CS/CS/CS/HB 1143

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., relating to the Drug-Free Workplace Act; deleting an
4	obsolete provision; amending s. 318.21, F.S.; revising
5	distribution of funds from civil penalties imposed for
6	traffic infractions by county courts; amending s.
7	381.00315, F.S.; directing the Department of Health to
8	accept funds from counties, municipalities, and certain
9	other entities for the purchase of certain products made
10	available under a contract of the United States Department
11	of Health and Human Services for the manufacture and
12	delivery of such products in response to a public health
13	emergency; amending s. 381.0072, F.S.; limiting Department
14	of Health food service inspections in nursing homes;
15	requiring the department to coordinate inspections with
16	the Agency for Health Care Administration; repealing s.
17	383.325, F.S., relating to confidentiality of inspection
18	reports of licensed birth center facilities; amending s.
19	395.002, F.S.; revising and deleting definitions
20	applicable to regulation of hospitals and other licensed
21	facilities; conforming a cross-reference; amending s.
22	395.003, F.S.; deleting an obsolete provision; conforming
23	a cross-reference; amending s. 395.0193, F.S.; requiring a
24	licensed facility to report certain peer review
25	information and final disciplinary actions to the Division
26	of Medical Quality Assurance of the Department of Health
27	rather than the Division of Health Quality Assurance of
28	the Agency for Health Care Administration; amending s.
29	395.1023, F.S.; providing for the Department of Children
30	and Family Services rather than the Department of Health
31	to perform certain functions with respect to child
32	protection cases; requiring certain hospitals to notify
33	the Department of Children and Family Services of
34	compliance; amending s. 395.1041, F.S., relating to
35	hospital emergency services and care; deleting obsolete
36	provisions; repealing s. 395.1046, F.S., relating to
37	complaint investigation procedures; amending s. 395.1055,
38	F.S.; requiring licensed facility beds to conform to
39	standards specified by the Agency for Health Care
40	Administration, the Florida Building Code, and the Florida
41	Fire Prevention Code; amending s. 395.10972, F.S.;
42	revising a reference to the Florida Society of Healthcare
43	Risk Management to conform to the current designation;
44	amending s. 395.2050, F.S.; revising a reference to the
45	federal Health Care Financing Administration to conform to
46	the current designation; amending s. 395.3036, F.S.;
47	correcting a reference; repealing s. 395.3037, F.S.,
48	relating to redundant definitions; amending ss. 154.11,
49	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
50	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
51	F.S.; revising references to the Joint Commission on
52	Accreditation of Healthcare Organizations, the Commission
53	on Accreditation of Rehabilitation Facilities, and the
54	Council on Accreditation to conform to their current
55	designations; amending s. 395.602, F.S.; revising the
56	definition of the term "rural hospital" to delete an
57	obsolete provision; amending s. 400.021, F.S.; revising
58	the definition of the term "geriatric outpatient clinic";
59	amending s. 400.0255, F.S.; correcting an obsolete cross-
60	reference to administrative rules; amending s. 400.063,
61	F.S.; deleting an obsolete provision; amending ss. 400.071
62	and 400.0712, F.S.; revising applicability of general
63	licensure requirements under part II of ch. 408, F.S., to
64	applications for nursing home licensure; revising
65	provisions governing inactive licenses; amending s.
66	400.111, F.S.; providing for disclosure of controlling
67	interest of a nursing home facility upon request by the
68	Agency for Health Care Administration; amending s.
69	400.1183, F.S.; revising grievance record maintenance and
70	reporting requirements for nursing homes; amending s.
71	400.141, F.S.; providing criteria for the provision of
72	respite services by nursing homes; requiring a written
73	plan of care; requiring a contract for services; requiring
74	resident release to caregivers to be designated in
75	writing; providing an exemption to the application of
76	discharge planning rules; providing for residents' rights;
77	providing for use of personal medications; providing terms
78	of respite stay; providing for communication of patient
79	information; requiring a physician order for care and
80	proof of a physical examination; providing for services
81	for respite patients and duties of facilities with respect
82	to such 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. 400.915, F.S.;
118	correcting an obsolete cross-reference to administrative
119	rules; amending s. 400.931, F.S.; deleting a requirement
120	that an applicant for a home medical equipment provider
121	license submit a surety bond to the agency; amending s.
122	400.932, F.S.; revising grounds for the imposition of
123	administrative penalties for certain violations by an
124	employee of a home medical equipment provider; amending s.
125	400.967, F.S.; revising the schedule of inspection
126	violations for intermediate care facilities for the
127	developmentally disabled; providing a penalty for certain
128	violations; amending s. 400.9905, F.S.; providing that
129	part X of ch, 400, F.S., the Health Care Clinic Act, does
130	not apply to an entity owned by a corporation with a
131	specified amount of annual sales of health care services
132	under certain circumstances or to an entity owned or
133	controlled by a publicly traded entity with a specified
134	amount of annual revenues; amending s. 400.991, F.S.;
135	conforming terminology; revising application requirements
136	relating to documentation of financial ability to operate
137	a mobile clinic; amending s. 408.034, F.S.; revising
138	agency authority relating to licensing of intermediate
139	care facilities for the developmentally disabled; amending
140	s. 408.036, F.S.; deleting an exemption from certain
141	certificate-of-need review requirements for a hospice or a
142	hospice inpatient facility; amending s. 408.043, F.S.;
143	revising requirements for certain freestanding inpatient
144	hospice care facilities to obtain a certificate of need;
145	amending s. 408.061, F.S.; revising health care facility
146	data reporting requirements; amending s. 408.10, F.S.;
147	removing agency authority to investigate certain consumer
148	complaints; amending s. 408.802, F.S.; removing
149	applicability of part II of ch. 408, F.S., relating to
150	general licensure requirements, to private review agents;
151	amending s. 408.804, F.S.; providing penalties for
152	altering, defacing, or falsifying a license certificate
153	issued by the agency or displaying such an altered,
154	defaced, or falsified certificate; amending s. 408.806,
155	F.S.; revising agency responsibilities for notification of
156	licensees of impending expiration of a license; requiring
157	payment of a late fee for a license application to be
158	considered complete under certain circumstances; amending
159	s. 408.810, F.S.; revising provisions relating to
160	information required for licensure; requiring proof of
161	submission of notice to a mortgagor or landlord regarding
162	provision of services requiring licensure; requiring
163	disclosure of information by a controlling interest of
164	certain court actions relating to financial instability
165	within a specified time period; amending s. 408.813, F.S.;
166	authorizing the agency to impose fines for unclassified
167	violations of part II of ch. 408, F.S.; amending s.
168	408.815, F.S.; authorizing the agency to extend a license
169	expiration date under certain circumstances; amending s.
170	409.221, F.S.; deleting a reporting requirement relating
171	to the consumer-directed care program; amending s.
172	409.91196, F.S.; conforming a cross-reference; amending s.
173	409.912, F.S.; revising procedures for implementation of a
174	Medicaid prescribed-drug spending-control program;
175	amending s. 429.07, F.S.; deleting the requirement for an
176	assisted living facility to obtain an additional license
177	in order to provide limited nursing services; deleting the
178	requirement for the agency to conduct quarterly monitoring
179	visits of facilities that hold a license to provide
180	extended congregate care services; deleting the
181	requirement for the department to report annually on the
182	status of and recommendations related to extended
183	congregate care; deleting the requirement for the agency
184	to conduct monitoring visits at least twice a year to
185	facilities providing limited nursing services; increasing
186	the licensure fees and the maximum fee required for the
187	standard license; increasing the licensure fees for the
188	extended congregate care license; eliminating the license
189	fee for the limited nursing services license; transferring
190	from another provision of law the requirement that a
191	biennial survey of an assisted living facility include
192	specific actions to determine whether the facility is
193	adequately protecting residents' rights; providing that an
194	assisted living facility that has a class I or class II
195	violation is subject to monitoring visits; requiring a
196	registered nurse to participate in certain monitoring
197	visits; amending s. 429.11, F.S.; revising licensure
198	application requirements for assisted living facilities to
199	eliminate provisional licenses; amending s. 429.12, F.S.;
200	revising notification requirements for the sale or
201	transfer of ownership of an assisted living facility;
202	amending s. 429.14, F.S.; removing a ground for the
203	imposition of an administrative penalty; clarifying
204	provisions relating to a facility's request for a hearing
205	under certain circumstances; authorizing the agency to
206	provide certain information relating to the licensure
207	status of assisted living facilities electronically or
208	through the agency's Internet website; amending s. 429.17,
209	F.S.; deleting provisions relating to the limited nursing
210	services license; revising agency responsibilities
211	regarding the issuance of conditional licenses; amending
212	s. 429.19, F.S.; clarifying that a monitoring fee may be
213	assessed in addition to an administrative fine; amending
214	s. 429.23, F.S.; deleting reporting requirements for
215	assisted living facilities relating to liability claims;
216	amending s. 429.255, F.S.; eliminating provisions
217	authorizing the use of volunteers to provide certain
218	health-care-related services in assisted living
219	facilities; authorizing assisted living facilities to
220	provide limited nursing services; requiring an assisted
221	living facility to be responsible for certain
222	recordkeeping and staff to be trained to monitor residents
223	receiving certain health-care-related services; amending
224	s. 429.28, F.S.; deleting a requirement for a biennial
225	survey of an assisted living facility, to conform to
226	changes made by the act; amending s. 429.35, F.S.;
227	authorizing the agency to provide certain information
228	relating to the inspections of assisted living facilities
229	electronically or through the agency's Internet website;
230	amending s. 429.41, F.S., relating to rulemaking;
231	conforming provisions to changes made by the act; amending
232	s. 429.53, F.S.; revising provisions relating to
233	consultation by the agency; revising a definition;
234	amending s. 429.54, F.S.; requiring licensed assisted
235	living facilities to electronically report certain data
236	semiannually to the agency in accordance with rules
237	adopted by the department; amending s. 429.71, F.S.;
238	revising schedule of inspection violations for adult
239	family-care homes; amending s. 429.911, F.S.; deleting a
240	ground for agency action against an adult day care center;
241	amending s. 429.915, F.S.; revising agency
242	responsibilities regarding the issuance of conditional
243	licenses; amending s. 483.294, F.S.; revising frequency of
244	agency inspections of multiphasic health testing centers;
245	amending s. 499.003, F.S.; defining the term "medical
246	convenience kit" for purposes of pt. I of ch. 499, F.S.;
247	providing an exception to applicability of the term;
248	removing a requirement that certain prescription drug
249	purchasers maintain a separate inventory of certain
250	prescription drugs; amending s. 499.01212, F.S.; providing
251	an exception to the requirement that a wholesale
252	distributor of prescription drugs provide a pedigree paper
253	to the person who receives the drug for wholesale
254	distribution of prescription drugs contained within a
255	medical convenience kit under specified conditions;
256	providing that the exception does not apply to any kit
257	that contains certain controlled substances; amending s.
258	626.9541, F.S.; authorizing an insurer offering a group or
259	individual health benefit plan to offer a wellness
260	program; authorizing rewards or incentives; providing that
261	such rewards or incentives are not insurance benefits;
262	providing for verification of a member's inability to
263	participate for medical reasons; amending s. 633.081,
264	F.S.; limiting Fire Marshal inspections of nursing homes
265	to once a year; providing for additional inspections based
266	on complaints and violations identified in the course of
267	orientation or training activities; amending s. 766.202,
268	F.S.; adding persons licensed under part XIV of ch. 468,
269	F.S., to the definition of "health care provider";
270	amending ss. 394.4787, 400.0239, 408.07, 430.80, and
271	651.118, F.S.; conforming terminology and cross-
272	references; revising a reference; providing an effective
273	date.
274
275	Be It Enacted by the Legislature of the State of Florida:
276
277	Section 1.  Present paragraph (e) of subsection (10) and
278	paragraph (e) of subsection (14) of section 112.0455, Florida
279	Statutes, are amended, and paragraphs (f) through (k) of
280	subsection (10) of that section are redesignated as paragraphs
281	(e) through (j), respectively, to read:
282	112.0455  Drug-Free Workplace Act.-
283	(10)  EMPLOYER PROTECTION.-
284	(e)  Nothing in this section shall be construed to operate
285	retroactively, and nothing in this section shall abrogate the
286	right of an employer under state law to conduct drug tests prior
287	to January 1, 1990. A drug test conducted by an employer prior
288	to January 1, 1990, is not subject to this section.
289	(14)  DISCIPLINE REMEDIES.-
290	(e)  Upon resolving an appeal filed pursuant to paragraph
291	(c), and finding a violation of this section, the commission may
292	order the following relief:
293	1.  Rescind the disciplinary action, expunge related
294	records from the personnel file of the employee or job applicant
295	and reinstate the employee.
296	2.  Order compliance with paragraph (10)(f)(g).
297	3.  Award back pay and benefits.
298	4.  Award the prevailing employee or job applicant the
299	necessary costs of the appeal, reasonable attorney's fees, and
300	expert witness fees.
301	Section 2.  Paragraph (n) of subsection (1) of section
302	154.11, Florida Statutes, is amended to read:
303	154.11  Powers of board of trustees.-
304	(1)  The board of trustees of each public health trust
305	shall be deemed to exercise a public and essential governmental
306	function of both the state and the county and in furtherance
307	thereof it shall, subject to limitation by the governing body of
308	the county in which such board is located, have all of the
309	powers necessary or convenient to carry out the operation and
310	governance of designated health care facilities, including, but
311	without limiting the generality of, the foregoing:
312	(n)  To appoint originally the staff of physicians to
313	practice in any designated facility owned or operated by the
314	board and to approve the bylaws and rules to be adopted by the
315	medical staff of any designated facility owned and operated by
316	the board, such governing regulations to be in accordance with
317	the standards of The Joint Commission on the Accreditation of
318	Hospitals which provide, among other things, for the method of
319	appointing additional staff members and for the removal of staff
320	members.
321	Section 3.  Subsection (15) of section 318.21, Florida
322	Statutes, is amended to read:
323	318.21  Disposition of civil penalties by county courts.-
324	All civil penalties received by a county court pursuant to the
325	provisions of this chapter shall be distributed and paid monthly
326	as follows:
327	(15)  Of the additional fine assessed under s. 318.18(3)(e)
328	for a violation of s. 316.1893, 50 percent of the moneys
329	received from the fines shall be remitted to the Department of
330	Revenue and deposited into the Brain and Spinal Cord Injury
331	Trust Fund of Department of Health and shall be appropriated to
332	the Department of Health Agency for Health Care Administration
333	as general revenue to provide an enhanced Medicaid payment to
334	nursing homes that serve Medicaid recipients with spinal cord
335	injuries that are medically complex and who are technologically
336	and respiratory dependent with brain and spinal cord injuries.
337	The remaining 50 percent of the moneys received from
338	enhanced fine imposed under s. 318.18(3)(e) shall be
339	the Department of Revenue and deposited into the
340	Health Administrative Trust Fund to provide financial support to
341	certified trauma centers in the counties where enhanced penalty
342	zones are established to ensure the availability and
343	accessibility of trauma services. Funds deposited into the
344	Administrative Trust Fund under this subsection shall be
345	allocated as follows:
346	(a)  Fifty percent shall be allocated equally among all
347	Level I, Level II, and pediatric trauma centers in recognition
348	of readiness costs for maintaining trauma services.
349	(b)  Fifty percent shall be allocated among Level I, Level
350	II, and pediatric trauma centers based on each center's relative
351	volume of trauma cases as reported in the Department of Health
352	Trauma Registry.
353	Section 4.  Subsection (3) is added to section 381.00315,
354	Florida Statutes, to read:
355	381.00315  Public health advisories; public health
356	emergencies.-The State Health Officer is responsible for
357	declaring public health emergencies and issuing public health
358	advisories.
359	(3)  To facilitate effective emergency management, when the
360	United States Department of Health and Human Services contracts
361	for the manufacture and delivery of licensable products in
362	response to a public health emergency and the terms of those
363	contracts are made available to the states, the department shall
364	accept funds provided by counties, municipalities, and other
365	entities designated in the state emergency management plan
366	required under s. 252.35(2)(a) for the purpose of participation
367	in such contracts. The department shall deposit the funds into
368	the Grants and Donations Trust Fund and expend the funds on
369	behalf of the donor county, municipality, or other entity for
370	the purchase the licensable products made available under the
371	contract.
372	Section 5.  Paragraph (e) is added to subsection (2) of
373	section 381.0072, Florida Statutes, to read:
374	381.0072  Food service protection.-It shall be the duty of
375	the Department of Health to adopt and enforce sanitation rules
376	consistent with law to ensure the protection of the public from
377	food-borne illness. These rules shall provide the standards and
378	requirements for the storage, preparation, serving, or display
379	of food in food service establishments as defined in this
380	section and which are not permitted or licensed under chapter
381	500 or chapter 509.
382	(2)  DUTIES.-
383	(e)  The department shall inspect food service
384	establishments in nursing homes licensed under part II of
385	chapter 400 twice each year. The department may make additional
386	inspections only in response to complaints. The department shall
387	coordinate inspections with the Agency for Health Care
388	Administration, such that the department's inspection is at
389	least 60 days after a recertification visit by the Agency for
390	Health Care Administration.
391	Section 6.  Section 383.325, Florida Statutes, is repealed.
392	Section 7.  Subsection (7) of section 394.4787, Florida
393	Statutes, is amended to read:
394	394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
395	and 394.4789.-As used in this section and ss. 394.4786,
396	394.4788, and 394.4789:
397	(7)  "Specialty psychiatric hospital" means a hospital
398	licensed by the agency pursuant to s. 395.002(26)(28) and part
399	II of chapter 408 as a specialty psychiatric hospital.
400	Section 8.  Subsection (2) of section 394.741, Florida
401	Statutes, is amended to read:
402	394.741  Accreditation requirements for providers of
403	behavioral health care services.-
404	(2)  Notwithstanding any provision of law to the contrary,
405	accreditation shall be accepted by the agency and department in
406	lieu of the agency's and department's facility licensure onsite
407	review requirements and shall be accepted as a substitute for
408	the department's administrative and program monitoring
409	requirements, except as required by subsections (3) and (4),
410	for:
411	(a)  Any organization from which the department purchases
412	behavioral health care services that is accredited by The Joint
413	Commission on Accreditation of Healthcare Organizations or the
414	Council on Accreditation for Children and Family Services, or
415	has those services that are being purchased by the department
416	accredited by the Commission on Accreditation of Rehabilitation
417	Facilities CARF-the Rehabilitation Accreditation Commission.
418	(b)  Any mental health facility licensed by the agency or
419	any substance abuse component licensed by the department that is
420	accredited by The Joint Commission on Accreditation of
421	Healthcare Organizations, the Commission on Accreditation of
422	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
423	Commission, or the Council on Accreditation of Children and
424	Family Services.
425	(c)  Any network of providers from which the department or
426	the agency purchases behavioral health care services accredited
427	by The Joint Commission on Accreditation of Healthcare
428	Organizations, the Commission on Accreditation of Rehabilitation
429	Facilities CARF-the Rehabilitation Accreditation Commission, the
430	Council on Accreditation of Children and Family Services, or the
431	National Committee for Quality Assurance. A provider
432	organization, which is part of an accredited network, is
433	afforded the same rights under this part.
434	Section 9.  Present subsections (15) through (32) of
435	section 395.002, Florida Statutes, are renumbered as subsections
436	(14) through (28), respectively, and present subsections (1),
437	(14), (24), (30), and (31), and paragraph (c) of present
438	subsection (28) of that section are amended to read:
439	395.002  Definitions.-As used in this chapter:
440	(1)  "Accrediting organizations" means nationally
441	recognized or approved accrediting organizations whose standards
442	incorporate comparable licensure requirements as determined by
443	the agency the Joint Commission on Accreditation of Healthcare
444	Organizations, the American Osteopathic Association, the
445	Commission on Accreditation of Rehabilitation Facilities, and
446	the Accreditation Association for Ambulatory Health Care, Inc.
447	(14)  "Initial denial determination" means a determination
448	by a private review agent that the health care services
449	furnished or proposed to be furnished to a patient are
450	inappropriate, not medically necessary, or not reasonable.
451	(24)  "Private review agent" means any person or entity
452	which performs utilization review services for third-party
453	payors on a contractual basis for outpatient or inpatient
454	services. However, the term shall not include full-time
455	employees, personnel, or staff of health insurers, health
456	maintenance organizations, or hospitals, or wholly owned
457	subsidiaries thereof or affiliates under common ownership, when
458	performing utilization review for their respective hospitals,
459	health maintenance organizations, or insureds of the same
460	insurance group. For this purpose, health insurers, health
461	maintenance organizations, and hospitals, or wholly owned
462	subsidiaries thereof or affiliates under common ownership,
463	include such entities engaged as administrators of self-
464	insurance as defined in s. 624.031.
465	(26)(28)  "Specialty hospital" means any facility which
466	meets the provisions of subsection (12), and which regularly
467	makes available either:
468	(c)  Intensive residential treatment programs for children
469	and adolescents as defined in subsection (14) (15).
470	(30)  "Utilization review" means a system for reviewing the
471	medical necessity or appropriateness in the allocation of health
472	care resources of hospital services given or proposed to be
473	given to a patient or group of patients.
474	(31)  "Utilization review plan" means a description of the
475	policies and procedures governing utilization review activities
476	performed by a private review agent.
477	Section 10.  Paragraph (c) of subsection (1) and paragraph
478	(b) of subsection (2) of section 395.003, Florida Statutes, are
479	amended to read:
480	395.003  Licensure; denial, suspension, and revocation.-
481	(1)
482	(c)  Until July 1, 2006, additional emergency departments
483	located off the premises of licensed hospitals may not be
484	authorized by the agency.
485	(2)
486	(b)  The agency shall, at the request of a licensee that is
487	a teaching hospital as defined in s. 408.07(45), issue a single
488	license to a licensee for facilities that have been previously
489	licensed as separate premises, provided such separately licensed
490	facilities, taken together, constitute the same premises as
491	defined in s. 395.002(22)(23). Such license for the single
492	premises shall include all of the beds, services, and programs
493	that were previously included on the licenses for the separate
494	premises. The granting of a single license under this paragraph
495	shall not in any manner reduce the number of beds, services, or
496	programs operated by the licensee.
497	Section 11.  Paragraph (e) of subsection (2) and subsection
498	(4) of section 395.0193, Florida Statutes, are amended to read:
499	395.0193  Licensed facilities; peer review; disciplinary
500	powers; agency or partnership with physicians.-
501	(2)  Each licensed facility, as a condition of licensure,
502	shall provide for peer review of physicians who deliver health
503	care services at the facility. Each licensed facility shall
504	develop written, binding procedures by which such peer review
505	shall be conducted. Such procedures shall include:
506	(e)  Recording of agendas and minutes which do not contain
507	confidential material, for review by the Division of Medical
508	Quality Assurance of the department Health Quality Assurance of
509	the agency.
510	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
511	actions taken under subsection (3) shall be reported in writing
512	to the Division of Medical Quality Assurance of the department
513	Health Quality Assurance of the agency within 30 working days
514	after its initial occurrence, regardless of the pendency of
515	appeals to the governing board of the hospital. The notification
516	shall identify the disciplined practitioner, the action taken,
517	and the reason for such action. All final disciplinary actions
518	taken under subsection (3), if different from those which were
519	reported to the department agency within 30 days after the
520	initial occurrence, shall be reported within 10 working days to
521	the Division of Medical Quality Assurance of the department
522	Health Quality Assurance of the agency in writing and shall
523	specify the disciplinary action taken and the specific grounds
524	therefor. The division shall review each report and determine
525	whether it potentially involved conduct by the licensee that is
526	subject to disciplinary action, in which case s. 456.073 shall
527	apply. The reports are not subject to inspection under s.
528	119.07(1) even if the division's investigation results in a
529	finding of probable cause.
530	Section 12.  Section 395.1023, Florida Statutes, is amended
531	to read:
532	395.1023  Child abuse and neglect cases; duties.-Each
533	licensed facility shall adopt a protocol that, at a minimum,
534	requires the facility to:
535	(1)  Incorporate a facility policy that every staff member
536	has an affirmative duty to report, pursuant to chapter 39, any
537	actual or suspected case of child abuse, abandonment, or
538	neglect; and
539	(2)  In any case involving suspected child abuse,
540	abandonment, or neglect, designate, at the request of the
541	Department of Children and Family Services, a staff physician to
542	act as a liaison between the hospital and the Department of
543	Children and Family Services office which is investigating the
544	suspected abuse, abandonment, or neglect, and the child
545	protection team, as defined in s. 39.01, when the case is
546	referred to such a team.
547
548	Each general hospital and appropriate specialty hospital shall
549	comply with the provisions of this section and shall notify the
550	agency and the Department of Children and Family Services of its
551	compliance by sending a copy of its policy to the agency and the
552	Department of Children and Family Services as required by rule.
553	The failure by a general hospital or appropriate specialty
554	hospital to comply shall be punished by a fine not exceeding
555	$1,000, to be fixed, imposed, and collected by the agency. Each
556	day in violation is considered a separate offense.
557	Section 13.  Subsection (2) and paragraph (d) of subsection
558	(3) of section 395.1041, Florida Statutes, are amended to read:
559	395.1041  Access to emergency services and care.-
560	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
561	shall establish and maintain an inventory of hospitals with
562	emergency services. The inventory shall list all services within
563	the service capability of the hospital, and such services shall
564	appear on the face of the hospital license. Each hospital having
565	emergency services shall notify the agency of its service
566	capability in the manner and form prescribed by the agency. The
567	agency shall use the inventory to assist emergency medical
568	services providers and others in locating appropriate emergency
569	medical care. The inventory shall also be made available to the
570	general public. On or before August 1, 1992, the agency shall
571	request that each hospital identify the services which are
572	within its service capability. On or before November 1, 1992,
573	the agency shall notify each hospital of the service capability
574	to be included in the inventory. The hospital has 15 days from
575	the date of receipt to respond to the notice. By December 1,
576	1992, the agency shall publish a final inventory. Each hospital
577	shall reaffirm its service capability when its license is
578	renewed and shall notify the agency of the addition of a new
579	service or the termination of a service prior to a change in its
580	service capability.
581	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
582	FACILITY OR HEALTH CARE PERSONNEL.-
583	(d)1.  Every hospital shall ensure the provision of
584	services within the service capability of the hospital, at all
585	times, either directly or indirectly through an arrangement with
586	another hospital, through an arrangement with one or more
587	physicians, or as otherwise made through prior arrangements. A
588	hospital may enter into an agreement with another hospital for
589	purposes of meeting its service capability requirement, and
590	appropriate compensation or other reasonable conditions may be
591	negotiated for these backup services.
592	2.  If any arrangement requires the provision of emergency
593	medical transportation, such arrangement must be made in
594	consultation with the applicable provider and may not require
595	the emergency medical service provider to provide transportation
596	that is outside the routine service area of that provider or in
597	a manner that impairs the ability of the emergency medical
598	service provider to timely respond to prehospital emergency
599	calls.
600	3.  A hospital shall not be required to ensure service
601	capability at all times as required in subparagraph 1. if, prior
602	to the receiving of any patient needing such service capability,
603	such hospital has demonstrated to the agency that it lacks the
604	ability to ensure such capability and it has exhausted all
605	reasonable efforts to ensure such capability through backup
606	arrangements. In reviewing a hospital's demonstration of lack of
607	ability to ensure service capability, the agency shall consider
608	factors relevant to the particular case, including the
609	following:
610	a.  Number and proximity of hospitals with the same service
611	capability.
612	b.  Number, type, credentials, and privileges of
613	specialists.
614	c.  Frequency of procedures.
615	d.  Size of hospital.
616	4.  The agency shall publish proposed rules implementing a
617	reasonable exemption procedure by November 1, 1992. Subparagraph
618	1. shall become effective upon the effective date of said rules
619	or January 31, 1993, whichever is earlier. For a period not to
620	exceed 1 year from the effective date of subparagraph 1., a
621	hospital requesting an exemption shall be deemed to be exempt
622	from offering the service until the agency initially acts to
623	deny or grant the original request. The agency has 45 days from
624	the date of receipt of the request to approve or deny the
625	request. After the first year from the effective date of
626	subparagraph 1., If the agency fails to initially act within the
627	time period, the hospital is deemed to be exempt from offering
628	the service until the agency initially acts to deny the request.
629	Section 14.  Section 395.1046, Florida Statutes, is
630	repealed.
631	Section 15.  Paragraph (e) of subsection (1) of section
632	395.1055, Florida Statutes, is amended to read:
633	395.1055  Rules and enforcement.-
634	(1)  The agency shall adopt rules pursuant to ss.
635	120.536(1) and 120.54 to implement the provisions of this part,
636	which shall include reasonable and fair minimum standards for
637	ensuring that:
638	(e)  Licensed facility beds conform to minimum space,
639	equipment, and furnishings standards as specified by the agency,
640	the Florida Building Code, and the Florida Fire Prevention Code
641	department.
642	Section 16.  Subsection (1) of section 395.10972, Florida
643	Statutes, is amended to read:
644	395.10972  Health Care Risk Manager Advisory Council.-The
645	Secretary of Health Care Administration may appoint a seven-
646	member advisory council to advise the agency on matters
647	pertaining to health care risk managers. The members of the
648	council shall serve at the pleasure of the secretary. The
649	council shall designate a chair. The council shall meet at the
650	call of the secretary or at those times as may be required by
651	rule of the agency. The members of the advisory council shall
652	receive no compensation for their services, but shall be
653	reimbursed for travel expenses as provided in s. 112.061. The
654	council shall consist of individuals representing the following
655	areas:
656	(1)  Two shall be active health care risk managers,
657	including one risk manager who is recommended by and a member of
658	the Florida Society for of Healthcare Risk Management and
659	Patient Safety.
660	Section 17.  Subsection (3) of section 395.2050, Florida
661	Statutes, is amended to read:
662	395.2050  Routine inquiry for organ and tissue donation;
663	certification for procurement activities; death records review.-
664	(3)  Each organ procurement organization designated by the
665	federal Centers for Medicare and Medicaid Services Health Care
666	Financing Administration and licensed by the state
667	an annual death records review in the organ procurement
668	organization's affiliated donor hospitals. The organ procurement
669	organization shall enlist the services of every Florida licensed
670	tissue bank and eye bank affiliated with or providing service to
671	the donor hospital and operating in the same service area to
672	participate in the death records review.
673	Section 18.  Subsection (2) of section 395.3036, Florida
674	Statutes, is amended to read:
675	395.3036  Confidentiality of records and meetings of
676	corporations that lease public hospitals or other public health
677	care facilities.-The records of a private corporation that
678	leases a public hospital or other public health care facility
679	are confidential and exempt from the provisions of s. 119.07(1)
680	and s. 24(a), Art. I of the State Constitution, and the meetings
681	of the governing board of a private corporation are exempt from
682	s. 286.011 and s. 24(b), Art. I of the State Constitution when
683	the public lessor complies with the public finance
684	accountability provisions of s. 155.40(5) with respect to the
685	transfer of any public funds to the private lessee and when the
686	private lessee meets at least three of the five following
687	criteria:
688	(2)  The public lessor and the private lessee do not
689	commingle any of their funds in any account maintained by either
690	of them, other than the payment of the rent and administrative
691	fees or the transfer of funds pursuant to s. 155.40     (2)
692	subsection (2).
693	Section 19.  Section 395.3037, Florida Statutes, is
694	repealed.
695	Section 20.  Subsections (1), (4), and (5) of section
696	395.3038, Florida Statutes, are amended to read:
697	395.3038  State-listed primary stroke centers and
698	comprehensive stroke centers; notification of hospitals.-
699	(1)  The agency shall make available on its website and to
700	the department a list of the name and address of each hospital
701	that meets the criteria for a primary stroke center and the name
702	and address of each hospital that meets the criteria for a
703	comprehensive stroke center. The list of primary and
704	comprehensive stroke centers shall include only those hospitals
705	that attest in an affidavit submitted to the agency that the
706	hospital meets the named criteria, or those hospitals that
707	attest in an affidavit submitted to the agency that the hospital
708	is certified as a primary or a comprehensive stroke center by
709	The Joint Commission on Accreditation of Healthcare
710	Organizations.
711	(4)  The agency shall adopt by rule criteria for a primary
712	stroke center which are substantially similar to the
713	certification standards for primary stroke centers of The Joint
714	Commission on Accreditation of Healthcare Organizations.
715	(5)  The agency shall adopt by rule criteria for a
716	comprehensive stroke center. However, if The Joint Commission on
717	Accreditation of Healthcare Organizations establishes criteria
718	for a comprehensive stroke center, the agency shall establish
719	criteria for a comprehensive stroke center which are
720	substantially similar to those criteria established by The Joint
721	Commission on Accreditation of Healthcare Organizations.
722	Section 21.  Paragraph (e) of subsection (2) of section
723	395.602, Florida Statutes, is amended to read:
724	395.602  Rural hospitals.-
725	(2)  DEFINITIONS.-As used in this part:
726	(e)  "Rural hospital" means an acute care hospital licensed
727	under this chapter, having 100 or fewer licensed beds and an
728	emergency room, which is:
729	1.  The sole provider within a county with a population
730	density of no greater than 100 persons per square mile;
731	2.  An acute care hospital, in a county with a population
732	density of no greater than 100 persons per square mile, which is
733	at least 30 minutes of travel time, on normally traveled roads
734	under normal traffic conditions, from any other acute care
735	hospital within the same county;
736	3.  A hospital supported by a tax district or subdistrict
737	whose boundaries encompass a population of 100 persons or fewer
738	per square mile;
739	4.  A hospital in a constitutional charter county with a
740	population of over 1 million persons that has imposed a local
741	option health service tax pursuant to law and in an area that
742	was directly impacted by a catastrophic event on August 24,
743	1992, for which the Governor of Florida declared a state of
744	emergency pursuant to chapter 125, and has 120 beds or less that
745	serves an agricultural community with an emergency room
746	utilization of no less than 20,000 visits and a Medicaid
747	inpatient utilization rate greater than 15 percent;
748	4.5.  A hospital with a service area that has a population
749	of 100 persons or fewer per square mile. As used in this
750	subparagraph, the term "service area" means the fewest number of
751	zip codes that account for 75 percent of the hospital's
752	discharges for the most recent 5-year period, based on
753	information available from the hospital inpatient discharge
754	database in the Florida Center for Health Information and Policy
755	Analysis at the Agency for Health Care Administration; or
756	5.6.  A hospital designated as a critical access hospital,
757	as defined in s. 408.07(15).
758
759	Population densities used in this paragraph must be based upon
760	the most recently completed United States census. A hospital
761	that received funds under s. 409.9116 for a quarter beginning no
762	later than July 1, 2002, is deemed to have been and shall
763	continue to be a rural hospital from that date through June 30,
764	2015, if the hospital continues to have 100 or fewer licensed
765	beds and an emergency room, or meets the criteria of
766	subparagraph 4. An acute care hospital that has not previously
767	been designated as a rural hospital and that meets the criteria
768	of this paragraph shall be granted such designation upon
769	application, including supporting documentation to the Agency
770	for Health Care Administration.
771	Section 22.  Subsection (8) of section 400.021, Florida
772	Statutes, is amended to read:
773	400.021  Definitions.-When used in this part, unless the
774	context otherwise requires, the term:
775	(8)  "Geriatric outpatient clinic" means a site for
776	providing outpatient health care to persons 60 years of age or
777	older, which is staffed by a registered nurse or a physician
778	assistant, or a licensed practical nurse under the direct
779	supervision of a registered nurse, advanced registered nurse
780	practitioner, or physician.
781	Section 23.  Paragraph (g) of subsection (2) of section
782	400.0239, Florida Statutes, is amended to read:
783	400.0239  Quality of Long-Term Care Facility Improvement
784	Trust Fund.-
785	(2)  Expenditures from the trust fund shall be allowable
786	for direct support of the following:
787	(g)  Other initiatives authorized by the Centers for
788	Medicare and Medicaid Services for the use of federal civil
789	monetary penalties, including projects recommended through the
790	Medicaid "Up-or-Out" Quality of Care Contract Management Program
791	pursuant to s. 400.148.
792	Section 24.  Subsection (15) of section 400.0255, Florida
793	Statutes, is amended to read
794	400.0255  Resident transfer or discharge; requirements and
795	procedures; hearings.-
796	(15)(a)  The department's Office of Appeals Hearings shall
797	conduct hearings under this section. The office shall notify the
798	facility of a resident's request for a hearing.
799	(b)  The department shall, by rule, establish procedures to
800	be used for fair hearings requested by residents. These
801	procedures shall be equivalent to the procedures used for fair
802	hearings for other Medicaid cases appearing in s. 409.285 and
803	applicable rules, chapter 10-2, part VI, Florida Administrative
804	Code. The burden of proof must be clear and convincing evidence.
805	A hearing decision must be rendered within 90 days after receipt
806	of the request for hearing.
807	(c)  If the hearing decision is favorable to the resident
808	who has been transferred or discharged, the resident must be
809	readmitted to the facility's first available bed.
810	(d)  The decision of the hearing officer shall be final.
811	Any aggrieved party may appeal the decision to the district
812	court of appeal in the appellate district where the facility is
813	located. Review procedures shall be conducted in accordance with
814	the Florida Rules of Appellate Procedure.
815	Section 25.  Subsection (2) of section 400.063, Florida
816	Statutes, is amended to read:
817	400.063  Resident protection.-
818	(2)  The agency is authorized to establish for each
819	facility, subject to intervention by the agency, a separate bank
820	account for the deposit to the credit of the agency of any
821	moneys received from the Health Care Trust Fund or any other
822	moneys received for the maintenance and care of residents in the
823	facility, and the agency is authorized to disburse moneys from
824	such account to pay obligations incurred for the purposes of
825	this section. The agency is authorized to requisition moneys
826	from the Health Care Trust Fund in advance of an actual need for
827	cash on the basis of an estimate by the agency of moneys to be
828	spent under the authority of this section. Any bank account
829	established under this section need not be approved in advance
830	of its creation as required by s. 17.58, but shall be secured by
831	depository insurance equal to or greater than the balance of
832	such account or by the pledge of collateral security in
833	conformance with criteria established in s. 18.11. The agency
834	shall notify the Chief Financial Officer of any such account so
835	established and shall make a quarterly accounting to the Chief
836	Financial Officer for all moneys deposited in such account.
837	Section 26.  Subsections (1) and (5) of section 400.071,
838	Florida Statutes, are amended to read:
839	400.071  Application for license.-
840	(1)  In addition to the requirements of part II of chapter
841	408, the application for a license shall be under oath and must
842	contain the following:
843	(a)  The location of the facility for which a license is
844	sought and an indication, as in the original application, that
845	such location conforms to the local zoning ordinances.
846	(b)  A signed affidavit disclosing any financial or
847	ownership interest that a controlling interest as defined in
848	part II of chapter 408 has held in the last 5 years in any
849	entity licensed by this state or any other state to provide
850	health or residential care which has closed voluntarily or
851	involuntarily; has filed for bankruptcy; has had a receiver
852	appointed; has had a license denied, suspended, or revoked; or
853	has had an injunction issued against it which was initiated by a
854	regulatory agency. The affidavit must disclose the reason any
855	such entity was closed, whether voluntarily or involuntarily.
856	(c)  The total number of beds and the total number of
857	Medicare and Medicaid certified beds.
858	(b)(d)  Information relating to the applicant and employees
859	which the agency requires by rule. The applicant must
860	demonstrate that sufficient numbers of qualified staff, by
861	training or experience, will be employed to properly care for
862	the type and number of residents who will reside in the
863	facility.
864	(c)(e)  Copies of any civil verdict or judgment involving
865	the applicant rendered within the 10 years preceding the
866	application, relating to medical negligence, violation of
867	residents' rights, or wrongful death. As a condition of
868	licensure, the licensee agrees to provide to the agency copies
869	of any new verdict or judgment involving the applicant, relating
870	to such matters, within 30 days after filing with the clerk of
871	the court. The information required in this paragraph shall be
872	maintained in the facility's licensure file and in an agency
873	database which is available as a public record.
874	(5)  As a condition of licensure, each facility must
875	establish and submit with its application a plan for quality
876	assurance and for conducting risk management.
877	Section 27.  Section 400.0712, Florida Statutes, is amended
878	to read:
879	400.0712  Application for inactive license.-
880	(1)  As specified in this section, the agency may issue an
881	inactive license to a nursing home facility for all or a portion
882	of its beds. Any request by a licensee that a nursing home or
883	portion of a nursing home become inactive must be submitted to
884	the agency in the approved format. The facility may not initiate
885	any suspension of services, notify residents, or initiate
886	inactivity before receiving approval from the agency; and a
887	licensee that violates this provision may not be issued an
888	inactive license.
889	(1)(2)  In addition to the powers granted under part II of
890	chapter 408, the agency may issue an inactive license to a
891	nursing home that chooses to use an unoccupied contiguous
892	portion of the facility for an alternative use to meet the needs
893	of elderly persons through the use of less restrictive, less
894	institutional services.
895	(a)  An inactive license issued under this subsection may
896	be granted for a period not to exceed the current licensure
897	expiration date but may be renewed by the agency at the time of
898	licensure renewal.
899	(b)  A request to extend the inactive license must be
900	submitted to the agency in the approved format and approved by
901	the agency in writing.
902	(c)  Nursing homes that receive an inactive license to
903	provide alternative services shall not receive preference for
904	participation in the Assisted Living for the Elderly Medicaid
905	waiver.
906	(2)(3)  The agency shall adopt rules pursuant to ss.
907	120.536(1) and 120.54 necessary to implement this section.
908	Section 28.  Section 400.111, Florida Statutes, is amended
909	to read:
910	400.111  Disclosure of controlling interest.-In addition to
911	the requirements of part II of chapter 408, when requested by
912	the agency, the licensee shall submit a signed affidavit
913	disclosing any financial or ownership interest that a
914	controlling interest has held within the last 5 years in any
915	entity licensed by the state or any other state to provide
916	health or residential care which entity has closed voluntarily
917	or involuntarily; has filed for bankruptcy; has had a receiver
918	appointed; has had a license denied, suspended, or revoked; or
919	has had an injunction issued against it which was initiated by a
920	regulatory agency. The affidavit must disclose the reason such
921	entity was closed, whether voluntarily or involuntarily.
922	Section 29.  Subsection (2) of section 400.1183, Florida
923	Statutes, is amended to read:
924	400.1183  Resident grievance procedures.-
925	(2)  Each facility shall maintain records of all grievances
926	for agency inspection and shall report to the agency at the time
927	of relicensure the total number of grievances handled during the
928	prior licensure period, a categorization of the cases underlying
929	the grievances, and the final disposition of the grievances.
930	Section 30.  Paragraphs (o) through (w) of subsection (1)
931	of section 400.141, Florida Statutes, are redesignated as
932	paragraphs (n) through (u), respectively, and present paragraphs
933	(f), (g), (j), (n), (o), and (r) of that subsection are amended,
934	to read:
935	400.141  Administration and management of nursing home
936	facilities.-
937	(1)  Every licensed facility shall comply with all
938	applicable standards and rules of the agency and shall:
939	(f)  Be allowed and encouraged by the agency to provide
940	other needed services under certain conditions. If the facility
941	has a standard licensure status, and has had no class I or class
942	II deficiencies during the past 2 years or has been awarded a
943	Gold Seal under the program established in s. 400.235, it may be
944	encouraged by the agency to provide services, including, but not
945	limited to, respite and adult day services, which enable
946	individuals to move in and out of the facility. A facility is
947	not subject to any additional licensure requirements for
948	providing these services.
949	1.  Respite care may be offered to persons in need of
950	short-term or temporary nursing home services. For each person
951	admitted under the respite care program, the facility licensee
952	must:
953	a.  Have a written abbreviated plan of care that, at a
954	minimum, includes nutritional requirements, medication orders,
955	physician orders, nursing assessments, and dietary preferences.
956	The nursing or physician assessments may take the place of all
957	other assessments required for full-time residents.
958	b.  Have a contract that, at a minimum, specifies the
959	services to be provided to the respite resident, including
960	charges for services, activities, equipment, emergency medical
961	services, and the administration of medications. If multiple
962	respite admissions for a single person are anticipated, the
963	original contract is valid for 1 year after the date of
964	execution.
965	c.  Ensure that each resident is released to his or her
966	caregiver or an individual designated in writing by the
967	caregiver.
968	2.  A person admitted under the respite care program is:
969	a.  Exempt from requirements in rule related to discharge
970	planning.
971	b.  Covered by the resident's rights set forth in s.
972	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
973	shall not be considered trust funds subject to the requirements
974	of s. 400.022(1)(h) until the resident has been in the facility
975	for more than 14 consecutive days.
976	c.  Allowed to use his or her personal medications for the
977	respite stay if permitted by facility policy. The facility must
978	obtain a physician's orders for the medications. The caregiver
979	may provide information regarding the medications as part of the
980	nursing assessment, which must agree with the physician's
981	orders. Medications shall be released with the resident upon
982	discharge in accordance with current orders.
983	3.  A person receiving respite care is entitled to a total
984	of 60 days in the facility within a contract year or a calendar
985	year if the contract is for less than 12 months. However, each
986	single stay may not exceed 14 days. If a stay exceeds 14
987	consecutive days, the facility must comply with all assessment
988	and care planning requirements applicable to nursing home
989	residents.
990	4.  A person receiving respite care must reside in a
991	licensed nursing home bed.
992	5.  A prospective respite resident must provide medical
993	information from a physician, a physician assistant, or a nurse
994	practitioner and other information from the primary caregiver as
995	may be required by the facility prior to or at the time of
996	admission to receive respite care. The medical information must
997	include a physician's order for respite care and proof of a
998	physical examination by a licensed physician, physician
999	assistant, or nurse practitioner. The physician's order and
1000	physical examination may be used to provide intermittent respite
1001	care for up to 12 months after the date the order is written.
1002	6.  The facility must assume the duties of the primary
1003	caregiver. To ensure continuity of care and services, the
1004	resident is entitled to retain his or her personal physician and
1005	must have access to medically necessary services such as
1006	physical therapy, occupational therapy, or speech therapy, as
1007	needed. The facility must arrange for transportation to these
1008	services if necessary. Respite care must be provided in
1009	accordance with this part and rules adopted by the agency.
1010	However, the agency shall, by rule, adopt modified requirements
1011	for resident assessment, resident care plans, resident
1012	contracts, physician orders, and other provisions, as
1013	appropriate, for short-term or temporary nursing home services.
1014	7.  The agency shall allow for shared programming and staff
1015	in a facility which meets minimum standards and offers services
1016	pursuant to this paragraph, but, if the facility is cited for
1017	deficiencies in patient care, may require additional staff and
1018	programs appropriate to the needs of service recipients. A
1019	person who receives respite care may not be counted as a
1020	resident of the facility for purposes of the facility's licensed
1021	capacity unless that person receives 24-hour respite care. A
1022	person receiving either respite care for 24 hours or longer or
1023	adult day services must be included when calculating minimum
1024	staffing for the facility. Any costs and revenues generated by a
1025	nursing home facility from nonresidential programs or services
1026	shall be excluded from the calculations of Medicaid per diems
1027	for nursing home institutional care reimbursement.
1028	(g)  If the facility has a standard license or is a Gold
1029	Seal facility, exceeds the minimum required hours of licensed
1030	nursing and certified nursing assistant direct care per resident
1031	per day, and is part of a continuing care facility licensed
1032	under chapter 651 or a retirement community that offers other
1033	services pursuant to part III of this chapter or part I or part
1034	III of chapter 429 on a single campus, be allowed to share
1035	programming and staff. At the time of inspection and in the
1036	semiannual report required pursuant to paragraph (n) (o), a
1037	continuing care facility or retirement community that uses this
1038	option must demonstrate through staffing records that minimum
1039	staffing requirements for the facility were met. Licensed nurses
1040	and certified nursing assistants who work in the nursing home
1041	facility may be used to provide services elsewhere on campus if
1042	the facility exceeds the minimum number of direct care hours
1043	required per resident per day and the total number of residents
1044	receiving direct care services from a licensed nurse or a
1045	certified nursing assistant does not cause the facility to
1046	violate the staffing ratios required under s. 400.23(3)(a).
1047	Compliance with the minimum staffing ratios shall be based on
1048	total number of residents receiving direct care services,
1049	regardless of where they reside on campus. If the facility
1050	receives a conditional license, it may not share staff until the
1051	conditional license status ends. This paragraph does not
1052	restrict the agency's authority under federal or state law to
1053	require additional staff if a facility is cited for deficiencies
1054	in care which are caused by an insufficient number of certified
1055	nursing assistants or licensed nurses. The agency may adopt
1056	rules for the documentation necessary to determine compliance
1057	with this provision.
1058	(j)  Keep full records of resident admissions and
1059	discharges; medical and general health status, including medical
1060	records, personal and social history, and identity and address
1061	of next of kin or other persons who may have responsibility for
1062	the affairs of the residents; and individual resident care plans
1063	including, but not limited to, prescribed services, service
1064	frequency and duration, and service goals. The records shall be
1065	open to inspection by the agency. The facility must maintain
1066	clinical records on each resident in accordance with accepted
1067	professional standards and practices that are complete,
1068	accurately documented, readily accessible, and systematically
1069	organized.
1070	(n)  Submit to the agency the information specified in s.
1071	400.071(1)(b) for a management company within 30 days after the
1072	effective date of the management agreement.
1073	(n)(o)1.  Submit semiannually to the agency, or more
1074	frequently if requested by the agency, information regarding
1075	facility staff-to-resident ratios, staff turnover, and staff
1076	stability, including information regarding certified nursing
1077	assistants, licensed nurses, the director of nursing, and the
1078	facility administrator. For purposes of this reporting:
1079	a.  Staff-to-resident ratios must be reported in the
1080	categories specified in s. 400.23(3)(a) and applicable rules.
1081	The ratio must be reported as an average for the most recent
1082	calendar quarter.
1083	b.  Staff turnover must be reported for the most recent 12-
1084	month period ending on the last workday of the most recent
1085	calendar quarter prior to the date the information is submitted.
1086	The turnover rate must be computed quarterly, with the annual
1087	rate being the cumulative sum of the quarterly rates. The
1088	turnover rate is the total number of terminations or separations
1089	experienced during the quarter, excluding any employee
1090	terminated during a probationary period of 3 months or less,
1091	divided by the total number of staff employed at the end of the
1092	period for which the rate is computed, and expressed as a
1093	percentage.
1094	c.  The formula for determining staff stability is the
1095	total number of employees that have been employed for more than
1096	12 months, divided by the total number of employees employed at
1097	the end of the most recent calendar quarter, and expressed as a
1098	percentage.
1099	d.  A nursing facility that has failed to comply with state
1100	minimum-staffing requirements for 2 consecutive days is
1101	prohibited from accepting new admissions until the facility has
1102	achieved the minimum-staffing requirements for a period of 6
1103	consecutive days. For the purposes of this sub-subparagraph, any
1104	person who was a resident of the facility and was absent from
1105	the facility for the purpose of receiving medical care at a
1106	separate location or was on a leave of absence is not considered
1107	a new admission. Failure to impose such an admissions moratorium
1108	is subject to a $1,000 fine constitutes a class II deficiency.
1109	e.  A nursing facility which does not have a conditional
1110	license may be cited for failure to comply with the standards in
1111	s. 400.23(3)(a)1.a. only if it has failed to meet those
1112	standards on 2 consecutive days or if it has failed to meet at
1113	least 97 percent of those standards on any one day.
1114	f.  A facility which has a conditional license must be in
1115	compliance with the standards in s. 400.23(3)(a) at all times.
1116	2.  This paragraph does not limit the agency's ability to
1117	impose a deficiency or take other actions if a facility does not
1118	have enough staff to meet the residents' needs.
1119	(r)  Report to the agency any filing for bankruptcy
1120	protection by the facility or its parent corporation,
1121	divestiture or spin-off of its assets, or corporate
1122	reorganization within 30 days after the completion of such
1123	activity.
1124	Section 31.  Subsection (3) of section 400.142, Florida
1125	Statutes, is amended to read:
1126	400.142  Emergency medication kits; orders not to
1127	resuscitate.-
1128	(3)  Facility staff may withhold or withdraw
1129	cardiopulmonary resuscitation if presented with an order not to
1130	resuscitate executed pursuant to s. 401.45. The agency shall
1131	adopt rules providing for the implementation of such orders.
1132	Facility staff and facilities shall not be subject to criminal
1133	prosecution or civil liability, nor be considered to have
1134	engaged in negligent or unprofessional conduct, for withholding
1135	or withdrawing cardiopulmonary resuscitation pursuant to such an
1136	order and rules adopted by the agency. The absence of an order
1137	not to resuscitate executed pursuant to s. 401.45 does not
1138	preclude a physician from withholding or withdrawing
1139	cardiopulmonary resuscitation as otherwise permitted by law.
1140	Section 32.  Subsections (11) through (15) of section
1141	400.147, Florida Statutes, are renumbered as subsections (10)
1142	through (14), respectively, and present subsection (10) is
1143	amended to read:
1144	400.147  Internal risk management and quality assurance
1145	program.-
1146	(10)  By the 10th of each month, each facility subject to
1147	this section shall report any notice received pursuant to s.
1148	400.0233(2) and each initial complaint that was filed with the
1149	clerk of the court and served on the facility during the
1150	previous month by a resident or a resident's family member,
1151	guardian, conservator, or personal legal representative. The
1152	report must include the name of the resident, the resident's
1153	date of birth and social security number, the Medicaid
1154	identification number for Medicaid-eligible persons, the date or
1155	dates of the incident leading to the claim or dates of
1156	residency, if applicable, and the type of injury or violation of
1157	rights alleged to have occurred. Each facility shall also submit
1158	a copy of the notices received pursuant to s. 400.0233(2) and
1159	complaints filed with the clerk of the court. This report is
1160	confidential as provided by law and is not discoverable or
1161	admissible in any civil or administrative action, except in such
1162	actions brought by the agency to enforce the provisions of this
1163	part.
1164	Section 33.  Section 400.148, Florida Statutes, is
1165	repealed.
1166	Section 34.  Paragraph (f) of subsection (5) of section
1167	400.162, Florida Statutes, is amended to read:
1168	400.162  Property and personal affairs of residents.-
1169	(5)
1170	(f)  At least every 3 months, the licensee shall furnish
1171	the resident and the guardian, trustee, or conservator, if any,
1172	for the resident a complete and verified statement of all funds
1173	and other property to which this subsection applies, detailing
1174	the amounts and items received, together with their sources and
1175	disposition. For resident property, the licensee shall furnish
1176	such a statement annually and within 7 calendar days after a
1177	request for a statement. In any event, the licensee shall
1178	furnish such statements a statement annually and upon the
1179	discharge or transfer of a resident. Any governmental agency or
1180	private charitable agency contributing funds or other property
1181	on account of a resident also shall be entitled to receive such
1182	statements statement annually and upon discharge or transfer and
1183	such other report as it may require pursuant to law.
1184	Section 35.  Paragraphs (d) and (e) of subsection (2) of
1185	section 400.179, Florida Statutes, are amended to read:
1186	400.179  Liability for Medicaid underpayments and
1187	overpayments.-
1188	(2)  Because any transfer of a nursing facility may expose
1189	the fact that Medicaid may have underpaid or overpaid the
1190	transferor, and because in most instances, any such underpayment
1191	or overpayment can only be determined following a formal field
1192	audit, the liabilities for any such underpayments or
1193	overpayments shall be as follows:
1194	(d)  Where the transfer involves a facility that has been
1195	leased by the transferor:
1196	1.  The transferee shall, as a condition to being issued a
1197	license by the agency, acquire, maintain, and provide proof to
1198	the agency of a bond with a term of 30 months, renewable
1199	annually, in an amount not less than the total of 3 months'
1200	Medicaid payments to the facility computed on the basis of the
1201	preceding 12-month average Medicaid payments to the facility.
1202	2.  A leasehold licensee may meet the requirements of
1203	subparagraph 1. by payment of a nonrefundable fee, paid at
1204	initial licensure, paid at the time of any subsequent change of
1205	ownership, and paid annually thereafter, in the amount of 1
1206	percent of the total of 3 months' Medicaid payments to the
1207	facility computed on the basis of the preceding 12-month average
1208	Medicaid payments to the facility. If a preceding 12-month
1209	average is not available, projected Medicaid payments may be
1210	used. The fee shall be deposited into the Grants and Donations
1211	Trust Fund and shall be accounted for separately as a Medicaid
1212	nursing home overpayment account. These fees shall be used at
1213	the sole discretion of the agency to repay nursing home Medicaid
1214	overpayments. Payment of this fee shall not release the licensee
1215	from any liability for any Medicaid overpayments, nor shall
1216	payment bar the agency from seeking to recoup overpayments from
1217	the licensee and any other liable party. As a condition of
1218	exercising this lease bond alternative, licensees paying this
1219	fee must maintain an existing lease bond through the end of the
1220	30-month term period of that bond. The agency is herein granted
1221	specific authority to promulgate all rules pertaining to the
1222	administration and management of this account, including
1223	withdrawals from the account, subject to federal review and
1224	approval. This provision shall take effect upon becoming law and
1225	shall apply to any leasehold license application. The financial
1226	viability of the Medicaid nursing home overpayment account shall
1227	be determined by the agency through annual review of the account
1228	balance and the amount of total outstanding, unpaid Medicaid
1229	overpayments owing from leasehold licensees to the agency as
1230	determined by final agency audits. By March 31 of each year, the
1231	agency shall assess the cumulative fees collected under this
1232	subparagraph, minus any amounts used to repay nursing home
1233	Medicaid overpayments and amounts transferred to contribute to
1234	the General Revenue Fund pursuant to s. 215.20. If the net
1235	cumulative collections, minus amounts utilized to repay nursing
1236	home Medicaid overpayments, exceed $25 million, the provisions
1237	of this paragraph shall not apply for the subsequent fiscal
1238	year.
1239	3.  The leasehold licensee may meet the bond requirement
1240	through other arrangements acceptable to the agency. The agency
1241	is herein granted specific authority to promulgate rules
1242	pertaining to lease bond arrangements.
1243	4.  All existing nursing facility licensees, operating the
1244	facility as a leasehold, shall acquire, maintain, and provide
1245	proof to the agency of the 30-month bond required in
1246	subparagraph 1., above, on and after July 1, 1993, for each
1247	license renewal.
1248	5.  It shall be the responsibility of all nursing facility
1249	operators, operating the facility as a leasehold, to renew the
1250	30-month bond and to provide proof of such renewal to the agency
1251	annually.
1252	6.  Any failure of the nursing facility operator to
1253	acquire, maintain, renew annually, or provide proof to the
1254	agency shall be grounds for the agency to deny, revoke, and
1255	suspend the facility license to operate such facility and to
1256	take any further action, including, but not limited to,
1257	enjoining the facility, asserting a moratorium pursuant to part
1258	II of chapter 408, or applying for a receiver, deemed necessary
1259	to ensure compliance with this section and to safeguard and
1260	protect the health, safety, and welfare of the facility's
1261	residents. A lease agreement required as a condition of bond
1262	financing or refinancing under s. 154.213 by a health facilities
1263	authority or required under s. 159.30 by a county or
1264	municipality is not a leasehold for purposes of this paragraph
1265	and is not subject to the bond requirement of this paragraph.
1266	(e)  For the 2009-2010 fiscal year only, the provisions of
1267	paragraph (d) shall not apply. This paragraph expires July 1,
1268	2010.
1269	Section 36.  Subsection (3) of section 400.19, Florida
1270	Statutes, is amended to read:
1271	400.19  Right of entry and inspection.-
1272	(3)  The agency shall every 15 months conduct at least one
1273	unannounced inspection to determine compliance by the licensee
1274	with statutes, and with rules promulgated under the provisions
1275	of those statutes, governing minimum standards of construction,
1276	quality and adequacy of care, and rights of residents. The
1277	survey shall be conducted every 6 months for the next 2-year
1278	period if the facility has been cited for a class I deficiency,
1279	has been cited for two or more class II deficiencies arising
1280	from separate surveys or investigations within a 60-day period,
1281	or has had three or more substantiated complaints within a 6-
1282	month period, each resulting in at least one class I or class II
1283	deficiency. In addition to any other fees or fines in this part,
1284	the agency shall assess a fine for each facility that is subject
1285	to the 6-month survey cycle. The fine for the 2-year period
1286	shall be $6,000, one-half to be paid at the completion of each
1287	survey. The agency may adjust this fine by the change in the
1288	Consumer Price Index, based on the 12 months immediately
1289	preceding the increase, to cover the cost of the additional
1290	surveys. The agency shall verify through subsequent inspection
1291	that any deficiency identified during inspection is corrected.
1292	However, the agency may verify the correction of a class III or
1293	class IV deficiency unrelated to resident rights or resident
1294	care without reinspecting the facility if adequate written
1295	documentation has been received from the facility, which
1296	provides assurance that the deficiency has been corrected. The
1297	giving or causing to be given of advance notice of such
1298	unannounced inspections by an employee of the agency to any
1299	unauthorized person shall constitute cause for suspension of not
1300	fewer than 5 working days according to the provisions of chapter
1301	110.
1302	Section 37.  Section 400.195, Florida Statutes, is
1303	repealed.
1304	Section 38.  Subsection (5) of section 400.23, Florida
1305	Statutes, is amended to read:
1306	400.23  Rules; evaluation and deficiencies; licensure
1307	status.-
1308	(5)(a)  The agency, in collaboration with the Division of
1309	Children's Medical Services Network of the Department of Health,
1310	must, no later than December 31, 1993, adopt rules for minimum
1311	standards of care for persons under 21 years of age who reside
1312	in nursing home facilities. The rules must include a methodology
1313	for reviewing a nursing home facility under ss. 408.031-408.045
1314	which serves only persons under 21 years of age. A facility may
1315	be exempt from these standards for specific persons between 18
1316	and 21 years of age, if the person's physician agrees that
1317	minimum standards of care based on age are not necessary.
1318	(b)  The agency, in collaboration with the Division of
1319	Children's Medical Services Network, shall adopt rules for
1320	minimum staffing requirements for nursing home facilities that
1321	serve persons under 21 years of age, which shall apply in lieu
1322	of the standards contained in subsection (3).
1323	1.  For persons under 21 years of age who require skilled
1324	care, the requirements shall include a minimum combined average
1325	of licensed nurses, respiratory therapists, respiratory care
1326	practitioners, and certified nursing assistants of 3.9 hours of
1327	direct care per resident per day for each nursing home facility.
1328	2.  For persons under 21 years of age who are fragile, the
1329	requirements shall include a minimum combined average of
1330	licensed nurses, respiratory therapists, respiratory care
1331	practitioners, and certified nursing assistants of 5 hours of
1332	direct care per resident per day for each nursing home facility.
1333	Section 39.  Subsection (1) of section 400.275, Florida
1334	Statutes, is amended to read:
1335	400.275  Agency duties.-
1336	(1)  The agency shall ensure that each newly hired nursing
1337	home surveyor, as a part of basic training, is assigned full-
1338	time to a licensed nursing home for at least 2 days within a 7-
1339	day period to observe facility operations outside of the survey
1340	process before the surveyor begins survey responsibilities. Such
1341	observations may not be the sole basis of a deficiency citation
1342	against the facility. The agency may not assign an individual to
1343	be a member of a survey team for purposes of a survey,
1344	evaluation, or consultation visit at a nursing home facility in
1345	which the surveyor was an employee within the preceding 2 5
1346	years.
1347	Section 40.  Subsection (2) of section 400.484, Florida
1348	Statutes, is amended to read:
1349	400.484  Right of inspection; violations deficiencies;
1350	fines.-
1351	(2)  The agency shall impose fines for various classes of
1352	violations deficiencies in accordance with the following
1353	schedule:
1354	(a)  Class I violations are defined in s. 408.813. A class
1355	I deficiency is any act, omission, or practice that results in a
1356	patient's death, disablement, or permanent injury, or places a
1357	patient at imminent risk of death, disablement, or permanent
1358	injury. Upon finding a class I violation deficiency, the agency
1359	shall impose an administrative fine in
1360	each occurrence and each day that the
1361	exists.
1362	(b)  Class II violations are defined in s. 408.813. A class
1363	II deficiency is any act, omission, or practice that has a
1364	direct adverse effect on the health, safety, or security of a
1365	patient. Upon finding a class II violation deficiency, the
1366	agency shall impose an administrative fine in the amount of
1367	$5,000 for each occurrence and each day that the violation
1368	deficiency exists.
1369	(c)  Class III violations are defined in s. 408.813. A
1370	class III deficiency is any act, omission, or practice that has
1371	an indirect, adverse effect on the health, safety, or security
1372	of a patient. Upon finding an uncorrected or repeated class III
1373	violation deficiency, the agency shall impose an administrative
1374	fine not to exceed $1,000 for each occurrence and each day that
1375	the uncorrected or repeated violation deficiency exists.
1376	(d)  Class IV violations are defined in s. 408.813. A class
1377	IV deficiency is any act, omission, or practice related to
1378	required reports, forms, or documents which does not have the
1379	potential of negatively affecting patients. These violations are
1380	of a type that the agency determines do not threaten the health,
1381	safety, or security of patients. Upon finding an uncorrected or
1382	repeated class IV violation deficiency, the agency shall impose
1383	an administrative fine not to exceed $500 for each occurrence
1384	and each day that the uncorrected or repeated violation
1385	deficiency exists.
1386	Section 41.  Paragraph (i) of subsection (1) and subsection
1387	(4) of section 400.606, Florida Statutes, are amended to read:
1388	400.606  License; application; renewal; conditional license
1389	or permit; certificate of need.-
1390	(1)  In addition to the requirements of part II of chapter
1391	408, the initial application and change of ownership application
1392	must be accompanied by a plan for the delivery of home,
1393	residential, and homelike inpatient hospice services to
1394	terminally ill persons and their families. Such plan must
1395	contain, but need not be limited to:
1396	(i)  The projected annual operating cost of the hospice.
1397
1398	If the applicant is an existing licensed health care provider,
1399	the application must be accompanied by a copy of the most recent
1400	profit-loss statement and, if applicable, the most recent
1401	licensure inspection report.
1402	(4)  A freestanding hospice facility that is primarily
1403	engaged in providing inpatient and related services and that is
1404	not otherwise licensed as a health care facility shall be
1405	required to obtain a certificate of need. However, a
1406	freestanding hospice facility with six or fewer beds shall not
1407	be required to comply with institutional standards such as, but
1408	not limited to, standards requiring sprinkler systems, emergency
1409	electrical systems, or special lavatory devices.
1410	Section 42.  Subsection (2) of section 400.607, Florida
1411	Statutes, is amended to read:
1412	400.607  Denial, suspension, revocation of license;
1413	emergency actions; imposition of administrative fine; grounds.-
1414	(2)  A violation of this part, part II of chapter 408, or
1415	applicable rules Any of the following actions by a licensed
1416	hospice or any of its employees shall be grounds for
1417	administrative action by the agency against a hospice.:
1418	(a)  A violation of the provisions of this part, part II of
1419	chapter 408, or applicable rules.
1420	(b)  An intentional or negligent act materially affecting
1421	the health or safety of a patient.
1422	Section 43.  Section 400.915, Florida Statutes, is amended
1423	to read:
1424	400.915  Construction and renovation; requirements.-The
1425	requirements for the construction or renovation of a PPEC center
1426	shall comply with:
1427	(1)  The provisions of chapter 553, which pertain to
1428	building construction standards, including plumbing, electrical
1429	code, glass, manufactured buildings, accessibility for the
1430	physically disabled;
1431	(2)  The provisions of s. 633.022 and applicable rules
1432	pertaining to physical minimum standards for nonresidential
1433	child care physical facilities in rule 10M-12.003, Florida
1434	Administrative Code, Child Care Standards; and
1435	(3)  The standards or rules adopted pursuant to this part
1436	and part II of chapter 408.
1437	Section 44.  Subsection (1) of section 400.925, Florida
1438	Statutes, is amended to read:
1439	400.925  Definitions.-As used in this part, the term:
1440	(1)  "Accrediting organizations" means The Joint Commission
1441	on Accreditation of Healthcare Organizations or other national
1442	accreditation agencies whose standards for accreditation are
1443	comparable to those required by this part for licensure.
1444	Section 45.  Subsections (3) through (6) of section
1445	400.931, Florida Statutes, are renumbered as subsections (2)
1446	through (5), respectively, and present subsection (2) of that
1447	section is amended to read:
1448	400.931  Application for license; fee; provisional license;
1449	temporary permit.-
1450	(2)  As an alternative to submitting proof of financial
1451	ability to operate as required in s. 408.810(8), the applicant
1452	may submit a $50,000 surety bond to the agency.
1453	Section 46.  Subsection (2) of section 400.932, Florida
1454	Statutes, is amended to read:
1455	400.932  Administrative penalties.-
1456	(2)  A violation of this part, part II of chapter 408, or
1457	applicable rules Any of the following actions by an employee of
1458	a home medical equipment provider shall be are grounds for
1459	administrative action or penalties by the agency.:
1460	(a)  Violation of this part, part II of chapter 408, or
1461	applicable rules.
1462	(b)  An intentional, reckless, or negligent act that
1463	materially affects the health or safety of a patient.
1464	Section 47.  Subsection (3) of section 400.967, Florida
1465	Statutes, is amended to read:
1466	400.967  Rules and classification of violations
1467	deficiencies.-
1468	(3)  The agency shall adopt rules to provide that, when the
1469	criteria established under this part and part II of chapter 408
1470	are not met, such violations deficiencies shall be classified
1471	according to the nature of the violation deficiency. The agency
1472	shall indicate the classification on the face of the notice of
1473	deficiencies as follows:
1474	(a)  Class I violations deficiencies are defined in s.
1475	408.813 those which the agency determines present an imminent
1476	danger to the residents or guests of the facility or a
1477	substantial probability that death or serious physical harm
1478	would result therefrom. The condition or practice constituting a
1479	class I violation must be abated or eliminated immediately,
1480	unless a fixed period of time, as determined by the agency, is
1481	required for correction. A class I violation deficiency is
1482	subject to a civil penalty in an amount not less than $5,000 and
1483	not exceeding $10,000 for each violation deficiency. A fine may
1484	be levied notwithstanding the correction of the violation
1485	deficiency.
1486	(b)  Class II violations deficiencies are defined in s.
1487	408.813 those which the agency determines have a direct or
1488	immediate relationship to the health, safety, or security of the
1489	facility residents, other than class I deficiencies. A class II
1490	violation deficiency is subject to a civil penalty in an amount
1491	not less than $1,000 and not exceeding $5,000 for each violation
1492	deficiency. A citation for a class II violation deficiency shall
1493	specify the time within which the violation deficiency must be
1494	corrected. If a class II violation deficiency is corrected
1495	within the time specified, no civil penalty shall be imposed,
1496	unless it is a repeated offense.
1497	(c)  Class III violations deficiencies are defined in s.
1498	408.813 those which the agency determines to have an indirect or
1499	potential relationship to the health, safety, or security of the
1500	facility residents, other than class I or class II deficiencies.
1501	A class III violation deficiency is subject to a civil penalty
1502	of not less than $500 and not exceeding $1,000 for each
1503	deficiency. A citation for a class III violation deficiency
1504	shall specify the time within which the violation deficiency
1505	must be corrected. If a class III violation deficiency is
1506	corrected within the time specified, no civil penalty shall be
1507	imposed, unless it is a repeated offense.
1508	(d)  Class IV violations are defined in s. 408.813. Upon
1509	finding an uncorrected or repeated class IV violation, the
1510	agency shall impose an administrative fine not to exceed $500
1511	for each occurrence and each day that the uncorrected or
1512	repeated violation exists.
1513	Section 48.  Subsections (4) and (7) of section 400.9905,
1514	Florida Statutes, are amended to read:
1515	400.9905  Definitions.-
1516	(4)  "Clinic" means an entity at which health care services
1517	are provided to individuals and which tenders charges for
1518	reimbursement for such services, including a mobile clinic and a
1519	portable health service or equipment provider. For purposes of
1520	this part, the term does not include and the licensure
1521	requirements of this part do not apply to:
1522	(a)  Entities licensed or registered by the state under
1523	chapter 395; or entities licensed or registered by the state and
1524	providing only health care services within the scope of services
1525	authorized under their respective licenses granted under ss.
1526	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1527	chapter except part X, chapter 429, chapter 463, chapter 465,
1528	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1529	chapter 651; end-stage renal disease providers authorized under
1530	42 C.F.R. part 405, subpart U; or providers certified under 42
1531	C.F.R. part 485, subpart B or subpart H; or any entity that
1532	provides neonatal or pediatric hospital-based health care
1533	services or other health care services by licensed practitioners
1534	solely within a hospital licensed under chapter 395.
1535	(b)  Entities that own, directly or indirectly, entities
1536	licensed or registered by the state pursuant to chapter 395; or
1537	entities that own, directly or indirectly, entities licensed or
1538	registered by the state and providing only health care services
1539	within the scope of services authorized pursuant to their
1540	respective licenses granted under ss. 383.30-383.335, chapter
1541	390, chapter 394, chapter 397, this chapter except part X,
1542	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1543	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1544	disease providers authorized under 42 C.F.R. part 405, subpart
1545	U; or providers certified under 42 C.F.R. part 485, subpart B or
1546	subpart H; or any entity that provides neonatal or pediatric
1547	hospital-based health care services by licensed practitioners
1548	solely within a hospital licensed under chapter 395.
1549	(c)  Entities that are owned, directly or indirectly, by an
1550	entity licensed or registered by the state pursuant to chapter
1551	395; or entities that are owned, directly or indirectly, by an
1552	entity licensed or registered by the state and providing only
1553	health care services within the scope of services authorized
1554	pursuant to their respective licenses granted under ss. 383.30-
1555	383.335, chapter 390, chapter 394, chapter 397, this chapter
1556	except part X, chapter 429, chapter 463, chapter 465, chapter
1557	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1558	651; end-stage renal disease providers authorized under 42
1559	C.F.R. part 405, subpart U; or providers certified under 42
1560	C.F.R. part 485, subpart B or subpart H; or any entity that
1561	provides neonatal or pediatric hospital-based health care
1562	services by licensed practitioners solely within a hospital
1563	under chapter 395.
1564	(d)  Entities that are under common ownership, directly or
1565	indirectly, with an entity licensed or registered by the state
1566	pursuant to chapter 395; or entities that are under common
1567	ownership, directly or indirectly, with an entity licensed or
1568	registered by the state and providing only health care services
1569	within the scope of services authorized pursuant to their
1570	respective licenses granted under ss. 383.30-383.335, chapter
1571	390, chapter 394, chapter 397, this chapter except part X,
1572	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1573	part I of chapter 483, chapter 484, or chapter 651; end-stage
1574	renal disease providers authorized under 42 C.F.R. part 405,
1575	subpart U; or providers certified under 42 C.F.R. part 485,
1576	subpart B or subpart H; or any entity that provides neonatal or
1577	pediatric hospital-based health care services by licensed
1578	practitioners solely within a hospital licensed under chapter
1579	395.
1580	(e)  An entity that is exempt from federal taxation under
1581	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1582	under 26 U.S.C. s. 409 that has a board of trustees not less
1583	than two-thirds of which are Florida-licensed health care
1584	practitioners and provides only physical therapy services under
1585	physician orders, any community college or university clinic,
1586	and any entity owned or operated by the federal or state
1587	government, including agencies, subdivisions, or municipalities
1588	thereof.
1589	(f)  A sole proprietorship, group practice, partnership, or
1590	corporation that provides health care services by physicians
1591	covered by s. 627.419, that is directly supervised by one or
1592	more of such physicians, and that is wholly owned by one or more
1593	of those physicians or by a physician and the spouse, parent,
1594	child, or sibling of that physician.
1595	(g)  A sole proprietorship, group practice, partnership, or
1596	corporation that provides health care services by licensed
1597	health care practitioners under chapter 457, chapter 458,
1598	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1599	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1600	chapter 490, chapter 491, or part I, part III, part X, part
1601	XIII, or part XIV of chapter 468, or s. 464.012, which are
1602	wholly owned by one or more licensed health care practitioners,
1603	or the licensed health care practitioners set forth in this
1604	paragraph and the spouse, parent, child, or sibling of a
1605	licensed health care practitioner, so long as one of the owners
1606	who is a licensed health care practitioner is supervising the
1607	business activities and is legally responsible for the entity's
1608	compliance with all federal and state laws. However, a health
1609	care practitioner may not supervise services beyond the scope of
1610	the practitioner's license, except that, for the purposes of
1611	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1612	provides only services authorized pursuant to s. 456.053(3)(b)
1613	may be supervised by a licensee specified in s. 456.053(3)(b).
1614	(h)  Clinical facilities affiliated with an accredited
1615	medical school at which training is provided for medical
1616	students, residents, or fellows.
1617	(i)  Entities that provide only oncology or radiation
1618	therapy services by physicians licensed under chapter 458 or
1619	chapter 459 or entities that provide oncology or radiation
1620	therapy services by physicians licensed under chapter 458 or
1621	chapter 459 which are owned by a corporation whose shares are
1622	publicly traded on a recognized stock exchange.
1623	(j)  Clinical facilities affiliated with a college of
1624	chiropractic accredited by the Council on Chiropractic Education
1625	at which training is provided for chiropractic students.
1626	(k)  Entities that provide licensed practitioners to staff
1627	emergency departments or to deliver anesthesia services in
1628	facilities licensed under chapter 395 and that derive at least
1629	90 percent of their gross annual revenues from the provision of
1630	such services. Entities claiming an exemption from licensure
1631	under this paragraph must provide documentation demonstrating
1632	compliance.
1633	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1634	perinatology clinical facilities that are a publicly traded
1635	corporation or that are wholly owned, directly or indirectly, by
1636	a publicly traded corporation. As used in this paragraph, a
1637	publicly traded corporation is a corporation that issues
1638	securities traded on an exchange registered with the United
1639	States Securities and Exchange Commission as a national
1640	securities exchange.
1641	(m)  Entities that are owned by a corporation that has $250
1642	million or more in total annual sales of health care services
1643	provided by licensed health care practitioners if one or more of
1644	the owners of the entity is a health care practitioner who is
1645	licensed in this state, is responsible for supervising the
1646	business activities of the entity, and is legally responsible
1647	for the entity's compliance with state law for purposes of this
1648	section.
1649	(n)  Entities that are owned or controlled, directly or
1650	indirectly, by a publicly traded entity with $100 million or
1651	more, in the aggregate, in total annual revenues derived from
1652	providing health care services by licensed health care
1653	practitioners that are employed or contracted by an entity
1654	described in this paragraph.
1655	(7)  "Portable health service or equipment provider" means
1656	an entity that contracts with or employs persons to provide
1657	portable health care services or equipment to multiple locations
1658	performing treatment or diagnostic testing of individuals, that
1659	bills third-party payors for those services, and that otherwise
1660	meets the definition of a clinic in subsection (4).
1661	Section 49.  Paragraph (b) of subsection (1) and paragraph
1662	(c) of subsection (4) of section 400.991, Florida Statutes, are
1663	amended to read:
1664	400.991  License requirements; background screenings;
1665	prohibitions.-
1666	(1)
1667	(b)  Each mobile clinic must obtain a separate health care
1668	clinic license and must provide to the agency, at least
1669	quarterly, its projected street location to enable the agency to
1670	locate and inspect such clinic. A portable health service or
1671	equipment provider must obtain a health care clinic license for
1672	a single administrative office and is not required to submit
1673	quarterly projected street locations.
1674	(4)  In addition to the requirements of part II of chapter
1675	408, the applicant must file with the application satisfactory
1676	proof that the clinic is in compliance with this part and
1677	applicable rules, including:
1678	(c)  Proof of financial ability to operate as required
1679	under ss. s. 408.810(8) and 408.8065. As an alternative to
1680	submitting proof of financial ability to operate as required
1681	under s. 408.810(8), the applicant may file a surety bond of at
1682	least $500,000 which guarantees that the clinic will act in full
1683	conformity with all legal requirements for operating a clinic,
1684	payable to the agency. The agency may adopt rules to specify
1685	related requirements for such surety bond.
1686	Section 50.  Paragraph (g) of subsection (1) and paragraph
1687	(a) of subsection (7) of section 400.9935, Florida Statutes, are
1688	amended to read:
1689	400.9935  Clinic responsibilities.-
1690	(1)  Each clinic shall appoint a medical director or clinic
1691	director who shall agree in writing to accept legal
1692	responsibility for the following activities on behalf of the
1693	clinic. The medical director or the clinic director shall:
1694	(g)  Conduct systematic reviews of clinic billings to
1695	ensure that the billings are not fraudulent or unlawful. Upon
1696	discovery of an unlawful charge, the medical director or clinic
1697	director shall take immediate corrective action. If the clinic
1698	performs only the technical component of magnetic resonance
1699	imaging, static radiographs, computed tomography, or positron
1700	emission tomography, and provides the professional
1701	interpretation of such services, in a fixed facility that is
1702	accredited by The Joint Commission on Accreditation of
1703	Healthcare Organizations or the Accreditation Association for
1704	Ambulatory Health Care, and the American College of Radiology;
1705	and if, in the preceding quarter, the percentage of scans
1706	performed by that clinic which was billed to all personal injury
1707	protection insurance carriers was less than 15 percent, the
1708	chief financial officer of the clinic may, in a written
1709	acknowledgment provided to the agency, assume the responsibility
1710	for the conduct of the systematic reviews of clinic billings to
1711	ensure that the billings are not fraudulent or unlawful.
1712	(7)(a)  Each clinic engaged in magnetic resonance imaging
1713	services must be accredited by The Joint Commission on
1714	Accreditation of Healthcare Organizations, the American College
1715	of Radiology, or the Accreditation Association for Ambulatory
1716	Health Care, within 1 year after licensure. A clinic that is
1717	accredited by the American College of Radiology or is within the
1718	original 1-year period after licensure and replaces its core
1719	magnetic resonance imaging equipment shall be given 1 year after
1720	the date on which the equipment is replaced to attain
1721	accreditation. However, a clinic may request a single, 6-month
1722	extension if it provides evidence to the agency establishing
1723	that, for good cause shown, such clinic cannot be accredited
1724	within 1 year after licensure, and that such accreditation will
1725	be completed within the 6-month extension. After obtaining
1726	accreditation as required by this subsection, each such clinic
1727	must maintain accreditation as a condition of renewal of its
1728	license. A clinic that files a change of ownership application
1729	must comply with the original accreditation timeframe
1730	requirements of the transferor. The agency shall deny a change
1731	of ownership application if the clinic is not in compliance with
1732	the accreditation requirements. When a clinic adds, replaces, or
1733	modifies magnetic resonance imaging equipment and the
1734	accreditation agency requires new accreditation, the clinic must
1735	be accredited within 1 year after the date of the addition,
1736	replacement, or modification but may request a single, 6-month
1737	extension if the clinic provides evidence of good cause to the
1738	agency.
1739	Section 51.  Subsection (2) of section 408.034, Florida
1740	Statutes, is amended to read:
1741	408.034  Duties and responsibilities of agency; rules.-
1742	(2)  In the exercise of its authority to issue licenses to
1743	health care facilities and health service providers, as provided
1744	under chapters 393 and 395 and parts II, and IV, and VIII of
1745	chapter 400, the agency may not issue a license to any health
1746	care facility or health service provider that fails to receive a
1747	certificate of need or an exemption for the licensed facility or
1748	service.
1749	Section 52.  Paragraph (d) of subsection (1) of section
1750	408.036, Florida Statutes, is amended to read:
1751	408.036  Projects subject to review; exemptions.-
1752	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
1753	health-care-related projects, as described in paragraphs (a)-
1754	(g), are subject to review and must file an application for a
1755	certificate of need with the agency. The agency is exclusively
1756	responsible for determining whether a health-care-related
1757	project is subject to review under ss. 408.031-408.045.
1758	(d)  The establishment of a hospice or hospice inpatient
1759	facility, except as provided in s. 408.043.
1760	Section 53.  Subsection (2) of section 408.043, Florida
1761	Statutes, is amended to read:
1762	408.043  Special provisions.-
1763	(2)  HOSPICES.-When an application is made for a
1764	certificate of need to establish or to expand a hospice, the
1765	need for such hospice shall be determined on the basis of the
1766	need for and availability of hospice services in the community.
1767	The formula on which the certificate of need is based shall
1768	discourage regional monopolies and promote competition. The
1769	inpatient hospice care component of a hospice which is a
1770	freestanding facility, or a part of a facility, which is
1771	primarily engaged in providing inpatient care and related
1772	services and is not licensed as a health care facility shall
1773	also be required to obtain a certificate of need. Provision of
1774	hospice care by any current provider of health care is a
1775	significant change in service and therefore requires a
1776	certificate of need for such services.
1777	Section 54.  Paragraph (k) of subsection (3) of section
1778	408.05, Florida Statutes, is amended to read:
1779	408.05  Florida Center for Health Information and Policy
1780	Analysis.-
1781	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
1782	produce comparable and uniform health information and statistics
1783	for the development of policy recommendations, the agency shall
1784	perform the following functions:
1785	(k)  Develop, in conjunction with the State Consumer Health
1786	Information and Policy Advisory Council, and implement a long-
1787	range plan for making available health care quality measures and
1788	financial data that will allow consumers to compare health care
1789	services. The health care quality measures and financial data
1790	the agency must make available shall include, but is not limited
1791	to, pharmaceuticals, physicians, health care facilities, and
1792	health plans and managed care entities. The agency shall submit
1793	the initial plan to the Governor, the President of the Senate,
1794	and the Speaker of the House of Representatives by January 1,
1795	2006, and shall update the plan and report on the status of its
1796	implementation annually thereafter. The agency shall also make
1797	the plan and status report available to the public on its
1798	Internet website. As part of the plan, the agency shall identify
1799	the process and timeframes for implementation, any barriers to
1800	implementation, and recommendations of changes in the law that
1801	may be enacted by the Legislature to eliminate the barriers. As
1802	preliminary elements of the plan, the agency shall:
1803	1.  Make available patient-safety indicators, inpatient
1804	quality indicators, and performance outcome and patient charge
1805	data collected from health care facilities pursuant to s.
1806	408.061(1)(a) and (2). The terms "patient-safety indicators" and
1807	"inpatient quality indicators" shall be as defined by the
1808	Centers for Medicare and Medicaid Services, the National Quality
1809	Forum, The Joint Commission on Accreditation of Healthcare
1810	Organizations, the Agency for Healthcare Research and Quality,
1811	the Centers for Disease Control and Prevention, or a similar
1812	national entity that establishes standards to measure the
1813	performance of health care providers, or by other states. The
1814	agency shall determine which conditions, procedures, health care
1815	quality measures, and patient charge data to disclose based upon
1816	input from the council. When determining which conditions and
1817	procedures are to be disclosed, the council and the agency shall
1818	consider variation in costs, variation in outcomes, and
1819	magnitude of variations and other relevant information. When
1820	determining which health care quality measures to disclose, the
1821	agency:
1822	a.  Shall consider such factors as volume of cases; average
1823	patient charges; average length of stay; complication rates;
1824	mortality rates; and infection rates, among others, which shall
1825	be adjusted for case mix and severity, if applicable.
1826	b.  May consider such additional measures that are adopted
1827	by the Centers for Medicare and Medicaid Studies, National
1828	Quality Forum, The Joint Commission on Accreditation of
1829	Healthcare Organizations, the Agency for Healthcare Research and
1830	Quality, Centers for Disease Control and Prevention, or a
1831	similar national entity that establishes standards to measure
1832	the performance of health care providers, or by other states.
1833
1834	When determining which patient charge data to disclose, the
1835	agency shall include such measures as the average of
1836	undiscounted charges on frequently performed procedures and
1837	preventive diagnostic procedures, the range of procedure charges
1838	from highest to lowest, average net revenue per adjusted patient
1839	day, average cost per adjusted patient day, and average cost per
1840	admission, among others.
1841	2.  Make available performance measures, benefit design,
1842	and premium cost data from health plans licensed pursuant to
1843	chapter 627 or chapter 641. The agency shall determine which
1844	health care quality measures and member and subscriber cost data
1845	to disclose, based upon input from the council. When determining
1846	which data to disclose, the agency shall consider information
1847	that may be required by either individual or group purchasers to
1848	assess the value of the product, which may include membership
1849	satisfaction, quality of care, current enrollment or membership,
1850	coverage areas, accreditation status, premium costs, plan costs,
1851	premium increases, range of benefits, copayments and
1852	deductibles, accuracy and speed of claims payment, credentials
1853	of physicians, number of providers, names of network providers,
1854	and hospitals in the network. Health plans shall make available
1855	to the agency any such data or information that is not currently
1856	reported to the agency or the office.
1857	3.  Determine the method and format for public disclosure
1858	of data reported pursuant to this paragraph. The agency shall
1859	make its determination based upon input from the State Consumer
1860	Health Information and Policy Advisory Council. At a minimum,
1861	the data shall be made available on the agency's Internet
1862	website in a manner that allows consumers to conduct an
1863	interactive search that allows them to view and compare the
1864	information for specific providers. The website must include
1865	such additional information as is determined necessary to ensure
1866	that the website enhances informed decisionmaking among
1867	consumers and health care purchasers, which shall include, at a
1868	minimum, appropriate guidance on how to use the data and an
1869	explanation of why the data may vary from provider to provider.
1870	The data specified in subparagraph 1. shall be released no later
1871	than January 1, 2006, for the reporting of infection rates, and
1872	no later than October 1, 2005, for mortality rates and
1873	complication rates. The data specified in subparagraph 2. shall
1874	be released no later than October 1, 2006.
1875	4.  Publish on its website undiscounted charges for no
1876	fewer than 150 of the most commonly performed adult and
1877	pediatric procedures, including outpatient, inpatient,
1878	diagnostic, and preventative procedures.
1879	Section 55.  Paragraph (a) of subsection (1) of section
1880	408.061, Florida Statutes, is amended to read:
1881	408.061  Data collection; uniform systems of financial
1882	reporting; information relating to physician charges;
1883	confidential information; immunity.-
1884	(1)  The agency shall require the submission by health care
1885	facilities, health care providers, and health insurers of data
1886	necessary to carry out the agency's duties. Specifications for
1887	data to be collected under this section shall be developed by
1888	the agency with the assistance of technical advisory panels
1889	including representatives of affected entities, consumers,
1890	purchasers, and such other interested parties as may be
1891	determined by the agency.
1892	(a)  Data submitted by health care facilities, including
1893	the facilities as defined in chapter 395, shall include, but are
1894	not limited to: case-mix data, patient admission and discharge
1895	data, hospital emergency department data which shall include the
1896	number of patients treated in the emergency department of a
1897	licensed hospital reported by patient acuity level, data on
1898	hospital-acquired infections as specified by rule, data on
1899	complications as specified by rule, data on readmissions as
1900	specified by rule, with patient and provider-specific
1901	identifiers included, actual charge data by diagnostic groups,
1902	financial data, accounting data, operating expenses, expenses
1903	incurred for rendering services to patients who cannot or do not
1904	pay, interest charges, depreciation expenses based on the
1905	expected useful life of the property and equipment involved, and
1906	demographic data. The agency shall adopt nationally recognized
1907	risk adjustment methodologies or software consistent with the
1908	standards of the Agency for Healthcare Research and Quality and
1909	as selected by the agency for all data submitted as required by
1910	this section. Data may be obtained from documents such as, but
1911	not limited to: leases, contracts, debt instruments, itemized
1912	patient bills, medical record abstracts, and related diagnostic
1913	information. Reported data elements shall be reported
1914	electronically and in accordance with rule 59E-7.012, Florida
1915	Administrative Code. Data submitted shall be certified
1916	chief executive officer or an appropriate and duly authorized
1917	representative or employee of the licensed facility that the
1918	information submitted is true and accurate.
1919	Section 56.  Subsection (43) of section 408.07, Florida
1920	Statutes, is amended to read:
1921	408.07  Definitions.-As used in this chapter, with the
1922	exception of ss. 408.031-408.045, the term:
1923	(43)  "Rural hospital" means an acute care hospital
1924	licensed under chapter 395, having 100 or fewer licensed beds
1925	and an emergency room, and which is:
1926	(a)  The sole provider within a county with a population
1927	density of no greater than 100 persons per square mile;
1928	(b)  An acute care hospital, in a county with a population
1929	density of no greater than 100 persons per square mile, which is
1930	at least 30 minutes of travel time, on normally traveled roads
1931	under normal traffic conditions, from another acute care
1932	hospital within the same county;
1933	(c)  A hospital supported by a tax district or subdistrict
1934	whose boundaries encompass a population of 100 persons or fewer
1935	per square mile;
1936	(d)  A hospital with a service area that has a population
1937	of 100 persons or fewer per square mile. As used in this
1938	paragraph, the term "service area" means the fewest number of
1939	zip codes that account for 75 percent of the hospital's
1940	discharges for the most recent 5-year period, based on
1941	information available from the hospital inpatient discharge
1942	database in the Florida Center for Health Information and Policy
1943	Analysis at the Agency for Health Care Administration; or
1944	(e)  A critical access hospital.
1945
1946	Population densities used in this subsection must be based upon
1947	the most recently completed United States census. A hospital
1948	that received funds under s. 409.9116 for a quarter beginning no
1949	later than July 1, 2002, is deemed to have been and shall
1950	continue to be a rural hospital from that date through June 30,
1951	2015, if the hospital continues to have 100 or fewer licensed
1952	beds and an emergency room, or meets the criteria of s.
1953	395.602(2)(e)4. An acute care hospital that has not previously
1954	been designated as a rural hospital and that meets the criteria
1955	of this subsection shall be granted such designation upon
1956	application, including supporting documentation, to the Agency
1957	for Health Care Administration.
1958	Section 57.  Section 408.10, Florida Statutes, is amended
1959	to read:
1960	408.10  Consumer complaints.-The agency shall:
1961	(1)  publish and make available to the public a toll-free
1962	telephone number for the purpose of handling consumer complaints
1963	and shall serve as a liaison between consumer entities and other
1964	private entities and governmental entities for the disposition
1965	of problems identified by consumers of health care.
1966	(2)  Be empowered to investigate consumer complaints
1967	relating to problems with health care facilities' billing
1968	practices and issue reports to be made public in any cases where
1969	the agency determines the health care facility has engaged in
1970	billing practices which are unreasonable and unfair to the
1971	consumer.
1972	Section 58.  Subsections (12) through (30) of section
1973	408.802, Florida Statutes, are renumbered as subsections (11)
1974	through (29), respectively, and present subsection (11) of that
1975	section is amended to read:
1976	408.802  Applicability.-The provisions of this part apply
1977	to the provision of services that require licensure as defined
1978	in this part and to the following entities licensed, registered,
1979	or certified by the agency, as described in chapters 112, 383,
1980	390, 394, 395, 400, 429, 440, 483, and 765:
1981	(11)  Private review agents, as provided under part I of
1982	chapter 395.
1983	Section 59.  Subsection (3) is added to section 408.804,
1984	Florida Statutes, to read:
1985	408.804  License required; display.-
1986	(3)  Any person who knowingly alters, defaces, or falsifies
1987	a license certificate issued by the agency, or causes or
1988	procures any person to commit such an offense, commits a
1989	misdemeanor of the second degree, punishable as provided in s.
1990	775.082 or s 775.083. Any licensee or provider who displays an
1991	altered, defaced, or falsified license certificate is subject to
1992	the penalties set forth in s. 408.815 and an administrative fine
1993	of $1,000 for each day of illegal display.
1994	Section 60.  Paragraph (d) of subsection (2) of section
1995	408.806, Florida Statutes, is amended, present subsections (3)
1996	through (8) are renumbered as subsections (4) through (9),
1997	respectively, and a new subsection (3) is added to that section,
1998	to read:
1999	408.806  License application process.-
2000	(2)
2001	(d)  The agency shall notify the licensee by mail or
2002	electronically at least 90 days before the expiration of a
2003	license that a renewal license is necessary to continue
2004	operation. The licensee's failure to timely file submit a
2005	renewal application and license application fee with the agency
2006	shall result in a $50 per day late fee charged to the licensee
2007	by the agency; however, the aggregate amount of the late fee may
2008	not exceed 50 percent of the licensure fee or $500, whichever is
2009	less. The agency shall provide a courtesy notice to the licensee
2010	by United States mail, electronically, or by any other manner at
2011	its address of record or mailing address, if provided, at least
2012	90 days prior to the expiration of a license informing the
2013	licensee of the expiration of the license. If the agency does
2014	not provide the courtesy notice or the licensee does not receive
2015	the courtesy notice, the licensee continues to be legally
2016	obligated to timely file the renewal application and license
2017	application fee with the agency and is not excused from the
2018	payment of a late fee. If an application is received after the
2019	required filing date and exhibits a hand-canceled postmark
2020	obtained from a United States post office dated on or before the
2021	required filing date, no fine will be levied.
2022	(3)  Payment of the late fee is required to consider any
2023	late application complete, and failure to pay the late fee is
2024	considered an omission from the application.
2025	Section 61.  Subsections (6) and (9) of section 408.810,
2026	Florida Statutes, are amended to read:
2027	408.810  Minimum licensure requirements.-In addition to the
2028	licensure requirements specified in this part, authorizing
2029	statutes, and applicable rules, each applicant and licensee must
2030	comply with the requirements of this section in order to obtain
2031	and maintain a license.
2032	(6)(a)  An applicant must provide the agency with proof of
2033	the applicant's legal right to occupy the property before a
2034	license may be issued. Proof may include, but need not be
2035	limited to, copies of warranty deeds, lease or rental
2036	agreements, contracts for deeds, quitclaim deeds, or other such
2037	documentation.
2038	(b)  In the event the property is encumbered by a mortgage
2039	or is leased, an applicant must provide the agency with proof
2040	that the mortgagor or landlord has been provided written notice
2041	of the applicant's intent as mortgagee or tenant to provide
2042	services that require licensure and instruct the mortgagor or
2043	landlord to serve the agency by certified mail with copies of
2044	any foreclosure or eviction actions initiated by the mortgagor
2045	or landlord against the applicant.
2046	(9)  A controlling interest may not withhold from the
2047	agency any evidence of financial instability, including, but not
2048	limited to, checks returned due to insufficient funds,
2049	delinquent accounts, nonpayment of withholding taxes, unpaid
2050	utility expenses, nonpayment for essential services, or adverse
2051	court action concerning the financial viability of the provider
2052	or any other provider licensed under this part that is under the
2053	control of the controlling interest. A controlling interest
2054	shall notify the agency within 10 days after a court action to
2055	initiate bankruptcy, foreclosure, or eviction proceedings
2056	concerning the provider, in which the controlling interest is a
2057	petitioner or defendant. Any person who violates this subsection
2058	commits a misdemeanor of the second degree, punishable as
2059	provided in s. 775.082 or s. 775.083. Each day of continuing
2060	violation is a separate offense.
2061	Section 62.  Subsection (3) is added to section 408.813,
2062	Florida Statutes, to read:
2063	408.813  Administrative fines; violations.-As a penalty for
2064	any violation of this part, authorizing statutes, or applicable
2065	rules, the agency may impose an administrative fine.
2066	(3)  The agency may impose an administrative fine for a
2067	violation that does not qualify as a class I, class II, class
2068	III, or class IV violation. Unless otherwise specified by law,
2069	the amount of the fine shall not exceed $500 for each violation.
2070	Unclassified violations may include:
2071	(a)  Violating any term or condition of a license.
2072	(b)  Violating any provision of this part, authorizing
2073	statutes, or applicable rules.
2074	(c)  Exceeding licensed capacity.
2075	(d)  Providing services beyond the scope of the license.
2076	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2077	Section 63.  Subsection (5) is added to section 408.815,
2078	Florida Statutes, to read:
2079	408.815  License or application denial; revocation.-
2080	(5)  In order to ensure the health, safety, and welfare of
2081	clients when a license has been denied, revoked, or is set to
2082	terminate, the agency may extend the license expiration date for
2083	a period of up to 30 days for the sole purpose of allowing the
2084	safe and orderly discharge of clients. The agency may impose
2085	conditions on the extension, including, but not limited to,
2086	prohibiting or limiting admissions, expedited discharge
2087	planning, required status reports, and mandatory monitoring by
2088	the agency or third parties. In imposing these conditions, the
2089	agency shall take into consideration the nature and number of
2090	clients, the availability and location of acceptable alternative
2091	placements, and the ability of the licensee to continue
2092	providing care to the clients. The agency may terminate the
2093	extension or modify the conditions at any time. This authority
2094	is in addition to any other authority granted to the agency
2095	under chapter 120, this part, and authorizing statutes but
2096	creates no right or entitlement to an extension of a license
2097	expiration date.
2098	Section 64.  Paragraph (k) of subsection (4) of section
2099	409.221, Florida Statutes, is amended to read:
2100	409.221  Consumer-directed care program.-
2101	(4)  CONSUMER-DIRECTED CARE.-
2102	(k)  Reviews and reports.-The agency and the Departments of
2103	Elderly Affairs, Health, and Children and Family Services and
2104	the Agency for Persons with Disabilities shall each, on an
2105	ongoing basis, review and assess the implementation of the
2106	consumer-directed care program. By January 15 of each year, the
2107	agency shall submit a written report to the Legislature that
2108	includes each department's review of the program and contains
2109	recommendations for improvements to the program.
2110	Section 65.  Subsection (1) of section 409.91196, Florida
2111	Statutes, is amended to read:
2112	409.91196  Supplemental rebate agreements; public records
2113	and public meetings exemption.-
2114	(1)  The rebate amount, percent of rebate, manufacturer's
2115	pricing, and supplemental rebate, and other trade secrets as
2116	defined in s. 688.002 that the agency has identified for use in
2117	negotiations, held by the Agency for Health Care Administration
2118	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2119	119.07(1) and s. 24(a), Art. I of the State Constitution.
2120	Section 66.  Paragraph (a) of subsection (39) of section
2121	409.912, Florida Statutes, is amended to read:
2122	409.912  Cost-effective purchasing of health care.-The
2123	agency shall purchase goods and services for Medicaid recipients
2124	in the most cost-effective manner consistent with the delivery
2125	of quality medical care. To ensure that medical services are
2126	effectively utilized, the agency may, in any case, require a
2127	confirmation or second physician's opinion of the correct
2128	diagnosis for purposes of authorizing future services under the
2129	Medicaid program. This section does not restrict access to
2130	emergency services or poststabilization care services as defined
2131	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2132	shall be rendered in a manner approved by the agency. The agency
2133	shall maximize the use of prepaid per capita and prepaid
2134	aggregate fixed-sum basis services when appropriate and other
2135	alternative service delivery and reimbursement methodologies,
2136	including competitive bidding pursuant to s. 287.057, designed
2137	to facilitate the cost-effective purchase of a case-managed
2138	continuum of care. The agency shall also require providers to
2139	minimize the exposure of recipients to the need for acute
2140	inpatient, custodial, and other institutional care and the
2141	inappropriate or unnecessary use of high-cost services. The
2142	agency shall contract with a vendor to monitor and evaluate the
2143	clinical practice patterns of providers in order to identify
2144	trends that are outside the normal practice patterns of a
2145	provider's professional peers or the national guidelines of a
2146	provider's professional association. The vendor must be able to
2147	provide information and counseling to a provider whose practice
2148	patterns are outside the norms, in consultation with the agency,
2149	to improve patient care and reduce inappropriate utilization.
2150	The agency may mandate prior authorization, drug therapy
2151	management, or disease management participation for certain
2152	populations of Medicaid beneficiaries, certain drug classes, or
2153	particular drugs to prevent fraud, abuse, overuse, and possible
2154	dangerous drug interactions. The Pharmaceutical and Therapeutics
2155	Committee shall make recommendations to the agency on drugs for
2156	which prior authorization is required. The agency shall inform
2157	the Pharmaceutical and Therapeutics Committee of its decisions
2158	regarding drugs subject to prior authorization. The agency is
2159	authorized to limit the entities it contracts with or enrolls as
2160	Medicaid providers by developing a provider network through
2161	provider credentialing. The agency may competitively bid single-
2162	source-provider contracts if procurement of goods or services
2163	results in demonstrated cost savings to the state without
2164	limiting access to care. The agency may limit its network based
2165	on the assessment of beneficiary access to care, provider
2166	availability, provider quality standards, time and distance
2167	standards for access to care, the cultural competence of the
2168	provider network, demographic characteristics of Medicaid
2169	beneficiaries, practice and provider-to-beneficiary standards,
2170	appointment wait times, beneficiary use of services, provider
2171	turnover, provider profiling, provider licensure history,
2172	previous program integrity investigations and findings, peer
2173	review, provider Medicaid policy and billing compliance records,
2174	clinical and medical record audits, and other factors. Providers
2175	shall not be entitled to enrollment in the Medicaid provider
2176	network. The agency shall determine instances in which allowing
2177	Medicaid beneficiaries to purchase durable medical equipment and
2178	other goods is less expensive to the Medicaid program than long-
2179	term rental of the equipment or goods. The agency may establish
2180	rules to facilitate purchases in lieu of long-term rentals in
2181	order to protect against fraud and abuse in the Medicaid program
2182	as defined in s. 409.913. The agency may seek federal waivers
2183	necessary to administer these policies.
2184	(39)(a)  The agency shall implement a Medicaid prescribed-
2185	drug spending-control program that includes the following
2186	components:
2187	1.  A Medicaid preferred drug list, which shall be a
2188	listing of cost-effective therapeutic options recommended by the
2189	Medicaid Pharmacy and Therapeutics Committee established
2190	pursuant to s. 409.91195 and adopted by the agency for each
2191	therapeutic class on the preferred drug list. At the discretion
2192	of the committee, and when feasible, the preferred drug list
2193	should include at least two products in a therapeutic class. The
2194	agency may post the preferred drug list and updates to the
2195	preferred drug list on an Internet website without following the
2196	rulemaking procedures of chapter 120. Antiretroviral agents are
2197	excluded from the preferred drug list. The agency shall also
2198	limit the amount of a prescribed drug dispensed to no more than
2199	a 34-day supply unless the drug products' smallest marketed
2200	package is greater than a 34-day supply, or the drug is
2201	determined by the agency to be a maintenance drug in which case
2202	a 100-day maximum supply may be authorized. The agency is
2203	authorized to seek any federal waivers necessary to implement
2204	these cost-control programs and to continue participation in the
2205	federal Medicaid rebate program, or alternatively to negotiate
2206	state-only manufacturer rebates. The agency may adopt rules to
2207	implement this subparagraph. The agency shall continue to
2208	provide unlimited contraceptive drugs and items. The agency must
2209	establish procedures to ensure that:
2210	a.  There is a response to a request for prior consultation
2211	by telephone or other telecommunication device within 24 hours
2212	after receipt of a request for prior consultation; and
2213	b.  A 72-hour supply of the drug prescribed is provided in
2214	an emergency or when the agency does not provide a response
2215	within 24 hours as required by sub-subparagraph a.
2216	2.  Reimbursement to pharmacies for Medicaid prescribed
2217	drugs shall be set at the lesser of: the average wholesale price
2218	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2219	plus 4.75 percent, the federal upper limit (FUL), the state
2220	maximum allowable cost (SMAC), or the usual and customary (UAC)
2221	charge billed by the provider.
2222	3.  For a prescribed drug billed as a 340B prescribed
2223	medication, the claim must meet the requirements of the Deficit
2224	Reduction Act of 2005 and the federal 340B program, contain a
2225	national drug code, and be billed at the actual acquisition cost
2226	or payment shall be denied.
2227	4.3.  The agency shall develop and implement a process for
2228	managing the drug therapies of Medicaid recipients who are using
2229	significant numbers of prescribed drugs each month. The
2230	management process may include, but is not limited to,
2231	comprehensive, physician-directed medical-record reviews, claims
2232	analyses, and case evaluations to determine the medical
2233	necessity and appropriateness of a patient's treatment plan and
2234	drug therapies. The agency may contract with a private
2235	organization to provide drug-program-management services. The
2236	Medicaid drug benefit management program shall include
2237	initiatives to manage drug therapies for HIV/AIDS patients,
2238	patients using 20 or more unique prescriptions in a 180-day
2239	period, and the top 1,000 patients in annual spending. The
2240	agency shall enroll any Medicaid recipient in the drug benefit
2241	management program if he or she meets the specifications of this
2242	provision and is not enrolled in a Medicaid health maintenance
2243	organization.
2244	5.4.  The agency may limit the size of its pharmacy network
2245	based on need, competitive bidding, price negotiations,
2246	credentialing, or similar criteria. The agency shall give
2247	special consideration to rural areas in determining the size and
2248	location of pharmacies included in the Medicaid pharmacy
2249	network. A pharmacy credentialing process may include criteria
2250	such as a pharmacy's full-service status, location, size,
2251	patient educational programs, patient consultation, disease
2252	management services, and other characteristics. The agency may
2253	impose a moratorium on Medicaid pharmacy enrollment when it is
2254	determined that it has a sufficient number of Medicaid-
2255	participating providers. The agency must allow dispensing
2256	practitioners to participate as a part of the Medicaid pharmacy
2257	network regardless of the practitioner's proximity to any other
2258	entity that is dispensing prescription drugs under the Medicaid
2259	program. A dispensing practitioner must meet all credentialing
2260	requirements applicable to his or her practice, as determined by
2261	the agency.
2262	6.5.  The agency shall develop and implement a program that
2263	requires Medicaid practitioners who prescribe drugs to use a
2264	counterfeit-proof prescription pad for Medicaid prescriptions.
2265	The agency shall require the use of standardized counterfeit-
2266	proof prescription pads by Medicaid-participating prescribers or
2267	prescribers who write prescriptions for Medicaid recipients. The
2268	agency may implement the program in targeted geographic areas or
2269	statewide.
2270	7.6.  The agency may enter into arrangements that require
2271	manufacturers of generic drugs prescribed to Medicaid recipients
2272	to provide rebates of at least 15.1 percent of the average
2273	manufacturer price for the manufacturer's generic products.
2274	These arrangements shall require that if a generic-drug
2275	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2276	at a level below 15.1 percent, the manufacturer must provide a
2277	supplemental rebate to the state in an amount necessary to
2278	achieve a 15.1-percent rebate level.
2279	8.7.  The agency may establish a preferred drug list as
2280	described in this subsection, and, pursuant to the establishment
2281	of such preferred drug list, it is authorized to negotiate
2282	supplemental rebates from manufacturers that are in addition to
2283	those required by Title XIX of the Social Security Act and at no
2284	less than 14 percent of the average manufacturer price as
2285	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2286	the federal or supplemental rebate, or both, equals or exceeds
2287	29 percent. There is no upper limit on the supplemental rebates
2288	the agency may negotiate. The agency may determine that specific
2289	products, brand-name or generic, are competitive at lower rebate
2290	percentages. Agreement to pay the minimum supplemental rebate
2291	percentage will guarantee a manufacturer that the Medicaid
2292	Pharmaceutical and Therapeutics Committee will consider a
2293	product for inclusion on the preferred drug list. However, a
2294	pharmaceutical manufacturer is not guaranteed placement on the
2295	preferred drug list by simply paying the minimum supplemental
2296	rebate. Agency decisions will be made on the clinical efficacy
2297	of a drug and recommendations of the Medicaid Pharmaceutical and
2298	Therapeutics Committee, as well as the price of competing
2299	products minus federal and state rebates. The agency is
2300	authorized to contract with an outside agency or contractor to
2301	conduct negotiations for supplemental rebates. For the purposes
2302	of this section, the term "supplemental rebates" means cash
2303	rebates. Effective July 1, 2004, value-added programs as a
2304	substitution for supplemental rebates are prohibited. The agency
2305	is authorized to seek any federal waivers to implement this
2306	initiative.
2307	9.8.  The Agency for Health Care Administration shall
2308	expand home delivery of pharmacy products. To assist Medicaid
2309	patients in securing their prescriptions and reduce program
2310	costs, the agency shall expand its current mail-order-pharmacy
2311	diabetes-supply program to include all generic and brand-name
2312	drugs used by Medicaid patients with diabetes. Medicaid
2313	recipients in the current program may obtain nondiabetes drugs
2314	on a voluntary basis. This initiative is limited to the
2315	geographic area covered by the current contract. The agency may
2316	seek and implement any federal waivers necessary to implement
2317	this subparagraph.
2318	10.9.  The agency shall limit to one dose per month any
2319	drug prescribed to treat erectile dysfunction.
2320	11.10.a.  The agency may implement a Medicaid behavioral
2321	drug management system. The agency may contract with a vendor
2322	that has experience in operating behavioral drug management
2323	systems to implement this program. The agency is authorized to
2324	seek federal waivers to implement this program.
2325	b.  The agency, in conjunction with the Department of
2326	Children and Family Services, may implement the Medicaid
2327	behavioral drug management system that is designed to improve
2328	the quality of care and behavioral health prescribing practices
2329	based on best practice guidelines, improve patient adherence to
2330	medication plans, reduce clinical risk, and lower prescribed
2331	drug costs and the rate of inappropriate spending on Medicaid
2332	behavioral drugs. The program may include the following
2333	elements:
2334	(I)  Provide for the development and adoption of best
2335	practice guidelines for behavioral health-related drugs such as
2336	antipsychotics, antidepressants, and medications for treating
2337	bipolar disorders and other behavioral conditions; translate
2338	them into practice; review behavioral health prescribers and
2339	compare their prescribing patterns to a number of indicators
2340	that are based on national standards; and determine deviations
2341	from best practice guidelines.
2342	(II)  Implement processes for providing feedback to and
2343	educating prescribers using best practice educational materials
2344	and peer-to-peer consultation.
2345	(III)  Assess Medicaid beneficiaries who are outliers in
2346	their use of behavioral health drugs with regard to the numbers
2347	and types of drugs taken, drug dosages, combination drug
2348	therapies, and other indicators of improper use of behavioral
2349	health drugs.
2350	(IV)  Alert prescribers to patients who fail to refill
2351	prescriptions in a timely fashion, are prescribed multiple same-
2352	class behavioral health drugs, and may have other potential
2353	medication problems.
2354	(V)  Track spending trends for behavioral health drugs and
2355	deviation from best practice guidelines.
2356	(VI)  Use educational and technological approaches to
2357	promote best practices, educate consumers, and train prescribers
2358	in the use of practice guidelines.
2359	(VII)  Disseminate electronic and published materials.
2360	(VIII)  Hold statewide and regional conferences.
2361	(IX)  Implement a disease management program with a model
2362	quality-based medication component for severely mentally ill
2363	individuals and emotionally disturbed children who are high
2364	users of care.
2365	12.11.a.  The agency shall implement a Medicaid
2366	prescription drug management system. The agency may contract
2367	with a vendor that has experience in operating prescription drug
2368	management systems in order to implement this system. Any
2369	management system that is implemented in accordance with this
2370	subparagraph must rely on cooperation between physicians and
2371	pharmacists to determine appropriate practice patterns and
2372	clinical guidelines to improve the prescribing, dispensing, and
2373	use of drugs in the Medicaid program. The agency may seek
2374	federal waivers to implement this program.
2375	b.  The drug management system must be designed to improve
2376	the quality of care and prescribing practices based on best
2377	practice guidelines, improve patient adherence to medication
2378	plans, reduce clinical risk, and lower prescribed drug costs and
2379	the rate of inappropriate spending on Medicaid prescription
2380	drugs. The program must:
2381	(I)  Provide for the development and adoption of best
2382	practice guidelines for the prescribing and use of drugs in the
2383	Medicaid program, including translating best practice guidelines
2384	into practice; reviewing prescriber patterns and comparing them
2385	to indicators that are based on national standards and practice
2386	patterns of clinical peers in their community, statewide, and
2387	nationally; and determine deviations from best practice
2388	guidelines.
2389	(II)  Implement processes for providing feedback to and
2390	educating prescribers using best practice educational materials
2391	and peer-to-peer consultation.
2392	(III)  Assess Medicaid recipients who are outliers in their
2393	use of a single or multiple prescription drugs with regard to
2394	the numbers and types of drugs taken, drug dosages, combination
2395	drug therapies, and other indicators of improper use of
2396	prescription drugs.
2397	(IV)  Alert prescribers to patients who fail to refill
2398	prescriptions in a timely fashion, are prescribed multiple drugs
2399	that may be redundant or contraindicated, or may have other
2400	potential medication problems.
2401	(V)  Track spending trends for prescription drugs and
2402	deviation from best practice guidelines.
2403	(VI)  Use educational and technological approaches to
2404	promote best practices, educate consumers, and train prescribers
2405	in the use of practice guidelines.
2406	(VII)  Disseminate electronic and published materials.
2407	(VIII)  Hold statewide and regional conferences.
2408	(IX)  Implement disease management programs in cooperation
2409	with physicians and pharmacists, along with a model quality-
2410	based medication component for individuals having chronic
2411	medical conditions.
2412	13.12.  The agency is authorized to contract for drug
2413	rebate administration, including, but not limited to,
2414	calculating rebate amounts, invoicing manufacturers, negotiating
2415	disputes with manufacturers, and maintaining a database of
2416	rebate collections.
2417	14.13.  The agency may specify the preferred daily dosing
2418	form or strength for the purpose of promoting best practices
2419	with regard to the prescribing of certain drugs as specified in
2420	the General Appropriations Act and ensuring cost-effective
2421	prescribing practices.
2422	15.14.  The agency may require prior authorization for
2423	Medicaid-covered prescribed drugs. The agency may, but is not
2424	required to, prior-authorize the use of a product:
2425	a.  For an indication not approved in labeling;
2426	b.  To comply with certain clinical guidelines; or
2427	c.  If the product has the potential for overuse, misuse,
2428	or abuse.
2429
2430	The agency may require the prescribing professional to provide
2431	information about the rationale and supporting medical evidence
2432	for the use of a drug. The agency may post prior authorization
2433	criteria and protocol and updates to the list of drugs that are
2434	subject to prior authorization on an Internet website without
2435	amending its rule or engaging in additional rulemaking.
2436	16.15.  The agency, in conjunction with the Pharmaceutical
2437	and Therapeutics Committee, may require age-related prior
2438	authorizations for certain prescribed drugs. The agency may
2439	preauthorize the use of a drug for a recipient who may not meet
2440	the age requirement or may exceed the length of therapy for use
2441	of this product as recommended by the manufacturer and approved
2442	by the Food and Drug Administration. Prior authorization may
2443	require the prescribing professional to provide information
2444	about the rationale and supporting medical evidence for the use
2445	of a drug.
2446	17.16.  The agency shall implement a step-therapy prior
2447	authorization approval process for medications excluded from the
2448	preferred drug list. Medications listed on the preferred drug
2449	list must be used within the previous 12 months prior to the
2450	alternative medications that are not listed. The step-therapy
2451	prior authorization may require the prescriber to use the
2452	medications of a similar drug class or for a similar medical
2453	indication unless contraindicated in the Food and Drug
2454	Administration labeling. The trial period between the specified
2455	steps may vary according to the medical indication. The step-
2456	therapy approval process shall be developed in accordance with
2457	the committee as stated in s. 409.91195(7) and (8). A drug
2458	product may be approved without meeting the step-therapy prior
2459	authorization criteria if the prescribing physician provides the
2460	agency with additional written medical or clinical documentation
2461	that the product is medically necessary because:
2462	a.  There is not a drug on the preferred drug list to treat
2463	the disease or medical condition which is an acceptable clinical
2464	alternative;
2465	b.  The alternatives have been ineffective in the treatment
2466	of the beneficiary's disease; or
2467	c.  Based on historic evidence and known characteristics of
2468	the patient and the drug, the drug is likely to be ineffective,
2469	or the number of doses have been ineffective.
2470
2471	The agency shall work with the physician to determine the best
2472	alternative for the patient. The agency may adopt rules waiving
2473	the requirements for written clinical documentation for specific
2474	drugs in limited clinical situations.
2475	18.17.  The agency shall implement a return and reuse
2476	program for drugs dispensed by pharmacies to institutional
2477	recipients, which includes payment of a $5 restocking fee for
2478	the implementation and operation of the program. The return and
2479	reuse program shall be implemented electronically and in a
2480	manner that promotes efficiency. The program must permit a
2481	pharmacy to exclude drugs from the program if it is not
2482	practical or cost-effective for the drug to be included and must
2483	provide for the return to inventory of drugs that cannot be
2484	credited or returned in a cost-effective manner. The agency
2485	shall determine if the program has reduced the amount of
2486	Medicaid prescription drugs which are destroyed on an annual
2487	basis and if there are additional ways to ensure more
2488	prescription drugs are not destroyed which could safely be
2489	reused. The agency's conclusion and recommendations shall be
2490	reported to the Legislature by December 1, 2005.
2491	Section 67.  Subsections (3) and (4) of section 429.07,
2492	Florida Statutes, are amended, and subsections (6) and (7) are
2493	added to that section, to read:
2494	429.07  License required; fee; inspections.-
2495	(3)  In addition to the requirements of s. 408.806, each
2496	license granted by the agency must state the type of care for
2497	which the license is granted. Licenses shall be issued for one
2498	or more of the following categories of care: standard, extended
2499	congregate care, limited nursing services, or limited mental
2500	health.
2501	(a)  A standard license shall be issued to a facility
2502	facilities providing one or more of the personal services
2503	identified in s. 429.02. Such licensee facilities may also
2504	employ or contract with a person licensed under part I of
2505	chapter 464 to administer medications and perform other tasks as
2506	specified in s. 429.255.
2507	(b)  An extended congregate care license shall be issued to
2508	a licensee facilities providing, directly or through contract,
2509	services beyond those authorized in paragraph (a), including
2510	acts performed pursuant to part I of chapter 464 by persons
2511	licensed thereunder, and supportive services defined by rule to
2512	persons who otherwise would be disqualified from continued
2513	residence in a facility licensed under this part.
2514	1.  In order for extended congregate care services to be
2515	provided in a facility licensed under this part, the agency must
2516	first determine that all requirements established in law and
2517	rule are met and must specifically designate, on the facility's
2518	license, that such services may be provided and whether the
2519	designation applies to all or part of a facility. Such
2520	designation may be made at the time of initial licensure or
2521	relicensure, or upon request in writing by a licensee under this
2522	part and part II of chapter 408. Notification of approval or
2523	denial of such request shall be made in accordance with part II
2524	of chapter 408. An existing licensee facilities qualifying to
2525	provide extended congregate care services must have maintained a
2526	standard license and may not have been subject to administrative
2527	sanctions during the previous 2 years, or since initial
2528	licensure if the facility has been licensed for less than 2
2529	years, for any of the following reasons:
2530	a.  A class I or class II violation;
2531	b.  Three or more repeat or recurring class III violations
2532	of identical or similar resident care standards as specified in
2533	rule from which a pattern of noncompliance is found by the
2534	agency;
2535	c.  Three or more class III violations that were not
2536	corrected in accordance with the corrective action plan approved
2537	by the agency;
2538	d.  Violation of resident care standards resulting in a
2539	requirement to employ the services of a consultant pharmacist or
2540	consultant dietitian;
2541	e.  Denial, suspension, or revocation of a license for
2542	another facility under this part in which the applicant for an
2543	extended congregate care license has at least 25 percent
2544	ownership interest; or
2545	f.  Imposition of a moratorium pursuant to this part or
2546	part II of chapter 408 or initiation of injunctive proceedings.
2547	2.  A licensee Facilities that is are licensed to provide
2548	extended congregate care services shall maintain a written
2549	progress report for on each person who receives such services,
2550	and the which report must describe describes the type, amount,
2551	duration, scope, and outcome of services that are rendered and
2552	the general status of the resident's health. A registered nurse,
2553	or appropriate designee, representing the agency shall visit
2554	such facilities at least quarterly to monitor residents who are
2555	receiving extended congregate care services and to determine if
2556	the facility is in compliance with this part, part II of chapter
2557	408, and rules that relate to extended congregate care. One of
2558	these visits may be in conjunction with the regular survey. The
2559	monitoring visits may be provided through contractual
2560	arrangements with appropriate community agencies. A registered
2561	nurse shall serve as part of the team that inspects such
2562	facility. The agency may waive one of the required yearly
2563	monitoring visits for a facility that has been licensed for at
2564	least 24 months to provide extended congregate care services,
2565	if, during the inspection, the registered nurse determines that
2566	extended congregate care services are being provided
2567	appropriately, and if the facility has no class I or class II
2568	violations and no uncorrected class III violations. Before such
2569	decision is made, the agency shall consult with the long-term
2570	care ombudsman council for the area in which the facility is
2571	located to determine if any complaints have been made and
2572	substantiated about the quality of services or care. The agency
2573	may not waive one of the required yearly monitoring visits if
2574	complaints have been made and substantiated.
2575	3.  Licensees Facilities that are licensed to provide
2576	extended congregate care services shall:
2577	a.  Demonstrate the capability to meet unanticipated
2578	resident service needs.
2579	b.  Offer a physical environment that promotes a homelike
2580	setting, provides for resident privacy, promotes resident
2581	independence, and allows sufficient congregate space as defined
2582	by rule.
2583	c.  Have sufficient staff available, taking into account
2584	the physical plant and firesafety features of the building, to
2585	assist with the evacuation of residents in an emergency, as
2586	necessary.
2587	d.  Adopt and follow policies and procedures that maximize
2588	resident independence, dignity, choice, and decisionmaking to
2589	permit residents to age in place to the extent possible, so that
2590	moves due to changes in functional status are minimized or
2591	avoided.
2592	e.  Allow residents or, if applicable, a resident's
2593	representative, designee, surrogate, guardian, or attorney in
2594	fact to make a variety of personal choices, participate in
2595	developing service plans, and share responsibility in
2596	decisionmaking.
2597	f.  Implement the concept of managed risk.
2598	g.  Provide, either directly or through contract, the
2599	services of a person licensed pursuant to part I of chapter 464.
2600	h.  In addition to the training mandated in s. 429.52,
2601	provide specialized training as defined by rule for facility
2602	staff.
2603	4.  Licensees Facilities licensed to provide extended
2604	congregate care services are exempt from the criteria for
2605	continued residency as set forth in rules adopted under s.
2606	429.41. Licensees Facilities so licensed shall adopt their own
2607	requirements within guidelines for continued residency set forth
2608	by rule. However, such licensees facilities may not serve
2609	residents who require 24-hour nursing supervision. Licensees
2610	Facilities licensed to provide extended congregate care services
2611	shall provide each resident with a written copy of facility
2612	policies governing admission and retention.
2613	5.  The primary purpose of extended congregate care
2614	services is to allow residents, as they become more impaired,
2615	the option of remaining in a familiar setting from which they
2616	would otherwise be disqualified for continued residency. A
2617	facility licensed to provide extended congregate care services
2618	may also admit an individual who exceeds the admission criteria
2619	for a facility with a standard license, if the individual is
2620	determined appropriate for admission to the extended congregate
2621	care facility.
2622	6.  Before admission of an individual to a facility
2623	licensed to provide extended congregate care services, the
2624	individual must undergo a medical examination as provided in s.
2625	429.26(4) and the facility must develop a preliminary service
2626	plan for the individual.
2627	7.  When a licensee facility can no longer provide or
2628	arrange for services in accordance with the resident's service
2629	plan and needs and the licensee's facility's policy, the
2630	licensee facility shall make arrangements for relocating the
2631	person in accordance with s. 429.28(1)(k).
2632	8.  Failure to provide extended congregate care services
2633	may result in denial of extended congregate care license
2634	renewal.
2635	9.  No later than January 1 of each year, the department,
2636	in consultation with the agency, shall prepare and submit to the
2637	Governor, the President of the Senate, the Speaker of the House
2638	of Representatives, and the chairs of appropriate legislative
2639	committees, a report on the status of, and recommendations
2640	related to, extended congregate care services. The status report
2641	must include, but need not be limited to, the following
2642	information:
2643	a.  A description of the facilities licensed to provide
2644	such services, including total number of beds licensed under
2645	this part.
2646	b.  The number and characteristics of residents receiving
2647	such services.
2648	c.  The types of services rendered that could not be
2649	provided through a standard license.
2650	d.  An analysis of deficiencies cited during licensure
2651	inspections.
2652	e.  The number of residents who required extended
2653	congregate care services at admission and the source of
2654	admission.
2655	f.  Recommendations for statutory or regulatory changes.
2656	g.  The availability of extended congregate care to state
2657	clients residing in facilities licensed under this part and in
2658	need of additional services, and recommendations for
2659	appropriations to subsidize extended congregate care services
2660	for such persons.
2661	h.  Such other information as the department considers
2662	appropriate.
2663	(c)  A limited nursing services license shall be issued to
2664	a facility that provides services beyond those authorized in
2665	paragraph (a) and as specified in this paragraph.
2666	1.  In order for limited nursing services to be provided in
2667	a facility licensed under this part, the agency must first
2668	determine that all requirements established in law and rule are
2669	met and must specifically designate, on the facility's license,
2670	that such services may be provided. Such designation may be made
2671	at the time of initial licensure or relicensure, or upon request
2672	in writing by a licensee under this part and part II of chapter
2673	408. Notification of approval or denial of such request shall be
2674	made in accordance with part II of chapter 408. Existing
2675	facilities qualifying to provide limited nursing services shall
2676	have maintained a standard license and may not have been subject
2677	to administrative sanctions that affect the health, safety, and
2678	welfare of residents for the previous 2 years or since initial
2679	licensure if the facility has been licensed for less than 2
2680	years.
2681	2.  Facilities that are licensed to provide limited nursing
2682	services shall maintain a written progress report on each person
2683	who receives such nursing services, which report describes the
2684	type, amount, duration, scope, and outcome of services that are
2685	rendered and the general status of the resident's health. A
2686	registered nurse representing the agency shall visit such
2687	facilities at least twice a year to monitor residents who are
2688	receiving limited nursing services and to determine if the
2689	facility is in compliance with applicable provisions of this
2690	part, part II of chapter 408, and related rules. The monitoring
2691	visits may be provided through contractual arrangements with
2692	appropriate community agencies. A registered nurse shall also
2693	serve as part of the team that inspects such facility.
2694	3.  A person who receives limited nursing services under
2695	this part must meet the admission criteria established by the
2696	agency for assisted living facilities. When a resident no longer
2697	meets the admission criteria for a facility licensed under this
2698	part, arrangements for relocating the person shall be made in
2699	accordance with s. 429.28(1)(k), unless the facility is licensed
2700	to provide extended congregate care services.
2701	(4)  In accordance with s. 408.805, an applicant or
2702	licensee shall pay a fee for each license application submitted
2703	under this part, part II of chapter 408, and applicable rules.
2704	The amount of the fee shall be established by rule.
2705	(a)  The biennial license fee required of a facility is
2706	$356 $300 per license, with an additional fee of $67.50 $50 per
2707	resident based on the total licensed resident capacity of the
2708	facility, except that no additional fee will be assessed for
2709	beds designated for recipients of optional state supplementation
2710	payments provided for in s. 409.212. The total fee may not
2711	exceed $18,000 $10,000.
2712	(b)  In addition to the total fee assessed under paragraph
2713	(a), the agency shall require facilities that are licensed to
2714	provide extended congregate care services under this part to pay
2715	an additional fee per licensed facility. The amount of the
2716	biennial fee shall be $501 $400 per license, with an additional
2717	fee of $10 per resident based on the total licensed resident
2718	capacity of the facility.
2719	(c)  In addition to the total fee assessed under paragraph
2720	(a), the agency shall require facilities that are licensed to
2721	provide limited nursing services under this part to pay an
2722	additional fee per licensed facility. The amount of the biennial
2723	fee shall be $250 per license, with an additional fee of $10 per
2724	resident based on the total licensed resident capacity of the
2725	facility.
2726	(6)  In order to determine whether the facility is
2727	adequately protecting residents' rights as provided in s.
2728	429.28, the biennial survey shall include private informal
2729	conversations with a sample of residents and consultation with
2730	the ombudsman council in the planning and service area in which
2731	the facility is located to discuss residents' experiences within
2732	the facility.
2733	(7)  An assisted living facility that has been cited within
2734	the previous 24-month period for a class I or class II
2735	violation, regardless of the status of any enforcement or
2736	disciplinary action, is subject to periodic unannounced
2737	monitoring to determine if the facility is in compliance with
2738	this part, part II of chapter 408, and applicable rules.
2739	Monitoring may occur through a desk review or an onsite
2740	assessment. If the class I or class II violation relates to
2741	providing or failing to provide nursing care, a registered nurse
2742	must participate in at least two onsite monitoring visits within
2743	a 12-month period.
2744	Section 68.  Subsection (7) of section 429.11, Florida
2745	Statutes, is renumbered as subsection (6), and present
2746	subsection (6) of that section is amended to read:
2747	429.11  Initial application for license; provisional
2748	license.-
2749	(6)  In addition to the license categories available in s.
2750	408.808, a provisional license may be issued to an applicant
2751	making initial application for licensure or making application
2752	for a change of ownership. A provisional license shall be
2753	limited in duration to a specific period of time not to exceed 6
2754	months, as determined by the agency.
2755	Section 69.  Section 429.12, Florida Statutes, is amended
2756	to read:
2757	429.12  Sale or transfer of ownership of a facility.-It is
2758	the intent of the Legislature to protect the rights of the
2759	residents of an assisted living facility when the facility is
2760	sold or the ownership thereof is transferred. Therefore, in
2761	addition to the requirements of part II of chapter 408, whenever
2762	a facility is sold or the ownership thereof is transferred,
2763	including leasing:.
2764	(1)  The transferee shall notify the residents, in writing,
2765	of the change of ownership within 7 days after receipt of the
2766	new license.
2767	(2)  The transferor of a facility the license of which is
2768	denied pending an administrative hearing shall, as a part of the
2769	written change-of-ownership contract, advise the transferee that
2770	a plan of correction must be submitted by the transferee and
2771	approved by the agency at least 7 days before the change of
2772	ownership and that failure to correct the condition which
2773	resulted in the moratorium pursuant to part II of chapter 408 or
2774	denial of licensure is grounds for denial of the transferee's
2775	license.
2776	Section 70.  Paragraphs (b) through (l) of subsection (1)
2777	of section 429.14, Florida Statutes, are redesignated as
2778	paragraphs (a) through (k), respectively, and present paragraph
2779	(a) of subsection (1) and subsections (5) and (6) of that
2780	section are amended to read:
2781	429.14  Administrative penalties.-
2782	(1)  In addition to the requirements of part II of chapter
2783	408, the agency may deny, revoke, and suspend any license issued
2784	under this part and impose an administrative fine in the manner
2785	provided in chapter 120 against a licensee of an assisted living
2786	facility for a violation of any provision of this part, part II
2787	of chapter 408, or applicable rules, or for any of the following
2788	actions by a licensee of an assisted living facility, for the
2789	actions of any person subject to level 2 background screening
2790	under s. 408.809, or for the actions of any facility employee:
2791	(a)  An intentional or negligent act seriously affecting
2792	the health, safety, or welfare of a resident of the facility.
2793	(5)  An action taken by the agency to suspend, deny, or
2794	revoke a facility's license under this part or part II of
2795	chapter 408, in which the agency claims that the facility owner
2796	or an employee of the facility has threatened the health,
2797	safety, or welfare of a resident of the facility shall be heard
2798	by the Division of Administrative Hearings of the Department of
2799	Management Services within 120 days after receipt of the
2800	facility's request for a hearing, unless that time limitation is
2801	waived by both parties. The administrative law judge must render
2802	a decision within 30 days after receipt of a proposed
2803	recommended order.
2804	(6)  The agency shall provide to the Division of Hotels and
2805	Restaurants of the Department of Business and Professional
2806	Regulation, on a monthly basis, a list of those assisted living
2807	facilities that have had their licenses denied, suspended, or
2808	revoked or that are involved in an appellate proceeding pursuant
2809	to s. 120.60 related to the denial, suspension, or revocation of
2810	a license. This information may be provided electronically or
2811	through the agency's Internet website.
2812	Section 71.  Subsections (1), (4), and (5) of section
2813	429.17, Florida Statutes, are amended to read:
2814	429.17  Expiration of license; renewal; conditional
2815	license.-
2816	(1)  Limited nursing, Extended congregate care, and limited
2817	mental health licenses shall expire at the same time as the
2818	facility's standard license, regardless of when issued.
2819	(4)  In addition to the license categories available in s.
2820	408.808, a conditional license may be issued to an applicant for
2821	license renewal if the applicant fails to meet all standards and
2822	requirements for licensure. A conditional license issued under
2823	this subsection shall be limited in duration to a specific
2824	period of time not to exceed 6 months, as determined by the
2825	agency, and shall be accompanied by an agency-approved plan of
2826	correction.
2827	(5)  When an extended congregate care or limited nursing
2828	license is requested during a facility's biennial license
2829	period, the fee shall be prorated in order to permit the
2830	additional license to expire at the end of the biennial license
2831	period. The fee shall be calculated as of the date the
2832	additional license application is received by the agency.
2833	Section 72.  Subsection (7) of section 429.19, Florida
2834	Statutes, is amended to read:
2835	429.19  Violations; imposition of administrative fines;
2836	grounds.-
2837	(7)  In addition to any administrative fines imposed, the
2838	agency may assess a survey or monitoring fee, equal to the
2839	lesser of one half of the facility's biennial license and bed
2840	fee or $500, to cover the cost of conducting initial complaint
2841	investigations that result in the finding of a violation that
2842	was the subject of the complaint or to monitor the health,
2843	safety, or security of residents under s. 429.07     (7) monitoring
2844	visits conducted under s. 429.28(3)(c) to verify the correction
2845	of the violations.
2846	Section 73.  Subsections (6) through (10) of section
2847	429.23, Florida Statutes, are renumbered as subsections (5)
2848	through (9), respectively, and present subsection (5) of that
2849	section is amended to read:
2850	429.23  Internal risk management and quality assurance
2851	program; adverse incidents and reporting requirements.-
2852	(5)  Each facility shall report monthly to the agency any
2853	liability claim filed against it. The report must include the
2854	name of the resident, the dates of the incident leading to the
2855	claim, if applicable, and the type of injury or violation of
2856	rights alleged to have occurred. This report is not discoverable
2857	in any civil or administrative action, except in such actions
2858	brought by the agency to enforce the provisions of this part.
2859	Section 74.  Paragraph (a) of subsection (1) and subsection
2860	(2) of section 429.255, Florida Statutes, are amended to read:
2861	429.255  Use of personnel; emergency care.-
2862	(1)(a)  Persons under contract to the facility or, facility
2863	staff, or volunteers, who are licensed according to part I of
2864	chapter 464, or those persons exempt under s. 464.022(1), and
2865	others as defined by rule, may administer medications to
2866	residents, take residents' vital signs, manage individual weekly
2867	pill organizers for residents who self-administer medication,
2868	give prepackaged enemas ordered by a physician, observe
2869	residents, document observations on the appropriate resident's
2870	record, report observations to the resident's physician, and
2871	contract or allow residents or a resident's representative,
2872	designee, surrogate, guardian, or attorney in fact to contract
2873	with a third party, provided residents meet the criteria for
2874	appropriate placement as defined in s. 429.26. Persons under
2875	contract to the facility or facility staff who are licensed
2876	according to part I of chapter 464 may provide limited nursing
2877	services. Nursing assistants certified pursuant to part II of
2878	chapter 464 may take residents' vital signs as directed by a
2879	licensed nurse or physician. The facility is responsible for
2880	maintaining documentation of services provided under this
2881	paragraph as required by rule and ensuring that staff are
2882	adequately trained to monitor residents receiving these
2883	services.
2884	(2)  In facilities licensed to provide extended congregate
2885	care, persons under contract to the facility or, facility staff,
2886	or volunteers, who are licensed according to part I of chapter
2887	464, or those persons exempt under s. 464.022(1), or those
2888	persons certified as nursing assistants pursuant to part II of
2889	chapter 464, may also perform all duties within the scope of
2890	their license or certification, as approved by the facility
2891	administrator and pursuant to this part.
2892	Section 75.  Subsection (3) of section 429.28, Florida
2893	Statutes, is amended to read:
2894	429.28  Resident bill of rights.-
2895	(3)(a)  The agency shall conduct a survey to determine
2896	general compliance with facility standards and compliance with
2897	residents' rights as a prerequisite to initial licensure or
2898	licensure renewal.
2899	(b)  In order to determine whether the facility is
2900	adequately protecting residents' rights, the biennial survey
2901	shall include private informal conversations with a sample of
2902	residents and consultation with the ombudsman council in the
2903	planning and service area in which the facility is located to
2904	discuss residents' experiences within the facility.
2905	(c)  During any calendar year in which no survey is
2906	conducted, the agency shall conduct at least one monitoring
2907	visit of each facility cited in the previous year for a class I
2908	or class II violation, or more than three uncorrected class III
2909	violations.
2910	(d)  The agency may conduct periodic followup inspections
2911	as necessary to monitor the compliance of facilities with a
2912	history of any class I, class II, or class III violations that
2913	threaten the health, safety, or security of residents.
2914	(e)  The agency may conduct complaint investigations as
2915	warranted to investigate any allegations of noncompliance with
2916	requirements required under this part or rules adopted under
2917	this part.
2918	Section 76.  Subsection (2) of section 429.35, Florida
2919	Statutes, is amended to read:
2920	429.35  Maintenance of records; reports.-
2921	(2)  Within 60 days after the date of the biennial
2922	inspection visit required under s. 408.811 or within 30 days
2923	after the date of any interim visit, the agency shall forward
2924	the results of the inspection to the local ombudsman council in
2925	whose planning and service area, as defined in part II of
2926	chapter 400, the facility is located; to at least one public
2927	library or, in the absence of a public library, the county seat
2928	in the county in which the inspected assisted living facility is
2929	located; and, when appropriate, to the district Adult Services
2930	and Mental Health Program Offices. This information may be
2931	provided electronically or through the agency's Internet
2932	website.
2933	Section 77.  Paragraphs (i) and (j) of subsection (1) of
2934	section 429.41, Florida Statutes, are amended to read:
2935	429.41  Rules establishing standards.-
2936	(1)  It is the intent of the Legislature that rules
2937	published and enforced pursuant to this section shall include
2938	criteria by which a reasonable and consistent quality of
2939	resident care and quality of life may be ensured and the results
2940	of such resident care may be demonstrated. Such rules shall also
2941	ensure a safe and sanitary environment that is residential and
2942	noninstitutional in design or nature. It is further intended
2943	that reasonable efforts be made to accommodate the needs and
2944	preferences of residents to enhance the quality of life in a
2945	facility. The agency, in consultation with the department, may
2946	adopt rules to administer the requirements of part II of chapter
2947	408. In order to provide safe and sanitary facilities and the
2948	highest quality of resident care accommodating the needs and
2949	preferences of residents, the department, in consultation with
2950	the agency, the Department of Children and Family Services, and
2951	the Department of Health, shall adopt rules, policies, and
2952	procedures to administer this part, which must include
2953	reasonable and fair minimum standards in relation to:
2954	(i)  Facilities holding an a limited nursing, extended
2955	congregate care, or limited mental health license.
2956	(j)  The establishment of specific criteria to define
2957	appropriateness of resident admission and continued residency in
2958	a facility holding a standard, limited nursing, extended
2959	congregate care, and limited mental health license.
2960	Section 78.  Subsections (1) and (2) of section 429.53,
2961	Florida Statutes, are amended to read:
2962	429.53  Consultation by the agency.-
2963	(1)  The area offices of licensure and certification of the
2964	agency shall provide consultation to the following upon request:
2965	(a)  A licensee of a facility.
2966	(b)  A person interested in obtaining a license to operate
2967	a facility under this part.
2968	(2)  As used in this section, "consultation" includes:
2969	(a)  An explanation of the requirements of this part and
2970	rules adopted pursuant thereto;
2971	(b)  An explanation of the license application and renewal
2972	procedures;
2973	(c)  The provision of a checklist of general local and
2974	state approvals required prior to constructing or developing a
2975	facility and a listing of the types of agencies responsible for
2976	such approvals;
2977	(d)  An explanation of benefits and financial assistance
2978	available to a recipient of supplemental security income
2979	residing in a facility;
2980	(c)(e)  Any other information which the agency deems
2981	necessary to promote compliance with the requirements of this
2982	part; and
2983	(f)  A preconstruction review of a facility to ensure
2984	compliance with agency rules and this part.
2985	Section 79.  Subsections (1) and (2) of section 429.54,
2986	Florida Statutes, are renumbered as subsections (2) and (3),
2987	respectively, and a new subsection (1) is added to that section
2988	to read:
2989	429.54  Collection of information; local subsidy.-
2990	(1)  A facility that is licensed under this part must
2991	report electronically to the agency semiannually data related to
2992	the facility, including, but not limited to, the total number of
2993	residents, the number of residents who are receiving limited
2994	mental health services, the number of residents who are
2995	receiving extended congregate care services, the number of
2996	residents who are receiving limited nursing services, and
2997	professional staffing employed by or under contract with the
2998	licensee to provide resident services. The department, in
2999	consultation with the agency, shall adopt rules to administer
3000	this subsection.
3001	Section 80.  Subsections (1) and (5) of section 429.71,
3002	Florida Statutes, are amended to read:
3003	429.71  Classification of violations deficiencies;
3004	administrative fines.-
3005	(1)  In addition to the requirements of part II of chapter
3006	408 and in addition to any other liability or penalty provided
3007	by law, the agency may impose an administrative fine on a
3008	provider according to the following classification:
3009	(a)  Class I violations are defined in s. 408.813 those
3010	conditions or practices related to the operation and maintenance
3011	of an adult family-care home or to the care of residents which
3012	the agency determines present an imminent danger to the
3013	residents or guests of the facility or a substantial probability
3014	that death or serious physical or emotional harm would result
3015	therefrom. The condition or practice that constitutes a class I
3016	violation must be abated or eliminated within 24 hours, unless a
3017	fixed period, as determined by the agency, is required for
3018	correction. A class I violation deficiency is subject to an
3019	administrative fine in an amount not less than $500 and not
3020	exceeding $1,000 for each violation. A fine may be levied
3021	notwithstanding the correction of the deficiency.
3022	(b)  Class II violations are defined in s. 408.813 those
3023	conditions or practices related to the operation and maintenance
3024	of an adult family-care home or to the care of residents which
3025	the agency determines directly threaten the physical or
3026	emotional health, safety, or security of the residents, other
3027	than class I violations. A class II violation is subject to an
3028	administrative fine in an amount not less than $250 and not
3029	exceeding $500 for each violation. A citation for a class II
3030	violation must specify the time within which the violation is
3031	required to be corrected. If a class II violation is corrected
3032	within the time specified, no civil penalty shall be imposed,
3033	unless it is a repeated offense.
3034	(c)  Class III violations are defined in s. 408.813 those
3035	conditions or practices related to the operation and maintenance
3036	of an adult family-care home or to the care of residents which
3037	the agency determines indirectly or potentially threaten the
3038	physical or emotional health, safety, or security of residents,
3039	other than class I or class II violations. A class III violation
3040	is subject to an administrative fine in an amount not less than
3041	$100 and not exceeding $250 for each violation. A citation for a
3042	class III violation shall specify the time within which the
3043	violation is required to be corrected. If a class III violation
3044	is corrected within the time specified, no civil penalty shall
3045	be imposed, unless it is a repeated violation offense.
3046	(d)  Class IV violations are defined in s. 408.813 those
3047	conditions or occurrences related to the operation and
3048	maintenance of an adult family-care home, or related to the
3049	required reports, forms, or documents, which do not have the
3050	potential of negatively affecting the residents. A provider that
3051	does not correct A class IV violation within the time limit
3052	specified by the agency is subject to an administrative fine in
3053	an amount not less than $50 and not exceeding $100 for each
3054	violation. Any class IV violation that is corrected during the
3055	time the agency survey is conducted will be identified as an
3056	agency finding and not as a violation, unless it is a repeat
3057	violation.
3058	(5)  As an alternative to or in conjunction with an
3059	administrative action against a provider, the agency may request
3060	a plan of corrective action that demonstrates a good faith
3061	effort to remedy each violation by a specific date, subject to
3062	the approval of the agency.
3063	Section 81.  Paragraphs (b) through (e) of subsection (2)
3064	of section 429.911, Florida Statutes, are redesignated as
3065	paragraphs (a) through (d), respectively, and present paragraph
3066	(a) of that subsection is amended to read:
3067	429.911  Denial, suspension, revocation of license;
3068	emergency action; administrative fines; investigations and
3069	inspections.-
3070	(2)  Each of the following actions by the owner of an adult
3071	day care center or by its operator or employee is a ground for
3072	action by the agency against the owner of the center or its
3073	operator or employee:
3074	(a)  An intentional or negligent act materially affecting
3075	the health or safety of center participants.
3076	Section 82.  Section 429.915, Florida Statutes, is amended
3077	to read:
3078	429.915  Conditional license.-In addition to the license
3079	categories available in part II of chapter 408, the agency may
3080	issue a conditional license to an applicant for license renewal
3081	or change of ownership if the applicant fails to meet all
3082	standards and requirements for licensure. A conditional license
3083	issued under this subsection must be limited to a specific
3084	period not exceeding 6 months, as determined by the agency, and
3085	must be accompanied by an approved plan of correction.
3086	Section 83.  Paragraphs (b) and (h) of subsection (3) of
3087	section 430.80, Florida Statutes, are amended to read:
3088	430.80  Implementation of a teaching nursing home pilot
3089	project.-
3090	(3)  To be designated as a teaching nursing home, a nursing
3091	home licensee must, at a minimum:
3092	(b)  Participate in a nationally recognized accreditation
3093	program and hold a valid accreditation, such as the
3094	accreditation awarded by The Joint Commission on Accreditation
3095	of Healthcare Organizations;
3096	(h)  Maintain insurance coverage pursuant to s.
3097	400.141(1)(q)(s) or proof of financial responsibility in a
3098	minimum amount of $750,000. Such proof of financial
3099	responsibility may include:
3100	1.  Maintaining an escrow account consisting of cash or
3101	assets eligible for deposit in accordance with s. 625.52; or
3102	2.  Obtaining and maintaining pursuant to chapter 675 an
3103	unexpired, irrevocable, nontransferable and nonassignable letter
3104	of credit issued by any bank or savings association organized
3105	and existing under the laws of this state or any bank or savings
3106	association organized under the laws of the United States that
3107	has its principal place of business in this state or has a
3108	branch office which is authorized to receive deposits in this
3109	state. The letter of credit shall be used to satisfy the
3110	obligation of the facility to the claimant upon presentment of a
3111	final judgment indicating liability and awarding damages to be
3112	paid by the facility or upon presentment of a settlement
3113	agreement signed by all parties to the agreement when such final
3114	judgment or settlement is a result of a liability claim against
3115	the facility.
3116	Section 84.  Paragraph (a) of subsection (2) of section
3117	440.13, Florida Statutes, is amended to read:
3118	440.13  Medical services and supplies; penalty for
3119	violations; limitations.-
3120	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3121	(a)  Subject to the limitations specified elsewhere in this
3122	chapter, the employer shall furnish to the employee such
3123	medically necessary remedial treatment, care, and attendance for
3124	such period as the nature of the injury or the process of
3125	recovery may require, which is in accordance with established
3126	practice parameters and protocols of treatment as provided for
3127	in this chapter, including medicines, medical supplies, durable
3128	medical equipment, orthoses, prostheses, and other medically
3129	necessary apparatus. Remedial treatment, care, and attendance,
3130	including work-hardening programs or pain-management programs
3131	accredited by the Commission on Accreditation of Rehabilitation
3132	Facilities or The Joint Commission on the Accreditation of
3133	Health Organizations or pain-management programs affiliated with
3134	medical schools, shall be considered as covered treatment only
3135	when such care is given based on a referral by a physician as
3136	defined in this chapter. Medically necessary treatment, care,
3137	and attendance does not include chiropractic services in excess
3138	of 24 treatments or rendered 12 weeks beyond the date of the
3139	initial chiropractic treatment, whichever comes first, unless
3140	the carrier authorizes additional treatment or the employee is
3141	catastrophically injured.
3142
3143	Failure of the carrier to timely comply with this subsection
3144	shall be a violation of this chapter and the carrier shall be
3145	subject to penalties as provided for in s. 440.525.
3146	Section 85.  Section 483.294, Florida Statutes, is amended
3147	to read:
3148	483.294  Inspection of centers.-In accordance with s.
3149	408.811, the agency shall biennially, at least once annually,
3150	inspect the premises and operations of all centers subject to
3151	licensure under this part.
3152	Section 86.  Subsections (32) through (54) of section
3153	499.003, Florida Statutes, are renumbered as subsections (33)
3154	through (55), respectively, present subsection (42) and
3155	paragraph (a) of present subsection (53) are amended, and a new
3156	subsection (32) is added to that subsection, to read:
3157	499.003  Definitions of terms used in this part.-As used in
3158	this part, the term:
3159	(32)  "Medical convenience kit" means packages or units
3160	that contain combination products as defined in 21 C.F.R. s.
3161	3.2(e)(2).
3162	(43)(42)  "Prescription drug" means a prescription,
3163	medicinal, or legend drug, including, but not limited to,
3164	finished dosage forms or active ingredients subject to, defined
3165	by, or described by s. 503(b) of the Federal Food, Drug, and
3166	Cosmetic Act or s. 465.003(8), s. 499.007(13), or subsection
3167	(11), subsection (46) (45), or subsection (53) (52).
3168	(54)(53)  "Wholesale distribution" means distribution of
3169	prescription drugs to persons other than a consumer or patient,
3170	but does not include:
3171	(a)  Any of the following activities, which is not a
3172	violation of s. 499.005(21) if such activity is conducted in
3173	accordance with s. 499.01(2)(g):
3174	1.  The purchase or other acquisition by a hospital or
3175	other health care entity that is a member of a group purchasing
3176	organization of a prescription drug for its own use from the
3177	group purchasing organization or from other hospitals or health
3178	care entities that are members of that organization.
3179	2.  The sale, purchase, or trade of a prescription drug or
3180	an offer to sell, purchase, or trade a prescription drug by a
3181	charitable organization described in s. 501(c)(3) of the
3182	Internal Revenue Code of 1986, as amended and revised, to a
3183	nonprofit affiliate of the organization to the extent otherwise
3184	permitted by law.
3185	3.  The sale, purchase, or trade of a prescription drug or
3186	an offer to sell, purchase, or trade a prescription drug among
3187	hospitals or other health care entities that are under common
3188	control. For purposes of this subparagraph, "common control"
3189	means the power to direct or cause the direction of the
3190	management and policies of a person or an organization, whether
3191	by ownership of stock, by voting rights, by contract, or
3192	otherwise.
3193	4.  The sale, purchase, trade, or other transfer of a
3194	prescription drug from or for any federal, state, or local
3195	government agency or any entity eligible to purchase
3196	prescription drugs at public health services prices pursuant to
3197	Pub. L. No. 102-585, s. 602 to a contract provider or its
3198	subcontractor for eligible patients of the agency or entity
3199	under the following conditions:
3200	a.  The agency or entity must obtain written authorization
3201	for the sale, purchase, trade, or other transfer of a
3202	prescription drug under this subparagraph from the State Surgeon
3203	General or his or her designee.
3204	b.  The contract provider or subcontractor must be
3205	authorized by law to administer or dispense prescription drugs.
3206	c.  In the case of a subcontractor, the agency or entity
3207	must be a party to and execute the subcontract.
3208	d.  A contract provider or subcontractor must maintain
3209	separate and apart from other prescription drug inventory any
3210	prescription drugs of the agency or entity in its possession.
3211	d.e.  The contract provider and subcontractor must maintain
3212	and produce immediately for inspection all records of movement
3213	or transfer of all the prescription drugs belonging to the
3214	agency or entity, including, but not limited to, the records of
3215	receipt and disposition of prescription drugs. Each contractor
3216	and subcontractor dispensing or administering these drugs must
3217	maintain and produce records documenting the dispensing or
3218	administration. Records that are required to be maintained
3219	include, but are not limited to, a perpetual inventory itemizing
3220	drugs received and drugs dispensed by prescription number or
3221	administered by patient identifier, which must be submitted to
3222	the agency or entity quarterly.
3223	e.f.  The contract provider or subcontractor may administer
3224	or dispense the prescription drugs only to the eligible patients
3225	of the agency or entity or must return the prescription drugs
3226	for or to the agency or entity. The contract provider or
3227	subcontractor must require proof from each person seeking to
3228	fill a prescription or obtain treatment that the person is an
3229	eligible patient of the agency or entity and must, at a minimum,
3230	maintain a copy of this proof as part of the records of the
3231	contractor or subcontractor required under sub-subparagraph d.
3232	e.
3233	f.g.  In addition to the departmental inspection authority
3234	set forth in s. 499.051, the establishment of the contract
3235	provider and subcontractor and all records pertaining to
3236	prescription drugs subject to this subparagraph shall be subject
3237	to inspection by the agency or entity. All records relating to
3238	prescription drugs of a manufacturer under this subparagraph
3239	shall be subject to audit by the manufacturer of those drugs,
3240	without identifying individual patient information.
3241	Section 87.  Paragraph (i) is added to subsection (3) of
3242	section 499.01212, Florida Statutes, to read:
3243	499.01212  Pedigree paper.-
3244	(3)  EXCEPTIONS.-A pedigree paper is not required for:
3245	(i)  The wholesale distribution of prescription drugs
3246	contained within a medical convenience kit if:
3247	1.  The medical convenience kit is assembled in an
3248	establishment that is registered as a medical device
3249	manufacturer with the United States Food and Drug
3250	Administration;
3251	2.  The medical convenience kit manufacturer purchased the
3252	prescription drug directly from the manufacturer or from a
3253	wholesaler that purchased the prescription drug directly from
3254	the manufacturer;
3255	3.  The medical convenience kit manufacturer complies with
3256	federal law for the distribution of the prescription drugs
3257	within the kit; and
3258	4.  The drugs contained in the medical convenience kit are:
3259	a.  Intravenous solutions intended for the replenishment of
3260	fluids and electrolytes;
3261	b.  Products intended to maintain the equilibrium of water
3262	and minerals in the body;
3263	c.  Products intended for irrigation or reconstitution;
3264	d.  Anesthetics; or
3265	e.  Anticoagulants.
3266
3267	This exemption does not apply to a convenience kit containing
3268	any controlled substance that appears in a schedule contained in
3269	or subject to chapter 893 or the federal Comprehensive Drug
3270	Abuse Prevention and Control Act of 1970.
3271	Section 88.  Subsection (3) is added to section 626.9541,
3272	Florida Statutes, to read:
3273	626.9541  Unfair methods of competition and unfair or
3274	deceptive acts or practices defined; alternative rates of
3275	payment; wellness programs.-
3276	(3)  WELLNESS PROGRAMS.-An insurer issuing a group or
3277	individual health benefit plan may offer a voluntary wellness or
3278	health-improvement program that allows for rewards or
3279	incentives, including, but not limited to, merchandise, gift
3280	cards, debit cards, premium discounts or rebates, contributions
3281	towards a member's health savings account, modifications to
3282	copayment, deductible, or coinsurance amounts, or any
3283	combination of these incentives, to encourage or reward
3284	participation in the program. The health plan member may be
3285	required to provide verification, such as a statement from his
3286	or her physician, that a medical condition makes it unreasonably
3287	difficult or medically inadvisable for the individual to
3288	participate in the wellness program. Any reward or incentive
3289	established under this subsection is not an insurance benefit
3290	and does not violate this section. This subsection does not
3291	prohibit an insurer from offering incentives or rewards to
3292	members for adherence to wellness or health improvement programs
3293	if otherwise allowed by state or federal law. Notwithstanding
3294	any provision of this subsection, no insurer, nor its agent, may
3295	use any incentive authorized by this subsection for the purpose
3296	of redirecting patients from one health care insurance plan to
3297	another.
3298	Section 89.  Subsection (1) of section 627.645, Florida
3299	Statutes, is amended to read:
3300	627.645  Denial of health insurance claims restricted.-
3301	(1)  No claim for payment under a health insurance policy
3302	or self-insured program of health benefits for treatment, care,
3303	or services in a licensed hospital which is accredited by The
3304	Joint Commission on the Accreditation of Hospitals, the American
3305	Osteopathic Association, or the Commission on the Accreditation
3306	of Rehabilitative Facilities shall be denied because such
3307	hospital lacks major surgical facilities and is primarily of a
3308	rehabilitative nature, if such rehabilitation is specifically
3309	for treatment of physical disability.
3310	Section 90.  Paragraph (c) of subsection (2) of section
3311	627.668, Florida Statutes, is amended to read:
3312	627.668  Optional coverage for mental and nervous disorders
3313	required; exception.-
3314	(2)  Under group policies or contracts, inpatient hospital
3315	benefits, partial hospitalization benefits, and outpatient
3316	benefits consisting of durational limits, dollar amounts,
3317	deductibles, and coinsurance factors shall not be less favorable
3318	than for physical illness generally, except that:
3319	(c)  Partial hospitalization benefits shall be provided
3320	under the direction of a licensed physician. For purposes of
3321	this part, the term "partial hospitalization services" is
3322	defined as those services offered by a program accredited by The
3323	Joint Commission on Accreditation of Hospitals (JCAH) or in
3324	compliance with equivalent standards. Alcohol rehabilitation
3325	programs accredited by The Joint Commission on Accreditation of
3326	Hospitals or approved by the state and licensed drug abuse
3327	rehabilitation programs shall also be qualified providers under
3328	this section. In any benefit year, if partial hospitalization
3329	services or a combination of inpatient and partial
3330	hospitalization are utilized, the total benefits paid for all
3331	such services shall not exceed the cost of 30 days of inpatient
3332	hospitalization for psychiatric services, including physician
3333	fees, which prevail in the community in which the partial
3334	hospitalization services are rendered. If partial
3335	hospitalization services benefits are provided beyond the limits
3336	set forth in this paragraph, the durational limits, dollar
3337	amounts, and coinsurance factors thereof need not be the same as
3338	those applicable to physical illness generally.
3339	Section 91.  Subsection (3) of section 627.669, Florida
3340	Statutes, is amended to read:
3341	627.669  Optional coverage required for substance abuse
3342	impaired persons; exception.-
3343	(3)  The benefits provided under this section shall be
3344	applicable only if treatment is provided by, or under the
3345	supervision of, or is prescribed by, a licensed physician or
3346	licensed psychologist and if services are provided in a program
3347	accredited by The Joint Commission on Accreditation of Hospitals
3348	or approved by the state.
3349	Section 92.  Paragraph (a) of subsection (1) of section
3350	627.736, Florida Statutes, is amended to read:
3351	627.736  Required personal injury protection benefits;
3352	exclusions; priority; claims.-
3353	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3354	with the security requirements of s. 627.733 shall provide
3355	personal injury protection to the named insured, relatives
3356	residing in the same household, persons operating the insured
3357	motor vehicle, passengers in such motor vehicle, and other
3358	persons struck by such motor vehicle and suffering bodily injury
3359	while not an occupant of a self-propelled vehicle, subject to
3360	the provisions of subsection (2) and paragraph (4)(e), to a
3361	limit of $10,000 for loss sustained by any such person as a
3362	result of bodily injury, sickness, disease, or death arising out
3363	of the ownership, maintenance, or use of a motor vehicle as
3364	follows:
3365	(a)  Medical benefits.-Eighty percent of all reasonable
3366	expenses for medically necessary medical, surgical, X-ray,
3367	dental, and rehabilitative services, including prosthetic
3368	devices, and medically necessary ambulance, hospital, and
3369	nursing services. However, the medical benefits shall provide
3370	reimbursement only for such services and care that are lawfully
3371	provided, supervised, ordered, or prescribed by a physician
3372	licensed under chapter 458 or chapter 459, a dentist licensed
3373	under chapter 466, or a chiropractic physician licensed under
3374	chapter 460 or that are provided by any of the following persons
3375	or entities:
3376	1.  A hospital or ambulatory surgical center licensed under
3377	chapter 395.
3378	2.  A person or entity licensed under ss. 401.2101-401.45
3379	that provides emergency transportation and treatment.
3380	3.  An entity wholly owned by one or more physicians
3381	licensed under chapter 458 or chapter 459, chiropractic
3382	physicians licensed under chapter 460, or dentists licensed
3383	under chapter 466 or by such practitioner or practitioners and
3384	the spouse, parent, child, or sibling of that practitioner or
3385	those practitioners.
3386	4.  An entity wholly owned, directly or indirectly, by a
3387	hospital or hospitals.
3388	5.  A health care clinic licensed under ss. 400.990-400.995
3389	that is:
3390	a.  Accredited by The Joint Commission on Accreditation of
3391	Healthcare Organizations, the American Osteopathic Association,
3392	the Commission on Accreditation of Rehabilitation Facilities, or
3393	the Accreditation Association for Ambulatory Health Care, Inc.;
3394	or
3395	b.  A health care clinic that:
3396	(I)  Has a medical director licensed under chapter 458,
3397	chapter 459, or chapter 460;
3398	(II)  Has been continuously licensed for more than 3 years
3399	or is a publicly traded corporation that issues securities
3400	traded on an exchange registered with the United States
3401	Securities and Exchange Commission as a national securities
3402	exchange; and
3403	(III)  Provides at least four of the following medical
3404	specialties:
3405	(A)  General medicine.
3406	(B)  Radiography.
3407	(C)  Orthopedic medicine.
3408	(D)  Physical medicine.
3409	(E)  Physical therapy.
3410	(F)  Physical rehabilitation.
3411	(G)  Prescribing or dispensing outpatient prescription
3412	medication.
3413	(H)  Laboratory services.
3414
3415	The Financial Services Commission shall adopt by rule the form
3416	that must be used by an insurer and a health care provider
3417	specified in subparagraph 3., subparagraph 4., or subparagraph
3418	5. to document that the health care provider meets the criteria
3419	of this paragraph, which rule must include a requirement for a
3420	sworn statement or affidavit.
3421
3422	Only insurers writing motor vehicle liability insurance in this
3423	state may provide the required benefits of this section, and no
3424	such insurer shall require the purchase of any other motor
3425	vehicle coverage other than the purchase of property damage
3426	liability coverage as required by s. 627.7275 as a condition for
3427	providing such required benefits. Insurers may not require that
3428	property damage liability insurance in an amount greater than
3429	$10,000 be purchased in conjunction with personal injury
3430	protection. Such insurers shall make benefits and required
3431	property damage liability insurance coverage available through
3432	normal marketing channels. Any insurer writing motor vehicle
3433	liability insurance in this state who fails to comply with such
3434	availability requirement as a general business practice shall be
3435	deemed to have violated part IX of chapter 626, and such
3436	violation shall constitute an unfair method of competition or an
3437	unfair or deceptive act or practice involving the business of
3438	insurance; and any such insurer committing such violation shall
3439	be subject to the penalties afforded in such part, as well as
3440	those which may be afforded elsewhere in the insurance code.
3441	Section 93.  Section 633.081, Florida Statutes, is amended
3442	to read:
3443	633.081  Inspection of buildings and equipment; orders;
3444	firesafety inspection training requirements; certification;
3445	disciplinary action.-The State Fire Marshal and her or his
3446	agents shall, at any reasonable hour, when the department has
3447	reasonable cause to believe that a violation of this chapter or
3448	s. 509.215, or a rule promulgated thereunder, or a minimum
3449	firesafety code adopted by a local authority, may exist, inspect
3450	any and all buildings and structures which are subject to the
3451	requirements of this chapter or s. 509.215 and rules promulgated
3452	thereunder. The authority to inspect shall extend to all
3453	equipment, vehicles, and chemicals which are located within the
3454	premises of any such building or structure. The State Fire
3455	Marshal and her or his agents shall inspect nursing homes
3456	licensed under part II of chapter 400 only once every calendar
3457	year and upon receiving a complaint forming the basis of a
3458	reasonable cause to believe that a violation of this chapter or
3459	s. 509.215, or a rule promulgated thereunder, or a minimum
3460	firesafety code adopted by a local authority may exist and upon
3461	identifying such a violation in the course of conducting
3462	orientation or training activities within a nursing home.
3463	(1)  Each county, municipality, and special district that
3464	has firesafety enforcement responsibilities shall employ or
3465	contract with a firesafety inspector. The firesafety inspector
3466	must conduct all firesafety inspections that are required by
3467	law. The governing body of a county, municipality, or special
3468	district that has firesafety enforcement responsibilities may
3469	provide a schedule of fees to pay only the costs of inspections
3470	conducted pursuant to this subsection and related administrative
3471	expenses. Two or more counties, municipalities, or special
3472	districts that have firesafety enforcement responsibilities may
3473	jointly employ or contract with a firesafety inspector.
3474	(2)  Every firesafety inspection conducted pursuant to
3475	state or local firesafety requirements shall be by a person
3476	certified as having met the inspection training requirements set
3477	by the State Fire Marshal. Such person shall:
3478	(a)  Be a high school graduate or the equivalent as
3479	determined by the department;
3480	(b)  Not have been found guilty of, or having pleaded
3481	guilty or nolo contendere to, a felony or a crime punishable by
3482	imprisonment of 1 year or more under the law of the United
3483	States, or of any state thereof, which involves moral turpitude,
3484	without regard to whether a judgment of conviction has been
3485	entered by the court having jurisdiction of such cases;
3486	(c)  Have her or his fingerprints on file with the
3487	department or with an agency designated by the department;
3488	(d)  Have good moral character as determined by the
3489	department;
3490	(e)  Be at least 18 years of age;
3491	(f)  Have satisfactorily completed the firesafety inspector
3492	certification examination as prescribed by the department; and
3493	(g)1.  Have satisfactorily completed, as determined by the
3494	department, a firesafety inspector training program of not less
3495	than 200 hours established by the department and administered by
3496	agencies and institutions approved by the department for the
3497	purpose of providing basic certification training for firesafety
3498	inspectors; or
3499	2.  Have received in another state training which is
3500	determined by the department to be at least equivalent to that
3501	required by the department for approved firesafety inspector
3502	education and training programs in this state.
3503	(3)  Each special state firesafety inspection which is
3504	required by law and is conducted by or on behalf of an agency of
3505	the state must be performed by an individual who has met the
3506	provision of subsection (2), except that the duration of the
3507	training program shall not exceed 120 hours of specific training
3508	for the type of property that such special state firesafety
3509	inspectors are assigned to inspect.
3510	(4)  A firefighter certified pursuant to s. 633.35 may
3511	conduct firesafety inspections, under the supervision of a
3512	certified firesafety inspector, while on duty as a member of a
3513	fire department company conducting inservice firesafety
3514	inspections without being certified as a firesafety inspector,
3515	if such firefighter has satisfactorily completed an inservice
3516	fire department company inspector training program of at least
3517	24 hours' duration as provided by rule of the department.
3518	(5)  Every firesafety inspector or special state firesafety
3519	inspector certificate is valid for a period of 3 years from the
3520	date of issuance. Renewal of certification shall be subject to
3521	the affected person's completing proper application for renewal
3522	and meeting all of the requirements for renewal as established
3523	under this chapter or by rule promulgated thereunder, which
3524	shall include completion of at least 40 hours during the
3525	preceding 3-year period of continuing education as required by
3526	the rule of the department or, in lieu thereof, successful
3527	passage of an examination as established by the department.
3528	(6)  The State Fire Marshal may deny, refuse to renew,
3529	suspend, or revoke the certificate of a firesafety inspector or
3530	special state firesafety inspector if it finds that any of the
3531	following grounds exist:
3532	(a)  Any cause for which issuance of a certificate could
3533	have been refused had it then existed and been known to the
3534	State Fire Marshal.
3535	(b)  Violation of this chapter or any rule or order of the
3536	State Fire Marshal.
3537	(c)  Falsification of records relating to the certificate.
3538	(d)  Having been found guilty of or having pleaded guilty
3539	or nolo contendere to a felony, whether or not a judgment of
3540	conviction has been entered.
3541	(e)  Failure to meet any of the renewal requirements.
3542	(f)  Having been convicted of a crime in any jurisdiction
3543	which directly relates to the practice of fire code inspection,
3544	plan review, or administration.
3545	(g)  Making or filing a report or record that the
3546	certificateholder knows to be false, or knowingly inducing
3547	another to file a false report or record, or knowingly failing
3548	to file a report or record required by state or local law, or
3549	knowingly impeding or obstructing such filing, or knowingly
3550	inducing another person to impede or obstruct such filing.
3551	(h)  Failing to properly enforce applicable fire codes or
3552	permit requirements within this state which the
3553	certificateholder knows are applicable by committing willful
3554	misconduct, gross negligence, gross misconduct, repeated
3555	negligence, or negligence resulting in a significant danger to
3556	life or property.
3557	(i)  Accepting labor, services, or materials at no charge
3558	or at a noncompetitive rate from any person who performs work
3559	that is under the enforcement authority of the certificateholder
3560	and who is not an immediate family member of the
3561	certificateholder. For the purpose of this paragraph, the term
3562	"immediate family member" means a spouse, child, parent,
3563	sibling, grandparent, aunt, uncle, or first cousin of the person
3564	or the person's spouse or any person who resides in the primary
3565	residence of the certificateholder.
3566	(7)  The department shall provide by rule for the
3567	certification of firesafety inspectors.
3568	Section 94.  Subsection (12) of section 641.495, Florida
3569	Statutes, is amended to read:
3570	641.495  Requirements for issuance and maintenance of
3571	certificate.-
3572	(12)  The provisions of part I of chapter 395 do not apply
3573	to a health maintenance organization that, on or before January
3574	1, 1991, provides not more than 10 outpatient holding beds for
3575	short-term and hospice-type patients in an ambulatory care
3576	facility for its members, provided that such health maintenance
3577	organization maintains current accreditation by The Joint
3578	Commission on Accreditation of Health Care Organizations, the
3579	Accreditation Association for Ambulatory Health Care, or the
3580	National Committee for Quality Assurance.
3581	Section 95.  Subsection (13) of section 651.118, Florida
3582	Statutes, is amended to read:
3583	651.118  Agency for Health Care Administration;
3584	certificates of need; sheltered beds; community beds.-
3585	(13)  Residents, as defined in this chapter, are not
3586	considered new admissions for the purpose of s.
3587	400.141(1)(n)(o)1.d.
3588	Section 96.  Subsection (2) of section 766.1015, Florida
3589	Statutes, is amended to read:
3590	766.1015  Civil immunity for members of or consultants to
3591	certain boards, committees, or other entities.-
3592	(2)  Such committee, board, group, commission, or other
3593	entity must be established in accordance with state law or in
3594	accordance with requirements of The Joint Commission on
3595	Accreditation of Healthcare Organizations, established and duly
3596	constituted by one or more public or licensed private hospitals
3597	or behavioral health agencies, or established by a governmental
3598	agency. To be protected by this section, the act, decision,
3599	omission, or utterance may not be made or done in bad faith or
3600	with malicious intent.
3601	Section 97.  Subsection (4) of section 766.202, Florida
3602	Statutes, is amended to read:
3603	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
3604	766.201-766.212, the term:
3605	(4)  "Health care provider" means any hospital, ambulatory
3606	surgical center, or mobile surgical facility as defined and
3607	licensed under chapter 395; a birth center licensed under
3608	chapter 383; any person licensed under chapter 458, chapter 459,
3609	chapter 460, chapter 461, chapter 462, chapter 463, part I of
3610	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
3611	or chapter 486; a clinical lab licensed under chapter 483; a
3612	health maintenance organization certificated under part I of
3613	chapter 641; a blood bank; a plasma center; an industrial
3614	clinic; a renal dialysis facility; or a professional association
3615	partnership, corporation, joint venture, or other association
3616	for professional activity by health care providers.
3617	Section 98.  This act shall take effect July 1, 2010.

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