CS/HB 1503

1	A bill to be entitled
2	An act relating to health care; amending s. 112.0455,
3	F.S., and repealing paragraph (10)(e), relating to a
4	prohibition against applying the Drug-Free Workplace Act
5	retroactively; conforming a cross-reference; repealing s.
6	383.325, F.S., relating to the requirement of a licensed
7	facility under s. 383.305, F.S., to maintain inspection
8	reports; repealing s. 395.1046, F.S., relating to the
9	investigation of complaints regarding hospitals; repealing
10	s. 395.3037, F.S.; deleting definitions relating to
11	obsolete provisions governing primary and comprehensive
12	stroke centers; amending s. 400.0239, F.S.; deleting an
13	obsolete provision; repealing s. 400.147(10), F.S.,
14	relating to a requirement that a nursing home facility
15	report any notice of a filing of a claim for a violation
16	of a resident's rights or a claim of negligence; repealing
17	s. 400.148, F.S., relating to the Medicaid "Up-or-Out"
18	Quality of Care Contract Management Program; repealing s.
19	400.195, F.S., relating to reporting requirements for the
20	Agency for Health Care Administration; amending s.
21	400.476, F.S.; providing requirements for an alternate
22	administrator of a home health agency; revising the duties
23	of the administrator; revising the requirements for a
24	director of nursing for a specified number of home health
25	agencies; prohibiting a home health agency from using an
26	individual as a home health aide unless the person has
27	completed training and an evaluation program; requiring a
28	home health aide to meet certain standards in order to be
29	competent in performing certain tasks; requiring a home
30	health agency and staff to comply with accepted
31	professional standards; providing certain requirements for
32	a written contract between certain personnel and the
33	agency; requiring a home health agency to provide certain
34	services through its employees; authorizing a home health
35	agency to provide additional services with another
36	organization; providing responsibilities of a home health
37	agency when it provides home health aide services through
38	another organization; requiring the home health agency to
39	coordinate personnel who provide home health services;
40	requiring personnel to communicate with the home health
41	agency; amending s. 400.487, F.S.; requiring a home health
42	agency to provide a patient or the patient's legal
43	representative a copy of the agreement between the agency
44	and the patient which specifies the home health services
45	to be provided; providing the rights that are protected by
46	the home health agency; requiring the home health agency
47	to furnish nursing services by or under the supervision of
48	a registered nurse; requiring the home health agency to
49	provide therapy services through a qualified therapist or
50	therapy assistant; providing the duties and qualifications
51	of a therapist and therapy assistant; requiring
52	supervision by a physical therapist or occupational
53	therapist of a physical therapist assistant or
54	occupational therapy assistant; providing duties of a
55	physical therapist assistant or occupational therapy
56	assistant; providing for speech therapy services to be
57	provided by a qualified speech-language pathologist or
58	audiologist; providing for a plan of care; providing that
59	only the staff of a home health agency may administer
60	drugs and treatments as ordered by certain health
61	professionals; providing requirements for verbal orders;
62	providing duties of a registered nurse, licensed practical
63	nurse, home health aide, and certified nursing assistant
64	who work for a home health agency; providing for
65	supervisory visits of services provided by a home health
66	agency; repealing s. 408.802(11), F.S., relating to the
67	applicability of the Health Care Licensing Procedures Act
68	to private review agents; repealing s. 409.912(15)(e),
69	(f), and (g), F.S., relating to a requirement for the
70	Agency for Health Care Administration to submit a report
71	to the Legislature regarding the operations of the CARE
72	program; repealing s. 429.12(2), F.S., relating to the
73	sale or transfer of ownership of an assisted living
74	facility; repealing s. 429.23(5), F.S., relating to each
75	assisted living facility's requirement to submit a report
76	to the agency regarding liability claims filed against it;
77	repealing s. 429.911(2)(a), F.S., relating to an
78	intentional or negligent act materially affecting the
79	health or safety of center participants as grounds for
80	which the agency may take action against the owner of an
81	adult day care center or its operator or employee;
82	requiring persons who apply for licensure renewal as a
83	dentist or dental hygienist to furnish certain information
84	to the Department of Health in a dental workforce survey;
85	requiring the Board of Dentistry to issue a
86	nondisciplinary citation and a notice for failure to
87	complete the survey within a specified time; providing
88	notification requirements for the citation; requiring the
89	department to serve as the coordinating body for the
90	purpose of collecting, disseminating, and updating dental
91	workforce data; requiring the department to maintain a
92	database regarding the state's dental workforce; requiring
93	the department to develop strategies to maximize federal
94	and state programs and to work with an advisory body to
95	address matters relating to the state's dental workforce;
96	providing membership of the advisory body; providing for
97	members of the advisory body to serve without
98	compensation; requiring the department to act as a
99	clearinghouse for collecting and disseminating information
100	regarding the dental workforce; requiring the department
101	and the board to adopt rules; providing legislative intent
102	regarding implementation of the act within existing
103	resources; amending s. 499.01, F.S.; authorizing certain
104	business entities to pay for prescription drugs obtained
105	by practitioners licensed under ch. 466, F.S.; amending s.
106	624.91, F.S.; revising the membership of the board of
107	directors of the Florida Healthy Kids Corporation to
108	include a member nominated by the Florida Dental
109	Association and appointed by the Governor; providing an
110	effective date.
111
112	Be It Enacted by the Legislature of the State of Florida:
113
114	Section 1.  Paragraph (e) of subsection (10) of section
115	112.0455, Florida Statutes, is repealed, and paragraph (e) of
116	subsection (14) of that section is amended to read:
117	112.0455  Drug-Free Workplace Act.-
118	(14)  DISCIPLINE REMEDIES.-
119	(e)  Upon resolving an appeal filed pursuant to paragraph
120	(c), and finding a violation of this section, the commission may
121	order the following relief:
122	1.  Rescind the disciplinary action, expunge related
123	records from the personnel file of the employee or job applicant
124	and reinstate the employee.
125	2.  Order compliance with paragraph (10)(f)(g).
126	3.  Award back pay and benefits.
127	4.  Award the prevailing employee or job applicant the
128	necessary costs of the appeal, reasonable attorney's fees, and
129	expert witness fees.
130	Section 2.  Section 383.325, Florida Statutes, is repealed.
131	Section 3.  Section 395.1046, Florida Statutes, is
132	repealed.
133	Section 4.  Section 395.3037, Florida Statutes, is
134	repealed.
135	Section 5.  Paragraph (g) of subsection (2) of section
136	400.0239, Florida Statutes, is amended to read:
137	400.0239  Quality of Long-Term Care Facility Improvement
138	Trust Fund.-
139	(2)  Expenditures from the trust fund shall be allowable
140	for direct support of the following:
141	(g)  Other initiatives authorized by the Centers for
142	Medicare and Medicaid Services for the use of federal civil
143	monetary penalties, including projects recommended through the
144	Medicaid "Up-or-Out" Quality of Care Contract Management Program
145	pursuant to s. 400.148.
146	Section 6.  Subsection (10) of section 400.147, Florida
147	Statutes, is repealed.
148	Section 7.  Section 400.148, Florida Statutes, is repealed.
149	Section 8.  Section 400.195, Florida Statutes, is repealed.
150	Section 9.  Section 400.476, Florida Statutes, is amended
151	to read:
152	400.476  Staffing requirements; notifications; limitations
153	on staffing services.-
154	(1)  ADMINISTRATOR.-
155	(a)  An administrator may manage only one home health
156	agency, except that an administrator may manage up to five home
157	health agencies if all five home health agencies have identical
158	controlling interests as defined in s. 408.803 and are located
159	within one agency geographic service area or within an
160	immediately contiguous county. If the home health agency is
161	licensed under this chapter and is part of a retirement
162	community that provides multiple levels of care, an employee of
163	the retirement community may administer the home health agency
164	and up to a maximum of four entities licensed under this chapter
165	or chapter 429 which all have identical controlling interests as
166	defined in s. 408.803. An administrator shall designate, in
167	writing, for each licensed entity, a qualified alternate
168	administrator to serve during the administrator's absence. An
169	alternate administrator must meet the requirements in this
170	paragraph and s. 400.462(1).
171	(b)  An administrator of a home health agency who is a
172	licensed physician, physician assistant, or registered nurse
173	licensed to practice in this state may also be the director of
174	nursing for a home health agency. An administrator may serve as
175	a director of nursing for up to the number of entities
176	authorized in subsection (2) only if there are 10 or fewer full-
177	time equivalent employees and contracted personnel in each home
178	health agency.
179	(c)  The administrator shall organize and direct the
180	agency's ongoing functions, maintain an ongoing liaison with the
181	board members and the staff, employ qualified personnel and
182	ensure adequate staff education and evaluations, ensure the
183	accuracy of public informational materials and activities,
184	implement an effective budgeting and accounting system, and
185	ensure that the home health agency operates in compliance with
186	this part and part II of chapter 408 and rules adopted for these
187	laws.
188	(d)  The administrator shall clearly set forth in writing
189	the organizational chart, services furnished, administrative
190	control authority, and lines of authority for the delegation of
191	responsibilities for patient care. These responsibilities must
192	be readily identifiable. Administrative and supervisory
193	functions may not be delegated to another agency or
194	organization, and the primary home health agency shall monitor
195	and control all services that are not furnished directly,
196	including services provided through contracts.
197	(2)  DIRECTOR OF NURSING.-
198	(a)  A director of nursing may be the director of nursing
199	for:
200	1.  Up to two licensed home health agencies if the agencies
201	have identical controlling interests as defined in s. 408.803
202	and are located within one agency geographic service area or
203	within an immediately contiguous county; or
204	2.  Up to five licensed home health agencies if:
205	a.  All of the home health agencies have identical
206	controlling interests as defined in s. 408.803;
207	b.  All of the home health agencies are located within one
208	agency geographic service area or within an immediately
209	contiguous county; and
210	c.  Each home health agency has a registered nurse who
211	meets the qualifications of a director of nursing and who has a
212	written delegation from the director of nursing to serve as the
213	director of nursing for that home health agency when the
214	director of nursing is not present; and.
215	d.  This person, or a similarly qualified alternate, is
216	available at all times during operating hours and participates
217	in all activities relevant to the professional services
218	furnished, including, but not limited to, the oversight of
219	nursing services, home health aides, and certified nursing
220	assistants and the assignment of personnel.
221
222	If a home health agency licensed under this chapter is part of a
223	retirement community that provides multiple levels of care, an
224	employee of the retirement community may serve as the director
225	of nursing of the home health agency and up to a maximum of four
226	entities, other than home health agencies, licensed under this
227	chapter or chapter 429 which all have identical controlling
228	interests as defined in s. 408.803.
229	(b)  A home health agency that provides skilled nursing
230	care may not operate for more than 30 calendar days without a
231	director of nursing. A home health agency that provides skilled
232	nursing care and the director of nursing of a home health agency
233	must notify the agency within 10 business days after termination
234	of the services of the director of nursing for the home health
235	agency. A home health agency that provides skilled nursing care
236	must notify the agency of the identity and qualifications of the
237	new director of nursing within 10 days after the new director is
238	hired. If a home health agency that provides skilled nursing
239	care operates for more than 30 calendar days without a director
240	of nursing, the home health agency commits a class II
241	deficiency. In addition to the fine for a class II deficiency,
242	the agency may issue a moratorium in accordance with s. 408.814
243	or revoke the license. The agency shall fine a home health
244	agency that fails to notify the agency as required in this
245	paragraph $1,000 for the first violation and $2,000 for a repeat
246	violation. The agency may not take administrative action against
247	a home health agency if the director of nursing fails to notify
248	the department upon termination of services as the director of
249	nursing for the home health agency.
250	(c)  A home health agency that is not Medicare or Medicaid
251	certified and does not provide skilled care or provides only
252	physical, occupational, or speech therapy is not required to
253	have a director of nursing and is exempt from paragraph (b).
254	(3)  TRAINING.-A home health agency shall ensure that each
255	certified nursing assistant employed by or under contract with
256	the home health agency and each home health aide employed by or
257	under contract with the home health agency is adequately trained
258	to perform the tasks of a home health aide in the home setting.
259	(a)  The home health agency may not use as a home health
260	aide on a full-time, temporary, per diem, or other basis any
261	individual to provide services unless the individual has
262	completed a training and competency evaluation program, or a
263	competency evaluation program, as permitted in s. 400.497, which
264	meets the minimum standards established by the agency in state
265	rules.
266	(b)  A home health aide is not competent in any task for
267	which he or she is evaluated as "unsatisfactory." The aide must
268	perform any such task only under direct supervision by a
269	licensed nurse until he or she receives training in the task and
270	satisfactorily passes a subsequent evaluation in performing the
271	task. A home health aide has not successfully passed a
272	competency evaluation if the aide does not have a passing score
273	on the test as specified by agency rule.
274	(4)  STAFFING.-Staffing services may be provided anywhere
275	within the state.
276	(5)  PERSONNEL.-
277	(a)  The home health agency and its staff must comply with
278	accepted professional standards and principles that apply to
279	professionals, including, but not limited to, the state practice
280	acts and the home health agency's policies and procedures.
281	(b)  If personnel under hourly or per-visit contracts are
282	used by the home health agency, there must be a written contract
283	between those personnel and the agency which specifies the
284	following requirements:
285	1.  Acceptance for care only of patients by the primary
286	home health agency.
287	2.  The services to be furnished.
288	3.  The necessity to conform to all applicable agency
289	policies, including personnel qualifications.
290	4.  The responsibility for participating in developing
291	plans of care.
292	5.  The manner in which services are controlled,
293	coordinated, and evaluated by the primary home health agency.
294	6.  The procedures for submitting clinical and progress
295	notes, scheduling visits, and providing periodic patient
296	evaluations.
297	7.  The procedures for payment for services furnished under
298	the contract.
299	(c)  A home health agency shall directly provide at least
300	one of the types of authorized services through home health
301	agency employees, but may provide additional services under
302	arrangements with another agency or organization. Services
303	furnished under such arrangements must have a written contract
304	conforming to the requirements specified in paragraph (b).
305	(d)  If home health aide services are provided by an
306	individual who is not employed directly by the home health
307	agency, the services of the home health aide must be provided
308	under arrangements as stated in paragraphs (b) and (c). If the
309	home health agency chooses to provide home health aide services
310	under arrangements with another organization, the
311	responsibilities of the home health agency include, but are not
312	limited to:
313	1.  Ensuring the overall quality of the care provided by
314	the aide.
315	2.  Supervising the aide's services as described in s.
316	400.487.
317	3.  Ensuring that each home health aide providing services
318	under arrangements with another organization has met the
319	training requirements or competency evaluation requirements of
320	s. 400.497.
321	(e)  The home health agency shall coordinate the efforts of
322	all personnel furnishing services, and the personnel shall
323	maintain communication with the home health agency to ensure
324	that personnel efforts support the objectives outlined in the
325	plan of care. The clinical record or minutes of case conferences
326	shall ensure that effective interchange, reporting, and
327	coordination of patient care occurs.
328	Section 10.  Section 400.487, Florida Statutes, is amended
329	to read:
330	400.487  Home health service agreements; physician's,
331	physician assistant's, and advanced registered nurse
332	practitioner's treatment orders; patient assessment;
333	establishment and review of plan of care; provision of services;
334	orders not to resuscitate.-
335	(1)  Services provided by a home health agency must be
336	covered by an agreement between the home health agency and the
337	patient or the patient's legal representative specifying the
338	home health services to be provided, the rates or charges for
339	services paid with private funds, and the sources of payment,
340	which may include Medicare, Medicaid, private insurance,
341	personal funds, or a combination thereof. The home health agency
342	shall provide a copy of the agreement to the patient or the
343	patient's legal representative. A home health agency providing
344	skilled care must make an assessment of the patient's needs
345	within 48 hours after the start of services.
346	(2)  When required by the provisions of chapter 464; part
347	I, part III, or part V of chapter 468; or chapter 486, the
348	attending physician, physician assistant, or advanced registered
349	nurse practitioner, acting within his or her respective scope of
350	practice, shall establish treatment orders for a patient who is
351	to receive skilled care. The treatment orders must be signed by
352	the physician, physician assistant, or advanced registered nurse
353	practitioner before a claim for payment for the skilled services
354	is submitted by the home health agency. If the claim is
355	submitted to a managed care organization, the treatment orders
356	must be signed within the time allowed under the provider
357	agreement. The treatment orders shall be reviewed, as frequently
358	as the patient's illness requires, by the physician, physician
359	assistant, or advanced registered nurse practitioner in
360	consultation with the home health agency.
361	(3)  A home health agency shall arrange for supervisory
362	visits by a registered nurse to the home of a patient receiving
363	home health aide services as specified in subsection (9) in
364	accordance with the patient's direction, approval, and agreement
365	to pay the charge for the visits.
366	(4)  The home health agency shall protect and promote the
367	rights of each individual under its care, including each of the
368	following rights:
369	(a)  Notice of rights.-The home health agency shall provide
370	the patient with a written notice of the patient's rights in
371	advance of furnishing care to the patient or during the initial
372	evaluation visit before the initiation of treatment. The home
373	health agency must maintain documentation showing that it has
374	complied with the requirements of this section.
375	(b)  Exercise of rights and respect for property and
376	person.-
377	1.  The patient has the right to exercise his or her rights
378	as a patient of the home health agency.
379	2.  The patient has the right to have his or her property
380	treated with respect.
381	3.  The patient has the right to voice grievances regarding
382	treatment or care that is or fails to be furnished, or regarding
383	the lack of respect for property by anyone who is furnishing
384	services on behalf of the home health agency, and not be
385	subjected to discrimination or reprisal for doing so.
386	4.  The home health agency must investigate complaints made
387	by a patient or the patient's family or guardian regarding
388	treatment or care that is or fails to be furnished or regarding
389	the lack of respect for the patient's property by anyone
390	furnishing services on behalf of the home health agency. The
391	home health agency shall document the existence of the complaint
392	and its resolution.
393	5.  The patient and his or her immediate family or
394	representative must be informed of the right to report
395	complaints via the statewide toll-free telephone number to the
396	agency as required in s. 408.810.
397	(c)  Right to be informed and to participate in planning
398	care and treatment.-
399	1.  The patient has the right to be informed, in advance,
400	about the care to be furnished and of any changes in the care to
401	be furnished. The home health agency shall advise the patient in
402	advance of which disciplines will furnish care and the frequency
403	of visits proposed to be furnished. The home health agency must
404	advise the patient in advance of any change in the plan of care
405	before the change is made.
406	2.  The patient has the right to participate in the
407	planning of the care. The home health agency must advise the
408	patient in advance of the right to participate in planning the
409	care or treatment and in planning changes in the care or
410	treatment. Each patient has the right to be informed of and to
411	participate in the planning of his or her care. Each patient
412	must be provided, upon request, a copy of the plan of care
413	established and maintained for that patient by the home health
414	agency.
415	(5)  When nursing services are ordered, the home health
416	agency to which a patient has been admitted for care must
417	provide the initial admission visit, all service evaluation
418	visits, and the discharge visit by a direct employee. Services
419	provided by others under contractual arrangements to a home
420	health agency must be monitored and managed by the admitting
421	home health agency. The admitting home health agency is fully
422	responsible for ensuring that all care provided through its
423	employees or contract staff is delivered in accordance with this
424	part and applicable rules.
425	(6)  The skilled care services provided by a home health
426	agency, directly or under contract, must be supervised and
427	coordinated in accordance with the plan of care. The home health
428	agency shall furnish skilled nursing services by or under the
429	supervision of a registered nurse and in accordance with the
430	plan of care. Any therapy services offered directly or under
431	arrangement by the home health agency must be provided by a
432	qualified therapist or by a qualified therapy assistant under
433	the supervision of a qualified therapist and in accordance with
434	the plan of care.
435	(a)  Duties and qualifications.-A qualified therapist shall
436	assist the physician in evaluating the level of function, help
437	develop or revise the plan of care, prepare clinical and
438	progress notes, advise and consult with the family and other
439	agency personnel, and participate in in-service programs. The
440	therapist or therapy assistant must meet the qualifications in
441	the state practice acts and applicable rules.
442	(b)  Physical therapist assistants and occupational therapy
443	assistants.-Services provided by a physical therapist assistant
444	or occupational therapy assistant must be under the supervision
445	of a qualified physical therapist or occupational therapist as
446	required in chapter 486 and part III of chapter 468,
447	respectively, and applicable rules. A physical therapist
448	assistant or occupational therapy assistant shall perform
449	services planned, delegated, and supervised by the therapist,
450	assist in preparing clinical notes and progress reports,
451	participate in educating the patient and his or her family, and
452	participate in in-service programs.
453	(c)  Speech therapy services.-Speech therapy services shall
454	be furnished only by or under supervision of a qualified speech-
455	language pathologist or audiologist as required in part I of
456	chapter 468 and applicable rules.
457	(d)  Care follows a written plan of care.-The plan of care
458	shall be reviewed by the physician or health professional who
459	provided the treatment orders pursuant to subsection (2) and
460	home health agency personnel as often as the severity of the
461	patient's condition requires, but at least once every 60 days or
462	more when there is a patient-elected transfer, a significant
463	change in condition, or a discharge and return to the same home
464	health agency during the 60-day episode. Professional staff of a
465	home health agency shall promptly alert the physician or other
466	health professional who provided the treatment orders of any
467	change that suggests a need to alter the plan of care.
468	(e)  Administration of drugs and treatment.-Only
469	professional staff of a home health agency may administer drugs
470	and treatments as ordered by the physician or health
471	professional pursuant to subsection (2), with the exception of
472	influenza and pneumococcal polysaccharide vaccines, which may be
473	administered according to the policy of the home health agency
474	developed in consultation with a physician and after an
475	assessment for contraindications. Verbal orders shall be in
476	writing and signed and dated with the date of receipt by the
477	registered nurse or qualified therapist who is responsible for
478	furnishing or supervising the ordered service. A verbal order
479	may be accepted only by personnel who are authorized to do so by
480	applicable state laws, rules, and internal policies of the home
481	health agency.
482	(7)  A registered nurse shall conduct the initial
483	evaluation visit, regularly reevaluate the patient's nursing
484	needs, initiate the plan of care and necessary revisions,
485	furnish those services requiring substantial and specialized
486	nursing skill, initiate appropriate preventive and
487	rehabilitative nursing procedures, prepare clinical and progress
488	notes, coordinate services, inform the physician and other
489	personnel of changes in the patient's condition and needs,
490	counsel the patient and his or her family in meeting nursing and
491	related needs, participate in in-service programs, and supervise
492	and teach other nursing personnel, unless the home health agency
493	providing the home health aide services is not Medicare-
494	certified or Medicaid-certified and does not provide skilled
495	care.
496	(8)  A licensed practical nurse shall furnish services in
497	accordance with agency policies, prepare clinical and progress
498	notes, assist the physician and registered nurse in performing
499	specialized procedures, prepare equipment and materials for
500	treatments observing aseptic technique as required, and assist
501	the patient in learning appropriate self-care techniques.
502	(9)  A home health aide and certified nursing assistant
503	shall provide services that are in the service provision plan
504	provided in s. 400.491 and other services that the home health
505	aide or certified nursing assistant is permitted to perform
506	under state law. The duties of a home health aide or certified
507	nursing assistant include the provision of hands-on personal
508	care, performance of simple procedures as an extension of
509	therapy or nursing services, assistance in ambulation or
510	exercises, and assistance in administering medications that are
511	ordinarily self-administered and are specified in agency rules.
512	Any services by a home health aide which are offered by a home
513	health agency must be provided by a qualified home health aide
514	or certified nursing assistant.
515	(a)  Assignment and duties.-A home health aide or certified
516	nursing assistant shall be assigned to a specific patient by a
517	registered nurse, unless the home health agency providing the
518	home health aide services is not Medicare-certified or Medicaid-
519	certified and does not provide skilled care. Written patient
520	care instructions for the home health aide and certified nursing
521	assistant must be prepared by the registered nurse or other
522	appropriate professional who is responsible for the supervision
523	of the home health aide and certified nursing assistant as
524	stated in this section.
525	(b)  Supervision.-If a patient receives skilled nursing
526	care, the registered nurse shall perform the supervisory visit.
527	If the patient is not receiving skilled nursing care but is
528	receiving physical therapy, occupational therapy, or speech-
529	language pathology services, the appropriate therapist may
530	provide the supervision. A registered nurse or other
531	professional must make an onsite visit to the patient's home at
532	least once every 2 weeks. The visit is not required while the
533	aide is providing care.
534	(c)  Supervisory visits.-If home health aide services are
535	provided to a patient who is not receiving skilled nursing care,
536	physical or occupational therapy, or speech-language pathology
537	services, a registered nurse must make a supervisory visit to
538	the patient's home at least once every 60 days, unless the home
539	health agency providing the home health aide services is not
540	Medicare-certified or Medicaid-certified and does not provide
541	skilled care, either directly or through contracts. The
542	registered nurse shall ensure that the aide is properly caring
543	for the patient and each supervisory visit must occur while the
544	home health aide is providing patient care. In addition to the
545	requirements in this subsection, a home health agency shall
546	arrange for additional supervisory visits by a registered nurse
547	to the home of a patient receiving home health aide services in
548	accordance with the patient's direction, approval, and agreement
549	to pay the charge for the visits.
550	(10)(7)  Home health agency personnel may withhold or
551	withdraw cardiopulmonary resuscitation if presented with an
552	order not to resuscitate executed pursuant to s. 401.45. The
553	agency shall adopt rules providing for the implementation of
554	such orders. Home health personnel and agencies shall not be
555	subject to criminal prosecution or civil liability, nor be
556	considered to have engaged in negligent or unprofessional
557	conduct, for withholding or withdrawing cardiopulmonary
558	resuscitation pursuant to such an order and rules adopted by the
559	agency.
560	Section 11.  Subsection (11) of section 408.802, Florida
561	Statutes, is repealed.
562	Section 12.  Paragraphs (e), (f), and (g) of subsection
563	(15) of section 409.912, Florida Statutes, are repealed.
564	Section 13.  Subsection (2) of section 429.12, Florida
565	Statutes, is repealed.
566	Section 14.  Subsection (5) of section 429.23, Florida
567	Statutes, is repealed.
568	Section 15.  Paragraph (a) of subsection (2) of section
569	429.911, Florida Statutes, is repealed.
570	Section 16.  Dental workforce survey.-
571	(1)  Beginning in 2012, each person who applies for
572	licensure renewal as a dentist or dental hygienist under chapter
573	466, Florida Statutes, must, in conjunction with the renewal of
574	such license under procedures and forms adopted by the Board of
575	Dentistry and in addition to any other information that may be
576	required from the applicant, furnish the following information
577	to the Department of Health, working in conjunction with the
578	board, in a dental workforce survey:
579	(a)  Licensee information, including, but not limited to:
580	1.  The name of the dental school or dental hygiene program
581	that the dentist or dental hygienist graduated from and the year
582	of graduation.
583	2.  The year that the dentist or dental hygienist began
584	practicing or working in this state.
585	3.  The geographic location of the dentist's or dental
586	hygienist's practice or address within the state.
587	4.  For a dentist in private practice:
588	a.  The number of full-time dental hygienists employed by
589	the dentist during the reporting period.
590	b.  The number of full-time dental assistants employed by
591	the dentist during the reporting period.
592	c.  The average number of patients treated per week by the
593	dentist during the reporting period.
594	d.  The settings where the dental care was delivered.
595	5.  Anticipated plans of the dentist to change the status
596	of his or her license or practice.
597	6.  The dentist's areas of specialty or certification.
598	7.  The year that the dentist completed a specialty program
599	recognized by the American Dental Association.
600	8.  For a hygienist:
601	a.  The average number of patients treated per week by the
602	hygienist during the reporting period.
603	b.  The settings where the dental care was delivered.
604	9.  The dentist's memberships in professional
605	organizations.
606	10.  The number of pro bono hours provided by the dentist
607	or dental hygienist during the last biennium.
608	(b)  Information concerning the availability and trends
609	relating to critically needed services, including, but not
610	limited to, the following types of care provided by the dentist
611	or dental hygienist:
612	1.  Dental care to children having special needs.
613	2.  Geriatric dental care.
614	3.  Dental services in emergency departments.
615	4.  Medicaid services.
616	5.  Other critically needed specialty areas, as determined
617	by the advisory body.
618	(2)  In addition to the completed survey, the dentist or
619	dental hygienist must submit a statement that the information
620	provided is true and accurate to the best of his or her
621	knowledge and belief.
622	(3)  Beginning in 2012, renewal of a license by a dentist
623	or dental hygienist licensed under chapter 466, Florida
624	Statutes, is not contingent upon the completion and submission
625	of the dental workforce survey; however, for any subsequent
626	license renewal, the board may not renew the license of any
627	dentist or dental hygienist until the survey required under this
628	section is completed and submitted by the licensee.
629	(4)(a)  Beginning in 2012, the Board of Dentistry shall
630	issue a nondisciplinary citation to any dentist or dental
631	hygienist licensed under chapter 466, Florida Statutes, who
632	fails to complete the survey within 90 days after the renewal of
633	his or her license to practice as a dentist or dental hygienist.
634	(b)  The citation must notify a dentist or dental hygienist
635	who fails to complete the survey required by this section that
636	his or her license will not be renewed for any subsequent
637	license renewal unless the dentist or dental hygienist completes
638	the survey.
639	(c)  In conjunction with issuing the license renewal notice
640	required by s. 456.038, Florida Statutes, the board shall notify
641	each dentist or dental hygienist licensed under chapter 466,
642	Florida Statutes, who fails to complete the survey that the
643	survey must be completed before the subsequent license renewal.
644	Section 17.  (1)  The Department of Health shall serve as
645	the coordinating body for the purpose of collecting and
646	regularly updating and disseminating dental workforce data. The
647	department shall work with multiple stakeholders, including the
648	Florida Dental Association and the Florida Dental Hygiene
649	Association, to assess and share with all communities of
650	interest all data collected in a timely fashion.
651	(2)  The Department of Health shall maintain a current
652	database to serve as a statewide source of data concerning the
653	dental workforce. The department, in conjunction with the Board
654	of Dentistry, shall also:
655	(a)  Develop strategies to maximize federal and state
656	programs that provide incentives for dentists to practice in
657	shortage areas that are federally designated. Strategies shall
658	include programs such as the Florida Health Services Corps
659	established under s. 381.0302, Florida Statutes.
660	(b)  Work in conjunction with an advisory body to address
661	matters relating to the state's dental workforce. The advisory
662	body shall provide input on developing questions for the dentist
663	workforce survey. The advisory body shall include, but need not
664	be limited to, the State Surgeon General or his or her designee,
665	the dean of each dental school accredited in the United States
666	and based in this state or his or her designee, a representative
667	from the Florida Dental Association, a representative from the
668	Florida Dental Hygiene Association, a representative from the
669	Board of Dentistry, and a dentist from each of the dental
670	specialties recognized by the American Dental Association's
671	Commission on Dental Accreditation. Members of the advisory body
672	shall serve without compensation.
673	(c)  Act as a clearinghouse for collecting and
674	disseminating information concerning the dental workforce.
675	(3)  The Department of Health and the Board of Dentistry
676	shall adopt rules necessary to administer this section.
677	Section 18.  It is the intent of the Legislature that the
678	Department of Health and the Board of Dentistry implement the
679	provisions of sections 16 through 20 of this act within existing
680	resources.
681	Section 19.  Paragraph (t) of subsection (2) of section
682	499.01, Florida Statutes, is amended to read:
683	499.01  Permits.-
684	(2)  The following permits are established:
685	(t)  Health care clinic establishment permit.-Effective
686	January 1, 2009, a health care clinic establishment permit is
687	required for the purchase of a prescription drug by a place of
688	business at one general physical location that provides health
689	care or veterinary services, which is owned and operated by a
690	business entity that has been issued a federal employer tax
691	identification number. For the purpose of this paragraph, the
692	term "qualifying practitioner" means a licensed health care
693	practitioner defined in s. 456.001, or a veterinarian licensed
694	under chapter 474, who is authorized under the appropriate
695	practice act to prescribe and administer a prescription drug.
696	1.  An establishment must provide, as part of the
697	application required under s. 499.012, designation of a
698	qualifying practitioner who will be responsible for complying
699	with all legal and regulatory requirements related to the
700	purchase, recordkeeping, storage, and handling of the
701	prescription drugs. In addition, the designated qualifying
702	practitioner shall be the practitioner whose name, establishment
703	address, and license number is used on all distribution
704	documents for prescription drugs purchased or returned by the
705	health care clinic establishment. Upon initial appointment of a
706	qualifying practitioner, the qualifying practitioner and the
707	health care clinic establishment shall notify the department on
708	a form furnished by the department within 10 days after such
709	employment. In addition, the qualifying practitioner and health
710	care clinic establishment shall notify the department within 10
711	days after any subsequent change.
712	2.  The health care clinic establishment must employ a
713	qualifying practitioner at each establishment.
714	3.  In addition to the remedies and penalties provided in
715	this part, a violation of this chapter by the health care clinic
716	establishment or qualifying practitioner constitutes grounds for
717	discipline of the qualifying practitioner by the appropriate
718	regulatory board.
719	4.  The purchase of prescription drugs by the health care
720	clinic establishment is prohibited during any period of time
721	when the establishment does not comply with this paragraph.
722	5.  A health care clinic establishment permit is not a
723	pharmacy permit or otherwise subject to chapter 465. A health
724	care clinic establishment that meets the criteria of a modified
725	Class II institutional pharmacy under s. 465.019 is not eligible
726	to be permitted under this paragraph.
727	6.  This paragraph does not apply to the purchase of a
728	prescription drug by a licensed practitioner under his or her
729	license. A professional corporation or limited liability company
730	composed of dentists and operating as authorized in s. 466.0285
731	may pay for prescription drugs obtained by a practitioner
732	licensed under chapter 466, and the licensed practitioner is
733	deemed the purchaser and owner of the prescription drugs.
734	Section 20.  Paragraph (a) of subsection (6) of section
735	624.91, Florida Statutes, is amended to read:
736	624.91  The Florida Healthy Kids Corporation Act.-
737	(6)  BOARD OF DIRECTORS.-
738	(a)  The Florida Healthy Kids Corporation shall operate
739	subject to the supervision and approval of a board of directors
740	chaired by the Chief Financial Officer or her or his designee,
741	and composed of 12 11 other members selected for 3-year terms of
742	office as follows:
743	1.  The Secretary of Health Care Administration, or his or
744	her designee.
745	2.  One member appointed by the Commissioner of Education
746	from the Office of School Health Programs of the Florida
747	Department of Education.
748	3.  One member appointed by the Chief Financial Officer
749	from among three members nominated by the Florida Pediatric
750	Society.
751	4.  One member, appointed by the Governor, who represents
752	the Children's Medical Services Program.
753	5.  One member appointed by the Chief Financial Officer
754	from among three members nominated by the Florida Hospital
755	Association.
756	6.  One member, appointed by the Governor, who is an expert
757	on child health policy.
758	7.  One member, appointed by the Chief Financial Officer,
759	from among three members nominated by the Florida Academy of
760	Family Physicians.
761	8.  One member, appointed by the Governor, who represents
762	the state Medicaid program.
763	9.  One member, appointed by the Chief Financial Officer,
764	from among three members nominated by the Florida Association of
765	Counties.
766	10.  The State Health Officer or her or his designee.
767	11.  The Secretary of Children and Family Services, or his
768	or her designee.
769	12.  One member, appointed by the Governor, from among
770	three members nominated by the Florida Dental Association.
771	Section 21.  This act shall take effect July 1, 2010.

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