HB 739

1	A bill to be entitled
2	An act relating to health care; amending s. 400.462, F.S.;
3	revising and providing definitions applicable to
4	regulation of home health agencies; amending s. 400.476,
5	F.S.; providing requirements for an alternate
6	administrator of a home health agency; providing
7	additional duties of an administrator and a director of
8	nursing of a home health agency; providing additional
9	training requirements for a home health aide; requiring a
10	written contract between the agency and certain personnel;
11	permitting other entities under contract with the home
12	health agency to provide services under certain
13	conditions; providing supervisory responsibilities of a
14	home health agency if services are provided under an
15	arrangement with another entity; amending s. 400.487,
16	F.S.; requiring the home health agency to provide a copy
17	of the service agreement to the patient or the patient's
18	legal representative; requiring the home health agency to
19	provide patients with a written notice of patient rights;
20	providing requirements for the provision of skilled
21	nursing and therapy services and the supervision thereof;
22	amending s. 400.933, F.S.; revising licensure inspection
23	requirements for home medical equipment providers;
24	amending s. 400.969, F.S.; providing a penalty for
25	violation of federal certification requirements for
26	intermediate care facilities for the developmentally
27	disabled; amending s. 408.805, F.S.; revising the method
28	for calculating the annual adjustment of license fees
29	assessed by the Agency for Health Care Administration;
30	amending s. 429.41, F.S.; revising firesafety requirements
31	for assisted living facilities; amending s. 429.65, F.S.;
32	revising definitions applicable to regulation of adult
33	family-care homes; providing an effective date.
34
35	Be It Enacted by the Legislature of the State of Florida:
36
37	Section 1.  Subsections (2) and (14) of section 400.462,
38	Florida Statutes, are amended, present subsections (27), (28),
39	and (29) are renumbered as subsections (28), (29), and (30),
40	respectively, and a new subsection (27) is added to that
41	section, to read:
42	400.462  Definitions.-As used in this part, the term:
43	(2)  "Admission" means a decision by the home health
44	agency, during or after an evaluation visit with the patient to
45	the patient's home, that there is reasonable expectation that
46	the patient's medical, nursing, and social needs for skilled
47	care can be adequately met by the agency in the patient's place
48	of residence. Admission includes completion of an agreement with
49	the patient or the patient's legal representative to provide
50	home health services as required in s. 400.487(1).
51	(14)  "Home health services" means health and medical
52	services and medical supplies furnished by an organization to an
53	individual in the individual's home or place of residence. The
54	term includes organizations that provide one or more of the
55	following:
56	(a)  Nursing care.
57	(b)  Physical, occupational, respiratory, or speech
58	therapy.
59	(c)  Home health aide services.
60	(d)  Dietetics and nutrition practice and nutrition
61	counseling.
62	(e)  Medical supplies and durable medical equipment,
63	restricted to drugs and biologicals prescribed by a physician.
64	(27)  "Primary home health agency" means the agency that is
65	responsible for the services furnished to patients and for
66	implementation of the plan of care.
67	Section 2.  Section 400.476, Florida Statutes, is amended
68	to read:
69	400.476  Personnel Staffing requirements; notifications;
70	limitations on staffing services.-
71	(1)  ADMINISTRATOR.-
72	(a)  An administrator may manage only one home health
73	agency, except that an administrator may manage up to five home
74	health agencies if all five home health agencies have identical
75	controlling interests as defined in s. 408.803 and are located
76	within one agency geographic service area or within an
77	immediately contiguous county. If the home health agency is
78	licensed under this chapter and is part of a retirement
79	community that provides multiple levels of care, an employee of
80	the retirement community may administer the home health agency
81	and up to a maximum of four entities licensed under this chapter
82	or chapter 429 which all have identical controlling interests as
83	defined in s. 408.803. An administrator shall designate, in
84	writing, for each licensed entity, a qualified alternate
85	administrator to serve during the administrator's absence. An
86	alternate administrator must meet the requirements of this
87	paragraph and the definition of administrator provided in s.
88	400.462.
89	(b)  An administrator of a home health agency who is a
90	licensed physician, physician assistant, or registered nurse
91	licensed to practice in this state may also be the director of
92	nursing for a home health agency. An administrator may serve as
93	a director of nursing for up to the number of entities
94	authorized in subsection (2) only if there are 10 or fewer full-
95	time equivalent employees and contracted personnel in each home
96	health agency.
97	(c)  An administrator of a home health agency shall:
98	1.  Organize and direct the agency's ongoing functions.
99	2.  Maintain ongoing liaisons with the board members and
100	the agency's staff.
101	3.  Employ qualified personnel.
102	4.  Ensure adequate staff education and evaluations.
103	5.  Ensure the accuracy of public information materials and
104	activities.
105	6.  Implement an effective budgeting and accounting system.
106	7.  Ensure that the home health agency operates in
107	compliance with this part, part II of chapter 408, and
108	department rules.
109	8.  Ensure that the organizational structure, including the
110	specific administrative responsibilities and the lines of
111	authority for the delegation of responsibility down to the
112	patient care level, and the services offered are clearly set
113	forth in writing. Administrative and supervisory functions may
114	not be delegated to another agency or organization and all
115	services not furnished directly by the primary home health
116	agency, including services provided through contracts, must be
117	monitored and controlled by the primary home health agency.
118	(2)  DIRECTOR OF NURSING.-
119	(a)  A director of nursing may be the director of nursing
120	for:
121	1.  Up to two licensed home health agencies if the agencies
122	have identical controlling interests as defined in s. 408.803
123	and are located within one agency geographic service area or
124	within an immediately contiguous county; or
125	2.  Up to five licensed home health agencies if:
126	a.  All of the home health agencies have identical
127	controlling interests as defined in s. 408.803;
128	b.  All of the home health agencies are located within one
129	agency geographic service area or within an immediately
130	contiguous county; and
131	c.  Each home health agency has a registered nurse who
132	meets the qualifications of a director of nursing and who has a
133	written delegation from the director of nursing to serve as the
134	director of nursing for that home health agency when the
135	director of nursing is not present; and
136	d.  The director of nursing, or a similarly qualified
137	alternate, is available at all times during the operating hours
138	of the home health agency and participates in all activities
139	related to the provision of professional services by the home
140	health agency, including, but not limited to, the assignment of
141	personnel and the oversight of nursing services, home health
142	aides, and certified nursing assistants.
143
144	If a home health agency licensed under this chapter is part of a
145	retirement community that provides multiple levels of care, an
146	employee of the retirement community may serve as the director
147	of nursing of the home health agency and up to a maximum of four
148	entities, other than home health agencies, licensed under this
149	chapter or chapter 429 which all have identical controlling
150	interests as defined in s. 408.803.
151	(b)  A home health agency that provides skilled nursing
152	care may not operate for more than 30 calendar days without a
153	director of nursing. A home health agency that provides skilled
154	nursing care and the director of nursing of a home health agency
155	must notify the agency within 10 business days after termination
156	of the services of the director of nursing for the home health
157	agency. A home health agency that provides skilled nursing care
158	must notify the agency of the identity and qualifications of the
159	new director of nursing within 10 days after the new director is
160	hired. If a home health agency that provides skilled nursing
161	care operates for more than 30 calendar days without a director
162	of nursing, the home health agency commits a class II
163	deficiency. In addition to the fine for a class II deficiency,
164	the agency may issue a moratorium in accordance with s. 408.814
165	or revoke the license. The agency shall fine a home health
166	agency that fails to notify the agency as required in this
167	paragraph $1,000 for the first violation and $2,000 for a repeat
168	violation. The agency may not take administrative action against
169	a home health agency if the director of nursing fails to notify
170	the department upon termination of services as the director of
171	nursing for the home health agency.
172	(c)  A home health agency that is not Medicare or Medicaid
173	certified and does not provide skilled care or provides only
174	physical, occupational, or speech therapy is not required to
175	have a director of nursing and is exempt from paragraph (b).
176	(3)  TRAINING.-A home health agency shall ensure that each
177	certified nursing assistant employed by or under contract with
178	the home health agency and each home health aide employed by or
179	under contract with the home health agency is adequately trained
180	to perform the tasks of a home health aide in the home setting.
181	(a)  The home health agency may not use an individual to
182	provide services as a home health aide on a full-time,
183	temporary, per diem, or other basis unless the individual has
184	completed a training and competency evaluation program or has
185	successfully passed a competency test, as provided in s.
186	400.497, that meets the minimum standards established under
187	agency rules.
188	(b)  A home health aide is not considered competent to
189	perform any task for which he or she has received an evaluation
190	of "unsatisfactory." The aide must not perform that task without
191	being under the direct supervision of a licensed practical nurse
192	until he or she receives training in that task and subsequently
193	receives an evaluation of "satisfactory." A home health aide is
194	not considered to have successfully passed a competency
195	evaluation if the aide does not have a passing score on the
196	competency test as specified in department rule.
197	(4)  STAFFING.-Staffing services may be provided anywhere
198	within the state.
199	(5)  PERSONNEL.-
200	(a)  A home health agency and its staff must comply with
201	accepted professional standards and principles, including, but
202	not limited to, the applicable practice act and the home health
203	agency's policies and procedures.
204	(b)  A home health agency that employs personnel on an
205	hourly or per-visit basis must provide a written contract
206	between the agency and those personnel that specifies the
207	following:
208	1.  The acceptance of patients for care only by the primary
209	home health agency.
210	2.  The services that shall be provided to the patient.
211	3.  The necessity for personnel to conform to all
212	applicable agency policies, including personnel qualifications.
213	4.  The responsibility of personnel to participate in
214	developing plans of care.
215	5.  The manner in which services will be controlled,
216	coordinated, and evaluated by the primary home health agency.
217	6.  The procedures for submitting clinical and progress
218	notes, the scheduling of visits, and the periodic evaluation of
219	patients.
220	7.  The procedures for payment for services furnished under
221	the contract.
222	(c)  A home health agency shall provide at least one type
223	of service directly through home health agency employees but may
224	provide additional services under an arrangement with another
225	agency or organization. Services provided under those
226	arrangements must have a written contract that conforms with the
227	requirements specified in paragraph (b).
228	(d)  If home health aide services are provided by an
229	individual who is not employed directly by the home health
230	agency, the services of that home health aide must be provided
231	pursuant to paragraphs (b) and (c). If the home health agency
232	chooses to provide home health aide services under an
233	arrangement with another agency or organization, the
234	responsibilities of the home health agency shall include, but
235	are not limited to:
236	1.  Ensuring the overall quality of the care provided by
237	the home health aide.
238	2.  Supervising the services provided by the home health
239	aide as described in s. 400.487.
240	3.  Ensuring that a home health aide who provides services
241	under an arrangement with another agency or organization has met
242	the training and competency evaluation requirements of s.
243	400.497.
244	(e)  All personnel furnishing home health services to a
245	patient must maintain liaison with the other home health aides
246	providing services to that patient to ensure that their efforts
247	are coordinated effectively and to support the objectives
248	outlined in the patient's plan of care. The clinical record or
249	minutes of case conferences shall be reviewed by the agency to
250	determine whether effective exchange, reporting, and
251	coordination of information regarding patient care has occurred.
252	Section 3.  Section 400.487, Florida Statutes, is amended
253	to read:
254	400.487  Home health service agreements; physician's,
255	physician assistant's, and advanced registered nurse
256	practitioner's treatment orders; notice of patient' rights;
257	patient assessment; establishment and review of plan of care;
258	provision of services; orders not to resuscitate.-
259	(1)  Services provided by a home health agency must be
260	covered by an agreement between the home health agency and the
261	patient or the patient's legal representative specifying the
262	home health services to be provided, the rates or charges for
263	services paid with private funds, and the sources of payment,
264	which may include Medicare, Medicaid, private insurance,
265	personal funds, or a combination thereof. The home health agency
266	shall provide a copy of the agreement to the patient or the
267	patient's legal representative. A home health agency providing
268	skilled care must make an assessment of the patient's needs
269	within 48 hours after the start of services.
270	(2)  When required by the provisions of chapter 464; part
271	I, part III, or part V of chapter 468; or chapter 486, the
272	attending physician, physician assistant, or advanced registered
273	nurse practitioner, acting within his or her respective scope of
274	practice, shall establish treatment orders for a patient who is
275	to receive skilled care. The treatment orders must be signed by
276	the physician, physician assistant, or advanced registered nurse
277	practitioner before a claim for payment for the skilled services
278	is submitted by the home health agency. If the claim is
279	submitted to a managed care organization, the treatment orders
280	must be signed within the time allowed under the provider
281	agreement. The treatment orders shall be reviewed, as frequently
282	as the patient's illness requires, by the physician, physician
283	assistant, or advanced registered nurse practitioner in
284	consultation with the home health agency.
285	(3)  A home health agency shall arrange for supervisory
286	visits by a registered nurse to the home of a patient receiving
287	home health aide services as specified in subsection (9) in
288	accordance with the patient's direction, approval, and agreement
289	to pay the charge for the visits.
290	(4)  A home health agency shall protect and promote the
291	rights of each individual under its care, including:
292	(a)  Notice of rights.-The home health agency shall provide
293	the patient with a written notice of the patient's rights before
294	furnishing care to the patient or during the initial evaluation
295	visit before the initiation of treatment or care. The home
296	health agency shall maintain documentation showing that it has
297	complied with the requirements of this subsection.
298	(b)  Exercise of patient rights and respect for property
299	and person.-The patient has the right to exercise his or her
300	rights as a patient of the home health agency, which shall
301	include:
302	1.  The patient has the right to have his or her property
303	treated with respect.
304	2.  The patient has the right to voice grievances regarding
305	treatment or care that is or fails to be furnished or a failure
306	to respect the patient's property by anyone who is furnishing
307	services on behalf of the home health agency, and the patient
308	may not be subjected to discrimination or reprisal for voicing
309	such grievances.
310	3.  The home health agency must investigate complaints made
311	by a patient or the patient's family or legal representative
312	regarding treatment or care that is or fails to be furnished or
313	a failure to respect the patient's property by anyone furnishing
314	services on behalf of the home health agency, and the home
315	health agency shall document both the existence of the complaint
316	and the resolution of the complaint.
317	4.  The patient and his or her immediate family or legal
318	representative must be informed of the right to report
319	complaints to the agency statewide toll-free telephone number as
320	provided in s. 408.810.
321	(c)  Right to be informed and participate in planning
322	treatment and care.-
323	1.  The Each patient has the right to be informed in
324	advance by the home health agency of: and
325	a.  The right to participate in the planning of his or her
326	treatment and care and planning any changes to the treatment and
327	care.
328	b.  The individuals who will provide the treatment and care
329	and the proposed frequency of their visits.
330	2.  Each patient must be provided, upon request, a copy of
331	the plan of care established and maintained for that patient by
332	the home health agency.
333	(5)  When nursing services are ordered, the home health
334	agency to which a patient has been admitted for care must
335	provide the initial admission visit, all service evaluation
336	visits, and the discharge visit by a direct employee. Services
337	provided by others under contractual arrangements to a home
338	health agency must be monitored and managed by the admitting
339	home health agency. The admitting home health agency is fully
340	responsible for ensuring that all care provided through its
341	employees or contract staff is delivered in accordance with this
342	part and applicable rules.
343	(6)  The skilled care services provided by a home health
344	agency, directly or under contract, must be supervised and
345	coordinated in accordance with the plan of care. The home health
346	agency shall provide skilled nursing services by or under the
347	supervision of a registered nurse and in accordance with the
348	plan of care. Any therapy services offered by the home health
349	agency directly or under a contractual arrangement shall be
350	provided by a qualified therapist or a qualified therapy
351	assistant under the supervision of a qualified therapist and in
352	accordance with the plan of care.
353	(a)  A qualified therapist assists the physician in
354	evaluating the patient's level of functioning, helps develop the
355	plan of care and revises the plan as necessary, prepares
356	clinical and progress notes, advises and consults with the
357	family and other agency personnel, and participates in inservice
358	programs.
359	(b)  The therapist or therapy assistant must meet the
360	qualifications in the applicable practice act and related rules.
361	(c)  A physical therapist assistant or occupational therapy
362	assistant who provides services must be under the supervision of
363	a qualified physical therapist or occupational therapist as
364	required in the applicable practice act and related rules.
365	(d)  A physical therapist assistant or occupational therapy
366	assistant performs services planned, delegated, and supervised
367	by the therapist, assists in preparing clinical notes and
368	progress reports, participates in educating the patient and
369	family, and participates in inservice training programs.
370	(e)  Speech therapy services are furnished only by or under
371	the supervision of a qualified speech-language pathologist or
372	audiologist as required in the applicable practice act and
373	related rules.
374	(f)  Services are provided according to a written plan of
375	care. The plan of care shall be reviewed by the physician or
376	health professional who provided the treatment orders in
377	subsection (2) and home health agency personnel as often as the
378	severity of the patient's condition requires, but at least once
379	every 60 days or more frequently when there is a beneficiary-
380	elected transfer, there is a significant change in the patient's
381	condition resulting in a change in the case-mix assignment, or a
382	patient is discharged and subsequently returned to the same home
383	health agency during the 60-day period. Home health agency
384	personnel shall promptly alert the physician or other health
385	professional who provided the treatment orders regarding any
386	changes that suggest a need to alter the plan of care.
387	(g)  Drugs and treatments may only be administered by home
388	health agency personnel as ordered by a physician or health
389	professional as specified in subsection (2), except that
390	influenza and pneumococcal polysaccharide vaccines may be
391	administered according to the agency's policy, which shall be
392	developed in consultation with a physician, and after an
393	assessment for contraindications. Verbal orders shall be put in
394	writing and signed and dated with the date of receipt by the
395	registered nurse or qualified therapist responsible for
396	furnishing or supervising the ordered services. Verbal orders
397	shall only be accepted by personnel authorized to do so under
398	applicable state law and department rules and by the home health
399	agency's internal policies.
400	(7)  The registered nurse shall make the initial evaluation
401	visit, regularly reevaluate the patient's nursing needs,
402	initiate the plan of care and necessary revisions, furnish those
403	services requiring substantial and specialized nursing skill,
404	initiate appropriate preventive and rehabilitative nursing
405	procedures, prepare clinical and progress notes, coordinate
406	services, inform the physician and other personnel of changes in
407	the patient's condition and needs, counsel the patient and
408	family regarding meeting nursing and related needs, participate
409	in inservice training programs, and supervise and teach other
410	nursing personnel.
411	(8)  The licensed practical nurse shall furnish services in
412	accordance with agency policies, prepare clinical and progress
413	notes, assist the physician and registered nurse in performing
414	specialized procedures, prepare equipment and materials for
415	treatments, observing aseptic technique as required, and assist
416	the patient in learning appropriate self-care techniques.
417	(9)  The home health aide and the certified nursing
418	assistant provide services that are ordered by the physician in
419	the plan of care and that the home health aide or the certified
420	nursing assistant is permitted to perform under state law. The
421	duties of a home health aide and a certified nursing assistant
422	include the provision of hands-on personal care, performance of
423	simple procedures as an extension of therapy or nursing
424	services, assistance in ambulation or exercises, and assistance
425	in administering medications that are ordinarily self-
426	administered, as specified in state rules. Home health aide
427	services offered by a home health agency must be provided by a
428	qualified home health aide or a certified nursing assistant.
429	(a)  The home health aide or the certified nursing
430	assistant shall be assigned to a specific patient by the
431	registered nurse. Written patient care instructions for the home
432	health aide and the certified nursing assistant shall be
433	prepared by the registered nurse or other appropriate
434	professional who is responsible for the supervision of the home
435	health aide and the certified nursing assistant.
436	(b)  If the patient receives skilled nursing care, the
437	registered nurse shall perform the supervisory visit. If the
438	patient is not receiving skilled nursing care but is receiving
439	physical therapy, occupational therapy, or speech-language
440	pathology services, the appropriate therapist may perform the
441	supervisory visit. The registered nurse or other professional
442	must make an onsite visit to the patient's home no less
443	frequently than every 2 weeks. The visit is not required to be
444	while the home health aide or the certified nursing assistant is
445	providing care.
446	(c)  If home health aide services are provided to a patient
447	who is not receiving skilled nursing care, physical or
448	occupational therapy, or speech-language pathology services, the
449	registered nurse must make a supervisory visit to the patient's
450	home at least every 60 days. In these cases, to ensure that the
451	home health aide or the certified nursing assistant is properly
452	caring for the patient, each supervisory visit must occur while
453	the home health aide or the certified nursing assistant is
454	providing patient care.
455	(10)(7)  Home health agency personnel may withhold or
456	withdraw cardiopulmonary resuscitation if presented with an
457	order not to resuscitate executed pursuant to s. 401.45. The
458	agency shall adopt rules providing for the implementation of
459	such orders. Home health personnel and agencies shall not be
460	subject to criminal prosecution or civil liability, nor be
461	considered to have engaged in negligent or unprofessional
462	conduct, for withholding or withdrawing cardiopulmonary
463	resuscitation pursuant to such an order and rules adopted by the
464	agency.
465	Section 4.  Subsection (2) of section 400.933, Florida
466	Statutes, is amended to read:
467	400.933  Licensure inspections and investigations.-
468	(2)  The agency shall accept, in lieu of its own periodic
469	inspections for licensure, submission of the following:
470	(a)  The survey or inspection of an accrediting
471	organization, provided the accreditation of the licensed home
472	medical equipment provider is not conditional or provisional and
473	provided the licensed home medical equipment provider authorizes
474	release of, and the agency receives the report of, the
475	accrediting organization.; or
476	(b)  A copy of a valid medical oxygen retail establishment
477	permit issued by the Department of Health, pursuant to chapter
478	499.
479	Section 5.  Subsection (1) of section 400.969, Florida
480	Statutes, is amended to read:
481	400.969  Violation of part; penalties.-
482	(1)  In addition to the requirements of part II of chapter
483	408, and except as provided in s. 400.967(3), a violation of any
484	provision of federal certification required pursuant to s.
485	400.960(8), this part, part II of chapter 408, or applicable
486	rules is punishable by payment of an administrative or civil
487	penalty not to exceed $5,000.
488	Section 6.  Section 408.805, Florida Statutes, is amended
489	to read:
490	408.805  Fees required; adjustments.-Unless otherwise
491	limited by authorizing statutes, License fees must be reasonably
492	calculated by the agency to cover its costs in carrying out its
493	responsibilities under this part, authorizing statutes, and
494	applicable rules, including the cost of licensure, inspection,
495	and regulation of providers.
496	(1)  Licensure fees shall be adjusted to provide for
497	biennial licensure under agency rules.
498	(2)  The agency shall annually adjust licensure fees,
499	including fees paid per bed, by not more than 10 percent above
500	the change in the Consumer Price Index based on the 12 months
501	immediately preceding the increase.
502	(3)  An inspection fee must be paid as required in
503	authorizing statutes.
504	(4)  Fees are nonrefundable.
505	(5)  When a change is reported that requires issuance of a
506	license, a fee may be assessed. The fee must be based on the
507	actual cost of processing and issuing the license.
508	(6)  A fee may be charged to a licensee requesting a
509	duplicate license. The fee may not exceed the actual cost of
510	duplication and postage.
511	(7)  Total fees collected may not exceed the cost of
512	administering this part, authorizing statutes, and applicable
513	rules.
514	Section 7.  Paragraph (a) of subsection (1) of section
515	429.41, Florida Statutes, is amended to read:
516	429.41  Rules establishing standards.-
517	(1)  It is the intent of the Legislature that rules
518	published and enforced pursuant to this section shall include
519	criteria by which a reasonable and consistent quality of
520	resident care and quality of life may be ensured and the results
521	of such resident care may be demonstrated. Such rules shall also
522	ensure a safe and sanitary environment that is residential and
523	noninstitutional in design or nature. It is further intended
524	that reasonable efforts be made to accommodate the needs and
525	preferences of residents to enhance the quality of life in a
526	facility. The agency, in consultation with the department, may
527	adopt rules to administer the requirements of part II of chapter
528	408. In order to provide safe and sanitary facilities and the
529	highest quality of resident care accommodating the needs and
530	preferences of residents, the department, in consultation with
531	the agency, the Department of Children and Family Services, and
532	the Department of Health, shall adopt rules, policies, and
533	procedures to administer this part, which must include
534	reasonable and fair minimum standards in relation to:
535	(a)  The requirements for and maintenance of facilities,
536	not in conflict with the provisions of chapter 553, relating to
537	plumbing, heating, cooling, lighting, ventilation, living space,
538	and other housing conditions, which will ensure the health,
539	safety, and comfort of residents and protection from fire
540	hazard, including adequate provisions for fire alarm and other
541	fire protection suitable to the size of the structure. Uniform
542	firesafety standards shall be established and enforced by the
543	State Fire Marshal in cooperation with the agency, the
544	department, and the Department of Health.
545	1.  Evacuation capability determination.-
546	a.  The provisions of the National Fire Protection
547	Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
548	for determining the ability of the residents, with or without
549	staff assistance, to relocate from or within a licensed facility
550	to a point of safety as provided in the fire codes adopted
551	herein. An evacuation capability evaluation for initial
552	licensure shall be conducted within 6 months after the date of
553	licensure. For existing licensed facilities that are not
554	equipped with an automatic fire sprinkler system, the
555	administrator shall evaluate the evacuation capability of
556	residents at least annually. The evacuation capability
557	evaluation for each facility not equipped with an automatic fire
558	sprinkler system shall be validated, without liability, by the
559	State Fire Marshal, by the local fire marshal, or by the local
560	authority having jurisdiction over firesafety, before the
561	license renewal date. If the State Fire Marshal, local fire
562	marshal, or local authority having jurisdiction over firesafety
563	has reason to believe that the evacuation capability of a
564	facility as reported by the administrator may have changed, it
565	may, with assistance from the facility administrator, reevaluate
566	the evacuation capability through timed exiting drills.
567	Translation of timed fire exiting drills to evacuation
568	capability may be determined:
569	(I)  Three minutes or less: prompt.
570	(II)  More than 3 minutes, but not more than 13 minutes:
571	slow.
572	(III)  More than 13 minutes: impractical.
573	b.  The Office of the State Fire Marshal shall provide or
574	cause the provision of training and education on the proper
575	application of Chapter 5, NFPA 101A, 1995 edition, to its
576	employees, to staff of the Agency for Health Care Administration
577	who are responsible for regulating facilities under this part,
578	and to local governmental inspectors. The Office of the State
579	Fire Marshal shall provide or cause the provision of this
580	training within its existing budget, but may charge a fee for
581	this training to offset its costs. The initial training must be
582	delivered within 6 months after July 1, 1995, and as needed
583	thereafter.
584	c.  The Office of the State Fire Marshal, in cooperation
585	with provider associations, shall provide or cause the provision
586	of a training program designed to inform facility operators on
587	how to properly review bid documents relating to the
588	installation of automatic fire sprinklers. The Office of the
589	State Fire Marshal shall provide or cause the provision of this
590	training within its existing budget, but may charge a fee for
591	this training to offset its costs. The initial training must be
592	delivered within 6 months after July 1, 1995, and as needed
593	thereafter.
594	d.  The administrator of a licensed facility shall sign an
595	affidavit verifying the number of residents occupying the
596	facility at the time of the evacuation capability evaluation.
597	2.  Firesafety requirements.-
598	a.  Except for the special applications provided herein,
599	effective January 1, 2011 1996, the provisions of the current
600	edition of the National Fire Protection Association, Life Safety
601	Code, NFPA 101, 1994 edition, Chapter 22 for new facilities and
602	Chapter 23 for existing facilities shall be the uniform fire
603	code applied by the State Fire Marshal for assisted living
604	facilities, pursuant to s. 633.022.
605	b.  Any new facility, regardless of size, that applies for
606	a license on or after January 1, 1996, must be equipped with an
607	automatic fire sprinkler system. The exceptions as provided in
608	s. 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein, apply
609	to any new facility housing eight or fewer residents. On July 1,
610	1995, local governmental entities responsible for the issuance
611	of permits for construction shall inform, without liability, any
612	facility whose permit for construction is obtained prior to
613	January 1, 1996, of this automatic fire sprinkler requirement.
614	As used in this part, the term "a new facility" does not mean an
615	existing facility that has undergone change of ownership.
616	c.  Notwithstanding any provision of s. 633.022 or of the
617	National Fire Protection Association, NFPA 101A, Chapter 5, 1995
618	edition, to the contrary, any existing facility housing eight or
619	fewer residents is not required to install an automatic fire
620	sprinkler system, nor to comply with any other requirement in
621	Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
622	requirements of NFPA 101, 1988 edition, that applies to this
623	size facility, unless the facility has been classified as
624	impractical to evacuate. Any existing facility housing eight or
625	fewer residents that is classified as impractical to evacuate
626	must install an automatic fire sprinkler system within the
627	timeframes granted in this section.
628	d.  Any existing facility that is required to install an
629	automatic fire sprinkler system under this paragraph need not
630	meet other firesafety requirements of Chapter 23, NFPA 101, 1994
631	edition, which exceed the provisions of NFPA 101, 1988 edition.
632	The mandate contained in this paragraph which requires certain
633	facilities to install an automatic fire sprinkler system
634	supersedes any other requirement.
635	e.  This paragraph does not supersede the exceptions
636	granted in NFPA 101, 1988 edition or 1994 edition.
637	f.  This paragraph does not exempt facilities from other
638	firesafety provisions adopted under s. 633.022 and local
639	building code requirements in effect before July 1, 1995.
640	g.  A local government may charge fees only in an amount
641	not to exceed the actual expenses incurred by local government
642	relating to the installation and maintenance of an automatic
643	fire sprinkler system in an existing and properly licensed
644	assisted living facility structure as of January 1, 1996.
645	h.  If a licensed facility undergoes major reconstruction
646	or addition to an existing building on or after January 1, 1996,
647	the entire building must be equipped with an automatic fire
648	sprinkler system. Major reconstruction of a building means
649	repair or restoration that costs in excess of 50 percent of the
650	value of the building as reported on the tax rolls, excluding
651	land, before reconstruction. Multiple reconstruction projects
652	within a 5-year period the total costs of which exceed 50
653	percent of the initial value of the building at the time the
654	first reconstruction project was permitted are to be considered
655	as major reconstruction. Application for a permit for an
656	automatic fire sprinkler system is required upon application for
657	a permit for a reconstruction project that creates costs that go
658	over the 50-percent threshold.
659	i.  Any facility licensed before January 1, 1996, that is
660	required to install an automatic fire sprinkler system shall
661	ensure that the installation is completed within the following
662	timeframes based upon evacuation capability of the facility as
663	determined under subparagraph 1.:
664	(I)  Impractical evacuation capability, 24 months.
665	(II)  Slow evacuation capability, 48 months.
666	(III)  Prompt evacuation capability, 60 months.
667
668	The beginning date from which the deadline for the automatic
669	fire sprinkler installation requirement must be calculated is
670	upon receipt of written notice from the local fire official that
671	an automatic fire sprinkler system must be installed. The local
672	fire official shall send a copy of the document indicating the
673	requirement of a fire sprinkler system to the Agency for Health
674	Care Administration.
675	j.  It is recognized that the installation of an automatic
676	fire sprinkler system may create financial hardship for some
677	facilities. The appropriate local fire official shall, without
678	liability, grant two 1-year extensions to the timeframes for
679	installation established herein, if an automatic fire sprinkler
680	installation cost estimate and proof of denial from two
681	financial institutions for a construction loan to install the
682	automatic fire sprinkler system are submitted. However, for any
683	facility with a class I or class II, or a history of uncorrected
684	class III, firesafety deficiencies, an extension must not be
685	granted. The local fire official shall send a copy of the
686	document granting the time extension to the Agency for Health
687	Care Administration.
688	k.  A facility owner whose facility is required to be
689	equipped with an automatic fire sprinkler system under Chapter
690	23, NFPA 101, 1994 edition, as adopted herein, must disclose to
691	any potential buyer of the facility that an installation of an
692	automatic fire sprinkler requirement exists. The sale of the
693	facility does not alter the timeframe for the installation of
694	the automatic fire sprinkler system.
695	l.  Existing facilities required to install an automatic
696	fire sprinkler system as a result of construction-type
697	restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
698	herein, or evacuation capability requirements shall be notified
699	by the local fire official in writing of the automatic fire
700	sprinkler requirement, as well as the appropriate date for final
701	compliance as provided in this subparagraph. The local fire
702	official shall send a copy of the document to the Agency for
703	Health Care Administration.
704	m.  Except in cases of life-threatening fire hazards, if an
705	existing facility experiences a change in the evacuation
706	capability, or if the local authority having jurisdiction
707	identifies a construction-type restriction, such that an
708	automatic fire sprinkler system is required, it shall be
709	afforded time for installation as provided in this subparagraph.
710
711	Facilities that are fully sprinkled and in compliance with other
712	firesafety standards are not required to conduct more than one
713	of the required fire drills between the hours of 11 p.m. and 7
714	a.m., per year. In lieu of the remaining drills, staff
715	responsible for residents during such hours may be required to
716	participate in a mock drill that includes a review of evacuation
717	procedures. Such standards must be included or referenced in the
718	rules adopted by the State Fire Marshal. Pursuant to s.
719	633.022(1)(b), the State Fire Marshal is the final
720	administrative authority for firesafety standards established
721	and enforced pursuant to this section. All licensed facilities
722	must have an annual fire inspection conducted by the local fire
723	marshal or authority having jurisdiction.
724	3.  Resident elopement requirements.-Facilities are
725	required to conduct a minimum of two resident elopement
726	prevention and response drills per year. All administrators and
727	direct care staff must participate in the drills which shall
728	include a review of procedures to address resident elopement.
729	Facilities must document the implementation of the drills and
730	ensure that the drills are conducted in a manner consistent with
731	the facility's resident elopement policies and procedures.
732	Section 8.  Subsections (2) and (11) of section 429.65,
733	Florida Statutes, are amended to read:
734	429.65  Definitions.-As used in this part, the term:
735	(2)  "Adult family-care home" means a full-time, family-
736	type living arrangement, in a private home, under which up to
737	two individuals a person who reside in the home and own or rent
738	owns or rents the home provide provides room, board, and
739	personal care, on a 24-hour basis, for no more than five
740	disabled adults or frail elders who are not relatives. The
741	following family-type living arrangements are not required to be
742	licensed as an adult family-care home:
743	(a)  An arrangement whereby a the person who resides in the
744	home and owns or rents the home provides room, board, and
745	personal care services for not more than two adults who do not
746	receive optional state supplementation under s. 409.212. The
747	person who provides the housing, meals, and personal care must
748	own or rent the home and reside therein.
749	(b)  An arrangement whereby a the person who owns or rents
750	the home provides room, board, and personal services only to his
751	or her relatives.
752	(c)  An establishment that is licensed as an assisted
753	living facility under this chapter.
754	(11)  "Provider" means one or two individuals a person who
755	are is licensed to operate an adult family-care home.
756	Section 9.  This act shall take effect July 1, 2010.

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