HB 1503

1	A bill to be entitled
2	An act relating to health care; amending s. 1.01, F.S.;
3	defining the term "Joint Commission"; amending s.
4	112.0455, F.S., relating to a prohibition against applying
5	the Drug-Free Workplace Act retroactively; conforming a
6	cross-reference; amending s. 154.11, F.S.; renaming the
7	Joint Commission on the Accreditation of Hospitals as the
8	"Joint Commission"; amending s. 318.21, F.S.; requiring
9	that certain fines received by the county court for
10	traffic infractions be remitted to the Department of
11	Revenue for deposit into the Brain and Spinal Cord Injury
12	Rehabilitation Trust Fund within the Department of Health
13	for use for Medicaid recipients who have spinal cord
14	injuries; repealing s. 383.325, F.S., relating to the
15	requirement of a licensed facility under s. 383.305, F.S.,
16	to maintain inspection reports; amending s. 394.4787,
17	F.S.; conforming a cross-reference; amending s. 394.741,
18	F.S.; renaming the Joint Commission on the Accreditation
19	of Healthcare Organizations as the "Joint Commission";
20	renaming the Council on Accreditation for Children and
21	Family Services as the "Council on Accreditation";
22	amending s. 395.002, F.S.; redefining the term
23	"accrediting organizations" as it relates to hospital
24	licensure and regulation; deleting the definitions for the
25	terms "initial denial determination," "private review
26	agent," and "utilization review plan" as they relate to
27	hospital licensure and regulation; amending s. 395.003,
28	F.S.; deleting a provision that prohibits the Agency for
29	Health Care Administration from authorizing emergency
30	departments that are located off the premises of a
31	licensed hospital; conforming a cross-reference; amending
32	s. 395.0193, F.S.; requiring the Division of Medical
33	Quality Assurance within the Department of Health to
34	conduct the reviews of the recordings of agendas and
35	minutes of licensed facilities; requiring the Division of
36	Medical Quality Assurance within the Department of Health
37	to report disciplinary actions rather than the Division of
38	Health Quality Assurance within the Agency for Health Care
39	Administration; amending s. 395.1023, F.S.; requiring a
40	licensed facility to adopt a protocol to designate a
41	physician in cases involving suspected child abuse at the
42	request of the Department of Children and Family Services
43	rather than the Department of Health; amending s.
44	395.1041, F.S.; deleting provisions that require the
45	Agency for Health Care Administration to request a
46	hospital to identify its services, notify each hospital of
47	the service capability to be included in the inventory,
48	and publish a final inventory; deleting obsolete
49	provisions; repealing s. 395.1046, F.S., relating to the
50	investigation of complaints regarding hospitals; amending
51	s. 395.1055, F.S.; requiring the agency to adopt rules
52	that ensure that licensed facility beds conform to certain
53	standards as specified by the agency, the Florida Building
54	Code, and the Florida Fire Prevention Code; amending s.
55	395.10972, F.S.; renaming the Florida Society of
56	Healthcare Risk Management as the "Florida Society for
57	Healthcare Risk Management and Patient Safety"; amending
58	s. 395.2050, F.S.; providing for an organ procurement
59	organization to be designated by the federal Centers for
60	Medicare and Medicaid Services rather than the federal
61	Health Care Financing Administration; amending s.
62	395.3036, F.S.; correcting a cross-reference; repealing s.
63	395.3037, F.S.; deleting definitions relating to obsolete
64	provisions governing primary and comprehensive stroke
65	centers; amending s. 395.3038, F.S.; renaming the Joint
66	Commission on the Accreditation of Healthcare
67	Organizations as the "Joint Commission"; amending s.
68	395.602, F.S.; redefining the term "rural hospital" as it
69	relates to hospital licensure and regulation; amending s.
70	400.021, F.S.; redefining the term "geriatric outpatient
71	clinic" as it relates to nursing homes; amending ss.
72	400.0239 and 400.063, F.S., relating to trust funds;
73	deleting obsolete provisions; amending s. 400.071, F.S.;
74	revising the requirements for an application for a license
75	to operate a nursing home facility; amending s. 400.0712,
76	F.S.; deleting the agency's authority to issue an inactive
77	license to a nursing home facility; amending s. 400.111,
78	F.S.; requiring the agency to request a licensee to submit
79	an affidavit disclosing financial or ownership interest
80	that a controlling interest has held in certain entities;
81	amending s. 400.1183, F.S.; requiring nursing home
82	facilities to maintain records of grievances for agency
83	inspection; deleting a requirement that a facility report
84	the number of grievances handled during the prior
85	licensure period; amending s. 400.141, F.S.; conforming a
86	cross-reference; deleting the requirement that a facility
87	submit to the agency information regarding a management
88	company with which it has entered into an agreement;
89	specifying a fine for a nursing facility's failure to
90	impose an admissions moratorium for not complying with
91	state minimum-staffing requirements; deleting the
92	requirement for a facility to report to the agency any
93	filing of bankruptcy protection, divestiture, or corporate
94	reorganization; amending s. 400.142, F.S.; deleting a
95	provision that requires the agency to adopt rules
96	regarding orders not to resuscitate; repealing s.
97	400.147(10), F.S., relating to a requirement that a
98	nursing home facility report any notice of a filing of a
99	claim for a violation of a resident's rights or a claim of
100	negligence; repealing s. 400.148, F.S., relating to the
101	Medicaid "Up-or-Out" Quality of Care Contract Management
102	Program; amending s. 400.19, F.S.; authorizing the agency
103	to verify the correction of certain deficiencies after an
104	unannounced inspection of a nursing home facility;
105	repealing s. 400.195, F.S., relating to agency reporting
106	requirements; amending s. 400.23, F.S.; renaming the
107	Children's Medical Services of the Department of Health as
108	the "Children's Medical Services Network"; deleting an
109	obsolete provision; amending s. 400.275, F.S.; deleting a
110	requirement that the agency ensure that a newly hired
111	nursing home surveyor is assigned full time to a licensed
112	nursing home to observe facility operations; amending s.
113	400.462, F.S.; revising definitions with regard to the
114	Home Health Services Act; defining the terms "primary home
115	health agency" and "temporary" with regard to the Home
116	Health Services Act; amending s. 400.476, F.S.; providing
117	requirements for an alternative administrator of a home
118	health agency; revising the duties of the administrator;
119	revising the requirements for a director of nursing for a
120	specified number of home health agencies; prohibiting a
121	home health agency from using an individual as a home
122	health aide unless the person has completed training and
123	an evaluation program; requiring a home health aide to
124	meet certain standards in order to be competent in
125	performing certain tasks; requiring a home health agency
126	and staff to comply with accepted professional standards;
127	providing certain requirements for a written contract
128	between certain personnel and the agency; requiring a home
129	health agency to provide certain services through its
130	employees; authorizing a home health agency to provide
131	additional services with another organization; providing
132	responsibilities of a home health agency when it provides
133	home health aide services through another organization;
134	requiring the home health agency to coordinate personnel
135	that provide home health services; requiring personnel to
136	communicate with the home health agency; amending s.
137	400.484, F.S.; redefining class I, II, III, and IV
138	deficiencies as class I, II, III, and IV violations;
139	amending s. 400.487, F.S.; requiring a home health agency
140	to provide a copy of the agreement between the agency and
141	a patient which specifies the home health services to be
142	provided; providing the rights that are protected by the
143	home health agency; requiring the home health agency to
144	furnish nursing services by or under the supervision of a
145	registered nurse; requiring the home health agency to
146	provide therapy services through a qualified therapist or
147	therapy assistant; providing the duties and qualifications
148	of a therapist and therapy assistant; requiring
149	supervision by a physical therapist or occupational
150	therapist of a physical therapist assistant or
151	occupational therapist assistant; providing duties of a
152	physical therapist assistant or occupational therapist
153	assistant; providing for speech therapy services to be
154	provided by a qualified speech pathologist or audiologist;
155	providing for a plan of care; providing that only the
156	staff of a home health agency may administer drugs and
157	treatments as ordered by certain health professionals;
158	providing requirements for verbal orders; providing duties
159	of a registered nurse, licensed practical nurse, home
160	health aide, and certified nursing assistant who work for
161	a home health agency; amending s. 400.606, F.S.; revising
162	the requirements for the plan for the delivery of home,
163	residential, and homelike inpatient hospice services for
164	terminally ill patients and their families; amending s.
165	400.607, F.S.; revising the grounds under which the agency
166	may take administrative action against a hospice; amending
167	s. 400.925, F.S.; renaming the Joint Commission on the
168	Accreditation of Healthcare Organizations as the "Joint
169	Commission" within the definition of the term "accrediting
170	organizations" as it relates to home medical equipment
171	providers; amending s. 400.931, F.S.; deleting the
172	requirement that an applicant for a license to be a home
173	medical equipment provider submit a surety bond to the
174	agency; amending s. 400.932, F.S.; revising the grounds
175	under which the agency may take administrative action
176	against a home medical equipment provider; amending s.
177	400.933, F.S.; prohibiting a home medical equipment
178	provider from submitting a survey or inspection of an
179	accrediting organization if the home medical equipment
180	provider's licensure is conditional or provisional;
181	amending s. 400.953, F.S.; deleting the requirement of a
182	general manager of a home medical equipment provider to
183	annually sign an affidavit regarding the background
184	screening of personnel; providing requirements for
185	submission of the affidavit; amending s. 400.967, F.S.;
186	redefining class I, II, III, and IV deficiencies as class
187	I, II, III, and IV violations as they relate to
188	intermediate care facilities for developmentally disabled
189	persons; amending s. 400.969, F.S.; revising the grounds
190	for an administrative or civil penalty; amending s.
191	400.9905, F.S.; redefining the term "portable service or
192	equipment provider" as it relates to the Health Care
193	Clinic Act; amending s. 400.991, F.S.; conforming a
194	provision to changes made by the act; revising application
195	requirements to show proof of financial ability to operate
196	a health care clinic; amending s. 400.9935, F.S.; renaming
197	the Joint Commission on the Accreditation of Healthcare
198	Organizations as the "Joint Commission" for purposes of
199	the Health Care Clinic Act; amending s. 408.034, F.S.;
200	prohibiting the agency from issuing a license to a health
201	care facility that applies for a license to operate an
202	intermediate care facility for developmentally disabled
203	persons under certain conditions; amending s. 408.036,
204	F.S., relating to certificates of need; conforming a
205	provision to changes made by the act; amending s. 408.043,
206	F.S.; requiring a freestanding facility or a part of the
207	facility that is the inpatient hospice care component of a
208	hospice to obtain a certificate of need; amending s.
209	408.05, F.S.; renaming the Joint Commission on the
210	Accreditation of Healthcare Organizations as the "Joint
211	Commission"; amending s. 408.061, F.S.; revising
212	requirements for the reporting of certified data elements
213	by health care facilities; amending s. 408.10, F.S.;
214	authorizing the agency to provide staffing for a toll-free
215	phone number for the purpose of handling consumer
216	complaints regarding a health care facility; repealing s.
217	408.802(11), F.S., relating to the applicability of the
218	Health Care Licensing Procedures Act to private review
219	agents; amending s. 408.804, F.S.; providing a criminal
220	penalty for altering, defacing, or falsifying a license
221	certificate of certain health care providers; providing
222	civil penalties for displaying an altered, defaced, or
223	falsified license certificate; amending s. 408.806, F.S.;
224	requiring the agency to provide a courtesy notice to a
225	licensee regarding the expiration of a licensee's license;
226	providing that failure of the agency to provide the
227	courtesy notice or failure of the licensee to receive the
228	notice is not an excuse for the licensee to timely renew
229	its license; providing that payment of the late fee is
230	required for a later application; amending s. 408.810,
231	F.S.; revising the requirements for obtaining and
232	maintaining a license for certain health care providers
233	and those who own a controlling interest in a health care
234	provider; amending s. 408.811, F.S.; providing that a
235	licensee's inspection report is not subject to
236	administrative challenge; amending s. 408.813, F.S.;
237	authorizing the agency to impose administrative fines for
238	unclassified violations; amending s. 408.815, F.S.;
239	authorizing the agency to extend the expiration date of a
240	license for the purpose of the safe and orderly discharge
241	of clients; authorizing the agency to impose conditions on
242	the extension; amending s. 409.906, F.S.; requiring the
243	agency, in consultation with the Department of Elderly
244	Affairs, to phase out the adult day health care waiver
245	program; requiring adult day health care waiver providers,
246	in consultation with resource centers for the aged to
247	assist in the transition of enrollees from the waiver
248	program; repealing s. 409.221(4)(k), F.S., relating to the
249	responsibility of the agency, the Department of Elderly
250	Affairs, the Department of Health, the Department of
251	Children and Family Services, and the Agency for Persons
252	with Disabilities to review and assess the implementation
253	of the consumer-directed care program and the agency's
254	responsibility to submit a report to the Legislature;
255	repealing s. 409.912(15)(e), (f), and (g), F.S., relating
256	to a requirement for the Agency for Health Care
257	Administration to submit a report to the Legislature
258	regarding the operations of the CARE program; amending s.
259	429.11, F.S.; deleting provisions relating to a
260	provisional license to operate as an assisted living
261	facility; repealing s. 429.12(2), F.S., relating to the
262	sale or transfer of ownership of an assisted living
263	facility; amending s. 429.14, F.S.; authorizing the agency
264	to provide electronically or through the agency's Internet
265	site information regarding the denial, suspension, or
266	revocation of a license to the Division of Hotels and
267	Restaurants of the Department of Business and Professional
268	Regulation; amending s. 429.17, F.S.; revising the
269	requirements for a conditional license to operate an
270	assisted living facility; repealing s. 429.23(5), F.S.,
271	relating to each assisted living facility's requirement to
272	submit a report to the agency regarding liability claims
273	filed against it; amending s. 429.35, F.S.; authorizing
274	the agency to provide electronically or through the
275	agency's Internet website information regarding the
276	results of an inspection to the local ombudsman council;
277	amending s. 429.53, F.S.; requiring the agency, rather
278	than the agency's area offices of licensure and
279	certification, to provide consultation to certain persons
280	and licensees regarding assisted living facilities;
281	redefining the term "consultation" as it relates to
282	assisted living facilities; amending s. 429.65, F.S.;
283	redefining the term "adult family-care home" as it relates
284	to the Adult Family-Care Home Act; amending s. 429.71,
285	F.S.; redefining class I, II, III, and IV deficiencies as
286	class I, II, III, and IV violations as they relate to
287	adult family-care homes; repealing s. 429.911, F.S.,
288	relating to the denial, suspension, or revocation of a
289	license to operate an adult day care center; amending s.
290	429.915, F.S.; revising requirements for a conditional
291	license to operate an adult day care center; amending s.
292	430.80, F.S.; conforming a cross-reference; renaming the
293	Joint Commission on the Accreditation of Healthcare
294	Organizations to the Joint Commission; amending s. 440.13,
295	F.S.; renaming the Joint Commission on the Accreditation
296	of Healthcare Organizations as the "Joint Commission";
297	amending s. 483.294, F.S.; requiring the agency to
298	biennially inspect the premises and operations of
299	multiphasic health testing centers; amending ss. 627.645,
300	627.668, and 627.669, F.S.; renaming the Joint Commission
301	on the Accreditation of Hospitals to the Joint Commission;
302	amending ss. 627.736 and 641.495 F.S.; renaming the Joint
303	Commission on the Accreditation of Healthcare
304	Organizations as the "Joint Commission"; amending s.
305	651.118, F.S.; conforming a cross-reference; amending s.
306	766.1015, F.S.; renaming the Joint Commission on the
307	Accreditation of Healthcare Organizations as the "Joint
308	Commission"; providing effective dates.
309
310	Be It Enacted by the Legislature of the State of Florida:
311
312	Section 1.  Subsection (16) is added to section 1.01,
313	Florida Statutes, to read:
314	1.01  Definitions.-In construing these statutes and each
315	and every word, phrase, or part hereof, where the context will
316	permit:
317	(16)  The term "Joint Commission" means the independent,
318	not-for-profit organization that evaluates and accredits
319	hospitals and health care organizations and programs in the
320	United States. The Joint Commission was formerly known as the
321	Joint Commission on Accreditation of Hospitals (JCAH) and the
322	Joint Commission on Accreditation of Healthcare Organizations
323	(JCAHO).
324	Section 2.  Paragraphs (f) through (k) of subsection (10)
325	of section 112.0455, Florida Statutes, are redesignated as
326	paragraphs (e) through (j), present paragraph (e) of that
327	subsection is amended, and paragraph (e) of subsection (14) of
328	that section is amended to read:
329	112.0455  Drug-Free Workplace Act.-
330	(10)  EMPLOYER PROTECTION.-
331	(e)  Nothing in this section shall be construed to operate
332	retroactively, and nothing in this section shall abrogate the
333	right of an employer under state law to conduct drug tests prior
334	to January 1, 1990. A drug test conducted by an employer prior
335	to January 1, 1990, is not subject to this section.
336	(14)  DISCIPLINE REMEDIES.-
337	(e)  Upon resolving an appeal filed pursuant to paragraph
338	(c), and finding a violation of this section, the commission may
339	order the following relief:
340	1.  Rescind the disciplinary action, expunge related
341	records from the personnel file of the employee or job applicant
342	and reinstate the employee.
343	2.  Order compliance with paragraph (10)(f)(g).
344	3.  Award back pay and benefits.
345	4.  Award the prevailing employee or job applicant the
346	necessary costs of the appeal, reasonable attorney's fees, and
347	expert witness fees.
348	Section 3.  Paragraph (n) of subsection (1) of section
349	154.11, Florida Statutes, is amended to read:
350	154.11  Powers of board of trustees.-
351	(1)  The board of trustees of each public health trust
352	shall be deemed to exercise a public and essential governmental
353	function of both the state and the county and in furtherance
354	thereof it shall, subject to limitation by the governing body of
355	the county in which such board is located, have all of the
356	powers necessary or convenient to carry out the operation and
357	governance of designated health care facilities, including, but
358	without limiting the generality of, the foregoing:
359	(n)  To appoint originally the staff of physicians to
360	practice in any designated facility owned or operated by the
361	board and to approve the bylaws and rules to be adopted by the
362	medical staff of any designated facility owned and operated by
363	the board, such governing regulations to be in accordance with
364	the standards of the Joint Commission on the Accreditation of
365	Hospitals which provide, among other things, for the method of
366	appointing additional staff members and for the removal of staff
367	members.
368	Section 4.  Subsection (15) of section 318.21, Florida
369	Statutes, is amended to read:
370	318.21  Disposition of civil penalties by county courts.-
371	All civil penalties received by a county court pursuant to the
372	provisions of this chapter shall be distributed and paid monthly
373	as follows:
374	(15)  Of the additional fine assessed under s. 318.18(3)(e)
375	for a violation of s. 316.1893, 50 percent of the moneys
376	received from the fines shall be remitted to the Department of
377	Revenue and deposited into Brain and Spinal Cord Injury
378	Rehabilitation Trust Fund within Department of Health and shall
379	be appropriated to the Department of Health Agency for Health
380	Care Administration as general revenue to provide an enhanced
381	Medicaid payment to nursing homes that serve Medicaid recipients
382	with brain and spinal cord injuries that are medically complex,
383	technologically dependent, and respiratory dependent. The
384	remaining 50 percent of the moneys received from the enhanced
385	fine imposed under s. 318.18(3)(e) shall be remitted to the
386	Department of Revenue and deposited into the Department of
387	Health Administrative Trust Fund to provide financial support to
388	certified trauma centers in the counties where enhanced penalty
389	zones are established to ensure the availability and
390	accessibility of trauma services. Funds deposited into the
391	Administrative Trust Fund under this subsection shall be
392	allocated as follows:
393	(a)  Fifty percent shall be allocated equally among all
394	Level I, Level II, and pediatric trauma centers in recognition
395	of readiness costs for maintaining trauma services.
396	(b)  Fifty percent shall be allocated among Level I, Level
397	II, and pediatric trauma centers based on each center's relative
398	volume of trauma cases as reported in the Department of Health
399	Trauma Registry.
400	Section 5.  Section 383.325, Florida Statutes, is repealed.
401	Section 6.  Subsection (7) of section 394.4787, Florida
402	Statutes, is amended to read:
403	394.4787  Definitions; ss. 394.4786,      394.4787, 394.4788,
404	and 394.4789.-As used in this section and ss. 394.4786,
405	394.4788, and 394.4789:
406	(7)  "Specialty psychiatric hospital" means a hospital
407	licensed by the agency pursuant to s. 395.002(26) s. 395.002(28)
408	and part II of chapter 408 as a specialty psychiatric hospital.
409	Section 7.  Subsection (2) of section 394.741, Florida
410	Statutes, is amended to read:
411	394.741  Accreditation requirements for providers of
412	behavioral health care services.-
413	(2)  Notwithstanding any provision of law to the contrary,
414	accreditation shall be accepted by the agency and department in
415	lieu of the agency's and department's facility licensure onsite
416	review requirements and shall be accepted as a substitute for
417	the department's administrative and program monitoring
418	requirements, except as required by subsections (3) and (4),
419	for:
420	(a)  Any organization from which the department purchases
421	behavioral health care services that is accredited by the Joint
422	Commission on Accreditation of Healthcare Organizations or the
423	Council on Accreditation for Children and Family Services, or
424	has those services that are being purchased by the department
425	accredited by CARF-the Rehabilitation Accreditation Commission.
426	(b)  Any mental health facility licensed by the agency or
427	any substance abuse component licensed by the department that is
428	accredited by the Joint Commission on Accreditation of
429	Healthcare Organizations, CARF-the Rehabilitation Accreditation
430	Commission, or the Council on Accreditation of Children and
431	Family Services.
432	(c)  Any network of providers from which the department or
433	the agency purchases behavioral health care services accredited
434	by the Joint Commission on Accreditation of Healthcare
435	Organizations, CARF-the Rehabilitation Accreditation Commission,
436	the Council on Accreditation of Children and Family Services, or
437	the National Committee for Quality Assurance. A provider
438	organization, which is part of an accredited network, is
439	afforded the same rights under this part.
440	Section 8.  Section 395.002, Florida Statutes, is amended
441	to read:
442	395.002  Definitions.-As used in this chapter, the term:
443	(1)  "Accrediting organizations" means nationally
444	recognized or approved accrediting organizations whose standards
445	incorporate comparable licensure requirements as determined by
446	the agency. the Joint Commission on Accreditation of Healthcare
447	Organizations, the American Osteopathic Association, the
448	Commission on Accreditation of Rehabilitation Facilities, and
449	the Accreditation Association for Ambulatory Health Care, Inc.
450	(2)  "Agency" means the Agency for Health Care
451	Administration.
452	(3)  "Ambulatory surgical center" or "mobile surgical
453	facility" means a facility the primary purpose of which is to
454	provide elective surgical care, in which the patient is admitted
455	to and discharged from such facility within the same working day
456	and is not permitted to stay overnight, and which is not part of
457	a hospital. However, a facility existing for the primary purpose
458	of performing terminations of pregnancy, an office maintained by
459	a physician for the practice of medicine, or an office
460	maintained for the practice of dentistry shall not be construed
461	to be an ambulatory surgical center, provided that any facility
462	or office which is certified or seeks certification as a
463	Medicare ambulatory surgical center shall be licensed as an
464	ambulatory surgical center pursuant to s. 395.003. Any structure
465	or vehicle in which a physician maintains an office and
466	practices surgery, and which can appear to the public to be a
467	mobile office because the structure or vehicle operates at more
468	than one address, shall be construed to be a mobile surgical
469	facility.
470	(4)  "Biomedical waste" means any solid or liquid waste as
471	defined in s. 381.0098(2)(a).
472	(5)  "Clinical privileges" means the privileges granted to
473	a physician or other licensed health care practitioner to render
474	patient care services in a hospital, but does not include the
475	privilege of admitting patients.
476	(6)  "Department" means the Department of Health.
477	(7)  "Director" means any member of the official board of
478	directors as reported in the organization's annual corporate
479	report to the Florida Department of State, or, if no such report
480	is made, any member of the operating board of directors. The
481	term excludes members of separate, restricted boards that serve
482	only in an advisory capacity to the operating board.
483	(8)  "Emergency medical condition" means:
484	(a)  A medical condition manifesting itself by acute
485	symptoms of sufficient severity, which may include severe pain,
486	such that the absence of immediate medical attention could
487	reasonably be expected to result in any of the following:
488	1.  Serious jeopardy to patient health, including a
489	pregnant woman or fetus.
490	2.  Serious impairment to bodily functions.
491	3.  Serious dysfunction of any bodily organ or part.
492	(b)  With respect to a pregnant woman:
493	1.  That there is inadequate time to effect safe transfer
494	to another hospital prior to delivery;
495	2.  That a transfer may pose a threat to the health and
496	safety of the patient or fetus; or
497	3.  That there is evidence of the onset and persistence of
498	uterine contractions or rupture of the membranes.
499	(9)  "Emergency services and care" means medical screening,
500	examination, and evaluation by a physician, or, to the extent
501	permitted by applicable law, by other appropriate personnel
502	under the supervision of a physician, to determine if an
503	emergency medical condition exists and, if it does, the care,
504	treatment, or surgery by a physician necessary to relieve or
505	eliminate the emergency medical condition, within the service
506	capability of the facility.
507	(10)  "General hospital" means any facility which meets the
508	provisions of subsection (12) and which regularly makes its
509	facilities and services available to the general population.
510	(11)  "Governmental unit" means the state or any county,
511	municipality, or other political subdivision, or any department,
512	division, board, or other agency of any of the foregoing.
513	(12)  "Hospital" means any establishment that:
514	(a)  Offers services more intensive than those required for
515	room, board, personal services, and general nursing care, and
516	offers facilities and beds for use beyond 24 hours by
517	individuals requiring diagnosis, treatment, or care for illness,
518	injury, deformity, infirmity, abnormality, disease, or
519	pregnancy; and
520	(b)  Regularly makes available at least clinical laboratory
521	services, diagnostic X-ray services, and treatment facilities
522	for surgery or obstetrical care, or other definitive medical
523	treatment of similar extent, except that a critical access
524	hospital, as defined in s. 408.07, shall not be required to make
525	available treatment facilities for surgery, obstetrical care, or
526	similar services as long as it maintains its critical access
527	hospital designation and shall be required to make such
528	facilities available only if it ceases to be designated as a
529	critical access hospital.
530
531	However, the provisions of this chapter do not apply to any
532	institution conducted by or for the adherents of any well-
533	recognized church or religious denomination that depends
534	exclusively upon prayer or spiritual means to heal, care for, or
535	treat any person. For purposes of local zoning matters, the term
536	"hospital" includes a medical office building located on the
537	same premises as a hospital facility, provided the land on which
538	the medical office building is constructed is zoned for use as a
539	hospital; provided the premises were zoned for hospital purposes
540	on January 1, 1992.
541	(13)  "Hospital bed" means a hospital accommodation which
542	is ready for immediate occupancy, or is capable of being made
543	ready for occupancy within 48 hours, excluding provision of
544	staffing, and which conforms to minimum space, equipment, and
545	furnishings standards as specified by rule of the agency for the
546	provision of services specified in this section to a single
547	patient.
548	(14)  "Initial denial determination" means a determination
549	by a private review agent that the health care services
550	furnished or proposed to be furnished to a patient are
551	inappropriate, not medically necessary, or not reasonable.
552	(14)(15)  "Intensive residential treatment programs for
553	children and adolescents" means a specialty hospital accredited
554	by an accrediting organization as defined in subsection (1)
555	which provides 24-hour care and which has the primary functions
556	of diagnosis and treatment of patients under the age of 18
557	having psychiatric disorders in order to restore such patients
558	to an optimal level of functioning.
559	(15)(16)  "Licensed facility" means a hospital, ambulatory
560	surgical center, or mobile surgical facility licensed in
561	accordance with this chapter.
562	(16)(17)  "Lifesafety" means the control and prevention of
563	fire and other life-threatening conditions on a premises for the
564	purpose of preserving human life.
565	(17)(18)  "Managing employee" means the administrator or
566	other similarly titled individual who is responsible for the
567	daily operation of the facility.
568	(18)(19)  "Medical staff" means physicians licensed under
569	chapter 458 or chapter 459 with privileges in a licensed
570	facility, as well as other licensed health care practitioners
571	with clinical privileges as approved by a licensed facility's
572	governing board.
573	(19)(20)  "Medically necessary transfer" means a transfer
574	made necessary because the patient is in immediate need of
575	treatment for an emergency medical condition for which the
576	facility lacks service capability or is at service capacity.
577	(20)(21)  "Mobile surgical facility" is a mobile facility
578	in which licensed health care professionals provide elective
579	surgical care under contract with the Department of Corrections
580	or a private correctional facility operating pursuant to chapter
581	957 and in which inmate patients are admitted to and discharged
582	from said facility within the same working day and are not
583	permitted to stay overnight. However, mobile surgical facilities
584	may only provide health care services to the inmate patients of
585	the Department of Corrections, or inmate patients of a private
586	correctional facility operating pursuant to chapter 957, and not
587	to the general public.
588	(21)(22)  "Person" means any individual, partnership,
589	corporation, association, or governmental unit.
590	(22)(23)  "Premises" means those buildings, beds, and
591	equipment located at the address of the licensed facility and
592	all other buildings, beds, and equipment for the provision of
593	hospital, ambulatory surgical, or mobile surgical care located
594	in such reasonable proximity to the address of the licensed
595	facility as to appear to the public to be under the dominion and
596	control of the licensee. For any licensee that is a teaching
597	hospital as defined in s. 408.07(45), reasonable proximity
598	includes any buildings, beds, services, programs, and equipment
599	under the dominion and control of the licensee that are located
600	at a site with a main address that is within 1 mile of the main
601	address of the licensed facility; and all such buildings, beds,
602	and equipment may, at the request of a licensee or applicant, be
603	included on the facility license as a single premises.
604	(24)  "Private review agent" means any person or entity
605	which performs utilization review services for third-party
606	payors on a contractual basis for outpatient or inpatient
607	services. However, the term shall not include full-time
608	employees, personnel, or staff of health insurers, health
609	maintenance organizations, or hospitals, or wholly owned
610	subsidiaries thereof or affiliates under common ownership, when
611	performing utilization review for their respective hospitals,
612	health maintenance organizations, or insureds of the same
613	insurance group. For this purpose, health insurers, health
614	maintenance organizations, and hospitals, or wholly owned
615	subsidiaries thereof or affiliates under common ownership,
616	include such entities engaged as administrators of self-
617	insurance as defined in s. 624.031.
618	(23)(25)  "Service capability" means all services offered
619	by the facility where identification of services offered is
620	evidenced by the appearance of the service in a patient's
621	medical record or itemized bill.
622	(24)(26)  "At service capacity" means the temporary
623	inability of a hospital to provide a service which is within the
624	service capability of the hospital, due to maximum use of the
625	service at the time of the request for the service.
626	(25)(27)  "Specialty bed" means a bed, other than a general
627	bed, designated on the face of the hospital license for a
628	dedicated use.
629	(26)(28)  "Specialty hospital" means any facility which
630	meets the provisions of subsection (12), and which regularly
631	makes available either:
632	(a)  The range of medical services offered by general
633	hospitals, but restricted to a defined age or gender group of
634	the population;
635	(b)  A restricted range of services appropriate to the
636	diagnosis, care, and treatment of patients with specific
637	categories of medical or psychiatric illnesses or disorders; or
638	(c)  Intensive residential treatment programs for children
639	and adolescents as defined in subsection (14) (15).
640	(27)(29)  "Stabilized" means, with respect to an emergency
641	medical condition, that no material deterioration of the
642	condition is likely, within reasonable medical probability, to
643	result from the transfer of the patient from a hospital.
644	(30)  "Utilization review" means a system for reviewing the
645	medical necessity or appropriateness in the allocation of health
646	care resources of hospital services given or proposed to be
647	given to a patient or group of patients.
648	(31)  "Utilization review plan" means a description of the
649	policies and procedures governing utilization review activities
650	performed by a private review agent.
651	(28)(32)  "Validation inspection" means an inspection of
652	the premises of a licensed facility by the agency to assess
653	whether a review by an accrediting organization has adequately
654	evaluated the licensed facility according to minimum state
655	standards.
656	Section 9.  Subsection (1) and paragraph (b) of subsection
657	(2) of section 395.003, Florida Statutes, are amended to read:
658	395.003  Licensure; denial, suspension, and revocation.-
659	(1)(a)  The requirements of part II of chapter 408 apply to
660	the provision of services that require licensure pursuant to ss.
661	395.001-395.1065 and part II of chapter 408 and to entities
662	licensed by or applying for such licensure from the Agency for
663	Health Care Administration pursuant to ss. 395.001-395.1065. A
664	license issued by the agency is required in order to operate a
665	hospital, ambulatory surgical center, or mobile surgical
666	facility in this state.
667	(b)1.  It is unlawful for a person to use or advertise to
668	the public, in any way or by any medium whatsoever, any facility
669	as a "hospital," "ambulatory surgical center," or "mobile
670	surgical facility" unless such facility has first secured a
671	license under the provisions of this part.
672	2.  This part does not apply to veterinary hospitals or to
673	commercial business establishments using the word "hospital,"
674	"ambulatory surgical center," or "mobile surgical facility" as a
675	part of a trade name if no treatment of human beings is
676	performed on the premises of such establishments.
677	(c)  Until July 1, 2006, additional emergency departments
678	located off the premises of licensed hospitals may not be
679	authorized by the agency.
680	(2)
681	(b)  The agency shall, at the request of a licensee that is
682	a teaching hospital as defined in s. 408.07(45), issue a single
683	license to a licensee for facilities that have been previously
684	licensed as separate premises, provided such separately licensed
685	facilities, taken together, constitute the same premises as
686	defined in s. 395.002(22)(23). Such license for the single
687	premises shall include all of the beds, services, and programs
688	that were previously included on the licenses for the separate
689	premises. The granting of a single license under this paragraph
690	shall not in any manner reduce the number of beds, services, or
691	programs operated by the licensee.
692	Section 10.  Paragraph (e) of subsection (2) and subsection
693	(4) of section 395.0193, Florida Statutes, are amended to read:
694	395.0193  Licensed facilities; peer review; disciplinary
695	powers; agency or partnership with physicians.-
696	(2)  Each licensed facility, as a condition of licensure,
697	shall provide for peer review of physicians who deliver health
698	care services at the facility. Each licensed facility shall
699	develop written, binding procedures by which such peer review
700	shall be conducted. Such procedures shall include:
701	(e)  Recording of agendas and minutes which do not contain
702	confidential material, for review by the Division of Medical
703	Quality Assurance of the department Health Quality Assurance of
704	the agency.
705	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
706	actions taken under subsection (3) shall be reported in writing
707	to the Division of Medical Quality Assurance of the department
708	Health Quality Assurance of the agency within 30 working days
709	after its initial occurrence, regardless of the pendency of
710	appeals to the governing board of the hospital. The notification
711	shall identify the disciplined practitioner, the action taken,
712	and the reason for such action. All final disciplinary actions
713	taken under subsection (3), if different from those which were
714	reported to the department agency within 30 days after the
715	initial occurrence, shall be reported within 10 working days to
716	the Division of Medical Quality Assurance of the department
717	Health Quality Assurance of the agency in writing and shall
718	specify the disciplinary action taken and the specific grounds
719	therefor. The division shall review each report and determine
720	whether it potentially involved conduct by the licensee that is
721	subject to disciplinary action, in which case s. 456.073 shall
722	apply. The reports are not subject to inspection under s.
723	119.07(1) even if the division's investigation results in a
724	finding of probable cause.
725	Section 11.  Section 395.1023, Florida Statutes, is amended
726	to read:
727	395.1023  Child abuse and neglect cases; duties.-Each
728	licensed facility shall adopt a protocol that, at a minimum,
729	requires the facility to:
730	(1)  Incorporate a facility policy that every staff member
731	has an affirmative duty to report, pursuant to chapter 39, any
732	actual or suspected case of child abuse, abandonment, or
733	neglect; and
734	(2)  In any case involving suspected child abuse,
735	abandonment, or neglect, designate, at the request of the
736	Department of Children and Family Services, a staff physician to
737	act as a liaison between the hospital and the Department of
738	Children and Family Services office which is investigating the
739	suspected abuse, abandonment, or neglect, and the child
740	protection team, as defined in s. 39.01, when the case is
741	referred to such a team.
742
743	Each general hospital and appropriate specialty hospital shall
744	comply with the provisions of this section and shall notify the
745	agency and the Department of Children and Family Services of its
746	compliance by sending a copy of its policy to the agency and the
747	Department of Children and Family Services as required by rule.
748	The failure by a general hospital or appropriate specialty
749	hospital to comply shall be punished by a fine not exceeding
750	$1,000, to be fixed, imposed, and collected by the agency. Each
751	day in violation is considered a separate offense.
752	Section 12.  Subsection (2) and paragraph (d) of subsection
753	(3) of section 395.1041, Florida Statutes, are amended to read:
754	395.1041  Access to emergency services and care.-
755	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
756	shall establish and maintain an inventory of hospitals with
757	emergency services. The inventory shall list all services within
758	the service capability of the hospital, and such services shall
759	appear on the face of the hospital license. Each hospital having
760	emergency services shall notify the agency of its service
761	capability in the manner and form prescribed by the agency. The
762	agency shall use the inventory to assist emergency medical
763	services providers and others in locating appropriate emergency
764	medical care. The inventory shall also be made available to the
765	general public. On or before August 1, 1992, the agency shall
766	request that each hospital identify the services which are
767	within its service capability. On or before November 1, 1992,
768	the agency shall notify each hospital of the service capability
769	to be included in the inventory. The hospital has 15 days from
770	the date of receipt to respond to the notice. By December 1,
771	1992, the agency shall publish a final inventory. Each hospital
772	shall reaffirm its service capability when its license is
773	renewed and shall notify the agency of the addition of a new
774	service or the termination of a service prior to a change in its
775	service capability.
776	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
777	FACILITY OR HEALTH CARE PERSONNEL.-
778	(d)1.  Every hospital shall ensure the provision of
779	services within the service capability of the hospital, at all
780	times, either directly or indirectly through an arrangement with
781	another hospital, through an arrangement with one or more
782	physicians, or as otherwise made through prior arrangements. A
783	hospital may enter into an agreement with another hospital for
784	purposes of meeting its service capability requirement, and
785	appropriate compensation or other reasonable conditions may be
786	negotiated for these backup services.
787	2.  If any arrangement requires the provision of emergency
788	medical transportation, such arrangement must be made in
789	consultation with the applicable provider and may not require
790	the emergency medical service provider to provide transportation
791	that is outside the routine service area of that provider or in
792	a manner that impairs the ability of the emergency medical
793	service provider to timely respond to prehospital emergency
794	calls.
795	3.  A hospital shall not be required to ensure service
796	capability at all times as required in subparagraph 1. if, prior
797	to the receiving of any patient needing such service capability,
798	such hospital has demonstrated to the agency that it lacks the
799	ability to ensure such capability and it has exhausted all
800	reasonable efforts to ensure such capability through backup
801	arrangements. In reviewing a hospital's demonstration of lack of
802	ability to ensure service capability, the agency shall consider
803	factors relevant to the particular case, including the
804	following:
805	a.  Number and proximity of hospitals with the same service
806	capability.
807	b.  Number, type, credentials, and privileges of
808	specialists.
809	c.  Frequency of procedures.
810	d.  Size of hospital.
811	4.  The agency shall publish proposed rules implementing a
812	reasonable exemption procedure by November 1, 1992. Subparagraph
813	1. shall become effective upon the effective date
814	or January 31, 1993, whichever is earlier. For a
815	exceed 1 year from the effective date of
816	hospital requesting an exemption shall be deemed to be exempt
817	from offering the service until the agency initially acts to
818	deny or grant the original request. The agency has 45 days from
819	the date of receipt of the request to approve or deny the
820	request. After the first year from the effective date of
821	subparagraph 1., If the agency fails to initially act within the
822	time period, the hospital is deemed to be exempt from offering
823	the service until the agency initially acts to deny the request.
824	Section 13.  Section 395.1046, Florida Statutes, is
825	repealed.
826	Section 14.  Paragraph (e) of subsection (1) of section
827	395.1055, Florida Statutes, is amended to read:
828	395.1055  Rules and enforcement.-
829	(1)  The agency shall adopt rules pursuant to ss.
830	120.536(1) and 120.54 to implement the provisions of this part,
831	which shall include reasonable and fair minimum standards for
832	ensuring that:
833	(e)  Licensed facility beds conform to minimum space,
834	equipment, and furnishings standards as specified by the agency,
835	the Florida Building Code, and the Florida Fire Prevention Code
836	department.
837	Section 15.  Subsection (1) of section 395.10972, Florida
838	Statutes, is amended to read:
839	395.10972  Health Care Risk Manager Advisory Council.-The
840	Secretary of Health Care Administration may appoint a seven-
841	member advisory council to advise the agency on matters
842	pertaining to health care risk managers. The members of the
843	council shall serve at the pleasure of the secretary. The
844	council shall designate a chair. The council shall meet at the
845	call of the secretary or at those times as may be required by
846	rule of the agency. The members of the advisory council shall
847	receive no compensation for their services, but shall be
848	reimbursed for travel expenses as provided in s. 112.061. The
849	council shall consist of individuals representing the following
850	areas:
851	(1)  Two shall be active health care risk managers,
852	including one risk manager who is recommended by and a member of
853	the Florida Society for of Healthcare Risk Management and
854	Patient Safety.
855	Section 16.  Subsection (3) of section 395.2050, Florida
856	Statutes, is amended to read:
857	395.2050  Routine inquiry for organ and tissue donation;
858	certification for procurement activities; death records review.-
859	(3)  Each organ procurement organization designated by the
860	federal Centers for Medicare and Medicaid Services Health Care
861	Financing Administration and licensed by the state shall conduct
862	an annual death records review in the organ procurement
863	organization's affiliated donor hospitals. The organ procurement
864	organization shall enlist the services of every Florida licensed
865	tissue bank and eye bank affiliated with or providing service to
866	the donor hospital and operating in the same service area to
867	participate in the death records review.
868	Section 17.  Subsection (2) of section 395.3036, Florida
869	Statutes, is amended to read:
870	395.3036  Confidentiality of records and meetings of
871	corporations that lease public hospitals or other public health
872	care facilities.-The records of a private corporation that
873	leases a public hospital or other public health care facility
874	are confidential and exempt from the provisions of s. 119.07(1)
875	and s. 24(a), Art. I of the State Constitution, and the meetings
876	of the governing board of a private corporation are exempt from
877	s. 286.011 and s. 24(b), Art. I of the State Constitution when
878	the public lessor complies with the public finance
879	accountability provisions of s. 155.40(5) with respect to the
880	transfer of any public funds to the private lessee and when the
881	private lessee meets at least three of the five following
882	criteria:
883	(2)  The public lessor and the private lessee do not
884	commingle any of their funds in any account maintained by either
885	of them, other than the payment of the rent and administrative
886	fees or the transfer of funds pursuant to subsection (5)      (2).
887	Section 18.  Section 395.3037, Florida Statutes, is
888	repealed.
889	Section 19.  Subsections (1), (4), and (5) of section
890	395.3038, Florida Statutes, are amended to read:
891	395.3038  State-listed primary stroke centers and
892	comprehensive stroke centers; notification of hospitals.-
893	(1)  The agency shall make available on its website and to
894	the department a list of the name and address of each hospital
895	that meets the criteria for a primary stroke center and the name
896	and address of each hospital that meets the criteria for a
897	comprehensive stroke center. The list of primary and
898	comprehensive stroke centers shall include only those hospitals
899	that attest in an affidavit submitted to the agency that the
900	hospital meets the named criteria, or those hospitals that
901	attest in an affidavit submitted to the agency that the hospital
902	is certified as a primary or a comprehensive stroke center by
903	the Joint Commission on Accreditation of Healthcare
904	Organizations.
905	(4)  The agency shall adopt by rule criteria for a primary
906	stroke center which are substantially similar to the
907	certification standards for primary stroke centers of the Joint
908	Commission on Accreditation of Healthcare Organizations.
909	(5)  The agency shall adopt by rule criteria for a
910	comprehensive stroke center. However, if the Joint Commission on
911	Accreditation of Healthcare Organizations establishes criteria
912	for a comprehensive stroke center, the agency shall establish
913	criteria for a comprehensive stroke center which are
914	substantially similar to those criteria established by the Joint
915	Commission on Accreditation of Healthcare Organizations.
916	Section 20.  Subsection (2) of section 395.602, Florida
917	Statutes, is amended to read:
918	395.602  Rural hospitals.-
919	(2)  DEFINITIONS.-As used in this part:
920	(e)  "Rural hospital" means an acute care hospital licensed
921	under this chapter, having 100 or fewer licensed beds and an
922	emergency room, which is:
923	1.  The sole provider within a county with a population
924	density of no greater than 100 persons per square mile;
925	2.  An acute care hospital, in a county with a population
926	density of no greater than 100 persons per square mile, which is
927	at least 30 minutes of travel time, on normally traveled roads
928	under normal traffic conditions, from any other acute care
929	hospital within the same county;
930	3.  A hospital supported by a tax district or subdistrict
931	whose boundaries encompass a population of 100 persons or fewer
932	per square mile;
933	4.  A hospital in a constitutional charter county with a
934	population of over 1 million persons that has imposed a local
935	option health service tax pursuant to law and in an area that
936	was directly impacted by a catastrophic event on August 24,
937	1992, for which the Governor of Florida declared a state of
938	emergency pursuant to chapter 125, and has 120 beds or less that
939	serves an agricultural community with an emergency room
940	utilization of no less than 20,000 visits and a Medicaid
941	inpatient utilization rate greater than 15 percent;
942	4.5.  A hospital with a service area that has a population
943	of 100 persons or fewer per square mile. As used in this
944	subparagraph, the term "service area" means the fewest number of
945	zip codes that account for 75 percent of the hospital's
946	discharges for the most recent 5-year period, based on
947	information available from the hospital inpatient discharge
948	database in the Florida Center for Health Information and Policy
949	Analysis at the Agency for Health Care Administration; or
950	5.6.  A hospital designated as a critical access hospital,
951	as defined in s. 408.07(15).
952
953	Population densities used in this paragraph must be based upon
954	the most recently completed United States census. A hospital
955	that received funds under s. 409.9116 for a quarter beginning no
956	later than July 1, 2002, is deemed to have been and shall
957	continue to be a rural hospital from that date through June 30,
958	2015, if the hospital continues to have 100 or fewer licensed
959	beds and an emergency room, or meets the criteria of
960	subparagraph 4. An acute care hospital that has not previously
961	been designated as a rural hospital and that meets the criteria
962	of this paragraph shall be granted such designation upon
963	application, including supporting documentation to the Agency
964	for Health Care Administration.
965	Section 21.  Subsection (8) of section 400.021, Florida
966	Statutes, is amended to read:
967	400.021  Definitions.-When used in this part, unless the
968	context otherwise requires, the term:
969	(8)  "Geriatric outpatient clinic" means a site for
970	providing outpatient health care to persons 60 years of age or
971	older, which is staffed by a registered nurse, or a physician
972	assistant, a licensed practical nurse under the direct
973	supervision of a registered nurse, or an advanced registered
974	nurse practitioner.
975	Section 22.  Paragraph (g) of subsection (2) of section
976	400.0239, Florida Statutes, is amended to read:
977	400.0239  Quality of Long-Term Care Facility Improvement
978	Trust Fund.-
979	(2)  Expenditures from the trust fund shall be allowable
980	for direct support of the following:
981	(g)  Other initiatives authorized by the Centers for
982	Medicare and Medicaid Services for the use of federal civil
983	monetary penalties, including projects recommended through the
984	Medicaid "Up-or-Out" Quality of Care Contract Management Program
985	pursuant to s. 400.148.
986	Section 23.  Subsection (2) of section 400.063, Florida
987	Statutes, is amended to read:
988	400.063  Resident protection.-
989	(2)  The agency is authorized to establish for each
990	facility, subject to intervention by the agency, a separate bank
991	account for the deposit to the credit of the agency of any
992	moneys received from the Health Care Trust Fund or any other
993	moneys received for the maintenance and care of residents in the
994	facility, and the agency is authorized to disburse moneys from
995	such account to pay obligations incurred for the purposes of
996	this section. The agency is authorized to requisition moneys
997	from the Health Care Trust Fund in advance of an actual need for
998	cash on the basis of an estimate by the agency of moneys to be
999	spent under the authority of this section. Any bank account
1000	established under this section need not be approved in advance
1001	of its creation as required by s. 17.58, but shall be secured by
1002	depository insurance equal to or greater than the balance of
1003	such account or by the pledge of collateral security in
1004	conformance with criteria established in s. 18.11. The agency
1005	shall notify the Chief Financial Officer of any such account so
1006	established and shall make a quarterly accounting to the Chief
1007	Financial Officer for all moneys deposited in such account.
1008	Section 24.  Subsections (1) and (5) of section 400.071,
1009	Florida Statutes, are amended to read:
1010	400.071  Application for license.-
1011	(1)  In addition to the requirements of part II of chapter
1012	408, the application for a license shall be under oath and must
1013	contain the following:
1014	(a)  The location of the facility for which a license is
1015	sought and an indication, as in the original application, that
1016	such location conforms to the local zoning ordinances.
1017	(b)  A signed affidavit disclosing any financial or
1018	ownership interest that a controlling interest as defined in
1019	part II of chapter 408 has held in the last 5 years in any
1020	entity licensed by this state or any other state to provide
1021	health or residential care which has closed voluntarily or
1022	involuntarily; has filed for bankruptcy; has had a receiver
1023	appointed; has had a license denied, suspended, or revoked; or
1024	has had an injunction issued against it which was initiated by a
1025	regulatory agency. The affidavit must disclose the reason any
1026	such entity was closed, whether voluntarily or involuntarily.
1027	(c)  The total number of beds and the total number of
1028	Medicare and Medicaid certified beds.
1029	(b)(d)  Information relating to the applicant and employees
1030	which the agency requires by rule. The applicant must
1031	demonstrate that sufficient numbers of qualified staff, by
1032	training or experience, will be employed to properly care for
1033	the type and number of residents who will reside in the
1034	facility.
1035	(c)(e)  Copies of any civil verdict or judgment involving
1036	the applicant rendered within the 10 years preceding the
1037	application, relating to medical negligence, violation of
1038	residents' rights, or wrongful death. As a condition of
1039	licensure, the licensee agrees to provide to the agency copies
1040	of any new verdict or judgment involving the applicant, relating
1041	to such matters, within 30 days after filing with the clerk of
1042	the court. The information required in this paragraph shall be
1043	maintained in the facility's licensure file and in an agency
1044	database which is available as a public record.
1045	(5)  As a condition of licensure, each facility must
1046	establish and submit with its application a plan for quality
1047	assurance and for conducting risk management.
1048	Section 25.  Section 400.0712, Florida Statutes, is amended
1049	to read:
1050	400.0712  Application for inactive license.-
1051	(1)  As specified in this section, the agency may issue an
1052	inactive license to a nursing home facility for all or a portion
1053	of its beds. Any request by a licensee that a nursing home or
1054	portion of a nursing home become inactive must be submitted to
1055	the agency in the approved format. The facility may not initiate
1056	any suspension of services, notify residents, or initiate
1057	inactivity before receiving approval from the agency; and a
1058	licensee that violates this provision may not be issued an
1059	inactive license.
1060	(1)(2)  In addition to the authority granted in part II of
1061	chapter 408, the agency may issue an inactive license to a
1062	nursing home that chooses to use an unoccupied contiguous
1063	portion of the facility for an alternative use to meet the needs
1064	of elderly persons through the use of less restrictive, less
1065	institutional services.
1066	(a)  An inactive license issued under this subsection may
1067	be granted for a period not to exceed the current licensure
1068	expiration date but may be renewed by the agency at the time of
1069	licensure renewal.
1070	(b)  A request to extend the inactive license must be
1071	submitted to the agency in the approved format and approved by
1072	the agency in writing.
1073	(c)  Nursing homes that receive an inactive license to
1074	provide alternative services shall not receive preference for
1075	participation in the Assisted Living for the Elderly Medicaid
1076	waiver.
1077	(2)(3)  The agency shall adopt rules pursuant to ss.
1078	120.536(1) and 120.54 necessary to administer implement this
1079	section.
1080	Section 26.  Section 400.111, Florida Statutes, is amended
1081	to read:
1082	400.111  Disclosure of controlling interest.-In addition to
1083	the requirements of part II of chapter 408, when requested by
1084	the agency, the licensee shall submit a signed affidavit
1085	disclosing any financial or ownership interest that a
1086	controlling interest has held within the last 5 years in any
1087	entity licensed by the state or any other state to provide
1088	health or residential care which entity has closed voluntarily
1089	or involuntarily; has filed for bankruptcy; has had a receiver
1090	appointed; has had a license denied, suspended, or revoked; or
1091	has had an injunction issued against it which was initiated by a
1092	regulatory agency. The affidavit must disclose the reason such
1093	entity was closed, whether voluntarily or involuntarily.
1094	Section 27.  Section 400.1183, Florida Statutes, is amended
1095	to read:
1096	400.1183  Resident grievance procedures.-
1097	(1)  Every nursing home must have a grievance procedure
1098	available to its residents and their families. The grievance
1099	procedure must include:
1100	(a)  An explanation of how to pursue redress of a
1101	grievance.
1102	(b)  The names, job titles, and telephone numbers of the
1103	employees responsible for implementing the facility's grievance
1104	procedure. The list must include the address and the toll-free
1105	telephone numbers of the ombudsman and the agency.
1106	(c)  A simple description of the process through which a
1107	resident may, at any time, contact the toll-free telephone
1108	hotline of the ombudsman or the agency to report the unresolved
1109	grievance.
1110	(d)  A procedure for providing assistance to residents who
1111	cannot prepare a written grievance without help.
1112	(2)  Each facility shall maintain records of all grievances
1113	for agency inspection and shall report to the agency at the time
1114	of relicensure the total number of grievances handled during the
1115	prior licensure period, a categorization of the cases underlying
1116	the grievances, and the final disposition of the grievances.
1117	(3)  Each facility must respond to the grievance within a
1118	reasonable time after its submission.
1119	(4)  The agency may investigate any grievance at any time.
1120	Section 28.  Subsection (1) of section 400.141, Florida
1121	Statutes, is amended to read:
1122	400.141  Administration and management of nursing home
1123	facilities.-
1124	(1)  Every licensed facility shall comply with all
1125	applicable standards and rules of the agency and shall:
1126	(a)  Be under the administrative direction and charge of a
1127	licensed administrator.
1128	(b)  Appoint a medical director licensed pursuant to
1129	chapter 458 or chapter 459. The agency may establish by rule
1130	more specific criteria for the appointment of a medical
1131	director.
1132	(c)  Have available the regular, consultative, and
1133	emergency services of physicians licensed by the state.
1134	(d)  Provide for resident use of a community pharmacy as
1135	specified in s. 400.022(1)(q). Any other law to the contrary
1136	notwithstanding, a registered pharmacist licensed in Florida,
1137	that is under contract with a facility licensed under this
1138	chapter or chapter 429, shall repackage a nursing facility
1139	resident's bulk prescription medication which has been packaged
1140	by another pharmacist licensed in any state in the United States
1141	into a unit dose system compatible with the system used by the
1142	nursing facility, if the pharmacist is requested to offer such
1143	service. In order to be eligible for the repackaging, a resident
1144	or the resident's spouse must receive prescription medication
1145	benefits provided through a former employer as part of his or
1146	her retirement benefits, a qualified pension plan as specified
1147	in s. 4972 of the Internal Revenue Code, a federal retirement
1148	program as specified under 5 C.F.R. s. 831, or a long-term care
1149	policy as defined in s. 627.9404(1). A pharmacist who correctly
1150	repackages and relabels the medication and the nursing facility
1151	which correctly administers such repackaged medication under
1152	this paragraph may not be held liable in any civil or
1153	administrative action arising from the repackaging. In order to
1154	be eligible for the repackaging, a nursing facility resident for
1155	whom the medication is to be repackaged shall sign an informed
1156	consent form provided by the facility which includes an
1157	explanation of the repackaging process and which notifies the
1158	resident of the immunities from liability provided in this
1159	paragraph. A pharmacist who repackages and relabels prescription
1160	medications, as authorized under this paragraph, may charge a
1161	reasonable fee for costs resulting from the implementation of
1162	this provision.
1163	(e)  Provide for the access of the facility residents to
1164	dental and other health-related services, recreational services,
1165	rehabilitative services, and social work services appropriate to
1166	their needs and conditions and not directly furnished by the
1167	licensee. When a geriatric outpatient nurse clinic is conducted
1168	in accordance with rules adopted by the agency, outpatients
1169	attending such clinic shall not be counted as part of the
1170	general resident population of the nursing home facility, nor
1171	shall the nursing staff of the geriatric outpatient clinic be
1172	counted as part of the nursing staff of the facility, until the
1173	outpatient clinic load exceeds 15 a day.
1174	(f)  Be allowed and encouraged by the agency to provide
1175	other needed services under certain conditions. If the facility
1176	has a standard licensure status, and has had no class I or class
1177	II deficiencies during the past 2 years or has been awarded a
1178	Gold Seal under the program established in s. 400.235, it may be
1179	encouraged by the agency to provide services, including, but not
1180	limited to, respite and adult day services, which enable
1181	individuals to move in and out of the facility. A facility is
1182	not subject to any additional licensure requirements for
1183	providing these services. Respite care may be offered to persons
1184	in need of short-term or temporary nursing home services.
1185	Respite care must be provided in accordance with this part and
1186	rules adopted by the agency. However, the agency shall, by rule,
1187	adopt modified requirements for resident assessment, resident
1188	care plans, resident contracts, physician orders, and other
1189	provisions, as appropriate, for short-term or temporary nursing
1190	home services. The agency shall allow for shared programming and
1191	staff in a facility which meets minimum standards and offers
1192	services pursuant to this paragraph, but, if the facility is
1193	cited for deficiencies in patient care, may require additional
1194	staff and programs appropriate to the needs of service
1195	recipients. A person who receives respite care may not be
1196	counted as a resident of the facility for purposes of the
1197	facility's licensed capacity unless that person receives 24-hour
1198	respite care. A person receiving either respite care for 24
1199	hours or longer or adult day services must be included when
1200	calculating minimum staffing for the facility. Any costs and
1201	revenues generated by a nursing home facility from
1202	nonresidential programs or services shall be excluded from the
1203	calculations of Medicaid per diems for nursing home
1204	institutional care reimbursement.
1205	(g)  If the facility has a standard license or is a Gold
1206	Seal facility, exceeds the minimum required hours of licensed
1207	nursing and certified nursing assistant direct care per resident
1208	per day, and is part of a continuing care facility licensed
1209	under chapter 651 or a retirement community that offers other
1210	services pursuant to part III of this chapter or part I or part
1211	III of chapter 429 on a single campus, be allowed to share
1212	programming and staff. At the time of inspection and in the
1213	semiannual report required pursuant to paragraph (n) (o), a
1214	continuing care facility or retirement community that uses this
1215	option must demonstrate through staffing records that minimum
1216	staffing requirements for the facility were met. Licensed nurses
1217	and certified nursing assistants who work in the nursing home
1218	facility may be used to provide services elsewhere on campus if
1219	the facility exceeds the minimum number of direct care hours
1220	required per resident per day and the total number of residents
1221	receiving direct care services from a licensed nurse or a
1222	certified nursing assistant does not cause the facility to
1223	violate the staffing ratios required under s. 400.23(3)(a).
1224	Compliance with the minimum staffing ratios shall be based on
1225	total number of residents receiving direct care services,
1226	regardless of where they reside on campus. If the facility
1227	receives a conditional license, it may not share staff until the
1228	conditional license status ends. This paragraph does not
1229	restrict the agency's authority under federal or state law to
1230	require additional staff if a facility is cited for deficiencies
1231	in care which are caused by an insufficient number of certified
1232	nursing assistants or licensed nurses. The agency may adopt
1233	rules for the documentation necessary to determine compliance
1234	with this provision.
1235	(h)  Maintain the facility premises and equipment and
1236	conduct its operations in a safe and sanitary manner.
1237	(i)  If the licensee furnishes food service, provide a
1238	wholesome and nourishing diet sufficient to meet generally
1239	accepted standards of proper nutrition for its residents and
1240	provide such therapeutic diets as may be prescribed by attending
1241	physicians. In making rules to implement this paragraph, the
1242	agency shall be guided by standards recommended by nationally
1243	recognized professional groups and associations with knowledge
1244	of dietetics.
1245	(j)  Keep full records of resident admissions and
1246	discharges; medical and general health status, including medical
1247	records, personal and social history, and identity and address
1248	of next of kin or other persons who may have responsibility for
1249	the affairs of the residents; and individual resident care plans
1250	including, but not limited to, prescribed services, service
1251	frequency and duration, and service goals. The records shall be
1252	open to inspection by the agency.
1253	(k)  Keep such fiscal records of its operations and
1254	conditions as may be necessary to provide information pursuant
1255	to this part.
1256	(l)  Furnish copies of personnel records for employees
1257	affiliated with such facility, to any other facility licensed by
1258	this state requesting this information pursuant to this part.
1259	Such information contained in the records may include, but is
1260	not limited to, disciplinary matters and any reason for
1261	termination. Any facility releasing such records pursuant to
1262	this part shall be considered to be acting in good faith and may
1263	not be held liable for information contained in such records,
1264	absent a showing that the facility maliciously falsified such
1265	records.
1266	(m)  Publicly display a poster provided by the agency
1267	containing the names, addresses, and telephone numbers for the
1268	state's abuse hotline, the State Long-Term Care Ombudsman, the
1269	Agency for Health Care Administration consumer hotline, the
1270	Advocacy Center for Persons with Disabilities, the Florida
1271	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1272	with a clear description of the assistance to be expected from
1273	each.
1274	(n)  Submit to the agency the information specified in s.
1275	400.071(1)(b) for a management company within 30 days after the
1276	effective date of the management agreement.
1277	(n)(o)1.  Submit semiannually to the agency, or more
1278	frequently if requested by the agency, information regarding
1279	facility staff-to-resident ratios, staff turnover, and staff
1280	stability, including information regarding certified nursing
1281	assistants, licensed nurses, the director of nursing, and the
1282	facility administrator. For purposes of this reporting:
1283	a.  Staff-to-resident ratios must be reported in the
1284	categories specified in s. 400.23(3)(a) and applicable rules.
1285	The ratio must be reported as an average for the most recent
1286	calendar quarter.
1287	b.  Staff turnover must be reported for the most recent 12-
1288	month period ending on the last workday of the most recent
1289	calendar quarter prior to the date the information is submitted.
1290	The turnover rate must be computed quarterly, with the annual
1291	rate being the cumulative sum of the quarterly rates. The
1292	turnover rate is the total number of terminations or separations
1293	experienced during the quarter, excluding any employee
1294	terminated during a probationary period of 3 months or less,
1295	divided by the total number of staff employed at the end of the
1296	period for which the rate is computed, and expressed as a
1297	percentage.
1298	c.  The formula for determining staff stability is the
1299	total number of employees that have been employed for more than
1300	12 months, divided by the total number of employees employed at
1301	the end of the most recent calendar quarter, and expressed as a
1302	percentage.
1303	d.  A nursing facility that has failed to comply with state
1304	minimum-staffing requirements for 2 consecutive days is
1305	prohibited from accepting new admissions until the facility has
1306	achieved the minimum-staffing requirements for a period of 6
1307	consecutive days. For the purposes of this sub-subparagraph, any
1308	person who was a resident of the facility and was absent from
1309	the facility for the purpose of receiving medical care at a
1310	separate location or was on a leave of absence is not considered
1311	a new admission. The agency shall fine the nursing facility
1312	$1,000 if it fails Failure to impose such an admissions
1313	moratorium constitutes a class II deficiency.
1314	e.  A nursing facility which does not have a conditional
1315	license may be cited for failure to comply with the standards in
1316	s. 400.23(3)(a)1.a. only if it has failed to meet those
1317	standards on 2 consecutive days or if it has failed to meet at
1318	least 97 percent of those standards on any one day.
1319	f.  A facility which has a conditional license must be in
1320	compliance with the standards in s. 400.23(3)(a) at all times.
1321	2.  This paragraph does not limit the agency's ability to
1322	impose a deficiency or take other actions if a facility does not
1323	have enough staff to meet the residents' needs.
1324	(o)(p)  Notify a licensed physician when a resident
1325	exhibits signs of dementia or cognitive impairment or has a
1326	change of condition in order to rule out the presence of an
1327	underlying physiological condition that may be contributing to
1328	such dementia or impairment. The notification must occur within
1329	30 days after the acknowledgment of such signs by facility
1330	staff. If an underlying condition is determined to exist, the
1331	facility shall arrange, with the appropriate health care
1332	provider, the necessary care and services to treat the
1333	condition.
1334	(p)(q)  If the facility implements a dining and hospitality
1335	attendant program, ensure that the program is developed and
1336	implemented under the supervision of the facility director of
1337	nursing. A licensed nurse, licensed speech or occupational
1338	therapist, or a registered dietitian must conduct training of
1339	dining and hospitality attendants. A person employed by a
1340	facility as a dining and hospitality attendant must perform
1341	tasks under the direct supervision of a licensed nurse.
1342	(r)  Report to the agency any filing for bankruptcy
1343	protection by the facility or its parent corporation,
1344	divestiture or spin-off of its assets, or corporate
1345	reorganization within 30 days after the completion of such
1346	activity.
1347	(q)(s)  Maintain general and professional liability
1348	insurance coverage that is in force at all times. In lieu of
1349	general and professional liability insurance coverage, a state-
1350	designated teaching nursing home and its affiliated assisted
1351	living facilities created under s. 430.80 may demonstrate proof
1352	of financial responsibility as provided in s. 430.80(3)(h).
1353	(r)(t)  Maintain in the medical record for each resident a
1354	daily chart of certified nursing assistant services provided to
1355	the resident. The certified nursing assistant who is caring for
1356	the resident must complete this record by the end of his or her
1357	shift. This record must indicate assistance with activities of
1358	daily living, assistance with eating, and assistance with
1359	drinking, and must record each offering of nutrition and
1360	hydration for those residents whose plan of care or assessment
1361	indicates a risk for malnutrition or dehydration.
1362	(s)(u)  Before November 30 of each year, subject to the
1363	availability of an adequate supply of the necessary vaccine,
1364	provide for immunizations against influenza viruses to all its
1365	consenting residents in accordance with the recommendations of
1366	the United States Centers for Disease Control and Prevention,
1367	subject to exemptions for medical contraindications and
1368	religious or personal beliefs. Subject to these exemptions, any
1369	consenting person who becomes a resident of the facility after
1370	November 30 but before March 31 of the following year must be
1371	immunized within 5 working days after becoming a resident.
1372	Immunization shall not be provided to any resident who provides
1373	documentation that he or she has been immunized as required by
1374	this paragraph. This paragraph does not prohibit a resident from
1375	receiving the immunization from his or her personal physician if
1376	he or she so chooses. A resident who chooses to receive the
1377	immunization from his or her personal physician shall provide
1378	proof of immunization to the facility. The agency may adopt and
1379	enforce any rules necessary to comply with or administer
1380	implement this paragraph subsection.
1381	(t)(v)  Assess all residents for eligibility for
1382	pneumococcal polysaccharide vaccination (PPV) and vaccinate
1383	residents when indicated within 60 days after the effective date
1384	of this act in accordance with the recommendations of the United
1385	States Centers for Disease Control and Prevention, subject to
1386	exemptions for medical contraindications and religious or
1387	personal beliefs. Residents admitted after the effective date of
1388	this act shall be assessed within 5 working days of admission
1389	and, when indicated, vaccinated within 60 days in accordance
1390	with the recommendations of the United States Centers for
1391	Disease Control and Prevention, subject to exemptions for
1392	medical contraindications and religious or personal beliefs.
1393	Immunization shall not be provided to any resident who provides
1394	documentation that he or she has been immunized as required by
1395	this paragraph. This paragraph does not prohibit a resident from
1396	receiving the immunization from his or her personal physician if
1397	he or she so chooses. A resident who chooses to receive the
1398	immunization from his or her personal physician shall provide
1399	proof of immunization to the facility. The agency may adopt and
1400	enforce any rules necessary to comply with or administer
1401	implement this paragraph.
1402	(u)(w)  Annually encourage and promote to its employees the
1403	benefits associated with immunizations against influenza viruses
1404	in accordance with the recommendations of the United States
1405	Centers for Disease Control and Prevention. The agency may adopt
1406	and enforce any rules necessary to comply with or administer
1407	implement this paragraph.
1408	Section 29.  Subsection (3) of section 400.142, Florida
1409	Statutes, is amended to read:
1410	400.142  Emergency medication kits; orders not to
1411	resuscitate.-
1412	(3)  Facility staff may withhold or withdraw
1413	cardiopulmonary resuscitation if presented with an order not to
1414	resuscitate executed pursuant to s. 401.45. The agency shall
1415	adopt rules providing for the implementation of such orders.
1416	Facility staff and facilities shall not be subject to criminal
1417	prosecution or civil liability, nor be considered to have
1418	engaged in negligent or unprofessional conduct, for withholding
1419	or withdrawing cardiopulmonary resuscitation pursuant to such an
1420	order and rules adopted by the agency. The absence of an order
1421	not to resuscitate executed pursuant to s. 401.45 does not
1422	preclude a physician from withholding or withdrawing
1423	cardiopulmonary resuscitation as otherwise permitted by law.
1424	Section 30.  Subsection (10) of section 400.147, Florida
1425	Statutes, is repealed.
1426	Section 31.  Section 400.148, Florida Statutes, is
1427	repealed.
1428	Section 32.  Subsection (3) of section 400.19, Florida
1429	Statutes, is amended to read:
1430	400.19  Right of entry and inspection.-
1431	(3)  The agency shall every 15 months conduct at least one
1432	unannounced inspection to determine compliance by the licensee
1433	with statutes, and with rules promulgated under the provisions
1434	of those statutes, governing minimum standards of construction,
1435	quality and adequacy of care, and rights of residents. The
1436	survey shall be conducted every 6 months for the next 2-year
1437	period if the facility has been cited for a class I deficiency,
1438	has been cited for two or more class II deficiencies arising
1439	from separate surveys or investigations within a 60-day period,
1440	or has had three or more substantiated complaints within a 6-
1441	month period, each resulting in at least one class I or class II
1442	deficiency. In addition to any other fees or fines in this part,
1443	the agency shall assess a fine for each facility that is subject
1444	to the 6-month survey cycle. The fine for the 2-year period
1445	shall be $6,000, one-half to be paid at the completion of each
1446	survey. The agency may adjust this fine by the change in the
1447	Consumer Price Index, based on the 12 months immediately
1448	preceding the increase, to cover the cost of the additional
1449	surveys. The agency shall verify through subsequent inspection
1450	that any deficiency identified during inspection is corrected.
1451	However, the agency may verify the correction of a class III or
1452	class IV deficiency unrelated to resident rights or resident
1453	care without reinspecting the facility if adequate written
1454	documentation has been received from the facility, which
1455	provides assurance that the deficiency has been corrected. The
1456	giving or causing to be given of advance notice of such
1457	unannounced inspections by an employee of the agency to any
1458	unauthorized person shall constitute cause for suspension of not
1459	fewer than 5 working days according to the provisions of chapter
1460	110.
1461	Section 33.  Section 400.195, Florida Statutes, is
1462	repealed.
1463	Section 34.  Subsection (5) of section 400.23, Florida
1464	Statutes, is amended to read:
1465	400.23  Rules; evaluation and deficiencies; licensure
1466	status.-
1467	(5)  The agency, in collaboration with the Division of
1468	Children's Medical Services Network of the Department of Health,
1469	must, no later than December 31, 1993, adopt rules for minimum
1470	standards of care for persons under 21 years of age who reside
1471	in nursing home facilities. The rules must include a methodology
1472	for reviewing a nursing home facility under ss. 408.031-408.045
1473	which serves only persons under 21 years of age. A facility may
1474	be exempt from these standards for specific persons between 18
1475	and 21 years of age, if the person's physician agrees that
1476	minimum standards of care based on age are not necessary.
1477	Section 35.  Subsection (1) of section 400.275, Florida
1478	Statutes, is amended to read:
1479	400.275  Agency duties.-
1480	(1)  The agency shall ensure that each newly hired nursing
1481	home surveyor, as a part of basic training, is assigned full-
1482	time to a licensed nursing home for at least 2 days within a 7-
1483	day period to observe facility operations outside of the survey
1484	process before the surveyor begins survey responsibilities. Such
1485	observations may not be the sole basis of a deficiency citation
1486	against the facility. The agency may not assign an individual to
1487	be a member of a survey team for purposes of a survey,
1488	evaluation, or consultation visit at a nursing home facility in
1489	which the surveyor was an employee within the preceding 5 years.
1490	Section 36.  Subsections (2) and (14) of section 400.462,
1491	Florida Statutes, are amended, present subsections (27), (28),
1492	and (29) of that section are renumbered as subsections (28),
1493	(29), and (30), respectively, and new subsections (27) and (31)
1494	are added to that section, to read:
1495	400.462  Definitions.-As used in this part, the term:
1496	(2)  "Admission" means a decision by the home health
1497	agency, during or after an evaluation visit with the patient to
1498	the patient's home, that there is reasonable expectation that
1499	the patient's medical, nursing, and social needs for skilled
1500	care can be adequately met by the agency in the patient's place
1501	of residence. Admission includes completion of an agreement with
1502	the patient or the patient's legal representative to provide
1503	home health services as required in s. 400.487(1).
1504	(14)  "Home health services" means health and medical
1505	services and medical supplies furnished by an organization to an
1506	individual in the individual's home or place of residence. The
1507	term includes organizations that provide one or more of the
1508	following:
1509	(a)  Nursing care.
1510	(b)  Physical, occupational, respiratory, or speech
1511	therapy.
1512	(c)  Home health aide services.
1513	(d)  Dietetics and nutrition practice and nutrition
1514	counseling.
1515	(e)  Medical supplies and durable medical equipment,
1516	restricted to drugs and biologicals prescribed by a physician.
1517	(27)  "Primary home health agency" means the agency that is
1518	responsible for the services furnished to patients and for
1519	implementation of the plan of care.
1520	(31)  "Temporary" means short term, such as for employee
1521	absences, temporary skill shortages, seasonal workloads.
1522	Section 37.  Section 400.476, Florida Statutes, is amended
1523	to read:
1524	400.476  Staffing requirements; notifications; limitations
1525	on staffing services.-
1526	(1)  ADMINISTRATOR.-
1527	(a)  An administrator may manage only one home health
1528	agency, except that an administrator may manage up to five home
1529	health agencies if all five home health agencies have identical
1530	controlling interests as defined in s. 408.803 and are located
1531	within one agency geographic service area or within an
1532	immediately contiguous county. If the home health agency is
1533	licensed under this chapter and is part of a retirement
1534	community that provides multiple levels of care, an employee of
1535	the retirement community may administer the home health agency
1536	and up to a maximum of four entities licensed under this chapter
1537	or chapter 429 which all have identical controlling interests as
1538	defined in s. 408.803. An administrator shall designate, in
1539	writing, for each licensed entity, a qualified alternate
1540	administrator to serve during the administrator's absence. An
1541	alternate administrator must meet the requirements in this
1542	paragraph and s. 400.462(1).
1543	(b)  An administrator of a home health agency who is a
1544	licensed physician, physician assistant, or registered nurse
1545	licensed to practice in this state may also be the director of
1546	nursing for a home health agency. An administrator may serve as
1547	a director of nursing for up to the number of entities
1548	authorized in subsection (2) only if there are 10 or fewer full-
1549	time equivalent employees and contracted personnel in each home
1550	health agency.
1551	(c)  The administrator shall organize and direct the
1552	agency's ongoing functions, maintain an ongoing liaison with the
1553	board members and the staff, employ qualified personnel and
1554	ensure adequate staff education and evaluations, ensures the
1555	accuracy of public informational materials and activities,
1556	implement an effective budgeting and accounting system, and
1557	ensures that the home health agency operates in compliance with
1558	this part and part II of chapter 408 and rules adopted for these
1559	laws.
1560	(d)  The administrator shall clearly set forth in writing
1561	the organizational chart, services furnished, administrative
1562	control, and lines of authority for the delegation of
1563	responsibilities for patient care. These responsibilities must
1564	be readily identifiable. Administrative and supervisory
1565	functions may not be delegated to another agency or
1566	organization, and the primary home health agency shall monitor
1567	and control all services that are not furnished directly,
1568	including services provided through contracts.
1569	(2)  DIRECTOR OF NURSING.-
1570	(a)  A director of nursing may be the director of nursing
1571	for:
1572	1.  Up to two licensed home health agencies if the agencies
1573	have identical controlling interests as defined in s. 408.803
1574	and are located within one agency geographic service area or
1575	within an immediately contiguous county; or
1576	2.  Up to five licensed home health agencies if:
1577	a.  All of the home health agencies have identical
1578	controlling interests as defined in s. 408.803;
1579	b.  All of the home health agencies are located within one
1580	agency geographic service area or within an immediately
1581	contiguous county; and
1582	c.  Each home health agency has a registered nurse who
1583	meets the qualifications of a director of nursing and who has a
1584	written delegation from the director of nursing to serve as the
1585	director of nursing for that home health agency when the
1586	director of nursing is not present; and.
1587	d.  This person, or similarly qualified alternate, is
1588	available at all times during operating hours and participates
1589	in all activities relevant to the professional services
1590	furnished, including, but not limited to, the oversight of
1591	nursing services, home health aides, and certified nursing
1592	assistants, and assignment of personnel.
1593
1594	If a home health agency licensed under this chapter is part of a
1595	retirement community that provides multiple levels of care, an
1596	employee of the retirement community may serve as the director
1597	of nursing of the home health agency and up to a maximum of four
1598	entities, other than home health agencies, licensed under this
1599	chapter or chapter 429 which all have identical controlling
1600	interests as defined in s. 408.803.
1601	(b)  A home health agency that provides skilled nursing
1602	care may not operate for more than 30 calendar days without a
1603	director of nursing. A home health agency that provides skilled
1604	nursing care and the director of nursing of a home health agency
1605	must notify the agency within 10 business days after termination
1606	of the services of the director of nursing for the home health
1607	agency. A home health agency that provides skilled nursing care
1608	must notify the agency of the identity and qualifications of the
1609	new director of nursing within 10 days after the new director is
1610	hired. If a home health agency that provides skilled nursing
1611	care operates for more than 30 calendar days without a director
1612	of nursing, the home health agency commits a class II
1613	deficiency. In addition to the fine for a class II deficiency,
1614	the agency may issue a moratorium in accordance with s. 408.814
1615	or revoke the license. The agency shall fine a home health
1616	agency that fails to notify the agency as required in this
1617	paragraph $1,000 for the first violation and $2,000 for a repeat
1618	violation. The agency may not take administrative action against
1619	a home health agency if the director of nursing fails to notify
1620	the department upon termination of services as the director of
1621	nursing for the home health agency.
1622	(c)  A home health agency that is not Medicare or Medicaid
1623	certified and does not provide skilled care or provides only
1624	physical, occupational, or speech therapy is not required to
1625	have a director of nursing and is exempt from paragraph (b).
1626	(3)  TRAINING.-A home health agency shall ensure that each
1627	certified nursing assistant employed by or under contract with
1628	the home health agency and each home health aide employed by or
1629	under contract with the home health agency is adequately trained
1630	to perform the tasks of a home health aide in the home setting.
1631	(a)  The home health agency may not use as a home health
1632	aide on a full-time, temporary, per diem, or other basis, any
1633	individual to provide services unless the individual has
1634	completed a training and competency evaluation program, or a
1635	competency evaluation program, as permitted in s. 400.497 which
1636	meets the minimum standards established by the agency in state
1637	rules.
1638	(b)  A home health aide is not competent in any task for
1639	which he or she is evaluated as "unsatisfactory." The aide must
1640	perform any such task only under direct supervision by a
1641	licensed nurse until he or she receives training in the task and
1642	satisfactorily passes a subsequent evaluation in performing the
1643	task. A home health aide has not successfully passed a
1644	competency evaluation if the aide does not have a passing score
1645	on the test as specified by agency rule.
1646	(4)  STAFFING.-Staffing services may be provided anywhere
1647	within the state.
1648	(5)  PERSONNEL.-
1649	(a)  The home health agency and its staff must comply with
1650	accepted professional standards and principles that apply to
1651	professionals, including, but not limited to, the state practice
1652	acts and the home health agency's policies and procedures.
1653	(b)  If personnel under hourly or per-visit contracts are
1654	used by the home health agency, there must be a written contract
1655	between those personnel and the agency which specifies the
1656	following requirements:
1657	1.  Acceptance for care only of patients by the primary
1658	home health agency.
1659	2.  The services to be furnished.
1660	3.  The necessity to conform to all applicable agency
1661	policies, including personnel qualifications.
1662	4.  The responsibility for participating in developing
1663	plans of care.
1664	5.  The manner in which services are controlled,
1665	coordinated, and evaluated by the primary home health agency.
1666	6.  The procedures for submitting clinical and progress
1667	notes, scheduling of visits, and periodic patient evaluation.
1668	7.  The procedures for payment for services furnished under
1669	the contract.
1670	(c)  A home health agency shall directly provide at least
1671	one of the types of services through home health agency
1672	employees, but may provide additional services under
1673	arrangements with another agency or organization. Services
1674	furnished under such arrangements must have a written contract
1675	conforming with the requirements specified in paragraph (b).
1676	(d)  If home health aide services are provided by an
1677	individual who is not employed directly by the home health
1678	agency, the services of the home health aide must be provided
1679	under arrangements as stated in paragraphs (b) and (c). If the
1680	home health agency chooses to provide home health aide services
1681	under arrangements with another organization, the
1682	responsibilities of the home health agency include, but are not
1683	limited to:
1684	1.  Ensuring the overall quality of the care provided by
1685	the aide;
1686	2.  Supervising the aide's services as described in s.
1687	400.487; and
1688	3.  Ensuring that each home health aide providing services
1689	under arrangements with another organization has met the
1690	training requirements or competency evaluation requirements of
1691	s. 400.497.
1692	(e)  The home health agency shall coordinate the efforts of
1693	all personnel furnishing services, and the personnel shall
1694	maintain communication with the home health agency to ensure
1695	that personnel efforts support the objectives outlined in the
1696	plan of care. The clinical record or minutes of case conferences
1697	shall ensure that effective interchange, reporting, and
1698	coordination of patient care occurs.
1699	Section 38.  Section 400.484, Florida Statutes, is amended
1700	to read:
1701	400.484  Right of inspection; violations deficiencies;
1702	fines.-
1703	(1)  In addition to the requirements of s. 408.811, the
1704	agency may make such inspections and investigations as are
1705	necessary in order to determine the state of compliance with
1706	this part, part II of chapter 408, and applicable rules.
1707	(2)  The agency shall impose fines for various classes of
1708	deficiencies in accordance with the following schedule:
1709	(a)  Class I violations are defined in s. 408.813. A class
1710	I deficiency is any act, omission, or practice that results in a
1711	patient's death, disablement, or permanent injury, or places a
1712	patient at imminent risk of death, disablement, or permanent
1713	injury. Upon finding a class I violation deficiency, the agency
1714	shall impose an administrative fine in the amount of $15,000 for
1715	each occurrence and each day that the violation deficiency
1716	exists.
1717	(b)  Class II violations are defined in s. 408.813. A class
1718	II deficiency is any act, omission, or practice that has a
1719	direct adverse effect on the health, safety, or security of a
1720	patient. Upon finding a class II violation deficiency, the
1721	agency shall impose an administrative fine in the amount of
1722	$5,000 for each occurrence and each day that the violation
1723	deficiency exists.
1724	(c)  Class III violations are defined in s. 408.813. A
1725	class III deficiency is any act, omission, or practice that has
1726	an indirect, adverse effect on the health, safety, or security
1727	of a patient. Upon finding an uncorrected or repeated class III
1728	violation deficiency, the agency shall impose an administrative
1729	fine not to exceed $1,000 for each occurrence and each day that
1730	the uncorrected or repeated violation deficiency exists.
1731	(d)  Class IV violations are defined in s. 408.813. A class
1732	IV deficiency is any act, omission, or practice related to
1733	required reports, forms, or documents which does not have the
1734	potential of negatively affecting patients. These violations are
1735	of a type that the agency determines do not threaten the health,
1736	safety, or security of patients. Upon finding an uncorrected or
1737	repeated class IV violation deficiency, the agency shall impose
1738	an administrative fine not to exceed $500 for each occurrence
1739	and each day that the uncorrected or repeated violation
1740	deficiency exists.
1741	(3)  In addition to any other penalties imposed pursuant to
1742	this section or part, the agency may assess costs related to an
1743	investigation that results in a successful prosecution,
1744	excluding costs associated with an attorney's time.
1745	Section 39.  Section 400.487, Florida Statutes, is amended
1746	to read:
1747	400.487  Home health service agreements; physician's,
1748	physician assistant's, and advanced registered nurse
1749	practitioner's treatment orders; patient assessment;
1750	establishment and review of plan of care; provision of services;
1751	orders not to resuscitate.-
1752	(1)  Services provided by a home health agency must be
1753	covered by an agreement between the home health agency and the
1754	patient or the patient's legal representative specifying the
1755	home health services to be provided, the rates or charges for
1756	services paid with private funds, and the sources of payment,
1757	which may include Medicare, Medicaid, private insurance,
1758	personal funds, or a combination thereof. The home health agency
1759	shall provide a copy of the agreement to the patient or the
1760	patient's legal representative. A home health agency providing
1761	skilled care must make an assessment of the patient's needs
1762	within 48 hours after the start of services.
1763	(2)  When required by the provisions of chapter 464; part
1764	I, part III, or part V of chapter 468; or chapter 486, the
1765	attending physician, physician assistant, or advanced registered
1766	nurse practitioner, acting within his or her respective scope of
1767	practice, shall establish treatment orders for a patient who is
1768	to receive skilled care. The treatment orders must be signed by
1769	the physician, physician assistant, or advanced registered nurse
1770	practitioner before a claim for payment for the skilled services
1771	is submitted by the home health agency. If the claim is
1772	submitted to a managed care organization, the treatment orders
1773	must be signed within the time allowed under the provider
1774	agreement. The treatment orders shall be reviewed, as frequently
1775	as the patient's illness requires, by the physician, physician
1776	assistant, or advanced registered nurse practitioner in
1777	consultation with the home health agency.
1778	(3)  A home health agency shall arrange for supervisory
1779	visits by a registered nurse to the home of a patient receiving
1780	home health aide services as specified in subsection (9) in
1781	accordance with the patient's direction, approval, and agreement
1782	to pay the charge for the visits.
1783	(4)  The home health agency shall protect and promote the
1784	rights of each individual under its care, including each of the
1785	following rights:
1786	(a)  Notice of rights.-The home health agency shall provide
1787	the patient with a written notice of the patient's rights in
1788	advance of furnishing care to the patient or during the initial
1789	evaluation visit before the initiation of treatment. The home
1790	health agency must maintain documentation showing that it has
1791	complied with the requirements of this section.
1792	(b)  Exercise of rights and respect for property and
1793	person.-
1794	1.  The patient has the right to exercise his or her rights
1795	as a patient of the home health agency.
1796	2.  The patient has the right to have his or her property
1797	treated with respect.
1798	3.  The patient has the right to voice grievances regarding
1799	treatment or care that is or fails to be furnished, or regarding
1800	the lack of respect for property by anyone who is furnishing
1801	services on behalf of the home health agency, and not be
1802	subjected to discrimination or reprisal for doing so.
1803	4.  The home health agency must investigate complaints made
1804	by a patient or the patient's family or guardian regarding
1805	treatment or care that is or fails to be furnished, or regarding
1806	the lack of respect for the patient's property by anyone
1807	furnishing services on behalf of the home health agency. The
1808	home health agency shall document the existence of the complaint
1809	and its resolution.
1810	5.  The patient and his or her immediate family or
1811	representative must be informed of the right to report
1812	complaints via the statewide toll-free telephone number to the
1813	agency as required in s. 408.810.
1814	(c)  Right to be informed and to participate in planning
1815	care and treatment.-
1816	1.  The patient has the right to be informed, in advance,
1817	about the care to be furnished and of any changes in the care to
1818	be furnished. The home health agency shall advise the patient in
1819	advance of which disciplines will furnish care and the frequency
1820	of visits proposed to be furnished. The home health agency must
1821	advise the patient in advance of any change in the plan of care
1822	before the change is made.
1823	2.  The patient has the right to participate in the
1824	planning of the care. The home health agency must advise the
1825	patient in advance of the right to participate in planning the
1826	care or treatment and in planning changes in the care or
1827	treatment. Each patient has the right to be informed of and to
1828	participate in the planning of his or her care. Each patient
1829	must be provided, upon request, a copy of the plan of care
1830	established and maintained for that patient by the home health
1831	agency.
1832	(5)  When nursing services are ordered, the home health
1833	agency to which a patient has been admitted for care must
1834	provide the initial admission visit, all service evaluation
1835	visits, and the discharge visit by a direct employee. Services
1836	provided by others under contractual arrangements to a home
1837	health agency must be monitored and managed by the admitting
1838	home health agency. The admitting home health agency is fully
1839	responsible for ensuring that all care provided through its
1840	employees or contract staff is delivered in accordance with this
1841	part and applicable rules.
1842	(6)  The skilled care services provided by a home health
1843	agency, directly or under contract, must be supervised and
1844	coordinated in accordance with the plan of care. The home health
1845	agency shall furnish skilled nursing services by or under the
1846	supervision of a registered nurse and in accordance with the
1847	plan of care. Any therapy services offered directly or under
1848	arrangement by the home health agency must be provided by a
1849	qualified therapist or by a qualified therapy assistant under
1850	the supervision of a qualified therapist and in accordance with
1851	the plan of care.
1852	(a)  Duties and qualifications.-A qualified therapist shall
1853	assist the physician in evaluating the level of function, help
1854	develop or revise the plan of care, prepare clinical and
1855	progress notes, advise and consult with the family and other
1856	agency personnel, and participate in in-service programs. The
1857	therapist or therapy assistant must meet the qualifications in
1858	the state practice acts and related applicable rules.
1859	(b)  Physical therapy assistants and occupational therapy
1860	assistants.-Services provided by a physical therapy assistant or
1861	occupational therapy assistant must be under the supervision of
1862	a qualified physical therapist or occupational therapist as
1863	required in chapter 486 and part III of chapter 468,
1864	respectively, and related applicable rules. A physical therapy
1865	assistant or occupational therapy assistant shall perform
1866	services planned, delegated, and supervised by the therapist,
1867	assist in preparing clinical notes and progress reports,
1868	participate in educating the patient and his or her family, and
1869	participate in in-service programs.
1870	(c)  Speech therapy services.-Speech therapy services shall
1871	be furnished only by or under supervision of a qualified speech
1872	pathologist or audiologist as required in part I of chapter 468
1873	and related applicable rules.
1874	(d)  Care follows a written plan of care.-The plan of care
1875	shall be reviewed by the physician or health professional who
1876	provided the treatment orders pursuant to subsection (2) and
1877	home health agency personnel as often as the severity of the
1878	patient's condition requires, but at least once every 60 days or
1879	more when there is a beneficiary-elected transfer, a significant
1880	change in condition resulting in a change in the case-mix
1881	assignment, or a discharge and return to the same home health
1882	agency during the 60-day episode. Professional staff of a home
1883	health agency shall promptly alert the physician or other health
1884	professional who provided the treatment orders of any change
1885	that suggests a need to alter the plan of care.
1886	(e)  Administration of drugs and treatment.-Only
1887	professional staff of a home health agency may administer drugs
1888	and treatments as ordered by the physician or health
1889	professional pursuant to subsection (2), with the exception of
1890	influenza and pneumococcal polysaccharide vaccines, which may be
1891	administered according to the policy of the home health agency
1892	developed in consultation with a physician and after an
1893	assessment for contraindications. The physician or health
1894	professional, as provided in subsection (2), shall put any
1895	verbal order in writing and sign and date it with the date of
1896	receipt by the registered nurse or qualified therapist who is
1897	responsible for furnishing or supervising the ordered service. A
1898	verbal order may be accepted only by personnel who are
1899	authorized to do so by applicable state laws, rules, and
1900	internal policies of the home health agency.
1901	(7)  A registered nurse shall conduct the initial
1902	evaluation visit, regularly reevaluate the patient's nursing
1903	needs, initiate the plan of care and necessary revisions,
1904	furnish those services requiring substantial and specialized
1905	nursing skill, initiate appropriate preventive and
1906	rehabilitative nursing procedures, prepare clinical and progress
1907	notes, coordinate services, inform the physician and other
1908	personnel of changes in the patient's condition and needs,
1909	counsel the patient and his or her family in meeting nursing and
1910	related needs, participate in in-service programs, and supervise
1911	and teach other nursing personnel.
1912	(8)  A licensed practical nurse shall furnish services in
1913	accordance with agency policies, prepare clinical and progress
1914	notes, assist the physician and registered nurse in performing
1915	specialized procedures, prepare equipment and materials for
1916	treatments observing aseptic technique as required, and assist
1917	the patient in learning appropriate self-care techniques.
1918	(9)  A home health aide and certified nursing assistant
1919	shall provide services that are ordered by the physician in the
1920	plan of care and that the aide or assistant is permitted to
1921	perform under state law. The duties of a home health aide or
1922	certified nursing assistant include the provision of hands-on
1923	personal care, performance of simple procedures as an extension
1924	of therapy or nursing services, assistance in ambulation or
1925	exercises, and assistance in administering medications that are
1926	ordinarily self-administered and are specified in agency rules.
1927	Any services by a home health aide which are offered by a home
1928	health agency must be provided by a qualified home health aide
1929	or certified nursing assistant.
1930	(a)  Assignment and duties.-A home health aide or certified
1931	nursing assistant shall be assigned to a specific patient by a
1932	registered nurse. Written patient care instructions for the home
1933	health aide and certified nursing assistant must be prepared by
1934	the registered nurse or other appropriate professional who is
1935	responsible for the supervision of the home health aide and
1936	certified nursing assistant as stated in this section.
1937	(b)  Supervision.-If a patient receives skilled nursing
1938	care, the registered nurse shall perform the supervisory visit.
1939	If the patient is not receiving skilled nursing care but is
1940	receiving physical therapy, occupational therapy, or speech-
1941	language pathology services, the appropriate therapist may
1942	provide the supervision. A registered nurse or other
1943	professional must make an onsite visit to the patient's home at
1944	least once every 2 weeks. The visit is not required while the
1945	aide is providing care.
1946	(c)  Supervising visits.-If home health aide services are
1947	provided to a patient who is not receiving skilled nursing care,
1948	physical or occupational therapy, or speech-language pathology
1949	services, a registered nurse must make a supervisory visit to
1950	the patient's home at least once every 60 days. The registered
1951	nurse shall ensure that the aide is properly caring for the
1952	patient and each supervisory visit must occur while the home
1953	health aide is providing patient care.
1954	(10)(7)  Home health agency personnel may withhold or
1955	withdraw cardiopulmonary resuscitation if presented with an
1956	order not to resuscitate executed pursuant to s. 401.45. The
1957	agency shall adopt rules providing for the implementation of
1958	such orders. Home health personnel and agencies shall not be
1959	subject to criminal prosecution or civil liability, nor be
1960	considered to have engaged in negligent or unprofessional
1961	conduct, for withholding or withdrawing cardiopulmonary
1962	resuscitation pursuant to such an order and rules adopted by the
1963	agency.
1964	Section 40.  Subsections (1) and (4) of section 400.606,
1965	Florida Statutes, are amended to read:
1966	400.606  License; application; renewal; conditional license
1967	or permit; certificate of need.-
1968	(1)  In addition to the requirements of part II of chapter
1969	408, the initial application and change of ownership application
1970	must be accompanied by a plan for the delivery of home,
1971	residential, and homelike inpatient hospice services to
1972	terminally ill persons and their families. Such plan must
1973	contain, but need not be limited to:
1974	(a)  The estimated average number of terminally ill persons
1975	to be served monthly.
1976	(b)  The geographic area in which hospice services will be
1977	available.
1978	(c)  A listing of services which are or will be provided,
1979	either directly by the applicant or through contractual
1980	arrangements with existing providers.
1981	(d)  Provisions for the implementation of hospice home care
1982	within 3 months after licensure.
1983	(e)  Provisions for the implementation of hospice homelike
1984	inpatient care within 12 months after licensure.
1985	(f)  The number and disciplines of professional staff to be
1986	employed.
1987	(g)  The name and qualifications of any existing or
1988	potential contractee.
1989	(h)  A plan for attracting and training volunteers.
1990	(i)  The projected annual operating cost of the hospice.
1991
1992	If the applicant is an existing licensed health care provider,
1993	the application must be accompanied by a copy of the most recent
1994	profit-loss statement and, if applicable, the most recent
1995	licensure inspection report.
1996	(4)  A freestanding hospice facility that is primarily
1997	engaged in providing inpatient and related services and that is
1998	not otherwise licensed as a health care facility shall be
1999	required to obtain a certificate of need. However, a
2000	freestanding hospice facility with six or fewer beds shall not
2001	be required to comply with institutional standards such as, but
2002	not limited to, standards requiring sprinkler systems, emergency
2003	electrical systems, or special lavatory devices.
2004	Section 41.  Subsection (2) of section 400.607, Florida
2005	Statutes, is amended to read:
2006	400.607  Denial, suspension, revocation of license;
2007	emergency actions; imposition of administrative fine; grounds.-
2008	(2)  A violation of the provisions of this part, part II of
2009	chapter 408, or applicable rules Any of the following actions by
2010	a licensed hospice or any of its employees shall be grounds for
2011	administrative action by the agency against a hospice.:
2012	(a)  A violation of the provisions of this part, part II of
2013	chapter 408, or applicable rules.
2014	(b)  An intentional or negligent act materially affecting
2015	the health or safety of a patient.
2016	Section 42.  Subsection (1) of section 400.925, Florida
2017	Statutes, is amended to read:
2018	400.925  Definitions.-As used in this part, the term:
2019	(1)  "Accrediting organizations" means the Joint Commission
2020	on Accreditation of Healthcare Organizations or other national
2021	accreditation agencies whose standards for accreditation are
2022	comparable to those required by this part for licensure.
2023	Section 43.  Section 400.931, Florida Statutes, is amended
2024	to read:
2025	400.931  Application for license; fee; provisional license;
2026	temporary permit.-
2027	(1)  In addition to the requirements of part II of chapter
2028	408, the applicant must file with the application satisfactory
2029	proof that the home medical equipment provider is in compliance
2030	with this part and applicable rules, including:
2031	(a)  A report, by category, of the equipment to be
2032	provided, indicating those offered either directly by the
2033	applicant or through contractual arrangements with existing
2034	providers. Categories of equipment include:
2035	1.  Respiratory modalities.
2036	2.  Ambulation aids.
2037	3.  Mobility aids.
2038	4.  Sickroom setup.
2039	5.  Disposables.
2040	(b)  A report, by category, of the services to be provided,
2041	indicating those offered either directly by the applicant or
2042	through contractual arrangements with existing providers.
2043	Categories of services include:
2044	1.  Intake.
2045	2.  Equipment selection.
2046	3.  Delivery.
2047	4.  Setup and installation.
2048	5.  Patient training.
2049	6.  Ongoing service and maintenance.
2050	7.  Retrieval.
2051	(c)  A listing of those with whom the applicant contracts,
2052	both the providers the applicant uses to provide equipment or
2053	services to its consumers and the providers for whom the
2054	applicant provides services or equipment.
2055	(2)  As an alternative to submitting proof of financial
2056	ability to operate as required in s. 408.810(8), the applicant
2057	may submit a $50,000 surety bond to the agency.
2058	(2)(3)  As specified in part II of chapter 408, the home
2059	medical equipment provider must also obtain and maintain
2060	professional and commercial liability insurance. Proof of
2061	liability insurance, as defined in s. 624.605, must be submitted
2062	with the application. The agency shall set the required amounts
2063	of liability insurance by rule, but the required amount must not
2064	be less than $250,000 per claim. In the case of contracted
2065	services, it is required that the contractor have liability
2066	insurance not less than $250,000 per claim.
2067	(3)(4)  When a change of the general manager of a home
2068	medical equipment provider occurs, the licensee must notify the
2069	agency of the change within 45 days.
2070	(4)(5)  In accordance with s. 408.805, an applicant or a
2071	licensee shall pay a fee for each license application submitted
2072	under this part, part II of chapter 408, and applicable rules.
2073	The amount of the fee shall be established by rule and may not
2074	exceed $300 per biennium. The agency shall set the fees in an
2075	amount that is sufficient to cover its costs in carrying out its
2076	responsibilities under this part. However, state, county, or
2077	municipal governments applying for licenses under this part are
2078	exempt from the payment of license fees.
2079	(5)(6)  An applicant for initial licensure, renewal, or
2080	change of ownership shall also pay an inspection fee not to
2081	exceed $400, which shall be paid by all applicants except those
2082	not subject to licensure inspection by the agency as described
2083	in s. 400.933.
2084	Section 44.  Subsection (2) of section 400.932, Florida
2085	Statutes, is amended to read:
2086	400.932  Administrative penalties.-
2087	(2)  A violation of this part, part II of chapter 408, or
2088	applicable rules Any of the following actions by an employee of
2089	a home medical equipment provider are grounds for administrative
2090	action or penalties by the agency.:
2091	(a)  Violation of this part, part II of chapter 408, or
2092	applicable rules.
2093	(b)  An intentional, reckless, or negligent act that
2094	materially affects the health or safety of a patient.
2095	Section 45.  Subsection (2) of section 400.933, Florida
2096	Statutes, is amended to read:
2097	400.933  Licensure inspections and investigations.-
2098	(2)  The agency shall accept, in lieu of its own periodic
2099	inspections for licensure, submission of the following:
2100	(a)  The survey or inspection of an accrediting
2101	organization, provided the accreditation of the licensed home
2102	medical equipment provider is not conditional or provisional and
2103	provided the licensed home medical equipment provider authorizes
2104	release of, and the agency receives the report of, the
2105	accrediting organization; or
2106	(b)  A copy of a valid medical oxygen retail establishment
2107	permit issued by the Department of Health, pursuant to chapter
2108	499.
2109	Section 46.  Subsection (2) of section 400.953, Florida
2110	Statutes, is amended to read:
2111	400.953  Background screening of home medical equipment
2112	provider personnel.-The agency shall require employment
2113	screening as provided in chapter 435, using the level 1
2114	standards for screening set forth in that chapter, for home
2115	medical equipment provider personnel.
2116	(2)  The general manager of each home medical equipment
2117	provider must sign an affidavit annually, under penalty of
2118	perjury, stating that all home medical equipment provider
2119	personnel hired on or after July 1, 1999, who enter the home of
2120	a patient in the capacity of their employment have been screened
2121	and that its remaining personnel have worked for the home
2122	medical equipment provider continuously since before July 1,
2123	1999. This attestation must be submitted in accordance with s.
2124	408.809(6).
2125	Section 47.  Section 400.967, Florida Statutes, is amended
2126	to read:
2127	400.967  Rules and classification of violations
2128	deficiencies.-
2129	(1)  It is the intent of the Legislature that rules adopted
2130	and enforced under this part and part II of chapter 408 include
2131	criteria by which a reasonable and consistent quality of
2132	resident care may be ensured, the results of such resident care
2133	can be demonstrated, and safe and sanitary facilities can be
2134	provided.
2135	(2)  Pursuant to the intention of the Legislature, the
2136	agency, in consultation with the Agency for Persons with
2137	Disabilities and the Department of Elderly Affairs, shall adopt
2138	and enforce rules to administer this part and part II of chapter
2139	408, which shall include reasonable and fair criteria governing:
2140	(a)  The location and construction of the facility;
2141	including fire and life safety, plumbing, heating, cooling,
2142	lighting, ventilation, and other housing conditions that will
2143	ensure the health, safety, and comfort of residents. The agency
2144	shall establish standards for facilities and equipment to
2145	increase the extent to which new facilities and a new wing or
2146	floor added to an existing facility after July 1, 2000, are
2147	structurally capable of serving as shelters only for residents,
2148	staff, and families of residents and staff, and equipped to be
2149	self-supporting during and immediately following disasters. The
2150	Agency for Health Care Administration shall work with facilities
2151	licensed under this part and report to the Governor and the
2152	Legislature by April 1, 2000, its recommendations for cost-
2153	effective renovation standards to be applied to existing
2154	facilities. In making such rules, the agency shall be guided by
2155	criteria recommended by nationally recognized, reputable
2156	professional groups and associations having knowledge concerning
2157	such subject matters. The agency shall update or revise such
2158	criteria as the need arises. All facilities must comply with
2159	those lifesafety code requirements and building code standards
2160	applicable at the time of approval of their construction plans.
2161	The agency may require alterations to a building if it
2162	determines that an existing condition constitutes a distinct
2163	hazard to life, health, or safety. The agency shall adopt fair
2164	and reasonable rules setting forth conditions under which
2165	existing facilities undergoing additions, alterations,
2166	conversions, renovations, or repairs are required to comply with
2167	the most recent updated or revised standards.
2168	(b)  The number and qualifications of all personnel,
2169	including management, medical nursing, and other personnel,
2170	having responsibility for any part of the care given to
2171	residents.
2172	(c)  All sanitary conditions within the facility and its
2173	surroundings, including water supply, sewage disposal, food
2174	handling, and general hygiene, which will ensure the health and
2175	comfort of residents.
2176	(d)  The equipment essential to the health and welfare of
2177	the residents.
2178	(e)  A uniform accounting system.
2179	(f)  The care, treatment, and maintenance of residents and
2180	measurement of the quality and adequacy thereof.
2181	(g)  The preparation and annual update of a comprehensive
2182	emergency management plan. The agency shall adopt rules
2183	establishing minimum criteria for the plan after consultation
2184	with the Department of Community Affairs. At a minimum, the
2185	rules must provide for plan components that address emergency
2186	evacuation transportation; adequate sheltering arrangements;
2187	postdisaster activities, including emergency power, food, and
2188	water; postdisaster transportation; supplies; staffing;
2189	emergency equipment; individual identification of residents and
2190	transfer of records; and responding to family inquiries. The
2191	comprehensive emergency management plan is subject to review and
2192	approval by the local emergency management agency. During its
2193	review, the local emergency management agency shall ensure that
2194	the following agencies, at a minimum, are given the opportunity
2195	to review the plan: the Department of Elderly Affairs, the
2196	Agency for Persons with Disabilities, the Agency for Health Care
2197	Administration, and the Department of Community Affairs. Also,
2198	appropriate volunteer organizations must be given the
2199	opportunity to review the plan. The local emergency management
2200	agency shall complete its review within 60 days and either
2201	approve the plan or advise the facility of necessary revisions.
2202	(h)  The use of restraint and seclusion. Such rules must be
2203	consistent with recognized best practices; prohibit inherently
2204	dangerous restraint or seclusion procedures; establish
2205	limitations on the use and duration of restraint and seclusion;
2206	establish measures to ensure the safety of clients and staff
2207	during an incident of restraint or seclusion; establish
2208	procedures for staff to follow before, during, and after
2209	incidents of restraint or seclusion, including individualized
2210	plans for the use of restraints or seclusion in emergency
2211	situations; establish professional qualifications of and
2212	training for staff who may order or be engaged in the use of
2213	restraint or seclusion; establish requirements for facility data
2214	collection and reporting relating to the use of restraint and
2215	seclusion; and establish procedures relating to the
2216	documentation of the use of restraint or seclusion in the
2217	client's facility or program record.
2218	(3)  The agency shall adopt rules to provide that, when the
2219	criteria established under this part and part II of chapter 408
2220	are not met, such violations deficiencies shall be classified
2221	according to the nature of the violation deficiency. The agency
2222	shall indicate the classification on the face of the notice of
2223	violations deficiencies as follows:
2224	(a)  Class I violations deficiencies are defined in s.
2225	408.813. those which the agency determines present an imminent
2226	danger to the residents or guests of the facility or a
2227	substantial probability that death or serious physical harm
2228	would result therefrom. The condition or practice constituting a
2229	class I violation must be abated or eliminated immediately,
2230	unless a fixed period of time, as determined by the agency, is
2231	required for correction. A class I violation deficiency is
2232	subject to a civil penalty in an amount not less than $5,000 and
2233	not exceeding $10,000 for each violation deficiency. A fine may
2234	be levied notwithstanding the correction of the violation
2235	deficiency.
2236	(b)  Class II violations deficiencies are defined in s.
2237	408.813. those which the agency determines have a direct or
2238	immediate relationship to the health, safety, or security of the
2239	facility residents, other than class I deficiencies. A class II
2240	violation deficiency is subject to a civil penalty in an amount
2241	not less than $1,000 and not exceeding $5,000 for each
2242	deficiency. A citation for a class II violation deficiency shall
2243	specify the time within which the violation deficiency must be
2244	corrected. If a class II violation deficiency is corrected
2245	within the time specified, no civil penalty shall be imposed,
2246	unless it is a repeated offense.
2247	(c)  Class III violations deficiencies are defined in s.
2248	408.813. those which the agency determines to have an indirect
2249	or potential relationship to the health, safety, or security of
2250	the facility residents, other than class I or class II
2251	deficiencies. A class III violation deficiency is subject to a
2252	civil penalty of not less than $500 and not exceeding $1,000 for
2253	each violation deficiency. A citation for a class III violation
2254	deficiency shall specify the time within which the violation
2255	deficiency must be corrected. If a class III violation
2256	deficiency is corrected within the time specified, no civil
2257	penalty shall be imposed, unless it is a repeated offense.
2258	(d)  Class IV violations are defined in s. 408.813.
2259	(4)  The agency shall approve or disapprove the plans and
2260	specifications within 60 days after receipt of the final plans
2261	and specifications. The agency may be granted one 15-day
2262	extension for the review period, if the secretary of the agency
2263	so approves. If the agency fails to act within the specified
2264	time, it is deemed to have approved the plans and
2265	specifications. When the agency disapproves plans and
2266	specifications, it must set forth in writing the reasons for
2267	disapproval. Conferences and consultations may be provided as
2268	necessary.
2269	(5)  The agency may charge an initial fee of $2,000 for
2270	review of plans and construction on all projects, no part of
2271	which is refundable. The agency may also collect a fee, not to
2272	exceed 1 percent of the estimated construction cost or the
2273	actual cost of review, whichever is less, for the portion of the
2274	review which encompasses initial review through the initial
2275	revised construction document review. The agency may collect its
2276	actual costs on all subsequent portions of the review and
2277	construction inspections. Initial fee payment must accompany the
2278	initial submission of plans and specifications. Any subsequent
2279	payment that is due is payable upon receipt of the invoice from
2280	the agency. Notwithstanding any other provision of law, all
2281	money received by the agency under this section shall be deemed
2282	to be trust funds, to be held and applied solely for the
2283	operations required under this section.
2284	Section 48.  Subsection (1) of section 400.969, Florida
2285	Statutes, is amended to read:
2286	400.969  Violation of part; penalties.-
2287	(1)  In addition to the requirements of part II of chapter
2288	408, and except as provided in s. 400.967(3), a violation of any
2289	provision of federal certification required pursuant to
2290	400.960(8), this part, part II of chapter 408, or applicable
2291	rules is punishable by payment of an administrative or civil
2292	penalty not to exceed $5,000.
2293	Section 49.  Subsection (7) of section 400.9905, Florida
2294	Statutes, is amended to read:
2295	400.9905  Definitions.-
2296	(7)  "Portable service or equipment provider" means an
2297	entity that contracts with or employs persons to provide
2298	portable service or equipment to multiple locations which
2299	performing treatment or diagnostic testing of individuals, that
2300	bills third-party payors for those services, and that otherwise
2301	meets the definition of a clinic in subsection (4).
2302	Section 50.  Subsections (1) and (4) of section 400.991,
2303	Florida Statutes, are amended to read:
2304	400.991  License requirements; background screenings;
2305	prohibitions.-
2306	(1)(a)  The requirements of part II of chapter 408 apply to
2307	the provision of services that require licensure pursuant to
2308	this part and part II of chapter 408 and to entities licensed by
2309	or applying for such licensure from the agency pursuant to this
2310	part. A license issued by the agency is required in order to
2311	operate a clinic in this state. Each clinic location shall be
2312	licensed separately regardless of whether the clinic is operated
2313	under the same business name or management as another clinic.
2314	(b)  Each mobile clinic must obtain a separate health care
2315	clinic license and must provide to the agency, at least
2316	quarterly, its projected street location to enable the agency to
2317	locate and inspect such clinic. A portable equipment and health
2318	services provider must obtain a health care clinic license for a
2319	single administrative office and is not required to submit
2320	quarterly projected street locations.
2321	(4)  In addition to the requirements of part II of chapter
2322	408, the applicant must file with the application satisfactory
2323	proof that the clinic is in compliance with this part and
2324	applicable rules, including:
2325	(a)  A listing of services to be provided either directly
2326	by the applicant or through contractual arrangements with
2327	existing providers;
2328	(b)  The number and discipline of each professional staff
2329	member to be employed; and
2330	(c)  Proof of financial ability to operate as required
2331	under ss. 408.810(8) and 408.8065 s. 408.810(8). As an
2332	alternative to submitting proof of financial ability to operate
2333	as required under s. 408.810(8), the applicant may file a surety
2334	bond of at least $500,000 which guarantees that the clinic will
2335	act in full conformity with all legal requirements for operating
2336	a clinic, payable to the agency. The agency may adopt rules to
2337	specify related requirements for such surety bond.
2338	Section 51.  Paragraph (g) of subsection (1) and paragraph
2339	(a) of subsection (7) of section 400.9935, Florida Statutes, are
2340	amended to read:
2341	400.9935  Clinic responsibilities.-
2342	(1)  Each clinic shall appoint a medical director or clinic
2343	director who shall agree in writing to accept legal
2344	responsibility for the following activities on behalf of the
2345	clinic. The medical director or the clinic director shall:
2346	(g)  Conduct systematic reviews of clinic billings to
2347	ensure that the billings are not fraudulent or unlawful. Upon
2348	discovery of an unlawful charge, the medical director or clinic
2349	director shall take immediate corrective action. If the clinic
2350	performs only the technical component of magnetic resonance
2351	imaging, static radiographs, computed tomography, or positron
2352	emission tomography, and provides the professional
2353	interpretation of such services, in a fixed facility that is
2354	accredited by the Joint Commission on Accreditation of
2355	Healthcare Organizations or the Accreditation Association for
2356	Ambulatory Health Care, and the American College of Radiology;
2357	and if, in the preceding quarter, the percentage of scans
2358	performed by that clinic which was billed to all personal injury
2359	protection insurance carriers was less than 15 percent, the
2360	chief financial officer of the clinic may, in a written
2361	acknowledgment provided to the agency, assume the responsibility
2362	for the conduct of the systematic reviews of clinic billings to
2363	ensure that the billings are not fraudulent or unlawful.
2364	(7)(a)  Each clinic engaged in magnetic resonance imaging
2365	services must be accredited by the Joint Commission on
2366	Accreditation of Healthcare Organizations, the American College
2367	of Radiology, or the Accreditation Association for Ambulatory
2368	Health Care, within 1 year after licensure. A clinic that is
2369	accredited by the American College of Radiology or is within the
2370	original 1-year period after licensure and replaces its core
2371	magnetic resonance imaging equipment shall be given 1 year after
2372	the date on which the equipment is replaced to attain
2373	accreditation. However, a clinic may request a single, 6-month
2374	extension if it provides evidence to the agency establishing
2375	that, for good cause shown, such clinic cannot be accredited
2376	within 1 year after licensure, and that such accreditation will
2377	be completed within the 6-month extension. After obtaining
2378	accreditation as required by this subsection, each such clinic
2379	must maintain accreditation as a condition of renewal of its
2380	license. A clinic that files a change of ownership application
2381	must comply with the original accreditation timeframe
2382	requirements of the transferor. The agency shall deny a change
2383	of ownership application if the clinic is not in compliance with
2384	the accreditation requirements. When a clinic adds, replaces, or
2385	modifies magnetic resonance imaging equipment and the
2386	accreditation agency requires new accreditation, the clinic must
2387	be accredited within 1 year after the date of the addition,
2388	replacement, or modification but may request a single, 6-month
2389	extension if the clinic provides evidence of good cause to the
2390	agency.
2391	Section 52.  Subsection (2) of section 408.034, Florida
2392	Statutes, is amended to read:
2393	408.034  Duties and responsibilities of agency; rules.-
2394	(2)  In the exercise of its authority to issue licenses to
2395	health care facilities and health service providers, as provided
2396	under chapters 393 and 395 and parts II, and IV, and VIII of
2397	chapter 400, the agency may not issue a license to any health
2398	care facility or health service provider that fails to receive a
2399	certificate of need or an exemption for the licensed facility or
2400	service.
2401	Section 53.  Paragraph (d) of subsection (1) of section
2402	408.036, Florida Statutes, is amended to read:
2403	408.036  Projects subject to review; exemptions.-
2404	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
2405	health-care-related projects, as described in paragraphs (a)-
2406	(g), are subject to review and must file an application for a
2407	certificate of need with the agency. The agency is exclusively
2408	responsible for determining whether a health-care-related
2409	project is subject to review under ss. 408.031-408.045.
2410	(d)  The establishment of a hospice or hospice inpatient
2411	facility, except as provided in s. 408.043.
2412	Section 54.  Subsection (2) of section 408.043, Florida
2413	Statutes, is amended to read:
2414	408.043  Special provisions.-
2415	(2)  HOSPICES.-When an application is made for a
2416	certificate of need to establish or to expand a hospice, the
2417	need for such hospice shall be determined on the basis of the
2418	need for and availability of hospice services in the community.
2419	The formula on which the certificate of need is based shall
2420	discourage regional monopolies and promote competition. The
2421	inpatient hospice care component of a hospice which is a
2422	freestanding facility, or a part of a facility, which is
2423	primarily engaged in providing inpatient care and related
2424	services and is not licensed as a health care facility shall
2425	also be required to obtain a certificate of need. Provision of
2426	hospice care by any current provider of health care is a
2427	significant change in service and therefore requires a
2428	certificate of need for such services.
2429	Section 55.  Paragraph (k) of subsection (3) of section
2430	408.05, Florida Statutes, is amended to read:
2431	408.05  Florida Center for Health Information and Policy
2432	Analysis.-
2433	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
2434	produce comparable and uniform health information and statistics
2435	for the development of policy recommendations, the agency shall
2436	perform the following functions:
2437	(k)  Develop, in conjunction with the State Consumer Health
2438	Information and Policy Advisory Council, and implement a long-
2439	range plan for making available health care quality measures and
2440	financial data that will allow consumers to compare health care
2441	services. The health care quality measures and financial data
2442	the agency must make available shall include, but is not limited
2443	to, pharmaceuticals, physicians, health care facilities, and
2444	health plans and managed care entities. The agency shall submit
2445	the initial plan to the Governor, the President of the Senate,
2446	and the Speaker of the House of Representatives by January 1,
2447	2006, and shall update the plan and report on the status of its
2448	implementation annually thereafter. The agency shall also make
2449	the plan and status report available to the public on its
2450	Internet website. As part of the plan, the agency shall identify
2451	the process and timeframes for implementation, any barriers to
2452	implementation, and recommendations of changes in the law that
2453	may be enacted by the Legislature to eliminate the barriers. As
2454	preliminary elements of the plan, the agency shall:
2455	1.  Make available patient-safety indicators, inpatient
2456	quality indicators, and performance outcome and patient charge
2457	data collected from health care facilities pursuant to s.
2458	408.061(1)(a) and (2). The terms "patient-safety indicators" and
2459	"inpatient quality indicators" shall be as defined by the
2460	Centers for Medicare and Medicaid Services, the National Quality
2461	Forum, the Joint Commission on Accreditation of Healthcare
2462	Organizations, the Agency for Healthcare Research and Quality,
2463	the Centers for Disease Control and Prevention, or a similar
2464	national entity that establishes standards to measure the
2465	performance of health care providers, or by other states. The
2466	agency shall determine which conditions, procedures, health care
2467	quality measures, and patient charge data to disclose based upon
2468	input from the council. When determining which conditions and
2469	procedures are to be disclosed, the council and the agency shall
2470	consider variation in costs, variation in outcomes, and
2471	magnitude of variations and other relevant information. When
2472	determining which health care quality measures to disclose, the
2473	agency:
2474	a.  Shall consider such factors as volume of cases; average
2475	patient charges; average length of stay; complication rates;
2476	mortality rates; and infection rates, among others, which shall
2477	be adjusted for case mix and severity, if applicable.
2478	b.  May consider such additional measures that are adopted
2479	by the Centers for Medicare and Medicaid Studies, National
2480	Quality Forum, the Joint Commission on Accreditation of
2481	Healthcare Organizations, the Agency for Healthcare Research and
2482	Quality, Centers for Disease Control and Prevention, or a
2483	similar national entity that establishes standards to measure
2484	the performance of health care providers, or by other states.
2485
2486	When determining which patient charge data to disclose, the
2487	agency shall include such measures as the average of
2488	undiscounted charges on frequently performed procedures and
2489	preventive diagnostic procedures, the range of procedure charges
2490	from highest to lowest, average net revenue per adjusted patient
2491	day, average cost per adjusted patient day, and average cost per
2492	admission, among others.
2493	2.  Make available performance measures, benefit design,
2494	and premium cost data from health plans licensed pursuant to
2495	chapter 627 or chapter 641. The agency shall determine which
2496	health care quality measures and member and subscriber cost data
2497	to disclose, based upon input from the council. When determining
2498	which data to disclose, the agency shall consider information
2499	that may be required by either individual or group purchasers to
2500	assess the value of the product, which may include membership
2501	satisfaction, quality of care, current enrollment or membership,
2502	coverage areas, accreditation status, premium costs, plan costs,
2503	premium increases, range of benefits, copayments and
2504	deductibles, accuracy and speed of claims payment, credentials
2505	of physicians, number of providers, names of network providers,
2506	and hospitals in the network. Health plans shall make available
2507	to the agency any such data or information that is not currently
2508	reported to the agency or the office.
2509	3.  Determine the method and format for public disclosure
2510	of data reported pursuant to this paragraph. The agency shall
2511	make its determination based upon input from the State Consumer
2512	Health Information and Policy Advisory Council. At a minimum,
2513	the data shall be made available on the agency's Internet
2514	website in a manner that allows consumers to conduct an
2515	interactive search that allows them to view and compare the
2516	information for specific providers. The website must include
2517	such additional information as is determined necessary to ensure
2518	that the website enhances informed decisionmaking among
2519	consumers and health care purchasers, which shall include, at a
2520	minimum, appropriate guidance on how to use the data and an
2521	explanation of why the data may vary from provider to provider.
2522	The data specified in subparagraph 1. shall be released no later
2523	than January 1, 2006, for the reporting of infection rates, and
2524	no later than October 1, 2005, for mortality rates and
2525	complication rates. The data specified in subparagraph 2. shall
2526	be released no later than October 1, 2006.
2527	4.  Publish on its website undiscounted charges for no
2528	fewer than 150 of the most commonly performed adult and
2529	pediatric procedures, including outpatient, inpatient,
2530	diagnostic, and preventative procedures.
2531	Section 56.  Paragraph (a) of subsection (1) of section
2532	408.061, Florida Statutes, is amended to read:
2533	408.061  Data collection; uniform systems of financial
2534	reporting; information relating to physician charges;
2535	confidential information; immunity.-
2536	(1)  The agency shall require the submission by health care
2537	facilities, health care providers, and health insurers of data
2538	necessary to carry out the agency's duties. Specifications for
2539	data to be collected under this section shall be developed by
2540	the agency with the assistance of technical advisory panels
2541	including representatives of affected entities, consumers,
2542	purchasers, and such other interested parties as may be
2543	determined by the agency.
2544	(a)  Data submitted by health care facilities, including
2545	the facilities as defined in chapter 395, shall include, but are
2546	not limited to: case-mix data, patient admission and discharge
2547	data, hospital emergency department data which shall include the
2548	number of patients treated in the emergency department of a
2549	licensed hospital reported by patient acuity level, data on
2550	hospital-acquired infections as specified by rule, data on
2551	complications as specified by rule, data on readmissions as
2552	specified by rule, with patient and provider-specific
2553	identifiers included, actual charge data by diagnostic groups,
2554	financial data, accounting data, operating expenses, expenses
2555	incurred for rendering services to patients who cannot or do not
2556	pay, interest charges, depreciation expenses based on the
2557	expected useful life of the property and equipment involved, and
2558	demographic data. The agency shall adopt nationally recognized
2559	risk adjustment methodologies or software consistent with the
2560	standards of the Agency for Healthcare Research and Quality and
2561	as selected by the agency for all data submitted as required by
2562	this section. Data may be obtained from documents such as, but
2563	not limited to: leases, contracts, debt instruments, itemized
2564	patient bills, medical record abstracts, and related diagnostic
2565	information. Reported data elements shall be reported
2566	electronically and in accordance with rule 59E-7.012, Florida
2567	Administrative Code. Data submitted shall be certified by the
2568	chief executive officer or an appropriate and duly authorized
2569	representative or employee of the licensed facility that the
2570	information submitted is true and accurate.
2571	Section 57.  Subsection (1) of section 408.10, Florida
2572	Statutes, is amended to read:
2573	408.10  Consumer complaints.-The agency shall:
2574	(1)  Publish and make available to the public a toll-free
2575	telephone number for the purpose of handling consumer complaints
2576	and shall serve as a liaison between consumer entities and other
2577	private entities and governmental entities for the disposition
2578	of problems identified by consumers of health care. The agency
2579	may provide staffing for this toll-free number through agency
2580	staff or other arrangements.
2581	Section 58.  Subsection (11) of section 408.802, Florida
2582	Statutes, is repealed.
2583	Section 59.  Effective October 1, 2010, subsection (3) is
2584	added to section 408.804, Florida Statutes, to read:
2585	408.804  License required; display.-
2586	(3)  Any person who knowingly alters, defaces, or falsifies
2587	any license certificate issued by the agency, or causes or
2588	procures any person to commit such an offense, commits a
2589	misdemeanor of the second degree, punishable as provided in s.
2590	775.082 or s. 775.083. Any licensee or provider who displays an
2591	altered, defaced, or falsified license certificate is subject to
2592	the penalties set forth in s. 408.815 and an administrative fine
2593	of $1,000 for each day of illegal display.
2594	Section 60.  Paragraph (d) of subsection (2) of section
2595	408.806, Florida Statutes, is amended to read:
2596	408.806  License application process.-
2597	(2)(d)  The agency shall notify the licensee by mail or
2598	electronically at least 90 days before the expiration of a
2599	license that a renewal license is necessary to continue
2600	operation. The licensee's failure to timely file submit a
2601	renewal application and license application fee with the agency
2602	shall result in a $50 per day late fee charged to the licensee
2603	by the agency; however, the aggregate amount of the late fee may
2604	not exceed 50 percent of the licensure fee or $500, whichever is
2605	less. The agency shall provide a courtesy notice to the licensee
2606	by United States mail, electronically, or by any other manner at
2607	its address of record at least 90 days before the expiration of
2608	a license informing the licensee of the expiration of the
2609	license. Any failure of the agency to provide the courtesy
2610	notice or any failure of the licensee to receive the courtesy
2611	notice does not excuse the licensee from the legal obligation to
2612	timely file the renewal application and license application fee
2613	with the agency and does not mitigate the late fee. Payment of
2614	the late fee is required in order for any late application to be
2615	complete, and failure to pay the late fee is an omission from
2616	the application. If an application is received after the
2617	required filing date and exhibits a hand-canceled postmark
2618	obtained from a United States post office dated on or before the
2619	required filing date, no fine will be levied.
2620	Section 61.  Subsections (6) and (9) of section 408.810,
2621	Florida Statutes, are amended to read:
2622	408.810  Minimum licensure requirements.-In addition to the
2623	licensure requirements specified in this part, authorizing
2624	statutes, and applicable rules, each applicant and licensee must
2625	comply with the requirements of this section in order to obtain
2626	and maintain a license.
2627	(6)(a)  An applicant must provide the agency with proof of
2628	the applicant's legal right to occupy the property before a
2629	license may be issued. Proof may include, but need not be
2630	limited to, copies of warranty deeds, lease or rental
2631	agreements, contracts for deeds, quitclaim deeds, or other such
2632	documentation.
2633	(b)  If the property is encumbered by a mortgage or is
2634	leased, an applicant must provide the agency with proof that the
2635	mortgagor or landlord has received written notice of the
2636	applicant's intent as mortgagee or tenant to provide services
2637	that require licensure and instructions that the agency be
2638	served by certified mail with copies of any actions initiated by
2639	the mortgagor or landlord against applicant.
2640	(9)  A controlling interest may not withhold from the
2641	agency any evidence of financial instability, including, but not
2642	limited to, checks returned due to insufficient funds,
2643	delinquent accounts, nonpayment of withholding taxes, unpaid
2644	utility expenses, nonpayment for essential services, or adverse
2645	court action concerning the financial viability of the provider
2646	or any other provider licensed under this part that is under the
2647	control of the controlling interest. A controlling interest
2648	shall notify the agency within 10 days after a court action,
2649	including, but not limited to, the initiation of bankruptcy
2650	proceedings, foreclosure, or eviction proceedings, in which the
2651	controlling interest is a petitioner or defendant. Any person
2652	who violates this subsection commits a misdemeanor of the second
2653	degree, punishable as provided in s. 775.082 or s. 775.083. Each
2654	day of continuing violation is a separate offense.
2655	Section 62.  Paragraph (a) of subsection (6) of section
2656	408.811, Florida Statutes, is amended to read:
2657	408.811  Right of inspection; copies; inspection reports;
2658	plan for correction of deficiencies.-
2659	(6)(a)  Each licensee shall maintain as public information,
2660	available upon request, records of all inspection reports
2661	pertaining to that provider that have been filed by the agency
2662	unless those reports are exempt from or contain information that
2663	is exempt from s. 119.07(1) and s. 24(a), Art. I of the State
2664	Constitution or is otherwise made confidential by law. Effective
2665	October 1, 2006, copies of such reports shall be retained in the
2666	records of the provider for at least 3 years following the date
2667	the reports are filed and issued, regardless of a change of
2668	ownership. The inspection report is not subject to challenge
2669	under s. 120.569 or s. 120.57.
2670	Section 63.  Subsection (2) of section 408.813, Florida
2671	Statutes, is amended to read:
2672	408.813  Administrative fines; violations.-As a penalty for
2673	any violation of this part, authorizing statutes, or applicable
2674	rules, the agency may impose an administrative fine.
2675	(2)(a)  Violations of this part, authorizing statutes, or
2676	applicable rules shall be classified according to the nature of
2677	the violation and the gravity of its probable effect on clients.
2678	The scope of a violation may be cited as an isolated, patterned,
2679	or widespread deficiency. An isolated deficiency is a deficiency
2680	affecting one or a very limited number of clients, or involving
2681	one or a very limited number of staff, or a situation that
2682	occurred only occasionally or in a very limited number of
2683	locations. A patterned deficiency is a deficiency in which more
2684	than a very limited number of clients are affected, or more than
2685	a very limited number of staff are involved, or the situation
2686	has occurred in several locations, or the same client or clients
2687	have been affected by repeated occurrences of the same deficient
2688	practice but the effect of the deficient practice is not found
2689	to be pervasive throughout the provider. A widespread deficiency
2690	is a deficiency in which the problems causing the deficiency are
2691	pervasive in the provider or represent systemic failure that has
2692	affected or has the potential to affect a large portion of the
2693	provider's clients. This subsection does not affect the
2694	legislative determination of the amount of a fine imposed under
2695	authorizing statutes. Violations shall be classified on the
2696	written notice as follows:
2697	1.(a)  Class "I" violations are those conditions or
2698	occurrences related to the operation and maintenance of a
2699	provider or to the care of clients which the agency determines
2700	present an imminent danger to the clients of the provider or a
2701	substantial probability that death or serious physical or
2702	emotional harm would result therefrom. The condition or practice
2703	constituting a class I violation shall be abated or eliminated
2704	within 24 hours, unless a fixed period, as determined by the
2705	agency, is required for correction. The agency shall impose an
2706	administrative fine as provided by law for a cited class I
2707	violation. A fine shall be levied notwithstanding the correction
2708	of the violation.
2709	2.(b)  Class "II" violations are those conditions or
2710	occurrences related to the operation and maintenance of a
2711	provider or to the care of clients which the agency determines
2712	directly threaten the physical or emotional health, safety, or
2713	security of the clients, other than class I violations. The
2714	agency shall impose an administrative fine as provided by law
2715	for a cited class II violation. A fine shall be levied
2716	notwithstanding the correction of the violation.
2717	3.(c)  Class "III" violations are those conditions or
2718	occurrences related to the operation and maintenance of a
2719	provider or to the care of clients which the agency determines
2720	indirectly or potentially threaten the physical or emotional
2721	health, safety, or security of clients, other than class I or
2722	class II violations. The agency shall impose an administrative
2723	fine as provided in this section for a cited class III
2724	violation. A citation for a class III violation must specify the
2725	time within which the violation is required to be corrected. If
2726	a class III violation is corrected within the time specified, a
2727	fine may not be imposed.
2728	4.(d)  Class "IV" violations are those conditions or
2729	occurrences related to the operation and maintenance of a
2730	provider or to required reports, forms, or documents that do not
2731	have the potential of negatively affecting clients. These
2732	violations are of a type that the agency determines do not
2733	threaten the health, safety, or security of clients. The agency
2734	shall impose an administrative fine as provided in this section
2735	for a cited class IV violation. A citation for a class IV
2736	violation must specify the time within which the violation is
2737	required to be corrected. If a class IV violation is corrected
2738	within the time specified, a fine may not be imposed.
2739	(b)  The agency may impose an administrative fine for
2740	violations that do not qualify as class I, class II, class III,
2741	or class IV violations. The amount of the fine may not exceed
2742	$500 for each violation. Unclassified violations may include:
2743	1.  Violating any term or condition of a license.
2744	2.  Violating any provision of this part, authorizing
2745	statutes, or applicable rules.
2746	3.  Exceeding licensed capacity without authorization.
2747	4.  Providing services beyond the scope of the license.
2748	5.  Violating a moratorium.
2749	Section 64.  Subsection (5) is added to section 408.815,
2750	Florida Statutes, to read:
2751	408.815  License or application denial; revocation.-
2752	(5)  In order to ensure the health, safety, and welfare of
2753	clients where a license has been denied, revoked, or is set to
2754	terminate, the agency may extend the license expiration date for
2755	up to 60 days after denial, revocation, or termination the sole
2756	purpose of allowing the safe and orderly discharge of clients.
2757	The agency may impose conditions on the extension, including,
2758	but not limited to, prohibiting or limiting admissions,
2759	expediting discharge planning, submitting required status
2760	reports, and mandatory monitoring by the agency or third
2761	parties. The agency may terminate the extension or modify the
2762	conditions at any time at its discretion. Upon the discharge of
2763	the final client, the extension shall immediately terminate and
2764	the provider shall cease operation and promptly surrender its
2765	license certificate to the agency. During the extension, the
2766	provider must continue to meet all other requirements of this
2767	part, authorizing statutes, and applicable rules. This authority
2768	is in addition to any other authority granted to the agency
2769	under chapter 120, this part, and the authorizing statutes, but
2770	does not create any right or entitlement to an extension of a
2771	license expiration date.
2772	Section 65.  Paragraph (d) is added to subsection (13) of
2773	section 409.906, Florida Statutes, to read:
2774	409.906  Optional Medicaid services.-Subject to specific
2775	appropriations, the agency may make payments for services which
2776	are optional to the state under Title XIX of the Social Security
2777	Act and are furnished by Medicaid providers to recipients who
2778	are determined to be eligible on the dates on which the services
2779	were provided. Any optional service that is provided shall be
2780	provided only when medically necessary and in accordance with
2781	state and federal law. Optional services rendered by providers
2782	in mobile units to Medicaid recipients may be restricted or
2783	prohibited by the agency. Nothing in this section shall be
2784	construed to prevent or limit the agency from adjusting fees,
2785	reimbursement rates, lengths of stay, number of visits, or
2786	number of services, or making any other adjustments necessary to
2787	comply with the availability of moneys and any limitations or
2788	directions provided for in the General Appropriations Act or
2789	chapter 216. If necessary to safeguard the state's systems of
2790	providing services to elderly and disabled persons and subject
2791	to the notice and review provisions of s. 216.177, the Governor
2792	may direct the Agency for Health Care Administration to amend
2793	the Medicaid state plan to delete the optional Medicaid service
2794	known as "Intermediate Care Facilities for the Developmentally
2795	Disabled." Optional services may include:
2796	(13)  HOME AND COMMUNITY-BASED SERVICES.-
2797	(d)  The agency, in consultation with the Department of
2798	Elderly Affairs, shall phase out the adult day health care
2799	waiver program and transfer existing waiver enrollees to other
2800	appropriate home and community-based service programs. Effective
2801	July 1, 2010, the adult day health care waiver program shall
2802	cease to enroll new members. Existing enrollees in the adult day
2803	health care program shall receive counseling regarding available
2804	options and shall be offered an alternative home and community-
2805	based services program based on eligibility and personal choice.
2806	Each enrollee in the waiver program shall continue to receive
2807	home and community-based services without interruption in the
2808	enrollee's program of choice. The providers of the adult day
2809	health care waiver program, in consultation with the resource
2810	centers for the aged, shall assist in the transition of
2811	enrollees and cease provision of adult day health care waiver
2812	services by December 31, 2010. The agency may seek federal
2813	waiver approval to administer this change.
2814	Section 66.  Paragraph (k) of subsection (4) of section
2815	409.221, Florida Statutes, is repealed.
2816	Section 67.  Paragraphs (e), (f), and (g) of subsection
2817	(15) of section 409.912, Florida Statutes, are repealed.
2818	Section 68.  Section 429.11, Florida Statutes, is amended
2819	to read:
2820	429.11  Initial application for license; provisional
2821	license.-
2822	(1)  Each applicant for licensure must comply with all
2823	provisions of part II of chapter 408 and must:
2824	(a)  Identify all other homes or facilities, including the
2825	addresses and the license or licenses under which they operate,
2826	if applicable, which are currently operated by the applicant or
2827	administrator and which provide housing, meals, and personal
2828	services to residents.
2829	(b)  Provide the location of the facility for which a
2830	license is sought and documentation, signed by the appropriate
2831	local government official, which states that the applicant has
2832	met local zoning requirements.
2833	(c)  Provide the name, address, date of birth, social
2834	security number, education, and experience of the administrator,
2835	if different from the applicant.
2836	(2)  The applicant shall provide proof of liability
2837	insurance as defined in s. 624.605.
2838	(3)  If the applicant is a community residential home, the
2839	applicant must provide proof that it has met the requirements
2840	specified in chapter 419.
2841	(4)  The applicant must furnish proof that the facility has
2842	received a satisfactory firesafety inspection. The local
2843	authority having jurisdiction or the State Fire Marshal must
2844	conduct the inspection within 30 days after written request by
2845	the applicant.
2846	(5)  The applicant must furnish documentation of a
2847	satisfactory sanitation inspection of the facility by the county
2848	health department.
2849	(6)  In addition to the license categories available in s.
2850	408.808, a provisional license may be issued to an applicant
2851	making initial application for licensure or making application
2852	for a change of ownership. A provisional license shall be
2853	limited in duration to a specific period of time not to exceed 6
2854	months, as determined by the agency.
2855	(6)(7)  A county or municipality may not issue an
2856	occupational license that is being obtained for the purpose of
2857	operating a facility regulated under this part without first
2858	ascertaining that the applicant has been licensed to operate
2859	such facility at the specified location or locations by the
2860	agency. The agency shall furnish to local agencies responsible
2861	for issuing occupational licenses sufficient instruction for
2862	making such determinations.
2863	Section 69.  Subsection (2) of section 429.12, Florida
2864	Statutes, is repealed.
2865	Section 70.  Subsections (5) and (6) of section 429.14,
2866	Florida Statutes, are amended to read:
2867	429.14  Administrative penalties.-
2868	(5)  An action taken by the agency to suspend, deny, or
2869	revoke a facility's license under this part or part II of
2870	chapter 408, in which the agency claims that the facility owner
2871	or an employee of the facility has threatened the health,
2872	safety, or welfare of a resident of the facility shall be heard
2873	by the Division of Administrative Hearings of the Department of
2874	Management Services within 120 days after receipt of the
2875	facility's request for a hearing, unless that time limitation is
2876	waived by both parties. The administrative law judge must render
2877	a decision within 30 days after receipt of a proposed
2878	recommended order.
2879	(6)  The agency shall provide to the Division of Hotels and
2880	Restaurants of the Department of Business and Professional
2881	Regulation, on a monthly basis, a list of those assisted living
2882	facilities that have had their licenses denied, suspended, or
2883	revoked or that are involved in an appellate proceeding pursuant
2884	to s. 120.60 related to the denial, suspension, or revocation of
2885	a license. This information may be provided electronically or
2886	through the agency's Internet website.
2887	Section 71.  Subsection (4) of section 429.17, Florida
2888	Statutes, is amended to read:
2889	429.17  Expiration of license; renewal; conditional
2890	license.-
2891	(4)  In addition to the license categories available in s.
2892	408.808, a conditional license may be issued to an applicant for
2893	license renewal if the applicant fails to meet all standards and
2894	requirements for licensure. A conditional license issued under
2895	this subsection shall be limited in duration to a specific
2896	period of time not to exceed 6 months, as determined by the
2897	agency, and shall be accompanied by an agency-approved plan of
2898	correction.
2899	Section 72.  Subsection (5) of section 429.23, Florida
2900	Statutes, is repealed.
2901	Section 73.  Subsection (2) of section 429.35, Florida
2902	Statutes, is amended to read:
2903	429.35  Maintenance of records; reports.-
2904	(2)  Within 60 days after the date of the biennial
2905	inspection visit required under s. 408.811 or within 30 days
2906	after the date of any interim visit, the agency shall forward
2907	the results of the inspection to the local ombudsman council in
2908	whose planning and service area, as defined in part II of
2909	chapter 400, the facility is located; to at least one public
2910	library or, in the absence of a public library, the county seat
2911	in the county in which the inspected assisted living facility is
2912	located; and, when appropriate, to the district Adult Services
2913	and Mental Health Program Offices. This information may be
2914	provided electronically or through the agency's Internet site.
2915	Section 74.  Section 429.53, Florida Statutes, is amended
2916	to read:
2917	429.53  Consultation by the agency.-
2918	(1)  The area offices of licensure and certification of the
2919	agency shall provide consultation to the following upon request:
2920	(a)  A licensee of a facility.
2921	(b)  A person interested in obtaining a license to operate
2922	a facility under this part.
2923	(2)  As used in this section, "consultation" includes:
2924	(a)  An explanation of the requirements of this part and
2925	rules adopted pursuant thereto;
2926	(b)  An explanation of the license application and renewal
2927	procedures; and
2928	(c)  The provision of a checklist of general local and
2929	state approvals required prior to constructing or developing a
2930	facility and a listing of the types of agencies responsible for
2931	such approvals;
2932	(d)  An explanation of benefits and financial assistance
2933	available to a recipient of supplemental security income
2934	residing in a facility;
2935	(c)(e)  Any other information that which the agency deems
2936	necessary to promote compliance with the requirements of this
2937	part.; and
2938	(f)  A preconstruction review of a facility to ensure
2939	compliance with agency rules and this part.
2940	(3)  The agency may charge a fee commensurate with the cost
2941	of providing consultation under this section.
2942	Section 75.  Subsections (2) and (11) of section 429.65,
2943	Florida Statutes, are amended to read:
2944	429.65  Definitions.-As used in this part, the term:
2945	(2)  "Adult family-care home" means a full-time, family-
2946	type living arrangement, in a private home, under which up to
2947	two individuals a person who reside in the home and own or rent
2948	owns or rents the home provide provides room, board, and
2949	personal care, on a 24-hour basis, for no more than five
2950	disabled adults or frail elders who are not relatives. The
2951	following family-type living arrangements are not required to be
2952	licensed as an adult family-care home:
2953	(a)  An arrangement whereby the person who resides in the
2954	home and owns or rents the home provides room, board, and
2955	personal services for not more than two adults who do not
2956	receive optional state supplementation under s. 409.212. The
2957	person who provides the housing, meals, and personal care must
2958	own or rent the home and reside therein.
2959	(b)  An arrangement whereby the person who owns or rents
2960	the home provides room, board, and personal services only to his
2961	or her relatives.
2962	(c)  An establishment that is licensed as an assisted
2963	living facility under this chapter.
2964	(11)  "Provider" means one or two individuals a person who
2965	are is licensed to operate an adult family-care home.
2966	Section 76.  Section 429.71, Florida Statutes, is amended
2967	to read:
2968	429.71  Classification of violations deficiencies;
2969	administrative fines.-
2970	(1)  In addition to the requirements of part II of chapter
2971	408 and in addition to any other liability or penalty provided
2972	by law, the agency may impose an administrative fine on a
2973	provider according to the following classification:
2974	(a)  Class I violations are defined in s. 408.813. those
2975	conditions or practices related to the operation and maintenance
2976	of an adult family-care home or to the care of residents which
2977	the agency determines present an imminent danger to the
2978	residents or guests of the facility or a substantial probability
2979	that death or serious physical or emotional harm would result
2980	therefrom. The condition or practice that constitutes a class I
2981	violation must be abated or eliminated within 24 hours, unless a
2982	fixed period, as determined by the agency, is required for
2983	correction. A class I violation deficiency is subject to an
2984	administrative fine in an amount not less than $500 and not
2985	exceeding $1,000 for each violation. A fine may be levied
2986	notwithstanding the correction of the violation deficiency.
2987	(b)  Class II violations are defined in s. 408.813. those
2988	conditions or practices related to the operation and maintenance
2989	of an adult family-care home or to the care of residents which
2990	the agency determines directly threaten the physical or
2991	emotional health, safety, or security of the residents, other
2992	than class I violations. A class II violation is subject to an
2993	administrative fine in an amount not less than $250 and not
2994	exceeding $500 for each violation. A citation for a class II
2995	violation must specify the time within which the violation is
2996	required to be corrected. If a class II violation is corrected
2997	within the time specified, no civil penalty shall be imposed,
2998	unless it is a repeated offense.
2999	(c)  Class III violations are defined in s. 408.813. those
3000	conditions or practices related to the operation and maintenance
3001	of an adult family-care home or to the care of residents which
3002	the agency determines indirectly or potentially threaten the
3003	physical or emotional health, safety, or security of residents,
3004	other than class I or class II violations. A class III violation
3005	is subject to an administrative fine in an amount not less than
3006	$100 and not exceeding $250 for each violation. A citation for a
3007	class III violation shall specify the time within which the
3008	violation is required to be corrected. If a class III violation
3009	is corrected within the time specified, no civil penalty shall
3010	be imposed, unless it is a repeated offense.
3011	(d)  Class IV violations are defined in s. 408.813. those
3012	conditions or occurrences related to the operation and
3013	maintenance of an adult family-care home, or related to the
3014	required reports, forms, or documents, which do not have the
3015	potential of negatively affecting the residents. A provider that
3016	does not correct A class IV violation within the time limit
3017	specified by the agency is subject to an administrative fine in
3018	an amount not less than $50 and not exceeding $100 for each
3019	violation. Any class IV violation that is corrected during the
3020	time the agency survey is conducted will be identified as an
3021	agency finding and not as a violation.
3022	(2)  The agency may impose an administrative fine for
3023	violations which do not qualify as class I, class II, class III,
3024	or class IV violations. The amount of the fine may shall not
3025	exceed $250 for each violation or $2,000 in the
3026	Unclassified violations may include:
3027	(a)  Violating any term or condition of a license.
3028	(b)  Violating any provision of this part, part II of
3029	chapter 408, or applicable rules.
3030	(c)  Failure to follow the criteria and procedures provided
3031	under part I of chapter 394 relating to the transportation,
3032	voluntary admission, and involuntary examination of adult
3033	family-care home residents.
3034	(d)  Exceeding licensed capacity.
3035	(e)  Providing services beyond the scope of the license.
3036	(f)  Violating a moratorium.
3037	(3)  Each day during which a violation occurs constitutes a
3038	separate offense.
3039	(4)  In determining whether a penalty is to be imposed, and
3040	in fixing the amount of any penalty to be imposed, the agency
3041	must consider:
3042	(a)  The gravity of the violation.
3043	(b)  Actions taken by the provider to correct a violation.
3044	(c)  Any previous violation by the provider.
3045	(d)  The financial benefit to the provider of committing or
3046	continuing the violation.
3047	(5)  As an alternative to or in conjunction with an
3048	administrative action against a provider, the agency may request
3049	a plan of corrective action that demonstrates a good faith
3050	effort to remedy each violation by a specific date, subject to
3051	the approval of the agency.
3052	Section 77.  Section 429.911, Florida Statutes, is
3053	repealed.
3054	Section 78.  Section 429.915, Florida Statutes, is amended
3055	to read:
3056	429.915  Conditional license.-In addition to the license
3057	categories available in part II of chapter 408, the agency may
3058	issue a conditional license to an applicant for license renewal
3059	or change of ownership if the applicant fails to meet all
3060	standards and requirements for licensure. A conditional license
3061	issued under this subsection must be limited to a specific
3062	period not exceeding 6 months, as determined by the agency, and
3063	must be accompanied by an approved plan of correction.
3064	Section 79.  Subsection (3) of section 430.80, Florida
3065	Statutes, is amended to read:
3066	430.80  Implementation of a teaching nursing home pilot
3067	project.-
3068	(3)  To be designated as a teaching nursing home, a nursing
3069	home licensee must, at a minimum:
3070	(a)  Provide a comprehensive program of integrated senior
3071	services that include institutional services and community-based
3072	services;
3073	(b)  Participate in a nationally recognized accreditation
3074	program and hold a valid accreditation, such as the
3075	accreditation awarded by the Joint Commission on Accreditation
3076	of Healthcare Organizations;
3077	(c)  Have been in business in this state for a minimum of
3078	10 consecutive years;
3079	(d)  Demonstrate an active program in multidisciplinary
3080	education and research that relates to gerontology;
3081	(e)  Have a formalized contractual relationship with at
3082	least one accredited health profession education program located
3083	in this state;
3084	(f)  Have a formalized contractual relationship with an
3085	accredited hospital that is designated by law as a teaching
3086	hospital; and
3087	(g)  Have senior staff members who hold formal faculty
3088	appointments at universities, which must include at least one
3089	accredited health profession education program.
3090	(h)  Maintain insurance coverage pursuant to s.
3091	400.141(1)(q) s. 400.141(1)(s) or proof of financial
3092	responsibility in a minimum amount of $750,000. Such proof of
3093	financial responsibility may include:
3094	1.  Maintaining an escrow account consisting of cash or
3095	assets eligible for deposit in accordance with s. 625.52; or
3096	2.  Obtaining and maintaining pursuant to chapter 675 an
3097	unexpired, irrevocable, nontransferable and nonassignable letter
3098	of credit issued by any bank or savings association organized
3099	and existing under the laws of this state or any bank or savings
3100	association organized under the laws of the United States that
3101	has its principal place of business in this state or has a
3102	branch office which is authorized to receive deposits in this
3103	state. The letter of credit shall be used to satisfy the
3104	obligation of the facility to the claimant upon presentment of a
3105	final judgment indicating liability and awarding damages to be
3106	paid by the facility or upon presentment of a settlement
3107	agreement signed by all parties to the agreement when such final
3108	judgment or settlement is a result of a liability claim against
3109	the facility.
3110	Section 80.  Paragraph (a) of subsection (2) of section
3111	440.13, Florida Statutes, is amended to read:
3112	440.13  Medical services and supplies; penalty for
3113	violations; limitations.-
3114	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3115	(a)  Subject to the limitations specified elsewhere in this
3116	chapter, the employer shall furnish to the employee such
3117	medically necessary remedial treatment, care, and attendance for
3118	such period as the nature of the injury or the process of
3119	recovery may require, which is in accordance with established
3120	practice parameters and protocols of treatment as provided for
3121	in this chapter, including medicines, medical supplies, durable
3122	medical equipment, orthoses, prostheses, and other medically
3123	necessary apparatus. Remedial treatment, care, and attendance,
3124	including work-hardening programs or pain-management programs
3125	accredited by the Commission on Accreditation of Rehabilitation
3126	Facilities or the Joint Commission on the Accreditation of
3127	Health Organizations or pain-management programs affiliated with
3128	medical schools, shall be considered as covered treatment only
3129	when such care is given based on a referral by a physician as
3130	defined in this chapter. Medically necessary treatment, care,
3131	and attendance does not include chiropractic services in excess
3132	of 24 treatments or rendered 12 weeks beyond the date of the
3133	initial chiropractic treatment, whichever comes first, unless
3134	the carrier authorizes additional treatment or the employee is
3135	catastrophically injured.
3136
3137	Failure of the carrier to timely comply with this subsection
3138	shall be a violation of this chapter and the carrier shall be
3139	subject to penalties as provided for in s. 440.525.
3140	Section 81.  Section 483.294, Florida Statutes, is amended
3141	to read:
3142	483.294  Inspection of centers.-In accordance with s.
3143	408.811, the agency shall biennially, at least once annually,
3144	inspect the premises and operations of all centers subject to
3145	licensure under this part.
3146	Section 82.  Subsection (1) of section 627.645, Florida
3147	Statutes, is amended to read:
3148	627.645  Denial of health insurance claims restricted.-
3149	(1)  A No claim for payment under a health insurance policy
3150	or self-insured program of health benefits for treatment, care,
3151	or services in a licensed hospital which is accredited by the
3152	Joint Commission on the Accreditation of Hospitals, the American
3153	Osteopathic Association, or the Commission on the Accreditation
3154	of Rehabilitative Facilities may not shall be denied because
3155	such hospital lacks major surgical facilities and is primarily
3156	of a rehabilitative nature, if such rehabilitation is
3157	specifically for treatment of physical disability.
3158	Section 83.  Paragraph (c) of subsection (2) of section
3159	627.668, Florida Statutes, is amended to read:
3160	627.668  Optional coverage for mental and nervous disorders
3161	required; exception.-
3162	(2)  Under group policies or contracts, inpatient hospital
3163	benefits, partial hospitalization benefits, and outpatient
3164	benefits consisting of durational limits, dollar amounts,
3165	deductibles, and coinsurance factors shall not be less favorable
3166	than for physical illness generally, except that:
3167	(c)  Partial hospitalization benefits shall be provided
3168	under the direction of a licensed physician. For purposes of
3169	this part, the term "partial hospitalization services" is
3170	defined as those services offered by a program accredited by the
3171	Joint Commission on Accreditation of Hospitals (JCAH) or in
3172	compliance with equivalent standards. Alcohol rehabilitation
3173	programs accredited by the Joint Commission on Accreditation of
3174	Hospitals or approved by the state and licensed drug abuse
3175	rehabilitation programs shall also be qualified providers under
3176	this section. In any benefit year, if partial hospitalization
3177	services or a combination of inpatient and partial
3178	hospitalization are utilized, the total benefits paid for all
3179	such services shall not exceed the cost of 30 days of inpatient
3180	hospitalization for psychiatric services, including physician
3181	fees, which prevail in the community in which the partial
3182	hospitalization services are rendered. If partial
3183	hospitalization services benefits are provided beyond the limits
3184	set forth in this paragraph, the durational limits, dollar
3185	amounts, and coinsurance factors thereof need not be the same as
3186	those applicable to physical illness generally.
3187	Section 84.  Subsection (3) of section 627.669, Florida
3188	Statutes, is amended to read:
3189	627.669  Optional coverage required for substance abuse
3190	impaired persons; exception.-
3191	(3)  The benefits provided under this section shall be
3192	applicable only if treatment is provided by, or under the
3193	supervision of, or is prescribed by, a licensed physician or
3194	licensed psychologist and if services are provided in a program
3195	accredited by the Joint Commission on Accreditation of Hospitals
3196	or approved by the state.
3197	Section 85.  Paragraph (a) of subsection (1) of section
3198	627.736, Florida Statutes, is amended to read:
3199	627.736  Required personal injury protection benefits;
3200	exclusions; priority; claims.-
3201	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3202	with the security requirements of s. 627.733 shall provide
3203	personal injury protection to the named insured, relatives
3204	residing in the same household, persons operating the insured
3205	motor vehicle, passengers in such motor vehicle, and other
3206	persons struck by such motor vehicle and suffering bodily injury
3207	while not an occupant of a self-propelled vehicle, subject to
3208	the provisions of subsection (2) and paragraph (4)(e), to a
3209	limit of $10,000 for loss sustained by any such person as a
3210	result of bodily injury, sickness, disease, or death arising out
3211	of the ownership, maintenance, or use of a motor vehicle as
3212	follows:
3213	(a)  Medical benefits.-Eighty percent of all reasonable
3214	expenses for medically necessary medical, surgical, X-ray,
3215	dental, and rehabilitative services, including prosthetic
3216	devices, and medically necessary ambulance, hospital, and
3217	nursing services. However, the medical benefits shall provide
3218	reimbursement only for such services and care that are lawfully
3219	provided, supervised, ordered, or prescribed by a physician
3220	licensed under chapter 458 or chapter 459, a dentist licensed
3221	under chapter 466, or a chiropractic physician licensed under
3222	chapter 460 or that are provided by any of the following persons
3223	or entities:
3224	1.  A hospital or ambulatory surgical center licensed under
3225	chapter 395.
3226	2.  A person or entity licensed under ss. 401.2101-401.45
3227	that provides emergency transportation and treatment.
3228	3.  An entity wholly owned by one or more physicians
3229	licensed under chapter 458 or chapter 459, chiropractic
3230	physicians licensed under chapter 460, or dentists licensed
3231	under chapter 466 or by such practitioner or practitioners and
3232	the spouse, parent, child, or sibling of that practitioner or
3233	those practitioners.
3234	4.  An entity wholly owned, directly or indirectly, by a
3235	hospital or hospitals.
3236	5.  A health care clinic licensed under ss. 400.990-400.995
3237	that is:
3238	a.  Accredited by the Joint Commission on Accreditation of
3239	Healthcare Organizations, the American Osteopathic Association,
3240	the Commission on Accreditation of Rehabilitation Facilities, or
3241	the Accreditation Association for Ambulatory Health Care, Inc.;
3242	or
3243	b.  A health care clinic that:
3244	(I)  Has a medical director licensed under chapter 458,
3245	chapter 459, or chapter 460;
3246	(II)  Has been continuously licensed for more than 3 years
3247	or is a publicly traded corporation that issues securities
3248	traded on an exchange registered with the United States
3249	Securities and Exchange Commission as a national securities
3250	exchange; and
3251	(III)  Provides at least four of the following medical
3252	specialties:
3253	(A)  General medicine.
3254	(B)  Radiography.
3255	(C)  Orthopedic medicine.
3256	(D)  Physical medicine.
3257	(E)  Physical therapy.
3258	(F)  Physical rehabilitation.
3259	(G)  Prescribing or dispensing outpatient prescription
3260	medication.
3261	(H)  Laboratory services.
3262
3263	The Financial Services Commission shall adopt by rule the form
3264	that must be used by an insurer and a health care provider
3265	specified in subparagraph 3., subparagraph 4., or subparagraph
3266	5. to document that the health care provider meets the criteria
3267	of this paragraph, which rule must include a requirement for a
3268	sworn statement or affidavit.
3269
3270	Only insurers writing motor vehicle liability insurance in this
3271	state may provide the required benefits of this section, and no
3272	such insurer shall require the purchase of any other motor
3273	vehicle coverage other than the purchase of property damage
3274	liability coverage as required by s. 627.7275 as a condition for
3275	providing such required benefits. Insurers may not require that
3276	property damage liability insurance in an amount greater than
3277	$10,000 be purchased in conjunction with personal injury
3278	protection. Such insurers shall make benefits and required
3279	property damage liability insurance coverage available through
3280	normal marketing channels. Any insurer writing motor vehicle
3281	liability insurance in this state who fails to comply with such
3282	availability requirement as a general business practice shall be
3283	deemed to have violated part IX of chapter 626, and such
3284	violation shall constitute an unfair method of competition or an
3285	unfair or deceptive act or practice involving the business of
3286	insurance; and any such insurer committing such violation shall
3287	be subject to the penalties afforded in such part, as well as
3288	those which may be afforded elsewhere in the insurance code.
3289	Section 86.  Subsection (12) of section 641.495, Florida
3290	Statutes, is amended to read:
3291	641.495  Requirements for issuance and maintenance of
3292	certificate.-
3293	(12)  The provisions of part I of chapter 395 do not apply
3294	to a health maintenance organization that, on or before January
3295	1, 1991, provides not more than 10 outpatient holding beds for
3296	short-term and hospice-type patients in an ambulatory care
3297	facility for its members, provided that such health maintenance
3298	organization maintains current accreditation by the Joint
3299	Commission on Accreditation of Health Care Organizations, the
3300	Accreditation Association for Ambulatory Health Care, or the
3301	National Committee for Quality Assurance.
3302	Section 87.  Subsection (13) of section 651.118, Florida
3303	Statutes, is amended to read:
3304	651.118  Agency for Health Care Administration;
3305	certificates of need; sheltered beds; community beds.-
3306	(13)  Residents, as defined in this chapter, are not
3307	considered new admissions for the purpose of s. 400.141(1)(n)1.d
3308	s. 400.141(1)(o)1.d.
3309	Section 88.  Subsection (2) of section 766.1015, Florida
3310	Statutes, is amended to read:
3311	766.1015  Civil immunity for members of or consultants to
3312	certain boards, committees, or other entities.-
3313	(2)  Such committee, board, group, commission, or other
3314	entity must be established in accordance with state law or in
3315	accordance with requirements of the Joint Commission on
3316	Accreditation of Healthcare Organizations, established and duly
3317	constituted by one or more public or licensed private hospitals
3318	or behavioral health agencies, or established by a governmental
3319	agency. To be protected by this section, the act, decision,
3320	omission, or utterance may not be made or done in bad faith or
3321	with malicious intent.
3322	Section 89.  Except as otherwise expressly provided in this
3323	act, this act shall take effect July 1, 2010.

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