices related to the operation and maintenance
2958	of an adult family-care home or to the care of residents which
2959	the agency determines present an imminent danger to the
2960	residents or guests of the facility or a substantial probability
2961	that death or serious physical or emotional harm would result
2962	therefrom. The condition or practice that constitutes a class I
2963	violation must be abated or eliminated within 24 hours, unless a
2964	fixed period, as determined by the agency, is required for
2965	correction. A class I violation deficiency is subject to an
2966	administrative fine in an amount not less than $500 and not
2967	exceeding $1,000 for each violation. A fine may be levied
2968	notwithstanding the correction of the deficiency.
2969	(b)  Class II violations are defined in s. 408.813 those
2970	conditions or practices related to the operation and maintenance
2971	of an adult family-care home or to the care of residents which
2972	the agency determines directly threaten the physical or
2973	emotional health, safety, or security of the residents, other
2974	than class I violations. A class II violation is subject to an
2975	administrative fine in an amount not less than $250 and not
2976	exceeding $500 for each violation. A citation for a class II
2977	violation must specify the time within which the violation is
2978	required to be corrected. If a class II violation is corrected
2979	within the time specified, no civil penalty shall be imposed,
2980	unless it is a repeated offense.
2981	(c)  Class III violations are defined in s. 408.813 those
2982	conditions or practices related to the operation and maintenance
2983	of an adult family-care home or to the care of residents which
2984	the agency determines indirectly or potentially threaten the
2985	physical or emotional health, safety, or security of residents,
2986	other than class I or class II violations. A class III violation
2987	is subject to an administrative fine in an amount not less than
2988	$100 and not exceeding $250 for each violation. A citation for a
2989	class III violation shall specify the time within which the
2990	violation is required to be corrected. If a class III violation
2991	is corrected within the time specified, no civil penalty shall
2992	be imposed, unless it is a repeated violation offense.
2993	(d)  Class IV violations are defined in s. 408.813 those
2994	conditions or occurrences related to the operation and
2995	maintenance of an adult family-care home, or related to the
2996	required reports, forms, or documents, which do not have the
2997	potential of negatively affecting the residents. A provider that
2998	does not correct A class IV violation within the time limit
2999	specified by the agency is subject to an administrative fine in
3000	an amount not less than $50 and not exceeding $100 for each
3001	violation. Any class IV violation that is corrected during the
3002	time the agency survey is conducted will be identified as an
3003	agency finding and not as a violation, unless it is a repeat
3004	violation.
3005	(5)  As an alternative to or in conjunction with an
3006	administrative action against a provider, the agency may request
3007	a plan of corrective action that demonstrates a good faith
3008	effort to remedy each violation by a specific date, subject to
3009	the approval of the agency.
3010	Section 79.  Paragraphs (b) through (e) of subsection (2)
3011	of section 429.911, Florida Statutes, are redesignated as
3012	paragraphs (a) through (d), respectively, and present paragraph
3013	(a) of that subsection is amended to read:
3014	429.911  Denial, suspension, revocation of license;
3015	emergency action; administrative fines; investigations and
3016	inspections.-
3017	(2)  Each of the following actions by the owner of an adult
3018	day care center or by its operator or employee is a ground for
3019	action by the agency against the owner of the center or its
3020	operator or employee:
3021	(a)  An intentional or negligent act materially affecting
3022	the health or safety of center participants.
3023	Section 80.  Section 429.915, Florida Statutes, is amended
3024	to read:
3025	429.915  Conditional license.-In addition to the license
3026	categories available in part II of chapter 408, the agency may
3027	issue a conditional license to an applicant for license renewal
3028	or change of ownership if the applicant fails to meet all
3029	standards and requirements for licensure. A conditional license
3030	issued under this subsection must be limited to a specific
3031	period not exceeding 6 months, as determined by the agency, and
3032	must be accompanied by an approved plan of correction.
3033	Section 81.  Paragraphs (b) and (h) of subsection (3) of
3034	section 430.80, Florida Statutes, are amended to read:
3035	430.80  Implementation of a teaching nursing home pilot
3036	project.-
3037	(3)  To be designated as a teaching nursing home, a nursing
3038	home licensee must, at a minimum:
3039	(b)  Participate in a nationally recognized accreditation
3040	program and hold a valid accreditation, such as the
3041	accreditation awarded by The Joint Commission on Accreditation
3042	of Healthcare Organizations;
3043	(h)  Maintain insurance coverage pursuant to s.
3044	400.141(1)(q)(s) or proof of financial responsibility in a
3045	minimum amount of $750,000. Such proof of financial
3046	responsibility may include:
3047	1.  Maintaining an escrow account consisting of cash or
3048	assets eligible for deposit in accordance with s. 625.52; or
3049	2.  Obtaining and maintaining pursuant to chapter 675 an
3050	unexpired, irrevocable, nontransferable and nonassignable letter
3051	of credit issued by any bank or savings association organized
3052	and existing under the laws of this state or any bank or savings
3053	association organized under the laws of the United States that
3054	has its principal place of business in this state or has a
3055	branch office which is authorized to receive deposits in this
3056	state. The letter of credit shall be used to satisfy the
3057	obligation of the facility to the claimant upon presentment of a
3058	final judgment indicating liability and awarding damages to be
3059	paid by the facility or upon presentment of a settlement
3060	agreement signed by all parties to the agreement when such final
3061	judgment or settlement is a result of a liability claim against
3062	the facility.
3063	Section 82.  Paragraph (a) of subsection (2) of section
3064	440.13, Florida Statutes, is amended to read:
3065	440.13  Medical services and supplies; penalty for
3066	violations; limitations.-
3067	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3068	(a)  Subject to the limitations specified elsewhere in this
3069	chapter, the employer shall furnish to the employee such
3070	medically necessary remedial treatment, care, and attendance for
3071	such period as the nature of the injury or the process of
3072	recovery may require, which is in accordance with established
3073	practice parameters and protocols of treatment as provided for
3074	in this chapter, including medicines, medical supplies, durable
3075	medical equipment, orthoses, prostheses, and other medically
3076	necessary apparatus. Remedial treatment, care, and attendance,
3077	including work-hardening programs or pain-management programs
3078	accredited by the Commission on Accreditation of Rehabilitation
3079	Facilities or The Joint Commission on the Accreditation of
3080	Health Organizations or pain-management programs affiliated with
3081	medical schools, shall be considered as covered treatment only
3082	when such care is given based on a referral by a physician as
3083	defined in this chapter. Medically necessary treatment, care,
3084	and attendance does not include chiropractic services in excess
3085	of 24 treatments or rendered 12 weeks beyond the date of the
3086	initial chiropractic treatment, whichever comes first, unless
3087	the carrier authorizes additional treatment or the employee is
3088	catastrophically injured.
3089
3090	Failure of the carrier to timely comply with this subsection
3091	shall be a violation of this chapter and the carrier shall be
3092	subject to penalties as provided for in s. 440.525.
3093	Section 83.  Section 483.294, Florida Statutes, is amended
3094	to read:
3095	483.294  Inspection of centers.-In accordance with s.
3096	408.811, the agency shall biennially, at least once annually,
3097	inspect the premises and operations of all centers subject to
3098	licensure under this part.
3099	Section 84.  Paragraph (a) of subsection (53) of section
3100	499.003, Florida Statutes, is amended to read:
3101	499.003  Definitions of terms used in this part.-As used in
3102	this part, the term:
3103	(53)  "Wholesale distribution" means distribution of
3104	prescription drugs to persons other than a consumer or patient,
3105	but does not include:
3106	(a)  Any of the following activities, which is not a
3107	violation of s. 499.005(21) if such activity is conducted in
3108	accordance with s. 499.01(2)(g):
3109	1.  The purchase or other acquisition by a hospital or
3110	other health care entity that is a member of a group purchasing
3111	organization of a prescription drug for its own use from the
3112	group purchasing organization or from other hospitals or health
3113	care entities that are members of that organization.
3114	2.  The sale, purchase, or trade of a prescription drug or
3115	an offer to sell, purchase, or trade a prescription drug by a
3116	charitable organization described in s. 501(c)(3) of the
3117	Internal Revenue Code of 1986, as amended and revised, to a
3118	nonprofit affiliate of the organization to the extent otherwise
3119	permitted by law.
3120	3.  The sale, purchase, or trade of a prescription drug or
3121	an offer to sell, purchase, or trade a prescription drug among
3122	hospitals or other health care entities that are under common
3123	control. For purposes of this subparagraph, "common control"
3124	means the power to direct or cause the direction of the
3125	management and policies of a person or an organization, whether
3126	by ownership of stock, by voting rights, by contract, or
3127	otherwise.
3128	4.  The sale, purchase, trade, or other transfer of a
3129	prescription drug from or for any federal, state, or local
3130	government agency or any entity eligible to purchase
3131	prescription drugs at public health services prices pursuant to
3132	Pub. L. No. 102-585, s. 602 to a contract provider or its
3133	subcontractor for eligible patients of the agency or entity
3134	under the following conditions:
3135	a.  The agency or entity must obtain written authorization
3136	for the sale, purchase, trade, or other transfer of a
3137	prescription drug under this subparagraph from the State Surgeon
3138	General or his or her designee.
3139	b.  The contract provider or subcontractor must be
3140	authorized by law to administer or dispense prescription drugs.
3141	c.  In the case of a subcontractor, the agency or entity
3142	must be a party to and execute the subcontract.
3143	d.  A contract provider or subcontractor must maintain
3144	separate and apart from other prescription drug inventory any
3145	prescription drugs of the agency or entity in its possession.
3146	d.e.  The contract provider and subcontractor must maintain
3147	and produce immediately for inspection all records of movement
3148	or transfer of all the prescription drugs belonging to the
3149	agency or entity, including, but not limited to, the records of
3150	receipt and disposition of prescription drugs. Each contractor
3151	and subcontractor dispensing or administering these drugs must
3152	maintain and produce records documenting the dispensing or
3153	administration. Records that are required to be maintained
3154	include, but are not limited to, a perpetual inventory itemizing
3155	drugs received and drugs dispensed by prescription number or
3156	administered by patient identifier, which must be submitted to
3157	the agency or entity quarterly.
3158	e.f.  The contract provider or subcontractor may administer
3159	or dispense the prescription drugs only to the eligible patients
3160	of the agency or entity or must return the prescription drugs
3161	for or to the agency or entity. The contract provider or
3162	subcontractor must require proof from each person seeking to
3163	fill a prescription or obtain treatment that the person is an
3164	eligible patient of the agency or entity and must, at a minimum,
3165	maintain a copy of this proof as part of the records of the
3166	contractor or subcontractor required under sub-subparagraph d.
3167	e.
3168	f.g.  In addition to the departmental inspection authority
3169	set forth in s. 499.051, the establishment of the contract
3170	provider and subcontractor and all records pertaining to
3171	prescription drugs subject to this subparagraph shall be subject
3172	to inspection by the agency or entity. All records relating to
3173	prescription drugs of a manufacturer under this subparagraph
3174	shall be subject to audit by the manufacturer of those drugs,
3175	without identifying individual patient information.
3176	Section 85.  Paragraph (i) is added to subsection (3) of
3177	section 499.01212, Florida Statutes, to read:
3178	499.01212  Pedigree paper.-
3179	(3)  EXCEPTIONS.-A pedigree paper is not required for:
3180	(i)  The wholesale distribution of prescription drugs
3181	contained within a sealed medical convenience kit if the kit:
3182	1.  Is assembled in an establishment that is registered as
3183	a medical device manufacturer with the Food and Drug
3184	Administration; and
3185	2.  Does not contain any controlled substance that appears
3186	in any schedule contained in or subject to chapter 893 or the
3187	federal Comprehensive Drug Abuse Prevention and Control Act of
3188	1970.
3189	Section 86.  Subsection (1) of section 627.645, Florida
3190	Statutes, is amended to read:
3191	627.645  Denial of health insurance claims restricted.-
3192	(1)  No claim for payment under a health insurance policy
3193	or self-insured program of health benefits for treatment, care,
3194	or services in a licensed hospital which is accredited by The
3195	Joint Commission on the Accreditation of Hospitals, the American
3196	Osteopathic Association, or the Commission on the Accreditation
3197	of Rehabilitative Facilities shall be denied because such
3198	hospital lacks major surgical facilities and is primarily of a
3199	rehabilitative nature, if such rehabilitation is specifically
3200	for treatment of physical disability.
3201	Section 87.  Paragraph (c) of subsection (2) of section
3202	627.668, Florida Statutes, is amended to read:
3203	627.668  Optional coverage for mental and nervous disorders
3204	required; exception.-
3205	(2)  Under group policies or contracts, inpatient hospital
3206	benefits, partial hospitalization benefits, and outpatient
3207	benefits consisting of durational limits, dollar amounts,
3208	deductibles, and coinsurance factors shall not be less favorable
3209	than for physical illness generally, except that:
3210	(c)  Partial hospitalization benefits shall be provided
3211	under the direction of a licensed physician. For purposes of
3212	this part, the term "partial hospitalization services" is
3213	defined as those services offered by a program accredited by The
3214	Joint Commission on Accreditation of Hospitals (JCAH) or in
3215	compliance with equivalent standards. Alcohol rehabilitation
3216	programs accredited by The Joint Commission on Accreditation of
3217	Hospitals or approved by the state and licensed drug abuse
3218	rehabilitation programs shall also be qualified providers under
3219	this section. In any benefit year, if partial hospitalization
3220	services or a combination of inpatient and partial
3221	hospitalization are utilized, the total benefits paid for all
3222	such services shall not exceed the cost of 30 days of inpatient
3223	hospitalization for psychiatric services, including physician
3224	fees, which prevail in the community in which the partial
3225	hospitalization services are rendered. If partial
3226	hospitalization services benefits are provided beyond the limits
3227	set forth in this paragraph, the durational limits, dollar
3228	amounts, and coinsurance factors thereof need not be the same as
3229	those applicable to physical illness generally.
3230	Section 88.  Subsection (3) of section 627.669, Florida
3231	Statutes, is amended to read:
3232	627.669  Optional coverage required for substance abuse
3233	impaired persons; exception.-
3234	(3)  The benefits provided under this section shall be
3235	applicable only if treatment is provided by, or under the
3236	supervision of, or is prescribed by, a licensed physician or
3237	licensed psychologist and if services are provided in a program
3238	accredited by The Joint Commission on Accreditation of Hospitals
3239	or approved by the state.
3240	Section 89.  Paragraph (a) of subsection (1) of section
3241	627.736, Florida Statutes, is amended to read:
3242	627.736  Required personal injury protection benefits;
3243	exclusions; priority; claims.-
3244	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3245	with the security requirements of s. 627.733 shall provide
3246	personal injury protection to the named insured, relatives
3247	residing in the same household, persons operating the insured
3248	motor vehicle, passengers in such motor vehicle, and other
3249	persons struck by such motor vehicle and suffering bodily injury
3250	while not an occupant of a self-propelled vehicle, subject to
3251	the provisions of subsection (2) and paragraph (4)(e), to a
3252	limit of $10,000 for loss sustained by any such person as a
3253	result of bodily injury, sickness, disease, or death arising out
3254	of the ownership, maintenance, or use of a motor vehicle as
3255	follows:
3256	(a)  Medical benefits.-Eighty percent of all reasonable
3257	expenses for medically necessary medical, surgical, X-ray,
3258	dental, and rehabilitative services, including prosthetic
3259	devices, and medically necessary ambulance, hospital, and
3260	nursing services. However, the medical benefits shall provide
3261	reimbursement only for such services and care that are lawfully
3262	provided, supervised, ordered, or prescribed by a physician
3263	licensed under chapter 458 or chapter 459, a dentist licensed
3264	under chapter 466, or a chiropractic physician licensed under
3265	chapter 460 or that are provided by any of the following persons
3266	or entities:
3267	1.  A hospital or ambulatory surgical center licensed under
3268	chapter 395.
3269	2.  A person or entity licensed under ss. 401.2101-401.45
3270	that provides emergency transportation and treatment.
3271	3.  An entity wholly owned by one or more physicians
3272	licensed under chapter 458 or chapter 459, chiropractic
3273	physicians licensed under chapter 460, or dentists licensed
3274	under chapter 466 or by such practitioner or practitioners and
3275	the spouse, parent, child, or sibling of that practitioner or
3276	those practitioners.
3277	4.  An entity wholly owned, directly or indirectly, by a
3278	hospital or hospitals.
3279	5.  A health care clinic licensed under ss. 400.990-400.995
3280	that is:
3281	a.  Accredited by The Joint Commission on Accreditation of
3282	Healthcare Organizations, the American Osteopathic Association,
3283	the Commission on Accreditation of Rehabilitation Facilities, or
3284	the Accreditation Association for Ambulatory Health Care, Inc.;
3285	or
3286	b.  A health care clinic that:
3287	(I)  Has a medical director licensed under chapter 458,
3288	chapter 459, or chapter 460;
3289	(II)  Has been continuously licensed for more than 3 years
3290	or is a publicly traded corporation that issues securities
3291	traded on an exchange registered with the United States
3292	Securities and Exchange Commission as a national securities
3293	exchange; and
3294	(III)  Provides at least four of the following medical
3295	specialties:
3296	(A)  General medicine.
3297	(B)  Radiography.
3298	(C)  Orthopedic medicine.
3299	(D)  Physical medicine.
3300	(E)  Physical therapy.
3301	(F)  Physical rehabilitation.
3302	(G)  Prescribing or dispensing outpatient prescription
3303	medication.
3304	(H)  Laboratory services.
3305
3306	The Financial Services Commission shall adopt by rule the form
3307	that must be used by an insurer and a health care provider
3308	specified in subparagraph 3., subparagraph 4., or subparagraph
3309	5. to document that the health care provider meets the criteria
3310	of this paragraph, which rule must include a requirement for a
3311	sworn statement or affidavit.
3312
3313	Only insurers writing motor vehicle liability insurance in this
3314	state may provide the required benefits of this section, and no
3315	such insurer shall require the purchase of any other motor
3316	vehicle coverage other than the purchase of property damage
3317	liability coverage as required by s. 627.7275 as a condition for
3318	providing such required benefits. Insurers may not require that
3319	property damage liability insurance in an amount greater than
3320	$10,000 be purchased in conjunction with personal injury
3321	protection. Such insurers shall make benefits and required
3322	property damage liability insurance coverage available through
3323	normal marketing channels. Any insurer writing motor vehicle
3324	liability insurance in this state who fails to comply with such
3325	availability requirement as a general business practice shall be
3326	deemed to have violated part IX of chapter 626, and such
3327	violation shall constitute an unfair method of competition or an
3328	unfair or deceptive act or practice involving the business of
3329	insurance; and any such insurer committing such violation shall
3330	be subject to the penalties afforded in such part, as well as
3331	those which may be afforded elsewhere in the insurance code.
3332	Section 90.  Section 633.081, Florida Statutes, is amended
3333	to read:
3334	633.081  Inspection of buildings and equipment; orders;
3335	firesafety inspection training requirements; certification;
3336	disciplinary action.-The State Fire Marshal and her or his
3337	agents shall, at any reasonable hour, when the department has
3338	reasonable cause to believe that a violation of this chapter or
3339	s. 509.215, or a rule promulgated thereunder, or a minimum
3340	firesafety code adopted by a local authority, may exist, inspect
3341	any and all buildings and structures which are subject to the
3342	requirements of this chapter or s. 509.215 and rules promulgated
3343	thereunder. The authority to inspect shall extend to all
3344	equipment, vehicles, and chemicals which are located within the
3345	premises of any such building or structure. The State Fire
3346	Marshal and her or his agents shall inspect nursing homes
3347	licensed under part II of chapter 400 only once every calendar
3348	year and upon receiving a complaint forming the basis of a
3349	reasonable cause to believe that a violation of this chapter or
3350	s. 509.215, or a rule promulgated thereunder, or a minimum
3351	firesafety code adopted by a local authority may exist and upon
3352	identifying such a violation in the course of conducting
3353	orientation or training activities within a nursing home.
3354	(1)  Each county, municipality, and special district that
3355	has firesafety enforcement responsibilities shall employ or
3356	contract with a firesafety inspector. The firesafety inspector
3357	must conduct all firesafety inspections that are required by
3358	law. The governing body of a county, municipality, or special
3359	district that has firesafety enforcement responsibilities may
3360	provide a schedule of fees to pay only the costs of inspections
3361	conducted pursuant to this subsection and related administrative
3362	expenses. Two or more counties, municipalities, or special
3363	districts that have firesafety enforcement responsibilities may
3364	jointly employ or contract with a firesafety inspector.
3365	(2)  Every firesafety inspection conducted pursuant to
3366	state or local firesafety requirements shall be by a person
3367	certified as having met the inspection training requirements set
3368	by the State Fire Marshal. Such person shall:
3369	(a)  Be a high school graduate or the equivalent as
3370	determined by the department;
3371	(b)  Not have been found guilty of, or having pleaded
3372	guilty or nolo contendere to, a felony or a crime punishable by
3373	imprisonment of 1 year or more under the law of the United
3374	States, or of any state thereof, which involves moral turpitude,
3375	without regard to whether a judgment of conviction has been
3376	entered by the court having jurisdiction of such cases;
3377	(c)  Have her or his fingerprints on file with the
3378	department or with an agency designated by the department;
3379	(d)  Have good moral character as determined by the
3380	department;
3381	(e)  Be at least 18 years of age;
3382	(f)  Have satisfactorily completed the firesafety inspector
3383	certification examination as prescribed by the department; and
3384	(g)1.  Have satisfactorily completed, as determined by the
3385	department, a firesafety inspector training program of not less
3386	than 200 hours established by the department and administered by
3387	agencies and institutions approved by the department for the
3388	purpose of providing basic certification training for firesafety
3389	inspectors; or
3390	2.  Have received in another state training which is
3391	determined by the department to be at least equivalent to that
3392	required by the department for approved firesafety inspector
3393	education and training programs in this state.
3394	(3)  Each special state firesafety inspection which is
3395	required by law and is conducted by or on behalf of an agency of
3396	the state must be performed by an individual who has met the
3397	provision of subsection (2), except that the duration of the
3398	training program shall not exceed 120 hours of specific training
3399	for the type of property that such special state firesafety
3400	inspectors are assigned to inspect.
3401	(4)  A firefighter certified pursuant to s. 633.35 may
3402	conduct firesafety inspections, under the supervision of a
3403	certified firesafety inspector, while on duty as a member of a
3404	fire department company conducting inservice firesafety
3405	inspections without being certified as a firesafety inspector,
3406	if such firefighter has satisfactorily completed an inservice
3407	fire department company inspector training program of at least
3408	24 hours' duration as provided by rule of the department.
3409	(5)  Every firesafety inspector or special state firesafety
3410	inspector certificate is valid for a period of 3 years from the
3411	date of issuance. Renewal of certification shall be subject to
3412	the affected person's completing proper application for renewal
3413	and meeting all of the requirements for renewal as established
3414	under this chapter or by rule promulgated thereunder, which
3415	shall include completion of at least 40 hours during the
3416	preceding 3-year period of continuing education as required by
3417	the rule of the department or, in lieu thereof, successful
3418	passage of an examination as established by the department.
3419	(6)  The State Fire Marshal may deny, refuse to renew,
3420	suspend, or revoke the certificate of a firesafety inspector or
3421	special state firesafety inspector if it finds that any of the
3422	following grounds exist:
3423	(a)  Any cause for which issuance of a certificate could
3424	have been refused had it then existed and been known to the
3425	State Fire Marshal.
3426	(b)  Violation of this chapter or any rule or order of the
3427	State Fire Marshal.
3428	(c)  Falsification of records relating to the certificate.
3429	(d)  Having been found guilty of or having pleaded guilty
3430	or nolo contendere to a felony, whether or not a judgment of
3431	conviction has been entered.
3432	(e)  Failure to meet any of the renewal requirements.
3433	(f)  Having been convicted of a crime in any jurisdiction
3434	which directly relates to the practice of fire code inspection,
3435	plan review, or administration.
3436	(g)  Making or filing a report or record that the
3437	certificateholder knows to be false, or knowingly inducing
3438	another to file a false report or record, or knowingly failing
3439	to file a report or record required by state or local law, or
3440	knowingly impeding or obstructing such filing, or knowingly
3441	inducing another person to impede or obstruct such filing.
3442	(h)  Failing to properly enforce applicable fire codes or
3443	permit requirements within this state which the
3444	certificateholder knows are applicable by committing willful
3445	misconduct, gross negligence, gross misconduct, repeated
3446	negligence, or negligence resulting in a significant danger to
3447	life or property.
3448	(i)  Accepting labor, services, or materials at no charge
3449	or at a noncompetitive rate from any person who performs work
3450	that is under the enforcement authority of the certificateholder
3451	and who is not an immediate family member of the
3452	certificateholder. For the purpose of this paragraph, the term
3453	"immediate family member" means a spouse, child, parent,
3454	sibling, grandparent, aunt, uncle, or first cousin of the person
3455	or the person's spouse or any person who resides in the primary
3456	residence of the certificateholder.
3457	(7)  The department shall provide by rule for the
3458	certification of firesafety inspectors.
3459	Section 91.  Subsection (12) of section 641.495, Florida
3460	Statutes, is amended to read:
3461	641.495  Requirements for issuance and maintenance of
3462	certificate.-
3463	(12)  The provisions of part I of chapter 395 do not apply
3464	to a health maintenance organization that, on or before January
3465	1, 1991, provides not more than 10 outpatient holding beds for
3466	short-term and hospice-type patients in an ambulatory care
3467	facility for its members, provided that such health maintenance
3468	organization maintains current accreditation by The Joint
3469	Commission on Accreditation of Health Care Organizations, the
3470	Accreditation Association for Ambulatory Health Care, or the
3471	National Committee for Quality Assurance.
3472	Section 92.  Subsection (13) of section 651.118, Florida
3473	Statutes, is amended to read:
3474	651.118  Agency for Health Care Administration;
3475	certificates of need; sheltered beds; community beds.-
3476	(13)  Residents, as defined in this chapter, are not
3477	considered new admissions for the purpose of s.
3478	400.141(1)(n)(o)1.d.
3479	Section 93.  Subsection (2) of section 766.1015, Florida
3480	Statutes, is amended to read:
3481	766.1015  Civil immunity for members of or consultants to
3482	certain boards, committees, or other entities.-
3483	(2)  Such committee, board, group, commission, or other
3484	entity must be established in accordance with state law or in
3485	accordance with requirements of The Joint Commission on
3486	Accreditation of Healthcare Organizations, established and duly
3487	constituted by one or more public or licensed private hospitals
3488	or behavioral health agencies, or established by a governmental
3489	agency. To be protected by this section, the act, decision,
3490	omission, or utterance may not be made or done in bad faith or
3491	with malicious intent.
3492	Section 94.  Subsection (4) of section 766.202, Florida
3493	Statutes, is amended to read:
3494	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3495	766.201-766.212, the term:
3496	(4)  "Health care provider" means any hospital, ambulatory
3497	surgical center, or mobile surgical facility as defined and
3498	licensed under chapter 395; a birth center licensed under
3499	chapter 383; any person licensed under chapter 458, chapter 459,
3500	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3501	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3502	or chapter 486; a clinical lab licensed under chapter 483; a
3503	health maintenance organization certificated under part I of
3504	chapter 641; a blood bank; a plasma center; an industrial
3505	clinic; a renal dialysis facility; or a professional association
3506	partnership, corporation, joint venture, or other association
3507	for professional activity by health care providers.
3508	Section 95.  This act shall take effect July 1, 2010.

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