CS/CS/HB 119

1	A bill to be entitled
2	An act relating to health care; amending s. 83.42, F.S.,
3	establishing that s. 400.0255, F.S., provides exclusive
4	procedures for resident transfer and discharge; amending
5	s. 112.0455, F.S., relating to the Drug-Free Workplace
6	Act; deleting an obsolete provision; deleting a
7	requirement that a laboratory that conducts drug tests
8	submit certain reports to the Agency for Health Care
9	Administration; amending s. 318.21, F.S.; revising
10	distribution of funds from civil penalties imposed for
11	traffic infractions by county courts; repealing s.
12	383.325, F.S., relating to confidentiality of inspection
13	reports of licensed birth center facilities; amending s.
14	395.002, F.S.; revising and deleting definitions
15	applicable to regulation of hospitals and other licensed
16	facilities; conforming a cross-reference; amending s.
17	395.003, F.S.; deleting an obsolete provision; conforming
18	a cross-reference; amending s. 395.0161, F.S.; deleting a
19	provision requiring licensure inspection fees for
20	hospitals, ambulatory surgical centers, and mobile
21	surgical facilities to be paid at the time of the
22	inspection; amending s. 395.0193, F.S.; requiring a
23	licensed facility to report certain peer review
24	information and final disciplinary actions to the Division
25	of Medical Quality Assurance of the Department of Health
26	rather than the Division of Health Quality Assurance of
27	the Agency for Health Care Administration; amending s.
28	395.1023, F.S.; providing for the Department of Children
29	and Family Services rather than the Department of Health
30	to perform certain functions with respect to child
31	protection cases; requiring certain hospitals to notify
32	the Department of Children and Family Services of
33	compliance; amending s. 395.1041, F.S., relating to
34	hospital emergency services and care; deleting obsolete
35	provisions; repealing s. 395.1046, F.S., relating to
36	complaint investigation procedures; amending s. 395.1055,
37	F.S.; requiring additional housekeeping and sanitation
38	procedures in licensed facilities for infection control
39	purposes; requiring licensed facility beds to conform to
40	standards specified by the Agency for Health Care
41	Administration, the Florida Building Code, and the Florida
42	Fire Prevention Code; amending s. 395.10972, F.S.;
43	revising a reference to the Florida Society of Healthcare
44	Risk Management to conform to the current designation;
45	amending s. 395.2050, F.S.; revising a reference to the
46	federal Health Care Financing Administration to conform to
47	the current designation; amending s. 395.3036, F.S.;
48	correcting a reference; repealing s. 395.3037, F.S.,
49	relating to redundant definitions; amending ss. 154.11,
50	394.741, 395.3038, 400.925, 400.9935, 408.05, 440.13,
51	627.645, 627.668, 627.669, 627.736, 641.495, and 766.1015,
52	F.S.; revising references to the Joint Commission on
53	Accreditation of Healthcare Organizations, the Commission
54	on Accreditation of Rehabilitation Facilities, and the
55	Council on Accreditation to conform to their current
56	designations; amending s. 395.4025, F.S.; authorizing the
57	Department of Health to grant additional extensions for
58	trauma center applicants under certain circumstances;
59	amending s. 395.602, F.S.; revising the definition of the
60	term "rural hospital" to delete an obsolete provision;
61	amending s. 400.021, F.S.; revising the definition of the
62	term "geriatric outpatient clinic" to include additional
63	staff; revising the term "resident care plan"; removing a
64	provision that requires certain signatures on the plan;
65	amending s. 400.0255, F.S.; correcting an obsolete cross-
66	reference to administrative rules; amending s. 400.063,
67	F.S.; deleting an obsolete provision; amending ss. 400.071
68	and 400.0712, F.S.; revising applicability of general
69	licensure requirements under part II of ch. 408, F.S., the
70	Health Care Licensing Procedures Act, to applications for
71	nursing home licensure; revising provisions governing
72	inactive licenses; amending s. 400.111, F.S.; providing
73	for disclosure of controlling interest of a nursing home
74	facility upon request by the Agency for Health Care
75	Administration; amending s. 400.1183, F.S.; revising
76	grievance record maintenance and reporting requirements
77	for nursing homes; amending s. 400.141, F.S.; providing
78	criteria for the provision of respite services by nursing
79	homes; requiring a written plan of care; requiring a
80	contract for services; requiring resident release to
81	caregivers to be designated in writing; providing an
82	exemption to the application of discharge planning rules;
83	providing for residents' rights; providing for use of
84	personal medications; providing terms of respite stay;
85	providing for communication of patient information;
86	requiring a physician's order for care and proof of a
87	physical examination; providing for services for respite
88	patients and duties of facilities with respect to such
89	patients; conforming a cross-reference; requiring
90	facilities to maintain clinical records that meet
91	specified standards; providing a fine relating to an
92	admissions moratorium; deleting requirement for facilities
93	to submit certain information related to management
94	companies to the agency; deleting a requirement for
95	facilities to notify the agency of certain bankruptcy
96	filings to conform to changes made by the act; providing a
97	limit on fees charged by a facility for copies of patient
98	records; amending s. 400.142, F.S.; deleting language
99	relating to agency adoption of rules; repealing s.
100	400.145, F.S., relating to records of care and treatment
101	of residents; repealing ss. 400.0234 and 429.294, F.S.,
102	relating to availability of facility records for
103	investigation of resident's rights violations and
104	defenses; amending 400.147, F.S.; removing a requirement
105	for nursing homes and related health care facilities to
106	notify the agency within a specified period of time after
107	receipt of an adverse incident report; revising reporting
108	requirements for licensed nursing home facilities relating
109	to adverse incidents; repealing s. 400.148, F.S., relating
110	to the Medicaid "Up-or-Out" Quality of Care Contract
111	Management Program; amending s. 400.179, F.S.; deleting an
112	obsolete provision; amending s. 400.19, F.S.; revising
113	inspection requirements; amending s. 400.23, F.S.;
114	deleting an obsolete provision; correcting a reference;
115	directing the agency to adopt rules for minimum staffing
116	standards in nursing homes that serve persons under 21
117	years of age; providing minimum staffing standards;
118	amending s. 400.275, F.S.; revising agency duties with
119	regard to training nursing home surveyor teams; revising
120	requirements for team members; amending s. 400.462, F.S.;
121	revising the definition of the term "remuneration" as it
122	applies to home health agencies; amending s. 400.484,
123	F.S.; revising the schedule of home health agency
124	inspection violations; amending s. 400.506, F.S.; deleting
125	language relating to exemptions from penalties imposed on
126	nurse registries if a nurse registry does not bill the
127	Florida Medicaid Program; providing criteria for an
128	administrator to manage a nurse registry; amending s.
129	400.509, F.S.; revising the service providers exempt from
130	licensure registration to include organizations that
131	provide companion services only for persons with
132	developmental disabilities; amending s. 400.606, F.S.;
133	revising the content requirements of the plan accompanying
134	an initial or change-of-ownership application for
135	licensure of a hospice; revising requirements relating to
136	certificates of need for certain hospice facilities;
137	amending s. 400.607, F.S.; revising grounds for agency
138	action against a hospice; amending s. 400.915, F.S.;
139	correcting an obsolete cross-reference to administrative
140	rules; amending s. 400.931, F.S.; deleting a requirement
141	that an applicant for a home medical equipment provider
142	license submit a surety bond to the agency; requiring
143	applicants to submit documentation of accreditation within
144	a specified period of time; amending s. 400.932, F.S.;
145	revising grounds for the imposition of administrative
146	penalties for certain violations by an employee of a home
147	medical equipment provider; amending s. 400.967, F.S.;
148	revising the schedule of inspection violations for
149	intermediate care facilities for the developmentally
150	disabled; providing a penalty for certain violations;
151	amending s. 400.9905, F.S.; revising the definitions of
152	the terms "clinic" and "portable equipment provider";
153	providing that part X of ch. 400, F.S., the Health Care
154	Clinic Act, does not apply to certain clinical facilities,
155	an entity owned by a corporation with a specified amount
156	of annual sales of health care services under certain
157	circumstances, an entity owned or controlled by a publicly
158	traded entity with a specified amount of annual revenues,
159	or an entity that employs a specified number of licensed
160	health care practitioners under certain conditions;
161	amending s. 400.991, F.S.; conforming terminology;
162	revising application requirements relating to
163	documentation of financial ability to operate a mobile
164	clinic; amending s. 408.033, F.S.; permitting fees
165	assessed on certain health care facilities to be collected
166	prospectively at the time of licensure renewal and
167	prorated for the licensure period; amending s. 408.034,
168	F.S.; revising agency authority relating to licensing of
169	intermediate care facilities for the developmentally
170	disabled; amending s. 408.036, F.S.; deleting an exemption
171	from certain certificate-of-need review requirements for a
172	hospice or a hospice inpatient facility; deleting a
173	requirement that the agency submit a report regarding
174	requests for exemption; amending s. 408.037, F.S.;
175	revising certificate-of-need requirements for general
176	hospital applicants to evaluate the applicant's parent
177	corporation if audited financial statements of the
178	applicant do not exist; amending s. 408.043, F.S.;
179	revising requirements for certain freestanding inpatient
180	hospice care facilities to obtain a certificate of need;
181	amending s. 408.061, F.S.; revising health care facility
182	data reporting requirements; amending s. 408.10, F.S.;
183	removing agency authority to investigate certain consumer
184	complaints; amending s. 408.802, F.S.; removing
185	applicability of part II of ch. 408, F.S., relating to
186	general licensure requirements, to private review agents;
187	amending s. 408.804, F.S.; providing penalties for
188	altering, defacing, or falsifying a license certificate
189	issued by the agency or displaying such an altered,
190	defaced, or falsified certificate; amending s. 408.806,
191	F.S.; revising agency responsibilities for notification of
192	licensees of impending expiration of a license; requiring
193	payment of a late fee for a license application to be
194	considered complete under certain circumstances; amending
195	s. 408.8065, F.S.; requiring home health agencies, home
196	medical equipment providers, and health care clinics to
197	submit projected financial statements; amending s.
198	408.809, F.S., relating to background screening of
199	specified employees of health care providers; revising
200	provisions for required rescreening; removing provisions
201	authorizing the agency to adopt rules establishing a
202	rescreening schedule; establishing a rescreening schedule;
203	amending s. 408.810, F.S.; requiring disclosure of
204	information by a controlling interest of certain court
205	actions relating to financial instability within a
206	specified time period; amending s. 408.813, F.S.;
207	authorizing the agency to impose fines for unclassified
208	violations of part II of ch. 408, F.S.; amending s.
209	408.815, F.S.; providing for certain mitigating
210	circumstances to be considered for any application subject
211	to denial; authorizing the agency to extend a license
212	expiration date under certain circumstances; amending s.
213	409.91196, F.S.; revising components of a Medicaid
214	prescribed-drug spending-control program; conforming a
215	cross-reference; amending s. 409.912, F.S.; revising
216	procedures for implementation of a Medicaid prescribed-
217	drug spending-control program; amending s. 429.07, F.S.;
218	deleting the requirement for an assisted living facility
219	to obtain an additional license in order to provide
220	limited nursing services; deleting the requirement for the
221	agency to conduct quarterly monitoring visits of
222	facilities that hold a license to provide extended
223	congregate care services; deleting the requirement for the
224	department to report annually on the status of and
225	recommendations related to extended congregate care;
226	deleting the requirement for the agency to conduct
227	monitoring visits at least twice a year to facilities
228	providing limited nursing services; eliminating the
229	license fee for the limited nursing services license;
230	transferring from another provision of law the requirement
231	that the standard survey of an assisted living facility
232	include specific actions to determine whether the facility
233	is adequately protecting residents' rights; providing that
234	under specified conditions an assisted living facility
235	that has a class I or class II violation is subject to
236	periodic unannounced monitoring; requiring a registered
237	nurse to participate in certain monitoring visits;
238	amending s. 429.11, F.S.; revising licensure application
239	requirements for assisted living facilities to eliminate
240	provisional licenses; amending s. 429.12, F.S.; deleting a
241	requirement that a transferor of an assisted living
242	facility advise the transferee to submit a plan for
243	correction of certain deficiencies to the Agency for
244	Health Care Administration before ownership of the
245	facility is transferred; amending s. 429.14, F.S.;
246	clarifying provisions relating to a facility's request for
247	a hearing under certain circumstances; amending s. 429.17,
248	F.S.; deleting provisions relating to the limited nursing
249	services license; revising agency responsibilities
250	regarding the issuance of conditional licenses; amending
251	s. 429.195, F.S.; revising the list of entities prohibited
252	from providing rebates; providing exceptions to prohibited
253	patient brokering for assisted living facilities; amending
254	s. 429.23, F.S.; deleting reporting requirements for
255	assisted living facilities relating to liability claims;
256	amending s. 429.255, F.S.; eliminating provisions
257	authorizing the use of volunteers to provide certain
258	health-care-related services in assisted living
259	facilities; authorizing assisted living facilities to
260	provide limited nursing services; requiring an assisted
261	living facility to be responsible for certain
262	recordkeeping and staff to be trained to monitor residents
263	receiving certain health-care-related services; amending
264	s. 429.28, F.S.; deleting a requirement for a biennial
265	survey of an assisted living facility, to conform to
266	changes made by the act; conforming a cross-reference;
267	amending s. 429.41, F.S., relating to rulemaking;
268	conforming provisions to changes made by the act; deleting
269	the requirement for the Department of Elderly Affairs to
270	submit a copy of proposed rules to the Legislature;
271	amending s. 429.53, F.S.; revising provisions relating to
272	consultation by the agency; revising a definition;
273	amending s. 429.71, F.S.; revising schedule of inspection
274	violations for adult family-care homes; amending s.
275	429.915, F.S.; revising agency responsibilities regarding
276	the issuance of conditional licenses; amending s. 440.102,
277	F.S.; deleting the requirement for laboratories to submit
278	a monthly report to the agency with statistical
279	information regarding the testing of employees and job
280	applicants; amending s. 456.053, F.S.; revising the
281	definition of the term "group practice" as it relates to
282	financial arrangements of referring health care providers
283	and providers of health care services to include group
284	practices that provide radiation therapy services under
285	certain circumstances; amending s. 483.035, F.S.;
286	requiring certain clinical laboratories operated by one or
287	more practitioners licensed under part I of ch. 464, F.S.,
288	the Nurse Practice Act, to be licensed under part I of ch.
289	483, F.S., the Florida Clinical Laboratory Law; amending
290	s. 483.051, F.S.; establishing qualifications necessary
291	for clinical laboratory licensure; amending s. 483.294,
292	F.S.; revising frequency of agency inspections of
293	multiphasic health testing centers; amending s. 499.003,
294	F.S.; removing the requirement for certain prescription
295	drug purchasers to maintain a separate inventory of
296	certain prescription drugs; amending s. 633.081, F.S.;
297	limiting State Fire Marshal inspections of nursing homes
298	to once a year; providing for additional inspections based
299	on complaints and violations identified in the course of
300	orientation or training activities; amending s. 766.202,
301	F.S.; adding persons licensed under part XIV of ch. 468,
302	F.S., relating to orthotics, prosthetics, and pedorthics,
303	to the definition of "health care provider"; amending s.
304	817.505, F.S.; creating an exception to the patient
305	brokering prohibition for assisted living facilities;
306	amending ss. 394.4787, 400.0239, 408.07, 430.80, and
307	651.118, F.S.; conforming terminology and references to
308	changes made by the act; revising a reference;
309	establishing that assisted living facility licensure fees
310	have been adjusted by Consumer Price Index since 1998 and
311	are not intended to be reset by this act; providing an
312	effective date.
313
314	Be It Enacted by the Legislature of the State of Florida:
315
316	Section 1.  Subsection (1) of section 83.42, Florida
317	Statutes, is amended to read:
318	83.42  Exclusions from application of part.-This part does
319	not apply to:
320	(1)  Residency or detention in a facility, whether public
321	or private, when residence or detention is incidental to the
322	provision of medical, geriatric, educational, counseling,
323	religious, or similar services. For residents of a facility
324	licensed under part II of chapter 400, the provisions of s.
325	400.0255 are the exclusive procedures for all transfers and
326	discharges.
327	Section 2.  Paragraphs (f) through (k) of subsection (10)
328	of section 112.0455, Florida Statutes, are redesignated as
329	paragraphs (e) through (j), respectively, paragraph (e) of
330	subsection (12) is redesignated as paragraph (d), and present
331	paragraph (e) of subsection (10), present paragraph (d) of
332	subsection (12), and paragraph (e) of subsection (14) of that
333	section are amended to read:
334	112.0455  Drug-Free Workplace Act.-
335	(10)  EMPLOYER PROTECTION.-
336	(e)  Nothing in this section shall be construed to operate
337	retroactively, and nothing in this section shall abrogate the
338	right of an employer under state law to conduct drug tests prior
339	to January 1, 1990. A drug test conducted by an employer prior
340	to January 1, 1990, is not subject to this section.
341	(12)  DRUG-TESTING STANDARDS; LABORATORIES.-
342	(d)  The laboratory shall submit to the Agency for Health
343	Care Administration a monthly report with statistical
344	information regarding the testing of employees and job
345	applicants. The reports shall include information on the methods
346	of analyses conducted, the drugs tested for, the number of
347	positive and negative results for both initial and confirmation
348	tests, and any other information deemed appropriate by the
349	Agency for Health Care Administration. No monthly report shall
350	identify specific employees or job applicants.
351	(14)  DISCIPLINE REMEDIES.-
352	(e)  Upon resolving an appeal filed pursuant to paragraph
353	(c), and finding a violation of this section, the commission may
354	order the following relief:
355	1.  Rescind the disciplinary action, expunge related
356	records from the personnel file of the employee or job applicant
357	and reinstate the employee.
358	2.  Order compliance with paragraph (10)(f)(g).
359	3.  Award back pay and benefits.
360	4.  Award the prevailing employee or job applicant the
361	necessary costs of the appeal, reasonable attorney's fees, and
362	expert witness fees.
363	Section 3.  Paragraph (n) of subsection (1) of section
364	154.11, Florida Statutes, is amended to read:
365	154.11  Powers of board of trustees.-
366	(1)  The board of trustees of each public health trust
367	shall be deemed to exercise a public and essential governmental
368	function of both the state and the county and in furtherance
369	thereof it shall, subject to limitation by the governing body of
370	the county in which such board is located, have all of the
371	powers necessary or convenient to carry out the operation and
372	governance of designated health care facilities, including, but
373	without limiting the generality of, the foregoing:
374	(n)  To appoint originally the staff of physicians to
375	practice in any designated facility owned or operated by the
376	board and to approve the bylaws and rules to be adopted by the
377	medical staff of any designated facility owned and operated by
378	the board, such governing regulations to be in accordance with
379	the standards of the Joint Commission on the Accreditation of
380	Hospitals which provide, among other things, for the method of
381	appointing additional staff members and for the removal of staff
382	members.
383	Section 4.  Subsection (15) of section 318.21, Florida
384	Statutes, is amended to read:
385	318.21  Disposition of civil penalties by county courts.-
386	All civil penalties received by a county court pursuant to the
387	provisions of this chapter shall be distributed and paid monthly
388	as follows:
389	(15)  Of the additional fine assessed under s. 318.18(3)(e)
390	for a violation of s. 316.1893, 50 percent of the moneys
391	received from the fines shall be remitted to the Department of
392	Revenue and deposited into the Brain and Spinal Cord Injury
393	Trust Fund of Department of Health and shall be appropriated to
394	the Department of Health Agency for Health Care Administration
395	as general revenue to provide an enhanced Medicaid payment to
396	nursing homes that serve Medicaid recipients with brain and
397	spinal cord injuries that are medically complex and who are
398	technologically and respiratory dependent. The remaining 50
399	percent of the moneys received from the enhanced fine imposed
400	under s. 318.18(3)(e) shall be remitted to the Department of
401	Revenue and deposited into the Department of Health Emergency
402	Medical Services Trust Fund to provide financial support to
403	certified trauma centers in the counties where enhanced penalty
404	zones are established to ensure the availability and
405	accessibility of trauma services. Funds deposited into the
406	Emergency Medical Services Trust Fund under this subsection
407	shall be allocated as follows:
408	(a)  Fifty percent shall be allocated equally among all
409	Level I, Level II, and pediatric trauma centers in recognition
410	of readiness costs for maintaining trauma services.
411	(b)  Fifty percent shall be allocated among Level I, Level
412	II, and pediatric trauma centers based on each center's relative
413	volume of trauma cases as reported in the Department of Health
414	Trauma Registry.
415	Section 5.  Section 383.325, Florida Statutes, is repealed.
416	Section 6.  Subsection (7) of section 394.4787, Florida
417	Statutes, is amended to read:
418	394.4787  Definitions; ss. 394.4786, 394.4787, 394.4788,
419	and 394.4789.-As used in this section and ss. 394.4786,
420	394.4788, and 394.4789:
421	(7)  "Specialty psychiatric hospital" means a hospital
422	licensed by the agency pursuant to s. 395.002(26)(28) and part
423	II of chapter 408 as a specialty psychiatric hospital.
424	Section 7.  Subsection (2) of section 394.741, Florida
425	Statutes, is amended to read:
426	394.741  Accreditation requirements for providers of
427	behavioral health care services.-
428	(2)  Notwithstanding any provision of law to the contrary,
429	accreditation shall be accepted by the agency and department in
430	lieu of the agency's and department's facility licensure onsite
431	review requirements and shall be accepted as a substitute for
432	the department's administrative and program monitoring
433	requirements, except as required by subsections (3) and (4),
434	for:
435	(a)  Any organization from which the department purchases
436	behavioral health care services that is accredited by the Joint
437	Commission on Accreditation of Healthcare Organizations or the
438	Council on Accreditation for Children and Family Services, or
439	has those services that are being purchased by the department
440	accredited by the Commission on Accreditation of Rehabilitation
441	Facilities CARF-the Rehabilitation Accreditation Commission.
442	(b)  Any mental health facility licensed by the agency or
443	any substance abuse component licensed by the department that is
444	accredited by the Joint Commission on Accreditation of
445	Healthcare Organizations, the Commission on Accreditation of
446	Rehabilitation Facilities CARF-the Rehabilitation Accreditation
447	Commission, or the Council on Accreditation of Children and
448	Family Services.
449	(c)  Any network of providers from which the department or
450	the agency purchases behavioral health care services accredited
451	by the Joint Commission on Accreditation of Healthcare
452	Organizations, the Commission on Accreditation of Rehabilitation
453	Facilities CARF-the Rehabilitation Accreditation Commission, the
454	Council on Accreditation of Children and Family Services, or the
455	National Committee for Quality Assurance. A provider
456	organization, which is part of an accredited network, is
457	afforded the same rights under this part.
458	Section 8.  Present subsections (15) through (32) of
459	section 395.002, Florida Statutes, are renumbered as subsections
460	(14) through (28), respectively, and present subsections (1),
461	(14), (24), (30), and (31) and paragraph (c) of present
462	subsection (28) of that section are amended to read:
463	395.002  Definitions.-As used in this chapter:
464	(1)  "Accrediting organizations" means nationally
465	recognized or approved accrediting organizations whose standards
466	incorporate comparable licensure requirements as determined by
467	the agency the Joint Commission on Accreditation of Healthcare
468	Organizations, the American Osteopathic Association, the
469	Commission on Accreditation of Rehabilitation Facilities, and
470	the Accreditation Association for Ambulatory Health Care, Inc.
471	(14)  "Initial denial determination" means a determination
472	by a private review agent that the health care services
473	furnished or proposed to be furnished to a patient are
474	inappropriate, not medically necessary, or not reasonable.
475	(24)  "Private review agent" means any person or entity
476	which performs utilization review services for third-party
477	payors on a contractual basis for outpatient or inpatient
478	services. However, the term shall not include full-time
479	employees, personnel, or staff of health insurers, health
480	maintenance organizations, or hospitals, or wholly owned
481	subsidiaries thereof or affiliates under common ownership, when
482	performing utilization review for their respective hospitals,
483	health maintenance organizations, or insureds of the same
484	insurance group. For this purpose, health insurers, health
485	maintenance organizations, and hospitals, or wholly owned
486	subsidiaries thereof or affiliates under common ownership,
487	include such entities engaged as administrators of self-
488	insurance as defined in s. 624.031.
489	(26)(28)  "Specialty hospital" means any facility which
490	meets the provisions of subsection (12), and which regularly
491	makes available either:
492	(c)  Intensive residential treatment programs for children
493	and adolescents as defined in subsection (14) (15).
494	(30)  "Utilization review" means a system for reviewing the
495	medical necessity or appropriateness in the allocation of health
496	care resources of hospital services given or proposed to be
497	given to a patient or group of patients.
498	(31)  "Utilization review plan" means a description of the
499	policies and procedures governing utilization review activities
500	performed by a private review agent.
501	Section 9.  Paragraph (c) of subsection (1) and paragraph
502	(b) of subsection (2) of section 395.003, Florida Statutes, are
503	amended to read:
504	395.003  Licensure; denial, suspension, and revocation.-
505	(1)
506	(c)  Until July 1, 2006, additional emergency departments
507	located off the premises of licensed hospitals may not be
508	authorized by the agency.
509	(2)
510	(b)  The agency shall, at the request of a licensee that is
511	a teaching hospital as defined in s. 408.07(45), issue a single
512	license to a licensee for facilities that have been previously
513	licensed as separate premises, provided such separately licensed
514	facilities, taken together, constitute the same premises as
515	defined in s. 395.002(22)(23). Such license for the single
516	premises shall include all of the beds, services, and programs
517	that were previously included on the licenses for the separate
518	premises. The granting of a single license under this paragraph
519	shall not in any manner reduce the number of beds, services, or
520	programs operated by the licensee.
521	Section 10.  Subsection (3) of section 395.0161, Florida
522	Statutes, is amended to read:
523	395.0161  Licensure inspection.-
524	(3)  In accordance with s. 408.805, an applicant or
525	licensee shall pay a fee for each license application submitted
526	under this part, part II of chapter 408, and applicable rules.
527	With the exception of state-operated licensed facilities, each
528	facility licensed under this part shall pay to the agency, at
529	the time of inspection, the following fees:
530	(a)  Inspection for licensure.-A fee shall be paid which is
531	not less than $8 per hospital bed, nor more than $12 per
532	hospital bed, except that the minimum fee shall be $400 per
533	facility.
534	(b)  Inspection for lifesafety only.-A fee shall be paid
535	which is not less than 75 cents per hospital bed, nor more than
536	$1.50 per hospital bed, except that the minimum fee shall be $40
537	per facility.
538	Section 11.  Paragraph (e) of subsection (2) and subsection
539	(4) of section 395.0193, Florida Statutes, are amended to read:
540	395.0193  Licensed facilities; peer review; disciplinary
541	powers; agency or partnership with physicians.-
542	(2)  Each licensed facility, as a condition of licensure,
543	shall provide for peer review of physicians who deliver health
544	care services at the facility. Each licensed facility shall
545	develop written, binding procedures by which such peer review
546	shall be conducted. Such procedures shall include:
547	(e)  Recording of agendas and minutes which do not contain
548	confidential material, for review by the Division of Medical
549	Quality Assurance of the department Health Quality Assurance of
550	the agency.
551	(4)  Pursuant to ss. 458.337 and 459.016, any disciplinary
552	actions taken under subsection (3) shall be reported in writing
553	to the Division of Medical Quality Assurance of the department
554	Health Quality Assurance of the agency within 30 working days
555	after its initial occurrence, regardless of the pendency of
556	appeals to the governing board of the hospital. The notification
557	shall identify the disciplined practitioner, the action taken,
558	and the reason for such action. All final disciplinary actions
559	taken under subsection (3), if different from those which were
560	reported to the department agency within 30 days after the
561	initial occurrence, shall be reported within 10 working days to
562	the Division of Medical Quality Assurance of the department
563	Health Quality Assurance of the agency in writing and shall
564	specify the disciplinary action taken and the specific grounds
565	therefor. The division shall review each report and determine
566	whether it potentially involved conduct by the licensee that is
567	subject to disciplinary action, in which case s. 456.073 shall
568	apply. The reports are not subject to inspection under s.
569	119.07(1) even if the division's investigation results in a
570	finding of probable cause.
571	Section 12.  Section 395.1023, Florida Statutes, is amended
572	to read:
573	395.1023  Child abuse and neglect cases; duties.-Each
574	licensed facility shall adopt a protocol that, at a minimum,
575	requires the facility to:
576	(1)  Incorporate a facility policy that every staff member
577	has an affirmative duty to report, pursuant to chapter 39, any
578	actual or suspected case of child abuse, abandonment, or
579	neglect; and
580	(2)  In any case involving suspected child abuse,
581	abandonment, or neglect, designate, at the request of the
582	Department of Children and Family Services, a staff physician to
583	act as a liaison between the hospital and the Department of
584	Children and Family Services office which is investigating the
585	suspected abuse, abandonment, or neglect, and the child
586	protection team, as defined in s. 39.01, when the case is
587	referred to such a team.
588
589	Each general hospital and appropriate specialty hospital shall
590	comply with the provisions of this section and shall notify the
591	agency and the Department of Children and Family Services of its
592	compliance by sending a copy of its policy to the agency and the
593	Department of Children and Family Services as required by rule.
594	The failure by a general hospital or appropriate specialty
595	hospital to comply shall be punished by a fine not exceeding
596	$1,000, to be fixed, imposed, and collected by the agency. Each
597	day in violation is considered a separate offense.
598	Section 13.  Subsection (2) and paragraph (d) of subsection
599	(3) of section 395.1041, Florida Statutes, are amended to read:
600	395.1041  Access to emergency services and care.-
601	(2)  INVENTORY OF HOSPITAL EMERGENCY SERVICES.-The agency
602	shall establish and maintain an inventory of hospitals with
603	emergency services. The inventory shall list all services within
604	the service capability of the hospital, and such services shall
605	appear on the face of the hospital license. Each hospital having
606	emergency services shall notify the agency of its service
607	capability in the manner and form prescribed by the agency. The
608	agency shall use the inventory to assist emergency medical
609	services providers and others in locating appropriate emergency
610	medical care. The inventory shall also be made available to the
611	general public. On or before August 1, 1992, the agency shall
612	request that each hospital identify the services which are
613	within its service capability. On or before November 1, 1992,
614	the agency shall notify each hospital of the service capability
615	to be included in the inventory. The hospital has 15 days from
616	the date of receipt to respond to the notice. By December 1,
617	1992, the agency shall publish a final inventory. Each hospital
618	shall reaffirm its service capability when its license is
619	renewed and shall notify the agency of the addition of a new
620	service or the termination of a service prior to a change in its
621	service capability.
622	(3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
623	FACILITY OR HEALTH CARE PERSONNEL.-
624	(d)1.  Every hospital shall ensure the provision of
625	services within the service capability of the hospital, at all
626	times, either directly or indirectly through an arrangement with
627	another hospital, through an arrangement with one or more
628	physicians, or as otherwise made through prior arrangements. A
629	hospital may enter into an agreement with another hospital for
630	purposes of meeting its service capability requirement, and
631	appropriate compensation or other reasonable conditions may be
632	negotiated for these backup services.
633	2.  If any arrangement requires the provision of emergency
634	medical transportation, such arrangement must be made in
635	consultation with the applicable provider and may not require
636	the emergency medical service provider to provide transportation
637	that is outside the routine service area of that provider or in
638	a manner that impairs the ability of the emergency medical
639	service provider to timely respond to prehospital emergency
640	calls.
641	3.  A hospital shall not be required to ensure service
642	capability at all times as required in subparagraph 1. if, prior
643	to the receiving of any patient needing such service capability,
644	such hospital has demonstrated to the agency that it lacks the
645	ability to ensure such capability and it has exhausted all
646	reasonable efforts to ensure such capability through backup
647	arrangements. In reviewing a hospital's demonstration of lack of
648	ability to ensure service capability, the agency shall consider
649	factors relevant to the particular case, including the
650	following:
651	a.  Number and proximity of hospitals with the same service
652	capability.
653	b.  Number, type, credentials, and privileges of
654	specialists.
655	c.  Frequency of procedures.
656	d.  Size of hospital.
657	4.  The agency shall publish proposed rules implementing a
658	reasonable exemption procedure by November 1, 1992. Subparagraph
659	1. shall become effective upon the effective date of said rules
660	or January 31, 1993, whichever is earlier. For a period not to
661	exceed 1 year from the effective date of subparagraph 1., a
662	hospital requesting an exemption shall be deemed to be exempt
663	from offering the service until the agency initially acts to
664	deny or grant the original request. The agency has 45 days after
665	from the date of receipt of the request to approve or deny the
666	request. After the first year from the effective date of
667	subparagraph 1., If the agency fails to initially act within
668	that the time period, the hospital is deemed to be exempt from
669	offering the service until the agency initially acts to deny the
670	request.
671	Section 14.  Section 395.1046, Florida Statutes, is
672	repealed.
673	Section 15.  Paragraphs (b) and (e) of subsection (1) of
674	section 395.1055, Florida Statutes, are amended to read:
675	395.1055  Rules and enforcement.-
676	(1)  The agency shall adopt rules pursuant to ss.
677	120.536(1) and 120.54 to implement the provisions of this part,
678	which shall include reasonable and fair minimum standards for
679	ensuring that:
680	(b)  Infection control, housekeeping, sanitary conditions,
681	and medical record procedures that will adequately protect
682	patient care and safety are established and implemented. These
683	procedures shall require housekeeping and sanitation staff to
684	wear masks and gloves when cleaning patient rooms and
685	disinfecting environmental surfaces in patient rooms in
686	accordance with the time instructions on the label of the
687	disinfectant used by the hospital. The agency may impose an
688	administrative fine for each day that a violation of this
689	paragraph occurs.
690	(e)  Licensed facility beds conform to minimum space,
691	equipment, and furnishings standards as specified by the agency,
692	the Florida Building Code, and the Florida Fire Prevention Code
693	department.
694	Section 16.  Subsection (1) of section 395.10972, Florida
695	Statutes, is amended to read:
696	395.10972  Health Care Risk Manager Advisory Council.-The
697	Secretary of Health Care Administration may appoint a seven-
698	member advisory council to advise the agency on matters
699	pertaining to health care risk managers. The members of the
700	council shall serve at the pleasure of the secretary. The
701	council shall designate a chair. The council shall meet at the
702	call of the secretary or at those times as may be required by
703	rule of the agency. The members of the advisory council shall
704	receive no compensation for their services, but shall be
705	reimbursed for travel expenses as provided in s. 112.061. The
706	council shall consist of individuals representing the following
707	areas:
708	(1)  Two shall be active health care risk managers,
709	including one risk manager who is recommended by and a member of
710	the Florida Society for of Healthcare Risk Management and
711	Patient Safety.
712	Section 17.  Subsection (3) of section 395.2050, Florida
713	Statutes, is amended to read:
714	395.2050  Routine inquiry for organ and tissue donation;
715	certification for procurement activities; death records review.-
716	(3)  Each organ procurement organization designated by the
717	federal Centers for Medicare and Medicaid Services Health Care
718	Financing Administration and licensed by the state shall conduct
719	an annual death records review in the organ procurement
720	organization's affiliated donor hospitals. The organ procurement
721	organization shall enlist the services of every Florida licensed
722	tissue bank and eye bank affiliated with or providing service to
723	the donor hospital and operating in the same service area to
724	participate in the death records review.
725	Section 18.  Subsection (2) of section 395.3036, Florida
726	Statutes, is amended to read:
727	395.3036  Confidentiality of records and meetings of
728	corporations that lease public hospitals or other public health
729	care facilities.-The records of a private corporation that
730	leases a public hospital or other public health care facility
731	are confidential and exempt from the provisions of s. 119.07(1)
732	and s. 24(a), Art. I of the State Constitution, and the meetings
733	of the governing board of a private corporation are exempt from
734	s. 286.011 and s. 24(b), Art. I of the State Constitution when
735	the public lessor complies with the public finance
736	accountability provisions of s. 155.40(5) with respect to the
737	transfer of any public funds to the private lessee and when the
738	private lessee meets at least three of the five following
739	criteria:
740	(2)  The public lessor and the private lessee do not
741	commingle any of their funds in any account maintained by either
742	of them, other than the payment of the rent and administrative
743	fees or the transfer of funds pursuant to s. 155.40 subsection
744	(2).
745	Section 19.  Section 395.3037, Florida Statutes, is
746	repealed.
747	Section 20.  Subsections (1), (4), and (5) of section
748	395.3038, Florida Statutes, are amended to read:
749	395.3038  State-listed primary stroke centers and
750	comprehensive stroke centers; notification of hospitals.-
751	(1)  The agency shall make available on its website and to
752	the department a list of the name and address of each hospital
753	that meets the criteria for a primary stroke center and the name
754	and address of each hospital that meets the criteria for a
755	comprehensive stroke center. The list of primary and
756	comprehensive stroke centers shall include only those hospitals
757	that attest in an affidavit submitted to the agency that the
758	hospital meets the named criteria, or those hospitals that
759	attest in an affidavit submitted to the agency that the hospital
760	is certified as a primary or a comprehensive stroke center by
761	the Joint Commission on Accreditation of Healthcare
762	Organizations.
763	(4)  The agency shall adopt by rule criteria for a primary
764	stroke center which are substantially similar to the
765	certification standards for primary stroke centers of the Joint
766	Commission on Accreditation of Healthcare Organizations.
767	(5)  The agency shall adopt by rule criteria for a
768	comprehensive stroke center. However, if the Joint Commission on
769	Accreditation of Healthcare Organizations establishes criteria
770	for a comprehensive stroke center, the agency shall establish
771	criteria for a comprehensive stroke center which are
772	substantially similar to those criteria established by the Joint
773	Commission on Accreditation of Healthcare Organizations.
774	Section 21.  Paragraph (d) of subsection (2) of section
775	395.4025, Florida Statutes, is amended to read:
776	395.4025  Trauma centers; selection; quality assurance;
777	records.-
778	(2)
779	(d)1.  Notwithstanding other provisions in this section,
780	the department may grant up to an additional 18 months to a
781	hospital applicant that is unable to meet all requirements as
782	provided in paragraph (c) at the time of application if the
783	number of applicants in the service area in which the applicant
784	is located is equal to or less than the service area allocation,
785	as provided by rule of the department. An applicant that is
786	granted additional time pursuant to this paragraph shall submit
787	a plan for departmental approval which includes timelines and
788	activities that the applicant proposes to complete in order to
789	meet application requirements. Any applicant that demonstrates
790	an ongoing effort to complete the activities within the
791	timelines outlined in the plan shall be included in the number
792	of trauma centers at such time that the department has conducted
793	a provisional review of the application and has determined that
794	the application is complete and that the hospital has the
795	critical elements required for a trauma center. An applicant
796	that has received an additional 18 months pursuant to this
797	paragraph shall be granted up to two additional 6-month
798	extensions to meet all requirements as provided in paragraph
799	(c), if construction related to a critical element is delayed as
800	a result of governmental action or inaction with respect to
801	regulations or permitting, and the applicant has made a good
802	faith effort to comply with the applicable regulations or obtain
803	the required permits.
804	2.  Timeframes provided in subsections (1)-(8) shall be
805	stayed until the department determines that the application is
806	complete and that the hospital has the critical elements
807	required for a trauma center.
808	Section 22.  Paragraph (e) of subsection (2) of section
809	395.602, Florida Statutes, is amended to read:
810	395.602  Rural hospitals.-
811	(2)  DEFINITIONS.-As used in this part:
812	(e)  "Rural hospital" means an acute care hospital licensed
813	under this chapter, having 100 or fewer licensed beds and an
814	emergency room, which is:
815	1.  The sole provider within a county with a population
816	density of no greater than 100 persons per square mile;
817	2.  An acute care hospital, in a county with a population
818	density of no greater than 100 persons per square mile, which is
819	at least 30 minutes of travel time, on normally traveled roads
820	under normal traffic conditions, from any other acute care
821	hospital within the same county;
822	3.  A hospital supported by a tax district or subdistrict
823	whose boundaries encompass a population of 100 persons or fewer
824	per square mile;
825	4.  A hospital in a constitutional charter county with a
826	population of over 1 million persons that has imposed a local
827	option health service tax pursuant to law and in an area that
828	was directly impacted by a catastrophic event on August 24,
829	1992, for which the Governor of Florida declared a state of
830	emergency pursuant to chapter 125, and has 120 beds or less that
831	serves an agricultural community with an emergency room
832	utilization of no less than 20,000 visits and a Medicaid
833	inpatient utilization rate greater than 15 percent;
834	4.5.  A hospital with a service area that has a population
835	of 100 persons or fewer per square mile. As used in this
836	subparagraph, the term "service area" means the fewest number of
837	zip codes that account for 75 percent of the hospital's
838	discharges for the most recent 5-year period, based on
839	information available from the hospital inpatient discharge
840	database in the Florida Center for Health Information and Policy
841	Analysis at the Agency for Health Care Administration; or
842	5.6.  A hospital designated as a critical access hospital,
843	as defined in s. 408.07(15).
844
845	Population densities used in this paragraph must be based upon
846	the most recently completed United States census. A hospital
847	that received funds under s. 409.9116 for a quarter beginning no
848	later than July 1, 2002, is deemed to have been and shall
849	continue to be a rural hospital from that date through June 30,
850	2015, if the hospital continues to have 100 or fewer licensed
851	beds and an emergency room, or meets the criteria of
852	subparagraph 4. An acute care hospital that has not previously
853	been designated as a rural hospital and that meets the criteria
854	of this paragraph shall be granted such designation upon
855	application, including supporting documentation to the Agency
856	for Health Care Administration.
857	Section 23.  Subsections (8) and (16) of section 400.021,
858	Florida Statutes, are amended to read:
859	400.021  Definitions.-When used in this part, unless the
860	context otherwise requires, the term:
861	(8)  "Geriatric outpatient clinic" means a site for
862	providing outpatient health care to persons 60 years of age or
863	older, which is staffed by a registered nurse or a physician
864	assistant, or a licensed practical nurse under the direct
865	supervision of a registered nurse, advanced registered nurse
866	practitioner, physician assistant, or physician.
867	(16)  "Resident care plan" means a written plan developed,
868	maintained, and reviewed not less than quarterly by a registered
869	nurse, with participation from other facility staff and the
870	resident or his or her designee or legal representative, which
871	includes a comprehensive assessment of the needs of an
872	individual resident; the type and frequency of services required
873	to provide the necessary care for the resident to attain or
874	maintain the highest practicable physical, mental, and
875	psychosocial well-being; a listing of services provided within
876	or outside the facility to meet those needs; and an explanation
877	of service goals. The resident care plan must be signed by the
878	director of nursing or another registered nurse employed by the
879	facility to whom institutional responsibilities have been
880	delegated and by the resident, the resident's designee, or the
881	resident's legal representative. The facility may not use an
882	agency or temporary registered nurse to satisfy the foregoing
883	requirement and must document the institutional responsibilities
884	that have been delegated to the registered nurse.
885	Section 24.  Paragraph (g) of subsection (2) of section
886	400.0239, Florida Statutes, is amended to read:
887	400.0239  Quality of Long-Term Care Facility Improvement
888	Trust Fund.-
889	(2)  Expenditures from the trust fund shall be allowable
890	for direct support of the following:
891	(g)  Other initiatives authorized by the Centers for
892	Medicare and Medicaid Services for the use of federal civil
893	monetary penalties, including projects recommended through the
894	Medicaid "Up-or-Out" Quality of Care Contract Management Program
895	pursuant to s. 400.148.
896	Section 25.  Subsection (15) of section 400.0255, Florida
897	Statutes, is amended to read
898	400.0255  Resident transfer or discharge; requirements and
899	procedures; hearings.-
900	(15)(a)  The department's Office of Appeals Hearings shall
901	conduct hearings under this section. The office shall notify the
902	facility of a resident's request for a hearing.
903	(b)  The department shall, by rule, establish procedures to
904	be used for fair hearings requested by residents. These
905	procedures shall be equivalent to the procedures used for fair
906	hearings for other Medicaid cases appearing in s. 409.285 and
907	applicable rules, chapter 10-2, part VI, Florida Administrative
908	Code. The burden of proof must be clear and convincing evidence.
909	A hearing decision must be rendered within 90 days after receipt
910	of the request for hearing.
911	(c)  If the hearing decision is favorable to the resident
912	who has been transferred or discharged, the resident must be
913	readmitted to the facility's first available bed.
914	(d)  The decision of the hearing officer shall be final.
915	Any aggrieved party may appeal the decision to the district
916	court of appeal in the appellate district where the facility is
917	located. Review procedures shall be conducted in accordance with
918	the Florida Rules of Appellate Procedure.
919	Section 26.  Subsection (2) of section 400.063, Florida
920	Statutes, is amended to read:
921	400.063  Resident protection.-
922	(2)  The agency is authorized to establish for each
923	facility, subject to intervention by the agency, a separate bank
924	account for the deposit to the credit of the agency of any
925	moneys received from the Health Care Trust Fund or any other
926	moneys received for the maintenance and care of residents in the
927	facility, and the agency is authorized to disburse moneys from
928	such account to pay obligations incurred for the purposes of
929	this section. The agency is authorized to requisition moneys
930	from the Health Care Trust Fund in advance of an actual need for
931	cash on the basis of an estimate by the agency of moneys to be
932	spent under the authority of this section. Any bank account
933	established under this section need not be approved in advance
934	of its creation as required by s. 17.58, but shall be secured by
935	depository insurance equal to or greater than the balance of
936	such account or by the pledge of collateral security in
937	conformance with criteria established in s. 18.11. The agency
938	shall notify the Chief Financial Officer of any such account so
939	established and shall make a quarterly accounting to the Chief
940	Financial Officer for all moneys deposited in such account.
941	Section 27.  Subsections (1) and (5) of section 400.071,
942	Florida Statutes, are amended to read:
943	400.071  Application for license.-
944	(1)  In addition to the requirements of part II of chapter
945	408, the application for a license shall be under oath and must
946	contain the following:
947	(a)  The location of the facility for which a license is
948	sought and an indication, as in the original application, that
949	such location conforms to the local zoning ordinances.
950	(b)  A signed affidavit disclosing any financial or
951	ownership interest that a controlling interest as defined in
952	part II of chapter 408 has held in the last 5 years in any
953	entity licensed by this state or any other state to provide
954	health or residential care which has closed voluntarily or
955	involuntarily; has filed for bankruptcy; has had a receiver
956	appointed; has had a license denied, suspended, or revoked; or
957	has had an injunction issued against it which was initiated by a
958	regulatory agency. The affidavit must disclose the reason any
959	such entity was closed, whether voluntarily or involuntarily.
960	(c)  The total number of beds and the total number of
961	Medicare and Medicaid certified beds.
962	(b)(d)  Information relating to the applicant and employees
963	which the agency requires by rule. The applicant must
964	demonstrate that sufficient numbers of qualified staff, by
965	training or experience, will be employed to properly care for
966	the type and number of residents who will reside in the
967	facility.
968	(e)  Copies of any civil verdict or judgment involving the
969	applicant rendered within the 10 years preceding the
970	application, relating to medical negligence, violation of
971	residents' rights, or wrongful death. As a condition of
972	licensure, the licensee agrees to provide to the agency copies
973	of any new verdict or judgment involving the applicant, relating
974	to such matters, within 30 days after filing with the clerk of
975	the court. The information required in this paragraph shall be
976	maintained in the facility's licensure file and in an agency
977	database which is available as a public record.
978	(5)  As a condition of licensure, each facility must
979	establish and submit with its application a plan for quality
980	assurance and for conducting risk management.
981	Section 28.  Section 400.0712, Florida Statutes, is amended
982	to read:
983	400.0712  Application for inactive license.-
984	(1)  As specified in this section, the agency may issue an
985	inactive license to a nursing home facility for all or a portion
986	of its beds. Any request by a licensee that a nursing home or
987	portion of a nursing home become inactive must be submitted to
988	the agency in the approved format. The facility may not initiate
989	any suspension of services, notify residents, or initiate
990	inactivity before receiving approval from the agency; and a
991	licensee that violates this provision may not be issued an
992	inactive license.
993	(1)(2)  In addition to the powers granted under part II of
994	chapter 408, the agency may issue an inactive license for a
995	portion of the total beds to a nursing home that chooses to use
996	an unoccupied contiguous portion of the facility for an
997	alternative use to meet the needs of elderly persons through the
998	use of less restrictive, less institutional services.
999	(a)  An inactive license issued under this subsection may
1000	be granted for a period not to exceed the current licensure
1001	expiration date but may be renewed by the agency at the time of
1002	licensure renewal.
1003	(b)  A request to extend the inactive license must be
1004	submitted to the agency in the approved format and approved by
1005	the agency in writing.
1006	(c)  Nursing homes that receive an inactive license to
1007	provide alternative services shall not receive preference for
1008	participation in the Assisted Living for the Elderly Medicaid
1009	waiver.
1010	(2)(3)  The agency shall adopt rules pursuant to ss.
1011	120.536(1) and 120.54 necessary to implement this section.
1012	Section 29.  Section 400.111, Florida Statutes, is amended
1013	to read:
1014	400.111  Disclosure of controlling interest.-In addition to
1015	the requirements of part II of chapter 408, when requested by
1016	the agency, the licensee shall submit a signed affidavit
1017	disclosing any financial or ownership interest that a
1018	controlling interest has held within the last 5 years in any
1019	entity licensed by the state or any other state to provide
1020	health or residential care which entity has closed voluntarily
1021	or involuntarily; has filed for bankruptcy; has had a receiver
1022	appointed; has had a license denied, suspended, or revoked; or
1023	has had an injunction issued against it which was initiated by a
1024	regulatory agency. The affidavit must disclose the reason such
1025	entity was closed, whether voluntarily or involuntarily.
1026	Section 30.  Subsection (2) of section 400.1183, Florida
1027	Statutes, is amended to read:
1028	400.1183  Resident grievance procedures.-
1029	(2)  Each facility shall maintain records of all grievances
1030	and shall retain a log for agency inspection of report to the
1031	agency at the time of relicensure the total number of grievances
1032	handled during the prior licensure period, a categorization of
1033	the cases underlying the grievances, and the final disposition
1034	of the grievances.
1035	Section 31.  Section 400.141, Florida Statutes, is amended
1036	to read:
1037	400.141  Administration and management of nursing home
1038	facilities.-
1039	(1)  Every licensed facility shall comply with all
1040	applicable standards and rules of the agency and shall:
1041	(a)  Be under the administrative direction and charge of a
1042	licensed administrator.
1043	(b)  Appoint a medical director licensed pursuant to
1044	chapter 458 or chapter 459. The agency may establish by rule
1045	more specific criteria for the appointment of a medical
1046	director.
1047	(c)  Have available the regular, consultative, and
1048	emergency services of physicians licensed by the state.
1049	(d)  Provide for resident use of a community pharmacy as
1050	specified in s. 400.022(1)(q). Any other law to the contrary
1051	notwithstanding, a registered pharmacist licensed in Florida,
1052	that is under contract with a facility licensed under this
1053	chapter or chapter 429, shall repackage a nursing facility
1054	resident's bulk prescription medication which has been packaged
1055	by another pharmacist licensed in any state in the United States
1056	into a unit dose system compatible with the system used by the
1057	nursing facility, if the pharmacist is requested to offer such
1058	service. In order to be eligible for the repackaging, a resident
1059	or the resident's spouse must receive prescription medication
1060	benefits provided through a former employer as part of his or
1061	her retirement benefits, a qualified pension plan as specified
1062	in s. 4972 of the Internal Revenue Code, a federal retirement
1063	program as specified under 5 C.F.R. s. 831, or a long-term care
1064	policy as defined in s. 627.9404(1). A pharmacist who correctly
1065	repackages and relabels the medication and the nursing facility
1066	which correctly administers such repackaged medication under
1067	this paragraph may not be held liable in any civil or
1068	administrative action arising from the repackaging. In order to
1069	be eligible for the repackaging, a nursing facility resident for
1070	whom the medication is to be repackaged shall sign an informed
1071	consent form provided by the facility which includes an
1072	explanation of the repackaging process and which notifies the
1073	resident of the immunities from liability provided in this
1074	paragraph. A pharmacist who repackages and relabels prescription
1075	medications, as authorized under this paragraph, may charge a
1076	reasonable fee for costs resulting from the implementation of
1077	this provision.
1078	(e)  Provide for the access of the facility residents to
1079	dental and other health-related services, recreational services,
1080	rehabilitative services, and social work services appropriate to
1081	their needs and conditions and not directly furnished by the
1082	licensee. When a geriatric outpatient nurse clinic is conducted
1083	in accordance with rules adopted by the agency, outpatients
1084	attending such clinic shall not be counted as part of the
1085	general resident population of the nursing home facility, nor
1086	shall the nursing staff of the geriatric outpatient clinic be
1087	counted as part of the nursing staff of the facility, until the
1088	outpatient clinic load exceeds 15 a day.
1089	(f)  Be allowed and encouraged by the agency to provide
1090	other needed services under certain conditions. If the facility
1091	has a standard licensure status, and has had no class I or class
1092	II deficiencies during the past 2 years or has been awarded a
1093	Gold Seal under the program established in s. 400.235, it may be
1094	encouraged by the agency to provide services, including, but not
1095	limited to, respite and adult day services, which enable
1096	individuals to move in and out of the facility. A facility is
1097	not subject to any additional licensure requirements for
1098	providing these services, under the following conditions:.
1099	1.  Respite care may be offered to persons in need of
1100	short-term or temporary nursing home services. For each person
1101	admitted under the respite care program, the facility licensee
1102	must:
1103	a.  Have a written abbreviated plan of care that, at a
1104	minimum, includes nutritional requirements, medication orders,
1105	physician orders, nursing assessments, and dietary preferences.
1106	The nursing or physician assessments may take the place of all
1107	other assessments required for full-time residents.
1108	b.  Have a contract that, at a minimum, specifies the
1109	services to be provided to the respite resident, including
1110	charges for services, activities, equipment, emergency medical
1111	services, and the administration of medications. If multiple
1112	respite admissions for a single person are anticipated, the
1113	original contract is valid for 1 year after the date of
1114	execution.
1115	c.  Ensure that each resident is released to his or her
1116	caregiver or an individual designated in writing by the
1117	caregiver.
1118	2.  A person admitted under the respite care program is:
1119	a.  Exempt from requirements in rule related to discharge
1120	planning.
1121	b.  Covered by the residents' rights set forth in s.
1122	400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
1123	shall not be considered trust funds subject to the requirements
1124	of s. 400.022(1)(h) until the resident has been in the facility
1125	for more than 14 consecutive days.
1126	c.  Allowed to use his or her personal medications for the
1127	respite stay if permitted by facility policy. The facility must
1128	obtain a physician's order for the medications. The caregiver
1129	may provide information regarding the medications as part of the
1130	nursing assessment and that information must agree with the
1131	physician's order. Medications shall be released with the
1132	resident upon discharge in accordance with current physician's
1133	orders.
1134	3.  A person receiving respite care is entitled to reside
1135	in the facility for a total of 60 days within a contract year or
1136	within a calendar year if the contract is for less than 12
1137	months. However, each single stay may not exceed 14 days. If a
1138	stay exceeds 14 consecutive days, the facility must comply with
1139	all assessment and care planning requirements applicable to
1140	nursing home residents.
1141	4.  A person receiving respite care must reside in a
1142	licensed nursing home bed.
1143	5.  A prospective respite resident must provide medical
1144	information from a physician, physician assistant, or nurse
1145	practitioner and other information from the primary caregiver as
1146	may be required by the facility before or at the time of
1147	admission to receive respite care. The medical information must
1148	include a physician's order for respite care and proof of a
1149	physical examination by a licensed physician, physician
1150	assistant, or nurse practitioner. The physician's order and
1151	physical examination may be used to provide intermittent respite
1152	care for up to 12 months after the date the order is written.
1153	6.  The facility must assume the duties of the primary
1154	caregiver. To ensure continuity of care and services, the
1155	resident is entitled to retain his or her personal physician and
1156	must have access to medically necessary services such as
1157	physical therapy, occupational therapy, or speech therapy, as
1158	needed. The facility must arrange for transportation to these
1159	services if necessary. Respite care must be provided in
1160	accordance with this part and rules adopted by the agency.
1161	However, the agency shall, by rule, adopt modified requirements
1162	for resident assessment, resident care plans, resident
1163	contracts, physician orders, and other provisions, as
1164	appropriate, for short-term or temporary nursing home services.
1165	7.  The agency shall allow for shared programming and staff
1166	in a facility which meets minimum standards and offers services
1167	pursuant to this paragraph, but, if the facility is cited for
1168	deficiencies in patient care, may require additional staff and
1169	programs appropriate to the needs of service recipients. A
1170	person who receives respite care may not be counted as a
1171	resident of the facility for purposes of the facility's licensed
1172	capacity unless that person receives 24-hour respite care. A
1173	person receiving either respite care for 24 hours or longer or
1174	adult day services must be included when calculating minimum
1175	staffing for the facility. Any costs and revenues generated by a
1176	nursing home facility from nonresidential programs or services
1177	shall be excluded from the calculations of Medicaid per diems
1178	for nursing home institutional care reimbursement.
1179	(g)  If the facility has a standard license or is a Gold
1180	Seal facility, exceeds the minimum required hours of licensed
1181	nursing and certified nursing assistant direct care per resident
1182	per day, and is part of a continuing care facility licensed
1183	under chapter 651 or a retirement community that offers other
1184	services pursuant to part III of this chapter or part I or part
1185	III of chapter 429 on a single campus, be allowed to share
1186	programming and staff. At the time of inspection and in the
1187	semiannual report required pursuant to paragraph (o), a
1188	continuing care facility or retirement community that uses this
1189	option must demonstrate through staffing records that minimum
1190	staffing requirements for the facility were met. Licensed nurses
1191	and certified nursing assistants who work in the nursing home
1192	facility may be used to provide services elsewhere on campus if
1193	the facility exceeds the minimum number of direct care hours
1194	required per resident per day and the total number of residents
1195	receiving direct care services from a licensed nurse or a
1196	certified nursing assistant does not cause the facility to
1197	violate the staffing ratios required under s. 400.23(3)(a).
1198	Compliance with the minimum staffing ratios shall be based on
1199	total number of residents receiving direct care services,
1200	regardless of where they reside on campus. If the facility
1201	receives a conditional license, it may not share staff until the
1202	conditional license status ends. This paragraph does not
1203	restrict the agency's authority under federal or state law to
1204	require additional staff if a facility is cited for deficiencies
1205	in care which are caused by an insufficient number of certified
1206	nursing assistants or licensed nurses. The agency may adopt
1207	rules for the documentation necessary to determine compliance
1208	with this provision.
1209	(h)  Maintain the facility premises and equipment and
1210	conduct its operations in a safe and sanitary manner.
1211	(i)  If the licensee furnishes food service, provide a
1212	wholesome and nourishing diet sufficient to meet generally
1213	accepted standards of proper nutrition for its residents and
1214	provide such therapeutic diets as may be prescribed by attending
1215	physicians. In making rules to implement this paragraph, the
1216	agency shall be guided by standards recommended by nationally
1217	recognized professional groups and associations with knowledge
1218	of dietetics.
1219	(j)  Keep full records of resident admissions and
1220	discharges; medical and general health status, including medical
1221	records, personal and social history, and identity and address
1222	of next of kin or other persons who may have responsibility for
1223	the affairs of the residents; and individual resident care plans
1224	including, but not limited to, prescribed services, service
1225	frequency and duration, and service goals. The records shall be
1226	open to inspection by the agency. The facility must maintain
1227	clinical records on each resident in accordance with accepted
1228	professional standards and practices that are complete,
1229	accurately documented, readily accessible, and systematically
1230	organized.
1231	(k)  Keep such fiscal records of its operations and
1232	conditions as may be necessary to provide information pursuant
1233	to this part.
1234	(l)  Furnish copies of personnel records for employees
1235	affiliated with such facility, to any other facility licensed by
1236	this state requesting this information pursuant to this part.
1237	Such information contained in the records may include, but is
1238	not limited to, disciplinary matters and any reason for
1239	termination. Any facility releasing such records pursuant to
1240	this part shall be considered to be acting in good faith and may
1241	not be held liable for information contained in such records,
1242	absent a showing that the facility maliciously falsified such
1243	records.
1244	(m)  Publicly display a poster provided by the agency
1245	containing the names, addresses, and telephone numbers for the
1246	state's abuse hotline, the State Long-Term Care Ombudsman, the
1247	Agency for Health Care Administration consumer hotline, the
1248	Advocacy Center for Persons with Disabilities, the Florida
1249	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
1250	with a clear description of the assistance to be expected from
1251	each.
1252	(n)  Submit to the agency the information specified in s.
1253	400.071(1)(b) for a management company within 30 days after the
1254	effective date of the management agreement.
1255	(n)(o)1.  Submit semiannually to the agency, or more
1256	frequently if requested by the agency, information regarding
1257	facility staff-to-resident ratios, staff turnover, and staff
1258	stability, including information regarding certified nursing
1259	assistants, licensed nurses, the director of nursing, and the
1260	facility administrator. For purposes of this reporting:
1261	a.  Staff-to-resident ratios must be reported in the
1262	categories specified in s. 400.23(3)(a) and applicable rules.
1263	The ratio must be reported as an average for the most recent
1264	calendar quarter.
1265	b.  Staff turnover must be reported for the most recent 12-
1266	month period ending on the last workday of the most recent
1267	calendar quarter prior to the date the information is submitted.
1268	The turnover rate must be computed quarterly, with the annual
1269	rate being the cumulative sum of the quarterly rates. The
1270	turnover rate is the total number of terminations or separations
1271	experienced during the quarter, excluding any employee
1272	terminated during a probationary period of 3 months or less,
1273	divided by the total number of staff employed at the end of the
1274	period for which the rate is computed, and expressed as a
1275	percentage.
1276	c.  The formula for determining staff stability is the
1277	total number of employees that have been employed for more than
1278	12 months, divided by the total number of employees employed at
1279	the end of the most recent calendar quarter, and expressed as a
1280	percentage.
1281	d.  A nursing facility that has failed to comply with state
1282	minimum-staffing requirements for 2 consecutive days is
1283	prohibited from accepting new admissions until the facility has
1284	achieved the minimum-staffing requirements for a period of 6
1285	consecutive days. For the purposes of this sub-subparagraph, any
1286	person who was a resident of the facility and was absent from
1287	the facility for the purpose of receiving medical care at a
1288	separate location or was on a leave of absence is not considered
1289	a new admission. Failure to impose such an admissions moratorium
1290	is subject to a $1,000 fine constitutes a class II deficiency.
1291	2.e.  A nursing facility which does not have a conditional
1292	license may be cited for failure to comply with the standards in
1293	s. 400.23(3)(a)1.b. and c. only if it has failed to meet those
1294	standards on 2 consecutive days or if it has failed to meet at
1295	least 97 percent of those standards on any one day.
1296	3.f.  A facility which has a conditional license must be in
1297	compliance with the standards in s. 400.23(3)(a) at all times.
1298	2.  This paragraph does not limit the agency's ability to
1299	impose a deficiency or take other actions if a facility does not
1300	have enough staff to meet the residents' needs.
1301	(o)(p)  Notify a licensed physician when a resident
1302	exhibits signs of dementia or cognitive impairment or has a
1303	change of condition in order to rule out the presence of an
1304	underlying physiological condition that may be contributing to
1305	such dementia or impairment. The notification must occur within
1306	30 days after the acknowledgment of such signs by facility
1307	staff. If an underlying condition is determined to exist, the
1308	facility shall arrange, with the appropriate health care
1309	provider, the necessary care and services to treat the
1310	condition.
1311	(p)(q)  If the facility implements a dining and hospitality
1312	attendant program, ensure that the program is developed and
1313	implemented under the supervision of the facility director of
1314	nursing. A licensed nurse, licensed speech or occupational
1315	therapist, or a registered dietitian must conduct training of
1316	dining and hospitality attendants. A person employed by a
1317	facility as a dining and hospitality attendant must perform
1318	tasks under the direct supervision of a licensed nurse.
1319	(r)  Report to the agency any filing for bankruptcy
1320	protection by the facility or its parent corporation,
1321	divestiture or spin-off of its assets, or corporate
1322	reorganization within 30 days after the completion of such
1323	activity.
1324	(q)(s)  Maintain general and professional liability
1325	insurance coverage that is in force at all times. In lieu of
1326	general and professional liability insurance coverage, a state-
1327	designated teaching nursing home and its affiliated assisted
1328	living facilities created under s. 430.80 may demonstrate proof
1329	of financial responsibility as provided in s. 430.80(3)(g).
1330	(r)(t)  Maintain in the medical record for each resident a
1331	daily chart of certified nursing assistant services provided to
1332	the resident. The certified nursing assistant who is caring for
1333	the resident must complete this record by the end of his or her
1334	shift. This record must indicate assistance with activities of
1335	daily living, assistance with eating, and assistance with
1336	drinking, and must record each offering of nutrition and
1337	hydration for those residents whose plan of care or assessment
1338	indicates a risk for malnutrition or dehydration.
1339	(s)(u)  Before November 30 of each year, subject to the
1340	availability of an adequate supply of the necessary vaccine,
1341	provide for immunizations against influenza viruses to all its
1342	consenting residents in accordance with the recommendations of
1343	the United States Centers for Disease Control and Prevention,
1344	subject to exemptions for medical contraindications and
1345	religious or personal beliefs. Subject to these exemptions, any
1346	consenting person who becomes a resident of the facility after
1347	November 30 but before March 31 of the following year must be
1348	immunized within 5 working days after becoming a resident.
1349	Immunization shall not be provided to any resident who provides
1350	documentation that he or she has been immunized as required by
1351	this paragraph. This paragraph does not prohibit a resident from
1352	receiving the immunization from his or her personal physician if
1353	he or she so chooses. A resident who chooses to receive the
1354	immunization from his or her personal physician shall provide
1355	proof of immunization to the facility. The agency may adopt and
1356	enforce any rules necessary to comply with or implement this
1357	paragraph.
1358	(t)(v)  Assess all residents for eligibility for
1359	pneumococcal polysaccharide vaccination (PPV) and vaccinate
1360	residents when indicated within 60 days after the effective date
1361	of this act in accordance with the recommendations of the United
1362	States Centers for Disease Control and Prevention, subject to
1363	exemptions for medical contraindications and religious or
1364	personal beliefs. Residents admitted after the effective date of
1365	this act shall be assessed within 5 working days of admission
1366	and, when indicated, vaccinated within 60 days in accordance
1367	with the recommendations of the United States Centers for
1368	Disease Control and Prevention, subject to exemptions for
1369	medical contraindications and religious or personal beliefs.
1370	Immunization shall not be provided to any resident who provides
1371	documentation that he or she has been immunized as required by
1372	this paragraph. This paragraph does not prohibit a resident from
1373	receiving the immunization from his or her personal physician if
1374	he or she so chooses. A resident who chooses to receive the
1375	immunization from his or her personal physician shall provide
1376	proof of immunization to the facility. The agency may adopt and
1377	enforce any rules necessary to comply with or implement this
1378	paragraph.
1379	(u)(w)  Annually encourage and promote to its employees the
1380	benefits associated with immunizations against influenza viruses
1381	in accordance with the recommendations of the United States
1382	Centers for Disease Control and Prevention. The agency may adopt
1383	and enforce any rules necessary to comply with or implement this
1384	paragraph.
1385
1386	This subsection does not limit the agency's ability to impose a
1387	deficiency or take other actions if a facility does not have
1388	enough staff to meet the residents' needs.
1389	(2)  Facilities that have been awarded a Gold Seal under
1390	the program established in s. 400.235 may develop a plan to
1391	provide certified nursing assistant training as prescribed by
1392	federal regulations and state rules and may apply to the agency
1393	for approval of their program.
1394	(3)  A facility may charge a reasonable fee for the copying
1395	of resident records. The fee may not exceed $1 per page for the
1396	first 25 pages and 25 cents per page for each page in excess of
1397	25 pages.
1398	Section 32.  Subsection (3) of section 400.142, Florida
1399	Statutes, is amended to read:
1400	400.142  Emergency medication kits; orders not to
1401	resuscitate.-
1402	(3)  Facility staff may withhold or withdraw
1403	cardiopulmonary resuscitation if presented with an order not to
1404	resuscitate executed pursuant to s. 401.45. The agency shall
1405	adopt rules providing for the implementation of such orders.
1406	Facility staff and facilities shall not be subject to criminal
1407	prosecution or civil liability, nor be considered to have
1408	engaged in negligent or unprofessional conduct, for withholding
1409	or withdrawing cardiopulmonary resuscitation pursuant to such an
1410	order and rules adopted by the agency. The absence of an order
1411	not to resuscitate executed pursuant to s. 401.45 does not
1412	preclude a physician from withholding or withdrawing
1413	cardiopulmonary resuscitation as otherwise permitted by law.
1414	Section 33.  Sections 400.0234, 400.145, and 429.294,
1415	Florida Statutes, are repealed.
1416	Section 34.  Subsection (9) and subsections (11) through
1417	(15) of section 400.147, Florida Statutes, are renumbered as
1418	subsections (8) through (13), respectively, and present
1419	subsections (7), (8), and (10) of that section are amended to
1420	read:
1421	400.147  Internal risk management and quality assurance
1422	program.-
1423	(7)  The facility shall initiate an investigation and shall
1424	notify the agency within 1 business day after the risk manager
1425	or his or her designee has received a report pursuant to
1426	paragraph (1)(d). Each facility shall complete the investigation
1427	and submit a report to the agency within 15 calendar days after
1428	an incident is determined to be an adverse incident. The
1429	notification must be made in writing and be provided
1430	electronically, by facsimile device or overnight mail delivery.
1431	The agency shall develop a form for reporting this information
1432	and the notification must include the name of the risk manager
1433	of the facility, information regarding the identity of the
1434	affected resident, the type of adverse incident, the initiation
1435	of an investigation by the facility, and whether the events
1436	causing or resulting in the adverse incident represent a
1437	potential risk to any other resident. The notification is
1438	confidential as provided by law and is not discoverable or
1439	admissible in any civil or administrative action, except in
1440	disciplinary proceedings by the agency or the appropriate
1441	regulatory board. The agency may investigate, as it deems
1442	appropriate, any such incident and prescribe measures that must
1443	or may be taken in response to the incident. The agency shall
1444	review each report incident and determine whether it potentially
1445	involved conduct by the health care professional who is subject
1446	to disciplinary action, in which case the provisions of s.
1447	456.073 shall apply.
1448	(8)(a)  Each facility shall complete the investigation and
1449	submit an adverse incident report to the agency for each adverse
1450	incident within 15 calendar days after its occurrence. If, after
1451	a complete investigation, the risk manager determines that the
1452	incident was not an adverse incident as defined in subsection
1453	(5), the facility shall include this information in the report.
1454	The agency shall develop a form for reporting this information.
1455	(b)  The information reported to the agency pursuant to
1456	paragraph (a) which relates to persons licensed under chapter
1457	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
1458	by the agency. The agency shall determine whether any of the
1459	incidents potentially involved conduct by a health care
1460	professional who is subject to disciplinary action, in which
1461	case the provisions of s. 456.073 shall apply.
1462	(c)  The report submitted to the agency must also contain
1463	the name of the risk manager of the facility.
1464	(d)  The adverse incident report is confidential as
1465	provided by law and is not discoverable or admissible in any
1466	civil or administrative action, except in disciplinary
1467	proceedings by the agency or the appropriate regulatory board.
1468	(10)  By the 10th of each month, each facility subject to
1469	this section shall report any notice received pursuant to s.
1470	400.0233(2) and each initial complaint that was filed with the
1471	clerk of the court and served on the facility during the
1472	previous month by a resident or a resident's family member,
1473	guardian, conservator, or personal legal representative. The
1474	report must include the name of the resident, the resident's
1475	date of birth and social security number, the Medicaid
1476	identification number for Medicaid-eligible persons, the date or
1477	dates of the incident leading to the claim or dates of
1478	residency, if applicable, and the type of injury or violation of
1479	rights alleged to have occurred. Each facility shall also submit
1480	a copy of the notices received pursuant to s. 400.0233(2) and
1481	complaints filed with the clerk of the court. This report is
1482	confidential as provided by law and is not discoverable or
1483	admissible in any civil or administrative action, except in such
1484	actions brought by the agency to enforce the provisions of this
1485	part.
1486	Section 35.  Section 400.148, Florida Statutes, is
1487	repealed.
1488	Section 36.  Paragraph (e) of subsection (2) of section
1489	400.179, Florida Statutes, is amended to read:
1490	400.179  Liability for Medicaid underpayments and
1491	overpayments.-
1492	(2)  Because any transfer of a nursing facility may expose
1493	the fact that Medicaid may have underpaid or overpaid the
1494	transferor, and because in most instances, any such underpayment
1495	or overpayment can only be determined following a formal field
1496	audit, the liabilities for any such underpayments or
1497	overpayments shall be as follows:
1498	(e)  For the 2009-2010 fiscal year only, the provisions of
1499	paragraph (d) shall not apply. This paragraph expires July 1,
1500	2010.
1501	Section 37.  Subsection (3) of section 400.19, Florida
1502	Statutes, is amended to read:
1503	400.19  Right of entry and inspection.-
1504	(3)  The agency shall every 15 months conduct at least one
1505	unannounced inspection to determine compliance by the licensee
1506	with statutes, and with rules promulgated under the provisions
1507	of those statutes, governing minimum standards of construction,
1508	quality and adequacy of care, and rights of residents. The
1509	survey shall be conducted every 6 months for the next 2-year
1510	period if the facility has been cited for a class I deficiency,
1511	has been cited for two or more class II deficiencies arising
1512	from separate surveys or investigations within a 60-day period,
1513	or has had three or more substantiated complaints within a 6-
1514	month period, each resulting in at least one class I or class II
1515	deficiency. In addition to any other fees or fines in this part,
1516	the agency shall assess a fine for each facility that is subject
1517	to the 6-month survey cycle. The fine for the 2-year period
1518	shall be $6,000, one-half to be paid at the completion of each
1519	survey. The agency may adjust this fine by the change in the
1520	Consumer Price Index, based on the 12 months immediately
1521	preceding the increase, to cover the cost of the additional
1522	surveys. The agency shall verify through subsequent inspection
1523	that any deficiency identified during inspection is corrected.
1524	However, the agency may verify the correction of a class III or
1525	class IV deficiency unrelated to resident rights or resident
1526	care without reinspecting the facility if adequate written
1527	documentation has been received from the facility, which
1528	provides assurance that the deficiency has been corrected. The
1529	giving or causing to be given of advance notice of such
1530	unannounced inspections by an employee of the agency to any
1531	unauthorized person shall constitute cause for suspension of not
1532	fewer than 5 working days according to the provisions of chapter
1533	110.
1534	Section 38.  Subsection (5) of section 400.23, Florida
1535	Statutes, is amended to read:
1536	400.23  Rules; evaluation and deficiencies; licensure
1537	status.-
1538	(5)(a)  The agency, in collaboration with the Division of
1539	Children's Medical Services Network of the Department of Health,
1540	must, no later than December 31, 1993, adopt rules for minimum
1541	standards of care for persons under 21 years of age who reside
1542	in nursing home facilities. The rules must include a methodology
1543	for reviewing a nursing home facility under ss. 408.031-408.045
1544	which serves only persons under 21 years of age. A facility may
1545	be exempt from these standards for specific persons between 18
1546	and 21 years of age, if the person's physician agrees that
1547	minimum standards of care based on age are not necessary.
1548	(b)  The agency, in collaboration with the Division of
1549	Children's Medical Services Network, shall adopt rules for
1550	minimum staffing requirements for nursing home facilities that
1551	serve persons under 21 years of age, which shall apply in lieu
1552	of the standards contained in subsection (3).
1553	1.  For persons under 21 years of age who require skilled
1554	care, the requirements shall include a minimum combined average
1555	of licensed nurses, respiratory therapists, respiratory care
1556	practitioners, and certified nursing assistants of 3.9 hours of
1557	direct care per resident per day for each nursing home facility.
1558	2.  For persons under 21 years of age who are fragile, the
1559	requirements shall include a minimum combined average of
1560	licensed nurses, respiratory therapists, respiratory care
1561	practitioners, and certified nursing assistants of 5 hours of
1562	direct care per resident per day for each nursing home facility.
1563	Section 39.  Subsection (1) of section 400.275, Florida
1564	Statutes, is amended to read:
1565	400.275  Agency duties.-
1566	(1)  The agency shall ensure that each newly hired nursing
1567	home surveyor, as a part of basic training, is assigned full-
1568	time to a licensed nursing home for at least 2 days within a 7-
1569	day period to observe facility operations outside of the survey
1570	process before the surveyor begins survey responsibilities. Such
1571	observations may not be the sole basis of a deficiency citation
1572	against the facility. The agency may not assign an individual to
1573	be a member of a survey team for purposes of a survey,
1574	evaluation, or consultation visit at a nursing home facility in
1575	which the surveyor was an employee within the preceding 2 5
1576	years.
1577	Section 40.  Subsection (27) of section 400.462, Florida
1578	Statutes, is amended to read:
1579	400.462  Definitions.-As used in this part, the term:
1580	(27)  "Remuneration" means any payment or other benefit
1581	made directly or indirectly, overtly or covertly, in cash or in
1582	kind. However, when the term is used in any provision of law
1583	relating to a health care provider, such term does not mean an
1584	item with an individual value of up to $15, including, but not
1585	limited to, plaques, certificates, trophies, or novelties that
1586	are intended solely for presentation or are customarily given
1587	away solely for promotional, recognition, or advertising
1588	purposes.
1589	Section 41.  Subsection (2) of section 400.484, Florida
1590	Statutes, is amended to read:
1591	400.484  Right of inspection; violations deficiencies;
1592	fines.-
1593	(2)  The agency shall impose fines for various classes of
1594	violations deficiencies in accordance with the following
1595	schedule:
1596	(a)  Class I violations are defined in s. 408.813. A class
1597	I deficiency is any act, omission, or practice that results in a
1598	patient's death, disablement, or permanent injury, or places a
1599	patient at imminent risk of death, disablement, or permanent
1600	injury. Upon finding a class I violation deficiency, the agency
1601	shall impose an administrative fine in the amount of $15,000 for
1602	each occurrence and each day that the violation deficiency
1603	exists.
1604	(b)  Class II violations are defined in s. 408.813. A class
1605	II deficiency is any act, omission, or practice that has a
1606	direct adverse effect on the health, safety, or security of a
1607	patient. Upon finding a class II violation deficiency, the
1608	agency shall impose an administrative fine in the amount of
1609	$5,000 for each occurrence and each day that the violation
1610	deficiency exists.
1611	(c)  Class III violations are defined in s. 408.813. A
1612	class III deficiency is any act, omission, or practice that has
1613	an indirect, adverse effect on the health, safety, or security
1614	of a patient. Upon finding an uncorrected or repeated class III
1615	violation deficiency, the agency shall impose an administrative
1616	fine not to exceed $1,000 for each occurrence and each day that
1617	the uncorrected or repeated violation deficiency exists.
1618	(d)  Class IV violations are defined in s. 408.813. A class
1619	IV deficiency is any act, omission, or practice related to
1620	required reports, forms, or documents which does not have the
1621	potential of negatively affecting patients. These violations are
1622	of a type that the agency determines do not threaten the health,
1623	safety, or security of patients. Upon finding an uncorrected or
1624	repeated class IV violation deficiency, the agency shall impose
1625	an administrative fine not to exceed $500 for each occurrence
1626	and each day that the uncorrected or repeated violation
1627	deficiency exists.
1628	Section 42.  Subsections (16) and (17) of section 400.506,
1629	Florida Statutes, are renumbered as subsections (17) and (18),
1630	respectively, paragraph (a) of subsection (15) is amended, and a
1631	new subsection (16) is added to that section, to read:
1632	400.506  Licensure of nurse registries; requirements;
1633	penalties.-
1634	(15)(a)  The agency may deny, suspend, or revoke the
1635	license of a nurse registry and shall impose a fine of $5,000
1636	against a nurse registry that:
1637	1.  Provides services to residents in an assisted living
1638	facility for which the nurse registry does not receive fair
1639	market value remuneration.
1640	2.  Provides staffing to an assisted living facility for
1641	which the nurse registry does not receive fair market value
1642	remuneration.
1643	3.  Fails to provide the agency, upon request, with copies
1644	of all contracts with assisted living facilities which were
1645	executed within the last 5 years.
1646	4.  Gives remuneration to a case manager, discharge
1647	planner, facility-based staff member, or third-party vendor who
1648	is involved in the discharge planning process of a facility
1649	licensed under chapter 395 or this chapter and from whom the
1650	nurse registry receives referrals. A nurse registry is exempt
1651	from this subparagraph if it does not bill the Florida Medicaid
1652	program or the Medicare program or share a controlling interest
1653	with any entity licensed, registered, or certified under part II
1654	of chapter 408 that bills the Florida Medicaid program or the
1655	Medicare program.
1656	5.  Gives remuneration to a physician, a member of the
1657	physician's office staff, or an immediate family member of the
1658	physician, and the nurse registry received a patient referral in
1659	the last 12 months from that physician or the physician's office
1660	staff. A nurse registry is exempt from this subparagraph if it
1661	does not bill the Florida Medicaid program or the Medicare
1662	program or share a controlling interest with any entity
1663	licensed, registered, or certified under part II of chapter 408
1664	that bills the Florida Medicaid program or the Medicare program.
1665	(16)  An administrator may manage only one nurse registry,
1666	except that an administrator may manage up to five registries if
1667	all five registries have identical controlling interests as
1668	defined in s. 408.803 and are located within one agency
1669	geographic service area or within an immediately contiguous
1670	county. An administrator shall designate, in writing, for each
1671	licensed entity, a qualified alternate administrator to serve
1672	during the administrator's absence.
1673	Section 43.  Subsection (1) of section 400.509, Florida
1674	Statutes, is amended to read:
1675	400.509  Registration of particular service providers
1676	exempt from licensure; certificate of registration; regulation
1677	of registrants.-
1678	(1)  Any organization that provides companion services or
1679	homemaker services and does not provide a home health service to
1680	a person is exempt from licensure under this part. However, any
1681	organization that provides companion services or homemaker
1682	services must register with the agency. An organization under
1683	contract with the Agency for Persons with Disabilities that
1684	provides companion services only for persons with a
1685	developmental disability, as defined in s. 393.063, are exempt
1686	from registration.
1687	Section 44.  Paragraph (i) of subsection (1) and subsection
1688	(4) of section 400.606, Florida Statutes, are amended to read:
1689	400.606  License; application; renewal; conditional license
1690	or permit; certificate of need.-
1691	(1)  In addition to the requirements of part II of chapter
1692	408, the initial application and change of ownership application
1693	must be accompanied by a plan for the delivery of home,
1694	residential, and homelike inpatient hospice services to
1695	terminally ill persons and their families. Such plan must
1696	contain, but need not be limited to:
1697	(i)  The projected annual operating cost of the hospice.
1698	If the applicant is an existing licensed health care provider,
1699	the application must be accompanied by a copy of the most recent
1700	profit-loss statement and, if applicable, the most recent
1701	licensure inspection report.
1702	(4)  A freestanding hospice facility that is primarily
1703	engaged in providing inpatient and related services and that is
1704	not otherwise licensed as a health care facility shall be
1705	required to obtain a certificate of need. However, a
1706	freestanding hospice facility with six or fewer beds shall not
1707	be required to comply with institutional standards such as, but
1708	not limited to, standards requiring sprinkler systems, emergency
1709	electrical systems, or special lavatory devices.
1710	Section 45.  Subsection (2) of section 400.607, Florida
1711	Statutes, is amended to read:
1712	400.607  Denial, suspension, revocation of license;
1713	emergency actions; imposition of administrative fine; grounds.-
1714	(2)  A violation of this part, part II of chapter 408, or
1715	applicable rules Any of the following actions by a licensed
1716	hospice or any of its employees shall be grounds for
1717	administrative action by the agency against a hospice.:
1718	(a)  A violation of the provisions of this part, part II of
1719	chapter 408, or applicable rules.
1720	(b)  An intentional or negligent act materially affecting
1721	the health or safety of a patient.
1722	Section 46.  Section 400.915, Florida Statutes, is amended
1723	to read:
1724	400.915  Construction and renovation; requirements.-The
1725	requirements for the construction or renovation of a PPEC center
1726	shall comply with:
1727	(1)  The provisions of chapter 553, which pertain to
1728	building construction standards, including plumbing, electrical
1729	code, glass, manufactured buildings, accessibility for the
1730	physically disabled;
1731	(2)  The provisions of s. 633.022 and applicable rules
1732	pertaining to physical minimum standards for nonresidential
1733	child care physical facilities in rule 10M-12.003, Florida
1734	Administrative Code, Child Care Standards; and
1735	(3)  The standards or rules adopted pursuant to this part
1736	and part II of chapter 408.
1737	Section 47.  Subsection (1) of section 400.925, Florida
1738	Statutes, is amended to read:
1739	400.925  Definitions.-As used in this part, the term:
1740	(1)  "Accrediting organizations" means the Joint Commission
1741	on Accreditation of Healthcare Organizations or other national
1742	accreditation agencies whose standards for accreditation are
1743	comparable to those required by this part for licensure.
1744	Section 48.  Subsection (2) of section 400.931, Florida
1745	Statutes, is amended to read:
1746	400.931  Application for license; fee; provisional license;
1747	temporary permit.-
1748	(2)  An applicant for initial licensure, change of
1749	ownership, or renewal to operate a licensed home medical
1750	equipment provider at a location outside the state must submit
1751	documentation of accreditation or an application for
1752	accreditation from an accrediting organization that is
1753	recognized by the agency. An applicant that has applied for
1754	accreditation must provide proof of accreditation that is not
1755	conditional or provisional within 120 days after the date the
1756	agency receives the application for licensure or the application
1757	shall be withdrawn from further consideration. Such
1758	accreditation must be maintained by the home medical equipment
1759	provider to maintain licensure. As an alternative to submitting
1760	proof of financial ability to operate as required in s.
1761	408.810(8), the applicant may submit a $50,000 surety bond to
1762	the agency.
1763	Section 49.  Subsection (2) of section 400.932, Florida
1764	Statutes, is amended to read:
1765	400.932  Administrative penalties.-
1766	(2)  A violation of this part, part II of chapter 408, or
1767	applicable rules Any of the following actions by an employee of
1768	a home medical equipment provider shall be are grounds for
1769	administrative action or penalties by the agency.:
1770	(a)  Violation of this part, part II of chapter 408, or
1771	applicable rules.
1772	(b)  An intentional, reckless, or negligent act that
1773	materially affects the health or safety of a patient.
1774	Section 50.  Subsection (3) of section 400.967, Florida
1775	Statutes, is amended to read:
1776	400.967  Rules and classification of violations
1777	deficiencies.-
1778	(3)  The agency shall adopt rules to provide that, when the
1779	criteria established under this part and part II of chapter 408
1780	are not met, such violations deficiencies shall be classified
1781	according to the nature of the violation deficiency. The agency
1782	shall indicate the classification on the face of the notice of
1783	deficiencies as follows:
1784	(a)  Class I violations deficiencies are defined in s.
1785	408.813 those which the agency determines present an imminent
1786	danger to the residents or guests of the facility or a
1787	substantial probability that death or serious physical harm
1788	would result therefrom. The condition or practice constituting a
1789	class I violation must be abated or eliminated immediately,
1790	unless a fixed period of time, as determined by the agency, is
1791	required for correction. A class I violation deficiency is
1792	subject to a civil penalty in an amount not less than $5,000 and
1793	not exceeding $10,000 for each violation deficiency. A fine may
1794	be levied notwithstanding the correction of the violation
1795	deficiency.
1796	(b)  Class II violations deficiencies are defined in s.
1797	408.813 those which the agency determines have a direct or
1798	immediate relationship to the health, safety, or security of the
1799	facility residents, other than class I deficiencies. A class II
1800	violation deficiency is subject to a civil penalty in an amount
1801	not less than $1,000 and not exceeding $5,000 for each violation
1802	deficiency. A citation for a class II violation deficiency shall
1803	specify the time within which the violation deficiency must be
1804	corrected. If a class II violation deficiency is corrected
1805	within the time specified, no civil penalty shall be imposed,
1806	unless it is a repeated offense.
1807	(c)  Class III violations deficiencies are defined in s.
1808	408.813 those which the agency determines to have an indirect or
1809	potential relationship to the health, safety, or security of the
1810	facility residents, other than class I or class II deficiencies.
1811	A class III violation deficiency is subject to a civil penalty
1812	of not less than $500 and not exceeding $1,000 for each
1813	deficiency. A citation for a class III violation deficiency
1814	shall specify the time within which the violation deficiency
1815	must be corrected. If a class III violation deficiency is
1816	corrected within the time specified, no civil penalty shall be
1817	imposed, unless it is a repeated offense.
1818	(d)  Class IV violations are defined in s. 408.813. Upon
1819	finding an uncorrected or repeated class IV violation, the
1820	agency shall impose an administrative fine not to exceed $500
1821	for each occurrence and each day that the uncorrected or
1822	repeated violation exists.
1823	Section 51.  Subsections (4) and (7) of section 400.9905,
1824	Florida Statutes, are amended to read:
1825	400.9905  Definitions.-
1826	(4)  "Clinic" means an entity at which health care services
1827	are provided to individuals and which tenders charges for
1828	reimbursement for such services, including a mobile clinic and a
1829	portable health service or equipment provider. For purposes of
1830	this part, the term does not include and the licensure
1831	requirements of this part do not apply to:
1832	(a)  Entities licensed or registered by the state under
1833	chapter 395; or entities licensed or registered by the state and
1834	providing only health care services within the scope of services
1835	authorized under their respective licenses granted under ss.
1836	383.30-383.335, chapter 390, chapter 394, chapter 397, this
1837	chapter except part X, chapter 429, chapter 463, chapter 465,
1838	chapter 466, chapter 478, part I of chapter 483, chapter 484, or
1839	chapter 651; end-stage renal disease providers authorized under
1840	42 C.F.R. part 405, subpart U; or providers certified under 42
1841	C.F.R. part 485, subpart B or subpart H; or any entity that
1842	provides neonatal or pediatric hospital-based health care
1843	services or other health care services by licensed practitioners
1844	solely within a hospital licensed under chapter 395.
1845	(b)  Entities that own, directly or indirectly, entities
1846	licensed or registered by the state pursuant to chapter 395; or
1847	entities that own, directly or indirectly, entities licensed or
1848	registered by the state and providing only health care services
1849	within the scope of services authorized pursuant to their
1850	respective licenses granted under ss. 383.30-383.335, chapter
1851	390, chapter 394, chapter 397, this chapter except part X,
1852	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1853	part I of chapter 483, chapter 484, chapter 651; end-stage renal
1854	disease providers authorized under 42 C.F.R. part 405, subpart
1855	U; or providers certified under 42 C.F.R. part 485, subpart B or
1856	subpart H; or any entity that provides neonatal or pediatric
1857	hospital-based health care services by licensed practitioners
1858	solely within a hospital licensed under chapter 395.
1859	(c)  Entities that are owned, directly or indirectly, by an
1860	entity licensed or registered by the state pursuant to chapter
1861	395; or entities that are owned, directly or indirectly, by an
1862	entity licensed or registered by the state and providing only
1863	health care services within the scope of services authorized
1864	pursuant to their respective licenses granted under ss. 383.30-
1865	383.335, chapter 390, chapter 394, chapter 397, this chapter
1866	except part X, chapter 429, chapter 463, chapter 465, chapter
1867	466, chapter 478, part I of chapter 483, chapter 484, or chapter
1868	651; end-stage renal disease providers authorized under 42
1869	C.F.R. part 405, subpart U; or providers certified under 42
1870	C.F.R. part 485, subpart B or subpart H; or any entity that
1871	provides neonatal or pediatric hospital-based health care
1872	services by licensed practitioners solely within a hospital
1873	under chapter 395.
1874	(d)  Entities that are under common ownership, directly or
1875	indirectly, with an entity licensed or registered by the state
1876	pursuant to chapter 395; or entities that are under common
1877	ownership, directly or indirectly, with an entity licensed or
1878	registered by the state and providing only health care services
1879	within the scope of services authorized pursuant to their
1880	respective licenses granted under ss. 383.30-383.335, chapter
1881	390, chapter 394, chapter 397, this chapter except part X,
1882	chapter 429, chapter 463, chapter 465, chapter 466, chapter 478,
1883	part I of chapter 483, chapter 484, or chapter 651; end-stage
1884	renal disease providers authorized under 42 C.F.R. part 405,
1885	subpart U; or providers certified under 42 C.F.R. part 485,
1886	subpart B or subpart H; or any entity that provides neonatal or
1887	pediatric hospital-based health care services by licensed
1888	practitioners solely within a hospital licensed under chapter
1889	395.
1890	(e)  An entity that is exempt from federal taxation under
1891	26 U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan
1892	under 26 U.S.C. s. 409 that has a board of trustees not less
1893	than two-thirds of which are Florida-licensed health care
1894	practitioners and provides only physical therapy services under
1895	physician orders, any community college or university clinic,
1896	and any entity owned or operated by the federal or state
1897	government, including agencies, subdivisions, or municipalities
1898	thereof.
1899	(f)  A sole proprietorship, group practice, partnership, or
1900	corporation that provides health care services by physicians
1901	covered by s. 627.419, that is directly supervised by one or
1902	more of such physicians, and that is wholly owned by one or more
1903	of those physicians or by a physician and the spouse, parent,
1904	child, or sibling of that physician.
1905	(g)  A sole proprietorship, group practice, partnership, or
1906	corporation that provides health care services by licensed
1907	health care practitioners under chapter 457, chapter 458,
1908	chapter 459, chapter 460, chapter 461, chapter 462, chapter 463,
1909	chapter 466, chapter 467, chapter 480, chapter 484, chapter 486,
1910	chapter 490, chapter 491, or part I, part III, part X, part
1911	XIII, or part XIV of chapter 468, or s. 464.012, which are
1912	wholly owned by one or more licensed health care practitioners,
1913	or the licensed health care practitioners set forth in this
1914	paragraph and the spouse, parent, child, or sibling of a
1915	licensed health care practitioner, so long as one of the owners
1916	who is a licensed health care practitioner is supervising the
1917	business activities and is legally responsible for the entity's
1918	compliance with all federal and state laws. However, a health
1919	care practitioner may not supervise services beyond the scope of
1920	the practitioner's license, except that, for the purposes of
1921	this part, a clinic owned by a licensee in s. 456.053(3)(b) that
1922	provides only services authorized pursuant to s. 456.053(3)(b)
1923	may be supervised by a licensee specified in s. 456.053(3)(b).
1924	(h)  Clinical facilities affiliated with an accredited
1925	medical school at which training is provided for medical
1926	students, residents, or fellows.
1927	(i)  Entities that provide only oncology or radiation
1928	therapy services by physicians licensed under chapter 458 or
1929	chapter 459 or entities that provide oncology or radiation
1930	therapy services by physicians licensed under chapter 458 or
1931	chapter 459 which are owned by a corporation whose shares are
1932	publicly traded on a recognized stock exchange.
1933	(j)  Clinical facilities affiliated with a college of
1934	chiropractic accredited by the Council on Chiropractic Education
1935	at which training is provided for chiropractic students.
1936	(k)  Entities that provide licensed practitioners to staff
1937	emergency departments or to deliver anesthesia services in
1938	facilities licensed under chapter 395 and that derive at least
1939	90 percent of their gross annual revenues from the provision of
1940	such services. Entities claiming an exemption from licensure
1941	under this paragraph must provide documentation demonstrating
1942	compliance.
1943	(l)  Orthotic, or prosthetic, pediatric cardiology, or
1944	perinatology clinical facilities that are a publicly traded
1945	corporation or that are wholly owned, directly or indirectly, by
1946	a publicly traded corporation. As used in this paragraph, a
1947	publicly traded corporation is a corporation that issues
1948	securities traded on an exchange registered with the United
1949	States Securities and Exchange Commission as a national
1950	securities exchange.
1951	(m)  Entities that are owned by a corporation that has $250
1952	million or more in total annual sales of health care services
1953	provided by licensed health care practitioners if one or more of
1954	the owners of the entity is a health care practitioner who is
1955	licensed in this state, is responsible for supervising the
1956	business activities of the entity, and is legally responsible
1957	for the entity's compliance with state law for purposes of this
1958	section.
1959	(n)  Entities that are owned or controlled, directly or
1960	indirectly, by a publicly traded entity with $100 million or
1961	more, in the aggregate, in total annual revenues derived from
1962	providing health care services by licensed health care
1963	practitioners that are employed or contracted by an entity
1964	described in this paragraph.
1965	(o)  Entities that employ 50 or more health care
1966	practitioners licensed under chapter 458 or chapter 459 when the
1967	billing for medical services is under a single tax
1968	identification number. The application for exemption under this
1969	paragraph shall contain information that includes the name,
1970	residence address, business address, and phone number of the
1971	entity that owns the practice; a complete list of the names and
1972	contact information of all the officers and directors of the
1973	entity; the name, residence address, business address, and
1974	medical license number of each licensed Florida health care
1975	practitioner employed by the entity; the corporate tax
1976	identification number of the entity seeking an exemption; a
1977	listing of health care services to be provided by the entity at
1978	the health care clinics owned or operated by the entity and a
1979	certified statement prepared by an independent certified public
1980	accountant which states that the entity and the health care
1981	clinics owned or operated by the entity have not received
1982	payment for health care services under personal injury
1983	protection insurance coverage for the previous year. If the
1984	agency determines that an entity that is exempt under this
1985	paragraph has received payments for medical services under
1986	personal injury protection insurance coverage the agency may
1987	deny or revoke the exemption from licensure under this
1988	paragraph.
1989	(7)  "Portable health service or equipment provider" means
1990	an entity that contracts with or employs persons to provide
1991	portable health services or equipment to multiple locations
1992	performing treatment or diagnostic testing of individuals, that
1993	bills third-party payors for those services, and that otherwise
1994	meets the definition of a clinic in subsection (4).
1995	Section 52.  Paragraph (b) of subsection (1) and paragraph
1996	(c) of subsection (4) of section 400.991, Florida Statutes, are
1997	amended to read:
1998	400.991  License requirements; background screenings;
1999	prohibitions.-
2000	(1)
2001	(b)  Each mobile clinic must obtain a separate health care
2002	clinic license and must provide to the agency, at least
2003	quarterly, its projected street location to enable the agency to
2004	locate and inspect such clinic. A portable health service or
2005	equipment provider must obtain a health care clinic license for
2006	a single administrative office and is not required to submit
2007	quarterly projected street locations.
2008	(4)  In addition to the requirements of part II of chapter
2009	408, the applicant must file with the application satisfactory
2010	proof that the clinic is in compliance with this part and
2011	applicable rules, including:
2012	(c)  Proof of financial ability to operate as required
2013	under ss. s. 408.810(8) and 408.8065. As an alternative to
2014	submitting proof of financial ability to operate as required
2015	under s. 408.810(8), the applicant may file a surety bond of at
2016	least $500,000 which guarantees that the clinic will act in full
2017	conformity with all legal requirements for operating a clinic,
2018	payable to the agency. The agency may adopt rules to specify
2019	related requirements for such surety bond.
2020	Section 53.  Paragraph (g) of subsection (1) and paragraph
2021	(a) of subsection (7) of section 400.9935, Florida Statutes, are
2022	amended to read:
2023	400.9935  Clinic responsibilities.-
2024	(1)  Each clinic shall appoint a medical director or clinic
2025	director who shall agree in writing to accept legal
2026	responsibility for the following activities on behalf of the
2027	clinic. The medical director or the clinic director shall:
2028	(g)  Conduct systematic reviews of clinic billings to
2029	ensure that the billings are not fraudulent or unlawful. Upon
2030	discovery of an unlawful charge, the medical director or clinic
2031	director shall take immediate corrective action. If the clinic
2032	performs only the technical component of magnetic resonance
2033	imaging, static radiographs, computed tomography, or positron
2034	emission tomography, and provides the professional
2035	interpretation of such services, in a fixed facility that is
2036	accredited by the Joint Commission on Accreditation of
2037	Healthcare Organizations or the Accreditation Association for
2038	Ambulatory Health Care, and the American College of Radiology;
2039	and if, in the preceding quarter, the percentage of scans
2040	performed by that clinic which was billed to all personal injury
2041	protection insurance carriers was less than 15 percent, the
2042	chief financial officer of the clinic may, in a written
2043	acknowledgment provided to the agency, assume the responsibility
2044	for the conduct of the systematic reviews of clinic billings to
2045	ensure that the billings are not fraudulent or unlawful.
2046	(7)(a)  Each clinic engaged in magnetic resonance imaging
2047	services must be accredited by the Joint Commission on
2048	Accreditation of Healthcare Organizations, the American College
2049	of Radiology, or the Accreditation Association for Ambulatory
2050	Health Care, within 1 year after licensure. A clinic that is
2051	accredited by the American College of Radiology or is within the
2052	original 1-year period after licensure and replaces its core
2053	magnetic resonance imaging equipment shall be given 1 year after
2054	the date on which the equipment is replaced to attain
2055	accreditation. However, a clinic may request a single, 6-month
2056	extension if it provides evidence to the agency establishing
2057	that, for good cause shown, such clinic cannot be accredited
2058	within 1 year after licensure, and that such accreditation will
2059	be completed within the 6-month extension. After obtaining
2060	accreditation as required by this subsection, each such clinic
2061	must maintain accreditation as a condition of renewal of its
2062	license. A clinic that files a change of ownership application
2063	must comply with the original accreditation timeframe
2064	requirements of the transferor. The agency shall deny a change
2065	of ownership application if the clinic is not in compliance with
2066	the accreditation requirements. When a clinic adds, replaces, or
2067	modifies magnetic resonance imaging equipment and the
2068	accreditation agency requires new accreditation, the clinic must
2069	be accredited within 1 year after the date of the addition,
2070	replacement, or modification but may request a single, 6-month
2071	extension if the clinic provides evidence of good cause to the
2072	agency.
2073	Section 54.  Paragraph (a) of subsection (2) of section
2074	408.033, Florida Statutes, is amended to read:
2075	408.033  Local and state health planning.-
2076	(2)  FUNDING.-
2077	(a)  The Legislature intends that the cost of local health
2078	councils be borne by assessments on selected health care
2079	facilities subject to facility licensure by the Agency for
2080	Health Care Administration, including abortion clinics, assisted
2081	living facilities, ambulatory surgical centers, birthing
2082	centers, clinical laboratories except community nonprofit blood
2083	banks and clinical laboratories operated by practitioners for
2084	exclusive use regulated under s. 483.035, home health agencies,
2085	hospices, hospitals, intermediate care facilities for the
2086	developmentally disabled, nursing homes, health care clinics,
2087	and multiphasic testing centers and by assessments on
2088	organizations subject to certification by the agency pursuant to
2089	chapter 641, part III, including health maintenance
2090	organizations and prepaid health clinics. Fees assessed may be
2091	collected prospectively at the time of licensure renewal and
2092	prorated for the licensure period.
2093	Section 55.  Subsection (2) of section 408.034, Florida
2094	Statutes, is amended to read:
2095	408.034  Duties and responsibilities of agency; rules.-
2096	(2)  In the exercise of its authority to issue licenses to
2097	health care facilities and health service providers, as provided
2098	under chapters 393 and 395 and parts II, and IV, and VIII of
2099	chapter 400, the agency may not issue a license to any health
2100	care facility or health service provider that fails to receive a
2101	certificate of need or an exemption for the licensed facility or
2102	service.
2103	Section 56.  Paragraph (d) of subsection (1) and paragraph
2104	(m) of subsection (3) of section 408.036, Florida Statutes, are
2105	amended to read:
2106	408.036  Projects subject to review; exemptions.-
2107	(1)  APPLICABILITY.-Unless exempt under subsection (3), all
2108	health-care-related projects, as described in paragraphs (a)-
2109	(g), are subject to review and must file an application for a
2110	certificate of need with the agency. The agency is exclusively
2111	responsible for determining whether a health-care-related
2112	project is subject to review under ss. 408.031-408.045.
2113	(d)  The establishment of a hospice or hospice inpatient
2114	facility, except as provided in s. 408.043.
2115	(3)  EXEMPTIONS.-Upon request, the following projects are
2116	subject to exemption from the provisions of subsection (1):
2117	(m)1.  For the provision of adult open-heart services in a
2118	hospital located within the boundaries of a health service
2119	planning district, as defined in s. 408.032(5), which has
2120	experienced an annual net out-migration of at least 600 open-
2121	heart-surgery cases for 3 consecutive years according to the
2122	most recent data reported to the agency, and the district's
2123	population per licensed and operational open-heart programs
2124	exceeds the state average of population per licensed and
2125	operational open-heart programs by at least 25 percent. All
2126	hospitals within a health service planning district which meet
2127	the criteria reference in sub-subparagraphs 2.a.-h. shall be
2128	eligible for this exemption on July 1, 2004, and shall receive
2129	the exemption upon filing for it and subject to the following:
2130	a.  A hospital that has received a notice of intent to
2131	grant a certificate of need or a final order of the agency
2132	granting a certificate of need for the establishment of an open-
2133	heart-surgery program is entitled to receive a letter of
2134	exemption for the establishment of an adult open-heart-surgery
2135	program upon filing a request for exemption and complying with
2136	the criteria enumerated in sub-subparagraphs 2.a.-h., and is
2137	entitled to immediately commence operation of the program.
2138	b.  An otherwise eligible hospital that has not received a
2139	notice of intent to grant a certificate of need or a final order
2140	of the agency granting a certificate of need for the
2141	establishment of an open-heart-surgery program is entitled to
2142	immediately receive a letter of exemption for the establishment
2143	of an adult open-heart-surgery program upon filing a request for
2144	exemption and complying with the criteria enumerated in sub-
2145	subparagraphs 2.a.-h., but is not entitled to commence operation
2146	of its program until December 31, 2006.
2147	2.  A hospital shall be exempt from the certificate-of-need
2148	review for the establishment of an open-heart-surgery program
2149	when the application for exemption submitted under this
2150	paragraph complies with the following criteria:
2151	a.  The applicant must certify that it will meet and
2152	continuously maintain the minimum licensure requirements adopted
2153	by the agency governing adult open-heart programs, including the
2154	most current guidelines of the American College of Cardiology
2155	and American Heart Association Guidelines for Adult Open Heart
2156	Programs.
2157	b.  The applicant must certify that it will maintain
2158	sufficient appropriate equipment and health personnel to ensure
2159	quality and safety.
2160	c.  The applicant must certify that it will maintain
2161	appropriate times of operation and protocols to ensure
2162	availability and appropriate referrals in the event of
2163	emergencies.
2164	d.  The applicant can demonstrate that it has discharged at
2165	least 300 inpatients with a principal diagnosis of ischemic
2166	heart disease for the most recent 12-month period as reported to
2167	the agency.
2168	e.  The applicant is a general acute care hospital that is
2169	in operation for 3 years or more.
2170	f.  The applicant is performing more than 300 diagnostic
2171	cardiac catheterization procedures per year, combined inpatient
2172	and outpatient.
2173	g.  The applicant's payor mix at a minimum reflects the
2174	community average for Medicaid, charity care, and self-pay
2175	patients or the applicant must certify that it will provide a
2176	minimum of 5 percent of Medicaid, charity care, and self-pay to
2177	open-heart-surgery patients.
2178	h.  If the applicant fails to meet the established criteria
2179	for open-heart programs or fails to reach 300 surgeries per year
2180	by the end of its third year of operation, it must show cause
2181	why its exemption should not be revoked.
2182	3.  By December 31, 2004, and annually thereafter, the
2183	agency shall submit a report to the Legislature providing
2184	information concerning the number of requests for exemption it
2185	has received under this paragraph during the calendar year and
2186	the number of exemptions it has granted or denied during the
2187	calendar year.
2188	Section 57.  Paragraph (c) of subsection (1) of section
2189	408.037, Florida Statutes, is amended to read:
2190	408.037  Application content.-
2191	(1)  Except as provided in subsection (2) for a general
2192	hospital, an application for a certificate of need must contain:
2193	(c)  An audited financial statement of the applicant or the
2194	applicant's parent corporation if audited financial statements
2195	of the applicant do not exist. In an application submitted by an
2196	existing health care facility, health maintenance organization,
2197	or hospice, financial condition documentation must include, but
2198	need not be limited to, a balance sheet and a profit-and-loss
2199	statement of the 2 previous fiscal years' operation.
2200	Section 58.  Subsection (2) of section 408.043, Florida
2201	Statutes, is amended to read:
2202	408.043  Special provisions.-
2203	(2)  HOSPICES.-When an application is made for a
2204	certificate of need to establish or to expand a hospice, the
2205	need for such hospice shall be determined on the basis of the
2206	need for and availability of hospice services in the community.
2207	The formula on which the certificate of need is based shall
2208	discourage regional monopolies and promote competition. The
2209	inpatient hospice care component of a hospice which is a
2210	freestanding facility, or a part of a facility, which is
2211	primarily engaged in providing inpatient care and related
2212	services and is not licensed as a health care facility shall
2213	also be required to obtain a certificate of need. Provision of
2214	hospice care by any current provider of health care is a
2215	significant change in service and therefore requires a
2216	certificate of need for such services.
2217	Section 59.  Paragraph (k) of subsection (3) of section
2218	408.05, Florida Statutes, is amended to read:
2219	408.05  Florida Center for Health Information and Policy
2220	Analysis.-
2221	(3)  COMPREHENSIVE HEALTH INFORMATION SYSTEM.-In order to
2222	produce comparable and uniform health information and statistics
2223	for the development of policy recommendations, the agency shall
2224	perform the following functions:
2225	(k)  Develop, in conjunction with the State Consumer Health
2226	Information and Policy Advisory Council, and implement a long-
2227	range plan for making available health care quality measures and
2228	financial data that will allow consumers to compare health care
2229	services. The health care quality measures and financial data
2230	the agency must make available shall include, but is not limited
2231	to, pharmaceuticals, physicians, health care facilities, and
2232	health plans and managed care entities. The agency shall update
2233	the plan and report on the status of its implementation
2234	annually. The agency shall also make the plan and status report
2235	available to the public on its Internet website. As part of the
2236	plan, the agency shall identify the process and timeframes for
2237	implementation, any barriers to implementation, and
2238	recommendations of changes in the law that may be enacted by the
2239	Legislature to eliminate the barriers. As preliminary elements
2240	of the plan, the agency shall:
2241	1.  Make available patient-safety indicators, inpatient
2242	quality indicators, and performance outcome and patient charge
2243	data collected from health care facilities pursuant to s.
2244	408.061(1)(a) and (2). The terms "patient-safety indicators" and
2245	"inpatient quality indicators" shall be as defined by the
2246	Centers for Medicare and Medicaid Services, the National Quality
2247	Forum, the Joint Commission on Accreditation of Healthcare
2248	Organizations, the Agency for Healthcare Research and Quality,
2249	the Centers for Disease Control and Prevention, or a similar
2250	national entity that establishes standards to measure the
2251	performance of health care providers, or by other states. The
2252	agency shall determine which conditions, procedures, health care
2253	quality measures, and patient charge data to disclose based upon
2254	input from the council. When determining which conditions and
2255	procedures are to be disclosed, the council and the agency shall
2256	consider variation in costs, variation in outcomes, and
2257	magnitude of variations and other relevant information. When
2258	determining which health care quality measures to disclose, the
2259	agency:
2260	a.  Shall consider such factors as volume of cases; average
2261	patient charges; average length of stay; complication rates;
2262	mortality rates; and infection rates, among others, which shall
2263	be adjusted for case mix and severity, if applicable.
2264	b.  May consider such additional measures that are adopted
2265	by the Centers for Medicare and Medicaid Studies, National
2266	Quality Forum, the Joint Commission on Accreditation of
2267	Healthcare Organizations, the Agency for Healthcare Research and
2268	Quality, Centers for Disease Control and Prevention, or a
2269	similar national entity that establishes standards to measure
2270	the performance of health care providers, or by other states.
2271
2272	When determining which patient charge data to disclose, the
2273	agency shall include such measures as the average of
2274	undiscounted charges on frequently performed procedures and
2275	preventive diagnostic procedures, the range of procedure charges
2276	from highest to lowest, average net revenue per adjusted patient
2277	day, average cost per adjusted patient day, and average cost per
2278	admission, among others.
2279	2.  Make available performance measures, benefit design,
2280	and premium cost data from health plans licensed pursuant to
2281	chapter 627 or chapter 641. The agency shall determine which
2282	health care quality measures and member and subscriber cost data
2283	to disclose, based upon input from the council. When determining
2284	which data to disclose, the agency shall consider information
2285	that may be required by either individual or group purchasers to
2286	assess the value of the product, which may include membership
2287	satisfaction, quality of care, current enrollment or membership,
2288	coverage areas, accreditation status, premium costs, plan costs,
2289	premium increases, range of benefits, copayments and
2290	deductibles, accuracy and speed of claims payment, credentials
2291	of physicians, number of providers, names of network providers,
2292	and hospitals in the network. Health plans shall make available
2293	to the agency any such data or information that is not currently
2294	reported to the agency or the office.
2295	3.  Determine the method and format for public disclosure
2296	of data reported pursuant to this paragraph. The agency shall
2297	make its determination based upon input from the State Consumer
2298	Health Information and Policy Advisory Council. At a minimum,
2299	the data shall be made available on the agency's Internet
2300	website in a manner that allows consumers to conduct an
2301	interactive search that allows them to view and compare the
2302	information for specific providers. The website must include
2303	such additional information as is determined necessary to ensure
2304	that the website enhances informed decisionmaking among
2305	consumers and health care purchasers, which shall include, at a
2306	minimum, appropriate guidance on how to use the data and an
2307	explanation of why the data may vary from provider to provider.
2308	4.  Publish on its website undiscounted charges for no
2309	fewer than 150 of the most commonly performed adult and
2310	pediatric procedures, including outpatient, inpatient,
2311	diagnostic, and preventative procedures.
2312	Section 60.  Paragraph (a) of subsection (1) of section
2313	408.061, Florida Statutes, is amended to read:
2314	408.061  Data collection; uniform systems of financial
2315	reporting; information relating to physician charges;
2316	confidential information; immunity.-
2317	(1)  The agency shall require the submission by health care
2318	facilities, health care providers, and health insurers of data
2319	necessary to carry out the agency's duties. Specifications for
2320	data to be collected under this section shall be developed by
2321	the agency with the assistance of technical advisory panels
2322	including representatives of affected entities, consumers,
2323	purchasers, and such other interested parties as may be
2324	determined by the agency.
2325	(a)  Data submitted by health care facilities, including
2326	the facilities as defined in chapter 395, shall include, but are
2327	not limited to: case-mix data, patient admission and discharge
2328	data, hospital emergency department data which shall include the
2329	number of patients treated in the emergency department of a
2330	licensed hospital reported by patient acuity level, data on
2331	hospital-acquired infections as specified by rule, data on
2332	complications as specified by rule, data on readmissions as
2333	specified by rule, with patient and provider-specific
2334	identifiers included, actual charge data by diagnostic groups,
2335	financial data, accounting data, operating expenses, expenses
2336	incurred for rendering services to patients who cannot or do not
2337	pay, interest charges, depreciation expenses based on the
2338	expected useful life of the property and equipment involved, and
2339	demographic data. The agency shall adopt nationally recognized
2340	risk adjustment methodologies or software consistent with the
2341	standards of the Agency for Healthcare Research and Quality and
2342	as selected by the agency for all data submitted as required by
2343	this section. Data may be obtained from documents such as, but
2344	not limited to: leases, contracts, debt instruments, itemized
2345	patient bills, medical record abstracts, and related diagnostic
2346	information. Reported data elements shall be reported
2347	electronically and in accordance with rule 59E-7.012, Florida
2348	Administrative Code. Data submitted shall be certified by the
2349	chief executive officer or an appropriate and duly authorized
2350	representative or employee of the licensed facility that the
2351	information submitted is true and accurate.
2352	Section 61.  Subsection (43) of section 408.07, Florida
2353	Statutes, is amended to read:
2354	408.07  Definitions.-As used in this chapter, with the
2355	exception of ss. 408.031-408.045, the term:
2356	(43)  "Rural hospital" means an acute care hospital
2357	licensed under chapter 395, having 100 or fewer licensed beds
2358	and an emergency room, and which is:
2359	(a)  The sole provider within a county with a population
2360	density of no greater than 100 persons per square mile;
2361	(b)  An acute care hospital, in a county with a population
2362	density of no greater than 100 persons per square mile, which is
2363	at least 30 minutes of travel time, on normally traveled roads
2364	under normal traffic conditions, from another acute care
2365	hospital within the same county;
2366	(c)  A hospital supported by a tax district or subdistrict
2367	whose boundaries encompass a population of 100 persons or fewer
2368	per square mile;
2369	(d)  A hospital with a service area that has a population
2370	of 100 persons or fewer per square mile. As used in this
2371	paragraph, the term "service area" means the fewest number of
2372	zip codes that account for 75 percent of the hospital's
2373	discharges for the most recent 5-year period, based on
2374	information available from the hospital inpatient discharge
2375	database in the Florida Center for Health Information and Policy
2376	Analysis at the Agency for Health Care Administration; or
2377	(e)  A critical access hospital.
2378
2379	Population densities used in this subsection must be based upon
2380	the most recently completed United States census. A hospital
2381	that received funds under s. 409.9116 for a quarter beginning no
2382	later than July 1, 2002, is deemed to have been and shall
2383	continue to be a rural hospital from that date through June 30,
2384	2015, if the hospital continues to have 100 or fewer licensed
2385	beds and an emergency room, or meets the criteria of s.
2386	395.602(2)(e)4. An acute care hospital that has not previously
2387	been designated as a rural hospital and that meets the criteria
2388	of this subsection shall be granted such designation upon
2389	application, including supporting documentation, to the Agency
2390	for Health Care Administration.
2391	Section 62.  Section 408.10, Florida Statutes, is amended
2392	to read:
2393	408.10  Consumer complaints.-The agency shall:
2394	(1)  publish and make available to the public a toll-free
2395	telephone number for the purpose of handling consumer complaints
2396	and shall serve as a liaison between consumer entities and other
2397	private entities and governmental entities for the disposition
2398	of problems identified by consumers of health care.
2399	(2)  Be empowered to investigate consumer complaints
2400	relating to problems with health care facilities' billing
2401	practices and issue reports to be made public in any cases where
2402	the agency determines the health care facility has engaged in
2403	billing practices which are unreasonable and unfair to the
2404	consumer.
2405	Section 63.  Subsections (12) through (30) of section
2406	408.802, Florida Statutes, are renumbered as subsections (11)
2407	through (29), respectively, and present subsection (11) of that
2408	section is amended to read:
2409	408.802  Applicability.-The provisions of this part apply
2410	to the provision of services that require licensure as defined
2411	in this part and to the following entities licensed, registered,
2412	or certified by the agency, as described in chapters 112, 383,
2413	390, 394, 395, 400, 429, 440, 483, and 765:
2414	(11)  Private review agents, as provided under part I of
2415	chapter 395.
2416	Section 64.  Subsection (3) is added to section 408.804,
2417	Florida Statutes, to read:
2418	408.804  License required; display.-
2419	(3)  Any person who knowingly alters, defaces, or falsifies
2420	a license certificate issued by the agency, or causes or
2421	procures any person to commit such an offense, commits a
2422	misdemeanor of the second degree, punishable as provided in s.
2423	775.082 or s 775.083. Any licensee or provider who displays an
2424	altered, defaced, or falsified license certificate is subject to
2425	the penalties set forth in s. 408.815 and an administrative fine
2426	of $1,000 for each day of illegal display.
2427	Section 65.  Paragraph (d) of subsection (2) of section
2428	408.806, Florida Statutes, is amended, and paragraph (e) is
2429	added to that subsection, to read:
2430	408.806  License application process.-
2431	(2)
2432	(d)  The agency shall notify the licensee by mail or
2433	electronically at least 90 days before the expiration of a
2434	license that a renewal license is necessary to continue
2435	operation. The licensee's failure to timely file submit a
2436	renewal application and license application fee with the agency
2437	shall result in a $50 per day late fee charged to the licensee
2438	by the agency; however, the aggregate amount of the late fee may
2439	not exceed 50 percent of the licensure fee or $500, whichever is
2440	less. The agency shall provide a courtesy notice to the licensee
2441	by United States mail, electronically, or by any other manner at
2442	its address of record or mailing address, if provided, at least
2443	90 days prior to the expiration of a license informing the
2444	licensee of the expiration of the license. If the licensee does
2445	not receive the courtesy notice, the licensee continues to be
2446	legally obligated to timely file the renewal application and
2447	license application fee with the agency and is not excused from
2448	the payment of a late fee. If an application is received after
2449	the required filing date and exhibits a hand-canceled postmark
2450	obtained from a United States post office dated on or before the
2451	required filing date, no fine will be levied.
2452	(e)  The applicant must pay the late fee before a late
2453	application is considered complete and failure to pay the late
2454	fee is considered an omission from the application for licensure
2455	pursuant to paragraph (3)(b).
2456	Section 66.  Paragraph (b) of subsection (1) of section
2457	408.8065, Florida Statutes, is amended to read:
2458	408.8065  Additional licensure requirements for home health
2459	agencies, home medical equipment providers, and health care
2460	clinics.-
2461	(1)  An applicant for initial licensure, or initial
2462	licensure due to a change of ownership, as a home health agency,
2463	home medical equipment provider, or health care clinic shall:
2464	(b)  Submit projected pro forma financial statements,
2465	including a balance sheet, income and expense statement, and a
2466	statement of cash flows for the first 2 years of operation which
2467	provide evidence that the applicant has sufficient assets,
2468	credit, and projected revenues to cover liabilities and
2469	expenses.
2470
2471	All documents required under this subsection must be prepared in
2472	accordance with generally accepted accounting principles and may
2473	be in a compilation form. The financial statements must be
2474	signed by a certified public accountant.
2475	Section 67.  Subsections (5) through (8) of section
2476	408.809, Florida Statutes are renumbered as subsections (6)
2477	through (9), respectively, and subsection (4) of that section is
2478	amended to read:
2479	408.809  Background screening; prohibited offenses.-
2480	(4)  In addition to the offenses listed in s. 435.04, all
2481	persons required to undergo background screening pursuant to
2482	this part or authorizing statutes must not have an arrest
2483	awaiting final disposition for, must not have been found guilty
2484	of, regardless of adjudication, or entered a plea of nolo
2485	contendere or guilty to, and must not have been adjudicated
2486	delinquent and the record not have been sealed or expunged for
2487	any of the following offenses or any similar offense of another
2488	jurisdiction:
2489	(a)  Any authorizing statutes, if the offense was a felony.
2490	(b)  This chapter, if the offense was a felony.
2491	(c)  Section 409.920, relating to Medicaid provider fraud.
2492	(d)  Section 409.9201, relating to Medicaid fraud.
2493	(e)  Section 741.28, relating to domestic violence.
2494	(f)  Section 817.034, relating to fraudulent acts through
2495	mail, wire, radio, electromagnetic, photoelectronic, or
2496	photooptical systems.
2497	(g)  Section 817.234, relating to false and fraudulent
2498	insurance claims.
2499	(h)  Section 817.505, relating to patient brokering.
2500	(i)  Section 817.568, relating to criminal use of personal
2501	identification information.
2502	(j)  Section 817.60, relating to obtaining a credit card
2503	through fraudulent means.
2504	(k)  Section 817.61, relating to fraudulent use of credit
2505	cards, if the offense was a felony.
2506	(l)  Section 831.01, relating to forgery.
2507	(m)  Section 831.02, relating to uttering forged
2508	instruments.
2509	(n)  Section 831.07, relating to forging bank bills,
2510	checks, drafts, or promissory notes.
2511	(o)  Section 831.09, relating to uttering forged bank
2512	bills, checks, drafts, or promissory notes.
2513	(p)  Section 831.30, relating to fraud in obtaining
2514	medicinal drugs.
2515	(q)  Section 831.31, relating to the sale, manufacture,
2516	delivery, or possession with the intent to sell, manufacture, or
2517	deliver any counterfeit controlled substance, if the offense was
2518	a felony.
2519	(5)  A person who serves as a controlling interest of, is
2520	employed by, or contracts with a licensee on July 31, 2010, who
2521	has been screened and qualified according to standards specified
2522	in s. 435.03 or s. 435.04 must be rescreened by July 31, 2015,
2523	in accordance with the schedule provided in paragraphs (a)-(c).
2524	The agency may adopt rules to establish a schedule to stagger
2525	the implementation of the required rescreening over the 5-year
2526	period, beginning July 31, 2010, through July 31, 2015. If, upon
2527	rescreening, such person has a disqualifying offense that was
2528	not a disqualifying offense at the time of the last screening,
2529	but is a current disqualifying offense and was committed before
2530	the last screening, he or she may apply for an exemption from
2531	the appropriate licensing agency and, if agreed to by the
2532	employer, may continue to perform his or her duties until the
2533	licensing agency renders a decision on the application for
2534	exemption if the person is eligible to apply for an exemption
2535	and the exemption request is received by the agency within 30
2536	days after receipt of the rescreening results by the person. The
2537	rescreening schedule shall be:
2538	(a)  Individuals whose last screening was conducted before
2539	December 31, 2003, must be rescreened by July 31, 2013.
2540	(b)  Individuals whose last screening was conducted between
2541	January 1, 2004, through December 31, 2007, must be rescreened
2542	by July 31, 2014.
2543	(c)  Individuals whose last screening was conducted between
2544	January 1, 2008, through July 31, 2010, must be rescreened by
2545	July 31, 2015.
2546	Section 68.  Subsection (9) of section 408.810, Florida
2547	Statutes, is amended to read:
2548	408.810  Minimum licensure requirements.-In addition to the
2549	licensure requirements specified in this part, authorizing
2550	statutes, and applicable rules, each applicant and licensee must
2551	comply with the requirements of this section in order to obtain
2552	and maintain a license.
2553	(9)  A controlling interest may not withhold from the
2554	agency any evidence of financial instability, including, but not
2555	limited to, checks returned due to insufficient funds,
2556	delinquent accounts, nonpayment of withholding taxes, unpaid
2557	utility expenses, nonpayment for essential services, or adverse
2558	court action concerning the financial viability of the provider
2559	or any other provider licensed under this part that is under the
2560	control of the controlling interest. A controlling interest
2561	shall notify the agency within 10 days after a court action to
2562	initiate bankruptcy, foreclosure, or eviction proceedings
2563	concerning the provider in which the controlling interest is a
2564	petitioner or defendant. Any person who violates this subsection
2565	commits a misdemeanor of the second degree, punishable as
2566	provided in s. 775.082 or s. 775.083. Each day of continuing
2567	violation is a separate offense.
2568	Section 69.  Subsection (3) is added to section 408.813,
2569	Florida Statutes, to read:
2570	408.813  Administrative fines; violations.-As a penalty for
2571	any violation of this part, authorizing statutes, or applicable
2572	rules, the agency may impose an administrative fine.
2573	(3)  The agency may impose an administrative fine for a
2574	violation that is not designated as a class I, class II, class
2575	III, or class IV violation. Unless otherwise specified by law,
2576	the amount of the fine shall not exceed $500 for each violation.
2577	Unclassified violations may include:
2578	(a)  Violating any term or condition of a license.
2579	(b)  Violating any provision of this part, authorizing
2580	statutes, or applicable rules.
2581	(c)  Exceeding licensed capacity.
2582	(d)  Providing services beyond the scope of the license.
2583	(e)  Violating a moratorium imposed pursuant to s. 408.814.
2584	Section 70.  Subsection (4) of section 408.815, Florida
2585	Statutes, is amended, and subsections (5) and (6) are added to
2586	that section, to read:
2587	408.815  License or application denial; revocation.-
2588	(4)  Unless an applicant is determined by the agency to
2589	satisfy the provisions of subsection (5) for the action in
2590	question, the agency shall deny an application for a license or
2591	license renewal based upon any of the following actions of an
2592	applicant, a controlling interest of the applicant, or any
2593	entity in which a controlling interest of the applicant was an
2594	owner or officer when the following actions occurred In addition
2595	to the grounds provided in authorizing statutes, the agency
2596	shall deny an application for a license or license renewal if
2597	the applicant or a person having a controlling interest in an
2598	applicant has been:
2599	(a)  Conviction Convicted of, or enters a plea of guilty or
2600	nolo contendere to, regardless of adjudication, a felony under
2601	chapter 409, chapter 817, chapter 893, 21 U.S.C. ss. 801-970, or
2602	42 U.S.C. ss. 1395-1396, Medicare fraud, Medicaid fraud, or
2603	insurance fraud, unless the sentence and any subsequent period
2604	of probation for such convictions or plea ended more than 15
2605	years prior to the date of the application;
2606	(b)  Termination Terminated for cause from the Medicare
2607	program or a state Florida Medicaid program pursuant to s.
2608	409.913, unless the applicant has been in good standing with the
2609	Medicare program or a state Florida Medicaid program for the
2610	most recent 5 years and the termination occurred at least 20
2611	years before the date of the application.; or
2612	(c)  Terminated for cause, pursuant to the appeals
2613	procedures established by the state or Federal Government, from
2614	the federal Medicare program or from any other state Medicaid
2615	program, unless the applicant has been in good standing with a
2616	state Medicaid program or the federal Medicare program for the
2617	most recent 5 years and the termination occurred at least 20
2618	years prior to the date of the application.
2619	(5)  For any application subject to denial under subsection
2620	(4), the agency may consider mitigating circumstances, as
2621	applicable, including, but not limited to:
2622	(a)  Completion or lawful release from confinement,
2623	supervision, or sanction, including any terms of probation, and
2624	full restitution;
2625	(b)  Execution of a compliance plan with the agency;
2626	(c)  Compliance with any integrity agreement or compliance
2627	plan with any other government agency;
2628	(d)  Determination by the Medicare program or a state
2629	Medicaid program that the controlling interest or entity in
2630	which the controlling interest was an owner or officer is
2631	currently allowed to participate in the Medicare program or a
2632	state Medicaid program, either directly as a provider or
2633	indirectly as an owner or officer of a provider entity;
2634	(e)  Continuation of licensure by the controlling interest
2635	or entity in which the controlling interest was an owner or
2636	officer, either directly as a licensee or indirectly as an owner
2637	or officer of a licensed entity in the state where the action
2638	occurred;
2639	(f)  Overall impact upon the public health, safety, or
2640	welfare; or
2641	(g)  Determination that license denial is not commensurate
2642	with the prior action taken by the Medicare program or a state
2643	Medicaid program.
2644
2645	After considering the circumstances set forth in this
2646	subsection, the agency shall grant the license, with or without
2647	conditions, grant a provisional license for a period of no more
2648	than the licensure cycle, with or without conditions, or deny
2649	the license.
2650	(6)  In order to ensure the health, safety, and welfare of
2651	clients when a license has been denied, revoked, or is set to
2652	terminate, the agency may extend the license expiration date for
2653	a period of up to 30 days for the sole purpose of allowing the
2654	safe and orderly discharge of clients. The agency may impose
2655	conditions on the extension, including, but not limited to,
2656	prohibiting or limiting admissions, expedited discharge
2657	planning, required status reports, and mandatory monitoring by
2658	the agency or third parties. When imposing these conditions, the
2659	agency shall take into consideration the nature and number of
2660	clients, the availability and location of acceptable alternative
2661	placements, and the ability of the licensee to continue
2662	providing care to the clients. The agency may terminate the
2663	extension or modify the conditions at any time. This authority
2664	is in addition to any other authority granted to the agency
2665	under chapter 120, this part, and authorizing statutes but
2666	creates no right or entitlement to an extension of a license
2667	expiration date.
2668	Section 71.  Subsection (1) of section 409.91196, Florida
2669	Statutes, is amended to read:
2670	409.91196  Supplemental rebate agreements; public records
2671	and public meetings exemption.-
2672	(1)  The rebate amount, percent of rebate, manufacturer's
2673	pricing, and supplemental rebate, and other trade secrets as
2674	defined in s. 688.002 that the agency has identified for use in
2675	negotiations, held by the Agency for Health Care Administration
2676	under s. 409.912(39)(a)8.7. are confidential and exempt from s.
2677	119.07(1) and s. 24(a), Art. I of the State Constitution.
2678	Section 72.  Paragraph (a) of subsection (39) of section
2679	409.912, Florida Statutes, is amended to read:
2680	409.912  Cost-effective purchasing of health care.-The
2681	agency shall purchase goods and services for Medicaid recipients
2682	in the most cost-effective manner consistent with the delivery
2683	of quality medical care. To ensure that medical services are
2684	effectively utilized, the agency may, in any case, require a
2685	confirmation or second physician's opinion of the correct
2686	diagnosis for purposes of authorizing future services under the
2687	Medicaid program. This section does not restrict access to
2688	emergency services or poststabilization care services as defined
2689	in 42 C.F.R. part 438.114. Such confirmation or second opinion
2690	shall be rendered in a manner approved by the agency. The agency
2691	shall maximize the use of prepaid per capita and prepaid
2692	aggregate fixed-sum basis services when appropriate and other
2693	alternative service delivery and reimbursement methodologies,
2694	including competitive bidding pursuant to s. 287.057, designed
2695	to facilitate the cost-effective purchase of a case-managed
2696	continuum of care. The agency shall also require providers to
2697	minimize the exposure of recipients to the need for acute
2698	inpatient, custodial, and other institutional care and the
2699	inappropriate or unnecessary use of high-cost services. The
2700	agency shall contract with a vendor to monitor and evaluate the
2701	clinical practice patterns of providers in order to identify
2702	trends that are outside the normal practice patterns of a
2703	provider's professional peers or the national guidelines of a
2704	provider's professional association. The vendor must be able to
2705	provide information and counseling to a provider whose practice
2706	patterns are outside the norms, in consultation with the agency,
2707	to improve patient care and reduce inappropriate utilization.
2708	The agency may mandate prior authorization, drug therapy
2709	management, or disease management participation for certain
2710	populations of Medicaid beneficiaries, certain drug classes, or
2711	particular drugs to prevent fraud, abuse, overuse, and possible
2712	dangerous drug interactions. The Pharmaceutical and Therapeutics
2713	Committee shall make recommendations to the agency on drugs for
2714	which prior authorization is required. The agency shall inform
2715	the Pharmaceutical and Therapeutics Committee of its decisions
2716	regarding drugs subject to prior authorization. The agency is
2717	authorized to limit the entities it contracts with or enrolls as
2718	Medicaid providers by developing a provider network through
2719	provider credentialing. The agency may competitively bid single-
2720	source-provider contracts if procurement of goods or services
2721	results in demonstrated cost savings to the state without
2722	limiting access to care. The agency may limit its network based
2723	on the assessment of beneficiary access to care, provider
2724	availability, provider quality standards, time and distance
2725	standards for access to care, the cultural competence of the
2726	provider network, demographic characteristics of Medicaid
2727	beneficiaries, practice and provider-to-beneficiary standards,
2728	appointment wait times, beneficiary use of services, provider
2729	turnover, provider profiling, provider licensure history,
2730	previous program integrity investigations and findings, peer
2731	review, provider Medicaid policy and billing compliance records,
2732	clinical and medical record audits, and other factors. Providers
2733	shall not be entitled to enrollment in the Medicaid provider
2734	network. The agency shall determine instances in which allowing
2735	Medicaid beneficiaries to purchase durable medical equipment and
2736	other goods is less expensive to the Medicaid program than long-
2737	term rental of the equipment or goods. The agency may establish
2738	rules to facilitate purchases in lieu of long-term rentals in
2739	order to protect against fraud and abuse in the Medicaid program
2740	as defined in s. 409.913. The agency may seek federal waivers
2741	necessary to administer these policies.
2742	(39)(a)  The agency shall implement a Medicaid prescribed-
2743	drug spending-control program that includes the following
2744	components:
2745	1.  A Medicaid preferred drug list, which shall be a
2746	listing of cost-effective therapeutic options recommended by the
2747	Medicaid Pharmacy and Therapeutics Committee established
2748	pursuant to s. 409.91195 and adopted by the agency for each
2749	therapeutic class on the preferred drug list. At the discretion
2750	of the committee, and when feasible, the preferred drug list
2751	should include at least two products in a therapeutic class. The
2752	agency may post the preferred drug list and updates to the
2753	preferred drug list on an Internet website without following the
2754	rulemaking procedures of chapter 120. Antiretroviral agents are
2755	excluded from the preferred drug list. The agency shall also
2756	limit the amount of a prescribed drug dispensed to no more than
2757	a 34-day supply unless the drug products' smallest marketed
2758	package is greater than a 34-day supply, or the drug is
2759	determined by the agency to be a maintenance drug in which case
2760	a 100-day maximum supply may be authorized. The agency is
2761	authorized to seek any federal waivers necessary to implement
2762	these cost-control programs and to continue participation in the
2763	federal Medicaid rebate program, or alternatively to negotiate
2764	state-only manufacturer rebates. The agency may adopt rules to
2765	implement this subparagraph. The agency shall continue to
2766	provide unlimited contraceptive drugs and items. The agency must
2767	establish procedures to ensure that:
2768	a.  There is a response to a request for prior consultation
2769	by telephone or other telecommunication device within 24 hours
2770	after receipt of a request for prior consultation; and
2771	b.  A 72-hour supply of the drug prescribed is provided in
2772	an emergency or when the agency does not provide a response
2773	within 24 hours as required by sub-subparagraph a.
2774	2.  Reimbursement to pharmacies for Medicaid prescribed
2775	drugs shall be set at the lesser of: the average wholesale price
2776	(AWP) minus 16.4 percent, the wholesaler acquisition cost (WAC)
2777	plus 4.75 percent, the federal upper limit (FUL), the state
2778	maximum allowable cost (SMAC), or the usual and customary (UAC)
2779	charge billed by the provider.
2780	3.  For a prescribed drug billed as a 340B prescribed
2781	medication rendered to all Medicaid-eligible individuals,
2782	including claims for cost sharing for which the agency is
2783	responsible, the claim must meet the requirements of the Deficit
2784	Reduction Act of 2005 and the federal 340B program and contain a
2785	national drug code.
2786	4.3.  The agency shall develop and implement a process for
2787	managing the drug therapies of Medicaid recipients who are using
2788	significant numbers of prescribed drugs each month. The
2789	management process may include, but is not limited to,
2790	comprehensive, physician-directed medical-record reviews, claims
2791	analyses, and case evaluations to determine the medical
2792	necessity and appropriateness of a patient's treatment plan and
2793	drug therapies. The agency may contract with a private
2794	organization to provide drug-program-management services. The
2795	Medicaid drug benefit management program shall include
2796	initiatives to manage drug therapies for HIV/AIDS patients,
2797	patients using 20 or more unique prescriptions in a 180-day
2798	period, and the top 1,000 patients in annual spending. The
2799	agency shall enroll any Medicaid recipient in the drug benefit
2800	management program if he or she meets the specifications of this
2801	provision and is not enrolled in a Medicaid health maintenance
2802	organization.
2803	5.4.  The agency may limit the size of its pharmacy network
2804	based on need, competitive bidding, price negotiations,
2805	credentialing, or similar criteria. The agency shall give
2806	special consideration to rural areas in determining the size and
2807	location of pharmacies included in the Medicaid pharmacy
2808	network. A pharmacy credentialing process may include criteria
2809	such as a pharmacy's full-service status, location, size,
2810	patient educational programs, patient consultation, disease
2811	management services, and other characteristics. The agency may
2812	impose a moratorium on Medicaid pharmacy enrollment when it is
2813	determined that it has a sufficient number of Medicaid-
2814	participating providers. The agency must allow dispensing
2815	practitioners to participate as a part of the Medicaid pharmacy
2816	network regardless of the practitioner's proximity to any other
2817	entity that is dispensing prescription drugs under the Medicaid
2818	program. A dispensing practitioner must meet all credentialing
2819	requirements applicable to his or her practice, as determined by
2820	the agency.
2821	6.5.  The agency shall develop and implement a program that
2822	requires Medicaid practitioners who prescribe drugs to use a
2823	counterfeit-proof prescription pad for Medicaid prescriptions.
2824	The agency shall require the use of standardized counterfeit-
2825	proof prescription pads by Medicaid-participating prescribers or
2826	prescribers who write prescriptions for Medicaid recipients. The
2827	agency may implement the program in targeted geographic areas or
2828	statewide.
2829	7.6.  The agency may enter into arrangements that require
2830	manufacturers of generic drugs prescribed to Medicaid recipients
2831	to provide rebates of at least 15.1 percent of the average
2832	manufacturer price for the manufacturer's generic products.
2833	These arrangements shall require that if a generic-drug
2834	manufacturer pays federal rebates for Medicaid-reimbursed drugs
2835	at a level below 15.1 percent, the manufacturer must provide a
2836	supplemental rebate to the state in an amount necessary to
2837	achieve a 15.1-percent rebate level.
2838	8.7.  The agency may establish a preferred drug list as
2839	described in this subsection, and, pursuant to the establishment
2840	of such preferred drug list, it is authorized to negotiate
2841	supplemental rebates from manufacturers that are in addition to
2842	those required by Title XIX of the Social Security Act and at no
2843	less than 14 percent of the average manufacturer price as
2844	defined in 42 U.S.C. s. 1936 on the last day of a quarter unless
2845	the federal or supplemental rebate, or both, equals or exceeds
2846	29 percent. There is no upper limit on the supplemental rebates
2847	the agency may negotiate. The agency may determine that specific
2848	products, brand-name or generic, are competitive at lower rebate
2849	percentages. Agreement to pay the minimum supplemental rebate
2850	percentage will guarantee a manufacturer that the Medicaid
2851	Pharmaceutical and Therapeutics Committee will consider a
2852	product for inclusion on the preferred drug list. However, a
2853	pharmaceutical manufacturer is not guaranteed placement on the
2854	preferred drug list by simply paying the minimum supplemental
2855	rebate. Agency decisions will be made on the clinical efficacy
2856	of a drug and recommendations of the Medicaid Pharmaceutical and
2857	Therapeutics Committee, as well as the price of competing
2858	products minus federal and state rebates. The agency is
2859	authorized to contract with an outside agency or contractor to
2860	conduct negotiations for supplemental rebates. For the purposes
2861	of this section, the term "supplemental rebates" means cash
2862	rebates. Effective July 1, 2004, value-added programs as a
2863	substitution for supplemental rebates are prohibited. The agency
2864	is authorized to seek any federal waivers to implement this
2865	initiative.
2866	9.8.  The Agency for Health Care Administration shall
2867	expand home delivery of pharmacy products. To assist Medicaid
2868	patients in securing their prescriptions and reduce program
2869	costs, the agency shall expand its current mail-order-pharmacy
2870	diabetes-supply program to include all generic and brand-name
2871	drugs used by Medicaid patients with diabetes. Medicaid
2872	recipients in the current program may obtain nondiabetes drugs
2873	on a voluntary basis. This initiative is limited to the
2874	geographic area covered by the current contract. The agency may
2875	seek and implement any federal waivers necessary to implement
2876	this subparagraph.
2877	10.9.  The agency shall limit to one dose per month any
2878	drug prescribed to treat erectile dysfunction.
2879	11.10.a.  The agency may implement a Medicaid behavioral
2880	drug management system. The agency may contract with a vendor
2881	that has experience in operating behavioral drug management
2882	systems to implement this program. The agency is authorized to
2883	seek federal waivers to implement this program.
2884	b.  The agency, in conjunction with the Department of
2885	Children and Family Services, may implement the Medicaid
2886	behavioral drug management system that is designed to improve
2887	the quality of care and behavioral health prescribing practices
2888	based on best practice guidelines, improve patient adherence to
2889	medication plans, reduce clinical risk, and lower prescribed
2890	drug costs and the rate of inappropriate spending on Medicaid
2891	behavioral drugs. The program may include the following
2892	elements:
2893	(I)  Provide for the development and adoption of best
2894	practice guidelines for behavioral health-related drugs such as
2895	antipsychotics, antidepressants, and medications for treating
2896	bipolar disorders and other behavioral conditions; translate
2897	them into practice; review behavioral health prescribers and
2898	compare their prescribing patterns to a number of indicators
2899	that are based on national standards; and determine deviations
2900	from best practice guidelines.
2901	(II)  Implement processes for providing feedback to and
2902	educating prescribers using best practice educational materials
2903	and peer-to-peer consultation.
2904	(III)  Assess Medicaid beneficiaries who are outliers in
2905	their use of behavioral health drugs with regard to the numbers
2906	and types of drugs taken, drug dosages, combination drug
2907	therapies, and other indicators of improper use of behavioral
2908	health drugs.
2909	(IV)  Alert prescribers to patients who fail to refill
2910	prescriptions in a timely fashion, are prescribed multiple same-
2911	class behavioral health drugs, and may have other potential
2912	medication problems.
2913	(V)  Track spending trends for behavioral health drugs and
2914	deviation from best practice guidelines.
2915	(VI)  Use educational and technological approaches to
2916	promote best practices, educate consumers, and train prescribers
2917	in the use of practice guidelines.
2918	(VII)  Disseminate electronic and published materials.
2919	(VIII)  Hold statewide and regional conferences.
2920	(IX)  Implement a disease management program with a model
2921	quality-based medication component for severely mentally ill
2922	individuals and emotionally disturbed children who are high
2923	users of care.
2924	12.11.a.  The agency shall implement a Medicaid
2925	prescription drug management system. The agency may contract
2926	with a vendor that has experience in operating prescription drug
2927	management systems in order to implement this system. Any
2928	management system that is implemented in accordance with this
2929	subparagraph must rely on cooperation between physicians and
2930	pharmacists to determine appropriate practice patterns and
2931	clinical guidelines to improve the prescribing, dispensing, and
2932	use of drugs in the Medicaid program. The agency may seek
2933	federal waivers to implement this program.
2934	b.  The drug management system must be designed to improve
2935	the quality of care and prescribing practices based on best
2936	practice guidelines, improve patient adherence to medication
2937	plans, reduce clinical risk, and lower prescribed drug costs and
2938	the rate of inappropriate spending on Medicaid prescription
2939	drugs. The program must:
2940	(I)  Provide for the development and adoption of best
2941	practice guidelines for the prescribing and use of drugs in the
2942	Medicaid program, including translating best practice guidelines
2943	into practice; reviewing prescriber patterns and comparing them
2944	to indicators that are based on national standards and practice
2945	patterns of clinical peers in their community, statewide, and
2946	nationally; and determine deviations from best practice
2947	guidelines.
2948	(II)  Implement processes for providing feedback to and
2949	educating prescribers using best practice educational materials
2950	and peer-to-peer consultation.
2951	(III)  Assess Medicaid recipients who are outliers in their
2952	use of a single or multiple prescription drugs with regard to
2953	the numbers and types of drugs taken, drug dosages, combination
2954	drug therapies, and other indicators of improper use of
2955	prescription drugs.
2956	(IV)  Alert prescribers to patients who fail to refill
2957	prescriptions in a timely fashion, are prescribed multiple drugs
2958	that may be redundant or contraindicated, or may have other
2959	potential medication problems.
2960	(V)  Track spending trends for prescription drugs and
2961	deviation from best practice guidelines.
2962	(VI)  Use educational and technological approaches to
2963	promote best practices, educate consumers, and train prescribers
2964	in the use of practice guidelines.
2965	(VII)  Disseminate electronic and published materials.
2966	(VIII)  Hold statewide and regional conferences.
2967	(IX)  Implement disease management programs in cooperation
2968	with physicians and pharmacists, along with a model quality-
2969	based medication component for individuals having chronic
2970	medical conditions.
2971	13.12.  The agency is authorized to contract for drug
2972	rebate administration, including, but not limited to,
2973	calculating rebate amounts, invoicing manufacturers, negotiating
2974	disputes with manufacturers, and maintaining a database of
2975	rebate collections.
2976	14.13.  The agency may specify the preferred daily dosing
2977	form or strength for the purpose of promoting best practices
2978	with regard to the prescribing of certain drugs as specified in
2979	the General Appropriations Act and ensuring cost-effective
2980	prescribing practices.
2981	15.14.  The agency may require prior authorization for
2982	Medicaid-covered prescribed drugs. The agency may, but is not
2983	required to, prior-authorize the use of a product:
2984	a.  For an indication not approved in labeling;
2985	b.  To comply with certain clinical guidelines; or
2986	c.  If the product has the potential for overuse, misuse,
2987	or abuse.
2988
2989	The agency may require the prescribing professional to provide
2990	information about the rationale and supporting medical evidence
2991	for the use of a drug. The agency shall accept electronic prior
2992	authorization requests from prescribers or pharmacists for any
2993	drug requiring prior authorization and may post prior
2994	authorization criteria and protocol and updates to the list of
2995	drugs that are subject to prior authorization on an Internet
2996	website without amending its rule or engaging in additional
2997	rulemaking.
2998	16.15.  The agency, in conjunction with the Pharmaceutical
2999	and Therapeutics Committee, may require age-related prior
3000	authorizations for certain prescribed drugs. The agency may
3001	preauthorize the use of a drug for a recipient who may not meet
3002	the age requirement or may exceed the length of therapy for use
3003	of this product as recommended by the manufacturer and approved
3004	by the Food and Drug Administration. Prior authorization may
3005	require the prescribing professional to provide information
3006	about the rationale and supporting medical evidence for the use
3007	of a drug.
3008	17.16.  The agency shall implement a step-therapy prior
3009	authorization approval process for medications excluded from the
3010	preferred drug list. Medications listed on the preferred drug
3011	list must be used within the previous 12 months prior to the
3012	alternative medications that are not listed. The step-therapy
3013	prior authorization may require the prescriber to use the
3014	medications of a similar drug class or for a similar medical
3015	indication unless contraindicated in the Food and Drug
3016	Administration labeling. The trial period between the specified
3017	steps may vary according to the medical indication. The step-
3018	therapy approval process shall be developed in accordance with
3019	the committee as stated in s. 409.91195(7) and (8). A drug
3020	product may be approved without meeting the step-therapy prior
3021	authorization criteria if the prescribing physician provides the
3022	agency with additional written medical or clinical documentation
3023	that the product is medically necessary because:
3024	a.  There is not a drug on the preferred drug list to treat
3025	the disease or medical condition which is an acceptable clinical
3026	alternative;
3027	b.  The alternatives have been ineffective in the treatment
3028	of the beneficiary's disease; or
3029	c.  Based on historic evidence and known characteristics of
3030	the patient and the drug, the drug is likely to be ineffective,
3031	or the number of doses have been ineffective.
3032
3033	The agency shall work with the physician to determine the best
3034	alternative for the patient. The agency may adopt rules waiving
3035	the requirements for written clinical documentation for specific
3036	drugs in limited clinical situations.
3037	18.17.  The agency shall implement a return and reuse
3038	program for drugs dispensed by pharmacies to institutional
3039	recipients, which includes payment of a $5 restocking fee for
3040	the implementation and operation of the program. The return and
3041	reuse program shall be implemented electronically and in a
3042	manner that promotes efficiency. The program must permit a
3043	pharmacy to exclude drugs from the program if it is not
3044	practical or cost-effective for the drug to be included and must
3045	provide for the return to inventory of drugs that cannot be
3046	credited or returned in a cost-effective manner. The agency
3047	shall determine if the program has reduced the amount of
3048	Medicaid prescription drugs which are destroyed on an annual
3049	basis and if there are additional ways to ensure more
3050	prescription drugs are not destroyed which could safely be
3051	reused. The agency's conclusion and recommendations shall be
3052	reported to the Legislature by December 1, 2005.
3053	Section 73.  Subsection (3) and paragraph (c) of subsection
3054	(4) of section 429.07, Florida Statutes, are amended, and
3055	subsections (6) and (7) are added to that section, to read:
3056	429.07  License required; fee; inspections.-
3057	(3)  In addition to the requirements of s. 408.806, each
3058	license granted by the agency must state the type of care for
3059	which the license is granted. Licenses shall be issued for one
3060	or more of the following categories of care: standard, extended
3061	congregate care, limited nursing services, or limited mental
3062	health.
3063	(a)  A standard license shall be issued to a facility
3064	facilities providing one or more of the personal services
3065	identified in s. 429.02. Such licensee facilities may also
3066	employ or contract with a person licensed under part I of
3067	chapter 464 to administer medications and perform other tasks as
3068	specified in s. 429.255.
3069	(b)  An extended congregate care license shall be issued to
3070	a licensee facilities providing, directly or through contract,
3071	services beyond those authorized in paragraph (a), including
3072	services performed by persons licensed under part I of chapter
3073	464 and supportive services, as defined by rule, to persons who
3074	would otherwise be disqualified from continued residence in a
3075	facility licensed under this part.
3076	1.  In order for extended congregate care services to be
3077	provided, the agency must first determine that all requirements
3078	established in law and rule are met and must specifically
3079	designate, on the facility's license, that such services may be
3080	provided and whether the designation applies to all or part of
3081	the facility. Such designation may be made at the time of
3082	initial licensure or relicensure, or upon request in writing by
3083	a licensee under this part and part II of chapter 408. The
3084	notification of approval or the denial of the request shall be
3085	made in accordance with part II of chapter 408. An existing
3086	licensee facilities qualifying to provide extended congregate
3087	care services must have maintained a standard license and may
3088	not have been subject to administrative sanctions during the
3089	previous 2 years, or since initial licensure if the facility has
3090	been licensed for less than 2 years, for any of the following
3091	reasons:
3092	a.  A class I or class II violation;
3093	b.  Three or more repeat or recurring class III violations
3094	of identical or similar resident care standards from which a
3095	pattern of noncompliance is found by the agency;
3096	c.  Three or more class III violations that were not
3097	corrected in accordance with the corrective action plan approved
3098	by the agency;
3099	d.  Violation of resident care standards which results in
3100	requiring the facility to employ the services of a consultant
3101	pharmacist or consultant dietitian;
3102	e.  Denial, suspension, or revocation of a license for
3103	another facility licensed under this part in which the applicant
3104	for an extended congregate care license has at least 25 percent
3105	ownership interest; or
3106	f.  Imposition of a moratorium pursuant to this part or
3107	part II of chapter 408 or initiation of injunctive proceedings.
3108	2.  A facility that is licensed to provide extended
3109	congregate care services shall maintain a written progress
3110	report for on each person who receives services which describes
3111	the type, amount, duration, scope, and outcome of services that
3112	are rendered and the general status of the resident's health. A
3113	registered nurse, or appropriate designee, representing the
3114	agency shall visit the facility at least quarterly to monitor
3115	residents who are receiving extended congregate care services
3116	and to determine if the facility is in compliance with this
3117	part, part II of chapter 408, and relevant rules. One of the
3118	visits may be in conjunction with the regular survey. The
3119	monitoring visits may be provided through contractual
3120	arrangements with appropriate community agencies. A registered
3121	nurse shall serve as part of the team that inspects the
3122	facility. The agency may waive one of the required yearly
3123	monitoring visits for a facility that has been licensed for at
3124	least 24 months to provide extended congregate care services,
3125	if, during the inspection, the registered nurse determines that
3126	extended congregate care services are being provided
3127	appropriately, and if the facility has no class I or class II
3128	violations and no uncorrected class III violations. The agency
3129	must first consult with the long-term care ombudsman council for
3130	the area in which the facility is located to determine if any
3131	complaints have been made and substantiated about the quality of
3132	services or care. The agency may not waive one of the required
3133	yearly monitoring visits if complaints have been made and
3134	substantiated.
3135	3.  A facility that is licensed to provide extended
3136	congregate care services must:
3137	a.  Demonstrate the capability to meet unanticipated
3138	resident service needs.
3139	b.  Offer a physical environment that promotes a homelike
3140	setting, provides for resident privacy, promotes resident
3141	independence, and allows sufficient congregate space as defined
3142	by rule.
3143	c.  Have sufficient staff available, taking into account
3144	the physical plant and firesafety features of the building, to
3145	assist with the evacuation of residents in an emergency.
3146	d.  Adopt and follow policies and procedures that maximize
3147	resident independence, dignity, choice, and decisionmaking to
3148	permit residents to age in place, so that moves due to changes
3149	in functional status are minimized or avoided.
3150	e.  Allow residents or, if applicable, a resident's
3151	representative, designee, surrogate, guardian, or attorney in
3152	fact to make a variety of personal choices, participate in
3153	developing service plans, and share responsibility in
3154	decisionmaking.
3155	f.  Implement the concept of managed risk.
3156	g.  Provide, directly or through contract, the services of
3157	a person licensed under part I of chapter 464.
3158	h.  In addition to the training mandated in s. 429.52,
3159	provide specialized training as defined by rule for facility
3160	staff.
3161	4.  A facility that is licensed to provide extended
3162	congregate care services is exempt from the criteria for
3163	continued residency set forth in rules adopted under s. 429.41.
3164	A licensed facility must adopt its own requirements within
3165	guidelines for continued residency set forth by rule. However,
3166	the facility may not serve residents who require 24-hour nursing
3167	supervision. A licensed facility that provides extended
3168	congregate care services must also provide each resident with a
3169	written copy of facility policies governing admission and
3170	retention.
3171	5.  The primary purpose of extended congregate care
3172	services is to allow residents, as they become more impaired,
3173	the option of remaining in a familiar setting from which they
3174	would otherwise be disqualified for continued residency. A
3175	facility licensed to provide extended congregate care services
3176	may also admit an individual who exceeds the admission criteria
3177	for a facility with a standard license, if the individual is
3178	determined appropriate for admission to the extended congregate
3179	care facility.
3180	6.  Before the admission of an individual to a facility
3181	licensed to provide extended congregate care services, the
3182	individual must undergo a medical examination as provided in s.
3183	429.26(4) and the facility must develop a preliminary service
3184	plan for the individual.
3185	7.  When a licensee facility can no longer provide or
3186	arrange for services in accordance with the resident's service
3187	plan and needs and the licensee's facility's policy, the
3188	licensee facility shall make arrangements for relocating the
3189	person in accordance with s. 429.28(1)(k).
3190	8.  Failure to provide extended congregate care services
3191	may result in denial of extended congregate care license
3192	renewal.
3193	(c)  A limited nursing services license shall be issued to
3194	a facility that provides services beyond those authorized in
3195	paragraph (a) and as specified in this paragraph.
3196	1.  In order for limited nursing services to be provided in
3197	a facility licensed under this part, the agency must first
3198	determine that all requirements established in law and rule are
3199	met and must specifically designate, on the facility's license,
3200	that such services may be provided. Such designation may be made
3201	at the time of initial licensure or relicensure, or upon request
3202	in writing by a licensee under this part and part II of chapter
3203	408. Notification of approval or denial of such request shall be
3204	made in accordance with part II of chapter 408. Existing
3205	facilities qualifying to provide limited nursing services shall
3206	have maintained a standard license and may not have been subject
3207	to administrative sanctions that affect the health, safety, and
3208	welfare of residents for the previous 2 years or since initial
3209	licensure if the facility has been licensed for less than 2
3210	years.
3211	2.  Facilities that are licensed to provide limited nursing
3212	services shall maintain a written progress report on each person
3213	who receives such nursing services, which report describes the
3214	type, amount, duration, scope, and outcome of services that are
3215	rendered and the general status of the resident's health. A
3216	registered nurse representing the agency shall visit such
3217	facilities at least twice a year to monitor residents who are
3218	receiving limited nursing services and to determine if the
3219	facility is in compliance with applicable provisions of this
3220	part, part II of chapter 408, and related rules. The monitoring
3221	visits may be provided through contractual arrangements with
3222	appropriate community agencies. A registered nurse shall also
3223	serve as part of the team that inspects such facility.
3224	3.  A person who receives limited nursing services under
3225	this part must meet the admission criteria established by the
3226	agency for assisted living facilities. When a resident no longer
3227	meets the admission criteria for a facility licensed under this
3228	part, arrangements for relocating the person shall be made in
3229	accordance with s. 429.28(1)(k), unless the facility is licensed
3230	to provide extended congregate care services.
3231	(4)  In accordance with s. 408.805, an applicant or
3232	licensee shall pay a fee for each license application submitted
3233	under this part, part II of chapter 408, and applicable rules.
3234	The amount of the fee shall be established by rule.
3235	(c)  In addition to the total fee assessed under paragraph
3236	(a), the agency shall require facilities that are licensed to
3237	provide limited nursing services under this part to pay an
3238	additional fee per licensed facility. The amount of the biennial
3239	fee shall be $250 per license, with an additional fee of $10 per
3240	resident based on the total licensed resident capacity of the
3241	facility.
3242	(6)  In order to determine whether the facility is
3243	adequately protecting residents' rights as provided in s.
3244	429.28, the agency's standard licensure survey shall include
3245	private informal conversations with a sample of residents and
3246	consultation with the ombudsman council in the planning and
3247	service area in which the facility is located to discuss
3248	residents' experiences within the facility.
3249	(7)  An assisted living facility that has been cited within
3250	the previous 24-month period for a class I or class II
3251	violation, regardless of the status of any enforcement or
3252	disciplinary action, is subject to periodic unannounced
3253	monitoring to determine if the facility is in compliance with
3254	this part, part II of chapter 408, and applicable rules.
3255	Monitoring may occur through a desk review or an onsite
3256	assessment. If the class I or class II violation relates to
3257	providing or failing to provide nursing care, a registered nurse
3258	must participate in monitoring activities during the 12-month
3259	period following the violation.
3260	Section 74.  Subsection (7) of section 429.11, Florida
3261	Statutes, is renumbered as subsection (6), and present
3262	subsection (6) of that section is amended to read:
3263	429.11  Initial application for license; provisional
3264	license.-
3265	(6)  In addition to the license categories available in s.
3266	408.808, a provisional license may be issued to an applicant
3267	making initial application for licensure or making application
3268	for a change of ownership. A provisional license shall be
3269	limited in duration to a specific period of time not to exceed 6
3270	months, as determined by the agency.
3271	Section 75.  Section 429.12, Florida Statutes, is amended
3272	to read:
3273	429.12  Sale or transfer of ownership of a facility.-It is
3274	the intent of the Legislature to protect the rights of the
3275	residents of an assisted living facility when the facility is
3276	sold or the ownership thereof is transferred. Therefore, in
3277	addition to the requirements of part II of chapter 408, whenever
3278	a facility is sold or the ownership thereof is transferred,
3279	including leasing,:
3280	(1)  the transferee shall notify the residents, in writing,
3281	of the change of ownership within 7 days after receipt of the
3282	new license.
3283	(2)  The transferor of a facility the license of which is
3284	denied pending an administrative hearing shall, as a part of the
3285	written change-of-ownership contract, advise the transferee that
3286	a plan of correction must be submitted by the transferee and
3287	approved by the agency at least 7 days before the change of
3288	ownership and that failure to correct the condition which
3289	resulted in the moratorium pursuant to part II of chapter 408 or
3290	denial of licensure is grounds for denial of the transferee's
3291	license.
3292	Section 76.  Subsection (5) of section 429.14, Florida
3293	Statutes, is amended to read:
3294	429.14  Administrative penalties.-
3295	(5)  An action taken by the agency to suspend, deny, or
3296	revoke a facility's license under this part or part II of
3297	chapter 408, in which the agency claims that the facility owner
3298	or an employee of the facility has threatened the health,
3299	safety, or welfare of a resident of the facility, shall be heard
3300	by the Division of Administrative Hearings of the Department of
3301	Management Services within 120 days after receipt of the
3302	facility's request for a hearing, unless that time limitation is
3303	waived by both parties. The administrative law judge must render
3304	a decision within 30 days after receipt of a proposed
3305	recommended order.
3306	Section 77.  Subsections (1), (4), and (5) of section
3307	429.17, Florida Statutes, are amended to read:
3308	429.17  Expiration of license; renewal; conditional
3309	license.-
3310	(1)  Limited nursing, Extended congregate care, and limited
3311	mental health licenses shall expire at the same time as the
3312	facility's standard license, regardless of when issued.
3313	(4)  In addition to the license categories available in s.
3314	408.808, a conditional license may be issued to an applicant for
3315	license renewal if the applicant fails to meet all standards and
3316	requirements for licensure. A conditional license issued under
3317	this subsection shall be limited in duration to a specific
3318	period of time not to exceed 6 months, as determined by the
3319	agency, and shall be accompanied by an agency-approved plan of
3320	correction.
3321	(5)  When an extended congregate care or limited nursing
3322	license is requested during a facility's biennial license
3323	period, the fee shall be prorated in order to permit the
3324	additional license to expire at the end of the biennial license
3325	period. The fee shall be calculated as of the date the
3326	additional license application is received by the agency.
3327	Section 78.  Section 429.195, Florida Statutes, is amended
3328	to read:
3329	429.195  Rebates prohibited; penalties.-
3330	(1)  It is unlawful for any assisted living facility
3331	licensed under this part to contract or promise to pay or
3332	receive any commission, bonus, kickback, or rebate or engage in
3333	any split-fee arrangement in any form whatsoever with any health
3334	care provider or health care facility pursuant to s. 817.505
3335	physician, surgeon, organization, agency, or person, either
3336	directly or indirectly, for residents referred to an assisted
3337	living facility licensed under this part. A facility may employ
3338	or contract with persons to market the facility, provided the
3339	employee or contract provider clearly indicates that he or she
3340	represents the facility. A person or agency independent of the
3341	facility may provide placement or referral services for a fee to
3342	individuals seeking assistance in finding a suitable facility;
3343	however, any fee paid for placement or referral services must be
3344	paid by the individual looking for a facility, not by the
3345	facility.
3346	(2)  A violation of this section shall be considered
3347	patient brokering and is punishable as provided in s. 817.505.
3348	(3)  This section does not apply to:
3349	(a)  An individual employed by the facility, or with whom
3350	the facility contracts to market the facility, if the employee
3351	or contract provider clearly indicates that he or she works with
3352	or for the facility.
3353	(b)  A referral service that provides information,
3354	consultation, or referrals to consumers to assist them in
3355	finding appropriate care or housing options for seniors or
3356	disabled adults, provided that such referred consumers are not
3357	Medicaid recipients.
3358	(c)  Residents of an assisted living facility who refer
3359	friends, family members, or other individuals with whom they
3360	have a personal relationship to the assisted living facility,
3361	and does not prohibit the assisted living facility from
3362	providing a monetary reward to the resident for making such a
3363	referral.
3364	Section 79.  Subsections (6) through (10) of section
3365	429.23, Florida Statutes, are renumbered as subsections (5)
3366	through (9), respectively, and present subsection (5) of that
3367	section is amended to read:
3368	429.23  Internal risk management and quality assurance
3369	program; adverse incidents and reporting requirements.-
3370	(5)  Each facility shall report monthly to the agency any
3371	liability claim filed against it. The report must include the
3372	name of the resident, the dates of the incident leading to the
3373	claim, if applicable, and the type of injury or violation of
3374	rights alleged to have occurred. This report is not discoverable
3375	in any civil or administrative action, except in such actions
3376	brought by the agency to enforce the provisions of this part.
3377	Section 80.  Paragraph (a) of subsection (1) and subsection
3378	(2) of section 429.255, Florida Statutes, are amended to read:
3379	429.255  Use of personnel; emergency care.-
3380	(1)(a)  Persons under contract to the facility or, facility
3381	staff, or volunteers, who are licensed according to part I of
3382	chapter 464, or those persons exempt under s. 464.022(1), and
3383	others as defined by rule, may administer medications to
3384	residents, take residents' vital signs, manage individual weekly
3385	pill organizers for residents who self-administer medication,
3386	give prepackaged enemas ordered by a physician, observe
3387	residents, document observations on the appropriate resident's
3388	record, report observations to the resident's physician, and
3389	contract or allow residents or a resident's representative,
3390	designee, surrogate, guardian, or attorney in fact to contract
3391	with a third party, provided residents meet the criteria for
3392	appropriate placement as defined in s. 429.26. Persons under
3393	contract to the facility or facility staff who are licensed
3394	according to part I of chapter 464 may provide limited nursing
3395	services. Nursing assistants certified pursuant to part II of
3396	chapter 464 may take residents' vital signs as directed by a
3397	licensed nurse or physician. The facility is responsible for
3398	maintaining documentation of services provided under this
3399	paragraph and as required by rule and for ensuring that staff
3400	are adequately trained to monitor residents receiving these
3401	services.
3402	(2)  In facilities licensed to provide extended congregate
3403	care, persons under contract to the facility or, facility staff,
3404	or volunteers, who are licensed according to part I of chapter
3405	464, or those persons exempt under s. 464.022(1), or those
3406	persons certified as nursing assistants pursuant to part II of
3407	chapter 464, may also perform all duties within the scope of
3408	their license or certification, as approved by the facility
3409	administrator and pursuant to this part.
3410	Section 81.  Subsections (4), (5), (6), and (7) of section
3411	429.28, Florida Statutes, are renumbered as subsections (3),
3412	(4), (5), and (6), respectively, and present subsections (3) and
3413	(6) of that section are amended to read:
3414	429.28  Resident bill of rights.-
3415	(3)(a)  The agency shall conduct a survey to determine
3416	general compliance with facility standards and compliance with
3417	residents' rights as a prerequisite to initial licensure or
3418	licensure renewal.
3419	(b)  In order to determine whether the facility is
3420	adequately protecting residents' rights, the biennial survey
3421	shall include private informal conversations with a sample of
3422	residents and consultation with the ombudsman council in the
3423	planning and service area in which the facility is located to
3424	discuss residents' experiences within the facility.
3425	(c)  During any calendar year in which no survey is
3426	conducted, the agency shall conduct at least one monitoring
3427	visit of each facility cited in the previous year for a class I
3428	or class II violation, or more than three uncorrected class III
3429	violations.
3430	(d)  The agency may conduct periodic followup inspections
3431	as necessary to monitor the compliance of facilities with a
3432	history of any class I, class II, or class III violations that
3433	threaten the health, safety, or security of residents.
3434	(e)  The agency may conduct complaint investigations as
3435	warranted to investigate any allegations of noncompliance with
3436	requirements required under this part or rules adopted under
3437	this part.
3438	(5)(6)  Any facility which terminates the residency of an
3439	individual who participated in activities specified in
3440	subsection (4) (5) shall show good cause in a court of competent
3441	jurisdiction.
3442	Section 82.  Subsections (4) and (5) of section 429.41,
3443	Florida Statutes, are renumbered as subsections (3) and (4),
3444	respectively, and paragraphs (i) and (j) of subsection (1) and
3445	present subsection (3) of that section are amended to read:
3446	429.41  Rules establishing standards.-
3447	(1)  It is the intent of the Legislature that rules
3448	published and enforced pursuant to this section shall include
3449	criteria by which a reasonable and consistent quality of
3450	resident care and quality of life may be ensured and the results
3451	of such resident care may be demonstrated. Such rules shall also
3452	ensure a safe and sanitary environment that is residential and
3453	noninstitutional in design or nature. It is further intended
3454	that reasonable efforts be made to accommodate the needs and
3455	preferences of residents to enhance the quality of life in a
3456	facility. The agency, in consultation with the department, may
3457	adopt rules to administer the requirements of part II of chapter
3458	408. In order to provide safe and sanitary facilities and the
3459	highest quality of resident care accommodating the needs and
3460	preferences of residents, the department, in consultation with
3461	the agency, the Department of Children and Family Services, and
3462	the Department of Health, shall adopt rules, policies, and
3463	procedures to administer this part, which must include
3464	reasonable and fair minimum standards in relation to:
3465	(i)  Facilities holding an a limited nursing, extended
3466	congregate care, or limited mental health license.
3467	(j)  The establishment of specific criteria to define
3468	appropriateness of resident admission and continued residency in
3469	a facility holding a standard, limited nursing, extended
3470	congregate care, and limited mental health license.
3471	(3)  The department shall submit a copy of proposed rules
3472	to the Speaker of the House of Representatives, the President of
3473	the Senate, and appropriate committees of substance for review
3474	and comment prior to the promulgation thereof. Rules promulgated
3475	by the department shall encourage the development of homelike
3476	facilities which promote the dignity, individuality, personal
3477	strengths, and decisionmaking ability of residents.
3478	Section 83.  Subsections (1) and (2) of section 429.53,
3479	Florida Statutes, are amended to read:
3480	429.53  Consultation by the agency.-
3481	(1)  The area offices of licensure and certification of the
3482	agency shall provide consultation to the following upon request:
3483	(a)  A licensee of a facility.
3484	(b)  A person interested in obtaining a license to operate
3485	a facility under this part.
3486	(2)  As used in this section, "consultation" includes:
3487	(a)  An explanation of the requirements of this part and
3488	rules adopted pursuant thereto;
3489	(b)  An explanation of the license application and renewal
3490	procedures; and
3491	(c)  The provision of a checklist of general local and
3492	state approvals required prior to constructing or developing a
3493	facility and a listing of the types of agencies responsible for
3494	such approvals;
3495	(d)  An explanation of benefits and financial assistance
3496	available to a recipient of supplemental security income
3497	residing in a facility;
3498	(c)(e)  Any other information which the agency deems
3499	necessary to promote compliance with the requirements of this
3500	part; and
3501	(f)  A preconstruction review of a facility to ensure
3502	compliance with agency rules and this part.
3503	Section 84.  Subsection (6) of section 429.71, Florida
3504	Statutes, is renumbered as subsection (5), and subsection (1)
3505	and present subsection (5) of that section are amended to read:
3506	429.71  Classification of violations deficiencies;
3507	administrative fines.-
3508	(1)  In addition to the requirements of part II of chapter
3509	408 and in addition to any other liability or penalty provided
3510	by law, the agency may impose an administrative fine on a
3511	provider according to the following classification:
3512	(a)  Class I violations are defined in s. 408.813 those
3513	conditions or practices related to the operation and maintenance
3514	of an adult family-care home or to the care of residents which
3515	the agency determines present an imminent danger to the
3516	residents or guests of the facility or a substantial probability
3517	that death or serious physical or emotional harm would result
3518	therefrom. The condition or practice that constitutes a class I
3519	violation must be abated or eliminated within 24 hours, unless a
3520	fixed period, as determined by the agency, is required for
3521	correction. A class I violation deficiency is subject to an
3522	administrative fine in an amount not less than $500 and not
3523	exceeding $1,000 for each violation. A fine may be levied
3524	notwithstanding the correction of the deficiency.
3525	(b)  Class II violations are defined in s. 408.813 those
3526	conditions or practices related to the operation and maintenance
3527	of an adult family-care home or to the care of residents which
3528	the agency determines directly threaten the physical or
3529	emotional health, safety, or security of the residents, other
3530	than class I violations. A class II violation is subject to an
3531	administrative fine in an amount not less than $250 and not
3532	exceeding $500 for each violation. A citation for a class II
3533	violation must specify the time within which the violation is
3534	required to be corrected. If a class II violation is corrected
3535	within the time specified, no civil penalty shall be imposed,
3536	unless it is a repeated offense.
3537	(c)  Class III violations are defined in s. 408.813 those
3538	conditions or practices related to the operation and maintenance
3539	of an adult family-care home or to the care of residents which
3540	the agency determines indirectly or potentially threaten the
3541	physical or emotional health, safety, or security of residents,
3542	other than class I or class II violations. A class III violation
3543	is subject to an administrative fine in an amount not less than
3544	$100 and not exceeding $250 for each violation. A citation for a
3545	class III violation shall specify the time within which the
3546	violation is required to be corrected. If a class III violation
3547	is corrected within the time specified, no civil penalty shall
3548	be imposed, unless it is a repeated violation offense.
3549	(d)  Class IV violations are defined in s. 408.813 those
3550	conditions or occurrences related to the operation and
3551	maintenance of an adult family-care home, or related to the
3552	required reports, forms, or documents, which do not have the
3553	potential of negatively affecting the residents. A provider that
3554	does not correct A class IV violation within the time limit
3555	specified by the agency is subject to an administrative fine in
3556	an amount not less than $50 and not exceeding $100 for each
3557	violation. Any class IV violation that is corrected during the
3558	time the agency survey is conducted will be identified as an
3559	agency finding and not as a violation, unless it is a repeat
3560	violation.
3561	(5)  As an alternative to or in conjunction with an
3562	administrative action against a provider, the agency may request
3563	a plan of corrective action that demonstrates a good faith
3564	effort to remedy each violation by a specific date, subject to
3565	the approval of the agency.
3566	Section 85.  Section 429.915, Florida Statutes, is amended
3567	to read:
3568	429.915  Conditional license.-In addition to the license
3569	categories available in part II of chapter 408, the agency may
3570	issue a conditional license to an applicant for license renewal
3571	or change of ownership if the applicant fails to meet all
3572	standards and requirements for licensure. A conditional license
3573	issued under this subsection must be limited to a specific
3574	period not exceeding 6 months, as determined by the agency, and
3575	must be accompanied by an approved plan of correction.
3576	Section 86.  Paragraphs (b) and (g) of subsection (3) of
3577	section 430.80, Florida Statutes, are amended to read:
3578	430.80  Implementation of a teaching nursing home pilot
3579	project.-
3580	(3)  To be designated as a teaching nursing home, a nursing
3581	home licensee must, at a minimum:
3582	(b)  Participate in a nationally recognized accreditation
3583	program and hold a valid accreditation, such as the
3584	accreditation awarded by the Joint Commission on Accreditation
3585	of Healthcare Organizations, or, at the time of initial
3586	designation, possess a Gold Seal Award as conferred by the state
3587	on its licensed nursing home;
3588	(g)  Maintain insurance coverage pursuant to s.
3589	400.141(1)(q)(s) or proof of financial responsibility in a
3590	minimum amount of $750,000. Such proof of financial
3591	responsibility may include:
3592	1.  Maintaining an escrow account consisting of cash or
3593	assets eligible for deposit in accordance with s. 625.52; or
3594	2.  Obtaining and maintaining pursuant to chapter 675 an
3595	unexpired, irrevocable, nontransferable and nonassignable letter
3596	of credit issued by any bank or savings association organized
3597	and existing under the laws of this state or any bank or savings
3598	association organized under the laws of the United States that
3599	has its principal place of business in this state or has a
3600	branch office which is authorized to receive deposits in this
3601	state. The letter of credit shall be used to satisfy the
3602	obligation of the facility to the claimant upon presentment of a
3603	final judgment indicating liability and awarding damages to be
3604	paid by the facility or upon presentment of a settlement
3605	agreement signed by all parties to the agreement when such final
3606	judgment or settlement is a result of a liability claim against
3607	the facility.
3608	Section 87.  Paragraph (d) of subsection (9) of section
3609	440.102, Florida Statutes, is amended to read:
3610	440.102  Drug-free workplace program requirements.-The
3611	following provisions apply to a drug-free workplace program
3612	implemented pursuant to law or to rules adopted by the Agency
3613	for Health Care Administration:
3614	(9)  DRUG-TESTING STANDARDS FOR LABORATORIES.-
3615	(d)  The laboratory shall submit to the Agency for Health
3616	Care Administration a monthly report with statistical
3617	information regarding the testing of employees and job
3618	applicants. The report must include information on the methods
3619	of analysis conducted, the drugs tested for, the number of
3620	positive and negative results for both initial tests and
3621	confirmation tests, and any other information deemed appropriate
3622	by the Agency for Health Care Administration. A monthly report
3623	must not identify specific employees or job applicants.
3624	Section 88.  Paragraph (a) of subsection (2) of section
3625	440.13, Florida Statutes, is amended to read:
3626	440.13  Medical services and supplies; penalty for
3627	violations; limitations.-
3628	(2)  MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.-
3629	(a)  Subject to the limitations specified elsewhere in this
3630	chapter, the employer shall furnish to the employee such
3631	medically necessary remedial treatment, care, and attendance for
3632	such period as the nature of the injury or the process of
3633	recovery may require, which is in accordance with established
3634	practice parameters and protocols of treatment as provided for
3635	in this chapter, including medicines, medical supplies, durable
3636	medical equipment, orthoses, prostheses, and other medically
3637	necessary apparatus. Remedial treatment, care, and attendance,
3638	including work-hardening programs or pain-management programs
3639	accredited by the Commission on Accreditation of Rehabilitation
3640	Facilities or the Joint Commission on the Accreditation of
3641	Health Organizations or pain-management programs affiliated with
3642	medical schools, shall be considered as covered treatment only
3643	when such care is given based on a referral by a physician as
3644	defined in this chapter. Medically necessary treatment, care,
3645	and attendance does not include chiropractic services in excess
3646	of 24 treatments or rendered 12 weeks beyond the date of the
3647	initial chiropractic treatment, whichever comes first, unless
3648	the carrier authorizes additional treatment or the employee is
3649	catastrophically injured.
3650
3651	Failure of the carrier to timely comply with this subsection
3652	shall be a violation of this chapter and the carrier shall be
3653	subject to penalties as provided for in s. 440.525.
3654	Section 89.  Paragraph (h) of subsection (3) of section
3655	456.053, Florida Statutes, is amended to read:
3656	456.053  Financial arrangements between referring health
3657	care providers and providers of health care services.-
3658	(3)  DEFINITIONS.-For the purpose of this section, the
3659	word, phrase, or term:
3660	(h)  "Group practice" means a group of two or more health
3661	care providers legally organized as a partnership, professional
3662	corporation, or similar association:
3663	1.  In which each health care provider who is a member of
3664	the group provides substantially the full range of services
3665	which the health care provider routinely provides, including
3666	medical care, consultation, diagnosis, or treatment, through the
3667	joint use of shared office space, facilities, equipment, and
3668	personnel;
3669	2.  For which substantially all of the services of the
3670	health care providers who are members of the group are provided
3671	through the group and are billed in the name of the group and
3672	amounts so received are treated as receipts of the group; and
3673	3.  In which the overhead expenses of and the income from
3674	the practice are distributed in accordance with methods
3675	previously determined by members of the group; and
3676	4.  In which a group practice that provides radiation
3677	therapy services provides the full range of radiation therapy
3678	services such that no single type of cancer, either as a primary
3679	or secondary diagnosis as described by the International
3680	Statistical Classification of Diseases, constitutes 40 percent
3681	or more of the group's cases that require professional and
3682	technical services for radiation therapy, and in which the
3683	health care providers within the group who are referring
3684	patients for radiation therapy services do not own 50 percent or
3685	more of the group practice. For purposes of this subparagraph,
3686	the term "cases" means a patient's radiation treatment course.
3687	Section 90.  Subsection (1) of section 483.035, Florida
3688	Statutes, is amended to read:
3689	483.035  Clinical laboratories operated by practitioners
3690	for exclusive use; licensure and regulation.-
3691	(1)  A clinical laboratory operated by one or more
3692	practitioners licensed under chapter 458, chapter 459, chapter
3693	460, chapter 461, chapter 462, part I of chapter 464, or chapter
3694	466, exclusively in connection with the diagnosis and treatment
3695	of their own patients, must be licensed under this part and must
3696	comply with the provisions of this part, except that the agency
3697	shall adopt rules for staffing, for personnel, including
3698	education and training of personnel, for proficiency testing,
3699	and for construction standards relating to the licensure and
3700	operation of the laboratory based upon and not exceeding the
3701	same standards contained in the federal Clinical Laboratory
3702	Improvement Amendments of 1988 and the federal regulations
3703	adopted thereunder.
3704	Section 91.  Subsections (1) and (9) of section 483.051,
3705	Florida Statutes, are amended to read:
3706	483.051  Powers and duties of the agency.-The agency shall
3707	adopt rules to implement this part, which rules must include,
3708	but are not limited to, the following:
3709	(1)  LICENSING; QUALIFICATIONS.-The agency shall provide
3710	for biennial licensure of all nonwaived clinical laboratories
3711	meeting the requirements of this part and shall prescribe the
3712	qualifications necessary for such licensure, including, but not
3713	limited to, application for or proof of a federal Clinical
3714	Laboratory Improvement Amendment (CLIA) certificate. For
3715	purposes of this section, the term "nonwaived clinical
3716	laboratories" means laboratories that perform any test that the
3717	Centers for Medicare and Medicaid Services has determined does
3718	not qualify for a certificate of waiver under the Clinical
3719	Laboratory Improvement Amendments of 1988 and the federal rules
3720	adopted thereunder.
3721	(9)  ALTERNATE-SITE TESTING.-The agency, in consultation
3722	with the Board of Clinical Laboratory Personnel, shall adopt, by
3723	rule, the criteria for alternate-site testing to be performed
3724	under the supervision of a clinical laboratory director. The
3725	elements to be addressed in the rule include, but are not
3726	limited to: a hospital internal needs assessment; a protocol of
3727	implementation including tests to be performed and who will
3728	perform the tests; criteria to be used in selecting the method
3729	of testing to be used for alternate-site testing; minimum
3730	training and education requirements for those who will perform
3731	alternate-site testing, such as documented training, licensure,
3732	certification, or other medical professional background not
3733	limited to laboratory professionals; documented inservice
3734	training as well as initial and ongoing competency validation;
3735	an appropriate internal and external quality control protocol;
3736	an internal mechanism for identifying and tracking alternate-
3737	site testing by the central laboratory; and recordkeeping
3738	requirements. Alternate-site testing locations must register
3739	when the clinical laboratory applies to renew its license. For
3740	purposes of this subsection, the term "alternate-site testing"
3741	means any laboratory testing done under the administrative
3742	control of a hospital, but performed out of the physical or
3743	administrative confines of the central laboratory.
3744	Section 92.  Section 483.294, Florida Statutes, is amended
3745	to read:
3746	483.294  Inspection of centers.-In accordance with s.
3747	408.811, the agency shall biennially, at least once annually,
3748	inspect the premises and operations of all centers subject to
3749	licensure under this part.
3750	Section 93.  Paragraph (a) of subsection (54) of section
3751	499.003, Florida Statutes, is amended to read:
3752	499.003  Definitions of terms used in this part.-As used in
3753	this part, the term:
3754	(54)  "Wholesale distribution" means distribution of
3755	prescription drugs to persons other than a consumer or patient,
3756	but does not include:
3757	(a)  Any of the following activities, which is not a
3758	violation of s. 499.005(21) if such activity is conducted in
3759	accordance with s. 499.01(2)(g):
3760	1.  The purchase or other acquisition by a hospital or
3761	other health care entity that is a member of a group purchasing
3762	organization of a prescription drug for its own use from the
3763	group purchasing organization or from other hospitals or health
3764	care entities that are members of that organization.
3765	2.  The sale, purchase, or trade of a prescription drug or
3766	an offer to sell, purchase, or trade a prescription drug by a
3767	charitable organization described in s. 501(c)(3) of the
3768	Internal Revenue Code of 1986, as amended and revised, to a
3769	nonprofit affiliate of the organization to the extent otherwise
3770	permitted by law.
3771	3.  The sale, purchase, or trade of a prescription drug or
3772	an offer to sell, purchase, or trade a prescription drug among
3773	hospitals or other health care entities that are under common
3774	control. For purposes of this subparagraph, "common control"
3775	means the power to direct or cause the direction of the
3776	management and policies of a person or an organization, whether
3777	by ownership of stock, by voting rights, by contract, or
3778	otherwise.
3779	4.  The sale, purchase, trade, or other transfer of a
3780	prescription drug from or for any federal, state, or local
3781	government agency or any entity eligible to purchase
3782	prescription drugs at public health services prices pursuant to
3783	Pub. L. No. 102-585, s. 602 to a contract provider or its
3784	subcontractor for eligible patients of the agency or entity
3785	under the following conditions:
3786	a.  The agency or entity must obtain written authorization
3787	for the sale, purchase, trade, or other transfer of a
3788	prescription drug under this subparagraph from the State Surgeon
3789	General or his or her designee.
3790	b.  The contract provider or subcontractor must be
3791	authorized by law to administer or dispense prescription drugs.
3792	c.  In the case of a subcontractor, the agency or entity
3793	must be a party to and execute the subcontract.
3794	d.  A contract provider or subcontractor must maintain
3795	separate and apart from other prescription drug inventory any
3796	prescription drugs of the agency or entity in its possession.
3797	d.e.  The contract provider and subcontractor must maintain
3798	and produce immediately for inspection all records of movement
3799	or transfer of all the prescription drugs belonging to the
3800	agency or entity, including, but not limited to, the records of
3801	receipt and disposition of prescription drugs. Each contractor
3802	and subcontractor dispensing or administering these drugs must
3803	maintain and produce records documenting the dispensing or
3804	administration. Records that are required to be maintained
3805	include, but are not limited to, a perpetual inventory itemizing
3806	drugs received and drugs dispensed by prescription number or
3807	administered by patient identifier, which must be submitted to
3808	the agency or entity quarterly.
3809	e.f.  The contract provider or subcontractor may administer
3810	or dispense the prescription drugs only to the eligible patients
3811	of the agency or entity or must return the prescription drugs
3812	for or to the agency or entity. The contract provider or
3813	subcontractor must require proof from each person seeking to
3814	fill a prescription or obtain treatment that the person is an
3815	eligible patient of the agency or entity and must, at a minimum,
3816	maintain a copy of this proof as part of the records of the
3817	contractor or subcontractor required under sub-subparagraph e.
3818	f.g.  In addition to the departmental inspection authority
3819	set forth in s. 499.051, the establishment of the contract
3820	provider and subcontractor and all records pertaining to
3821	prescription drugs subject to this subparagraph shall be subject
3822	to inspection by the agency or entity. All records relating to
3823	prescription drugs of a manufacturer under this subparagraph
3824	shall be subject to audit by the manufacturer of those drugs,
3825	without identifying individual patient information.
3826	Section 94.  Subsection (1) of section 627.645, Florida
3827	Statutes, is amended to read:
3828	627.645  Denial of health insurance claims restricted.-
3829	(1)  No claim for payment under a health insurance policy
3830	or self-insured program of health benefits for treatment, care,
3831	or services in a licensed hospital which is accredited by the
3832	Joint Commission on the Accreditation of Hospitals, the American
3833	Osteopathic Association, or the Commission on the Accreditation
3834	of Rehabilitative Facilities shall be denied because such
3835	hospital lacks major surgical facilities and is primarily of a
3836	rehabilitative nature, if such rehabilitation is specifically
3837	for treatment of physical disability.
3838	Section 95.  Paragraph (c) of subsection (2) of section
3839	627.668, Florida Statutes, is amended to read:
3840	627.668  Optional coverage for mental and nervous disorders
3841	required; exception.-
3842	(2)  Under group policies or contracts, inpatient hospital
3843	benefits, partial hospitalization benefits, and outpatient
3844	benefits consisting of durational limits, dollar amounts,
3845	deductibles, and coinsurance factors shall not be less favorable
3846	than for physical illness generally, except that:
3847	(c)  Partial hospitalization benefits shall be provided
3848	under the direction of a licensed physician. For purposes of
3849	this part, the term "partial hospitalization services" is
3850	defined as those services offered by a program accredited by the
3851	Joint Commission on Accreditation of Hospitals (JCAH) or in
3852	compliance with equivalent standards. Alcohol rehabilitation
3853	programs accredited by the Joint Commission on Accreditation of
3854	Hospitals or approved by the state and licensed drug abuse
3855	rehabilitation programs shall also be qualified providers under
3856	this section. In any benefit year, if partial hospitalization
3857	services or a combination of inpatient and partial
3858	hospitalization are utilized, the total benefits paid for all
3859	such services shall not exceed the cost of 30 days of inpatient
3860	hospitalization for psychiatric services, including physician
3861	fees, which prevail in the community in which the partial
3862	hospitalization services are rendered. If partial
3863	hospitalization services benefits are provided beyond the limits
3864	set forth in this paragraph, the durational limits, dollar
3865	amounts, and coinsurance factors thereof need not be the same as
3866	those applicable to physical illness generally.
3867	Section 96.  Subsection (3) of section 627.669, Florida
3868	Statutes, is amended to read:
3869	627.669  Optional coverage required for substance abuse
3870	impaired persons; exception.-
3871	(3)  The benefits provided under this section shall be
3872	applicable only if treatment is provided by, or under the
3873	supervision of, or is prescribed by, a licensed physician or
3874	licensed psychologist and if services are provided in a program
3875	accredited by the Joint Commission on Accreditation of Hospitals
3876	or approved by the state.
3877	Section 97.  Paragraph (a) of subsection (1) of section
3878	627.736, Florida Statutes, is amended to read:
3879	627.736  Required personal injury protection benefits;
3880	exclusions; priority; claims.-
3881	(1)  REQUIRED BENEFITS.-Every insurance policy complying
3882	with the security requirements of s. 627.733 shall provide
3883	personal injury protection to the named insured, relatives
3884	residing in the same household, persons operating the insured
3885	motor vehicle, passengers in such motor vehicle, and other
3886	persons struck by such motor vehicle and suffering bodily injury
3887	while not an occupant of a self-propelled vehicle, subject to
3888	the provisions of subsection (2) and paragraph (4)(e), to a
3889	limit of $10,000 for loss sustained by any such person as a
3890	result of bodily injury, sickness, disease, or death arising out
3891	of the ownership, maintenance, or use of a motor vehicle as
3892	follows:
3893	(a)  Medical benefits.-Eighty percent of all reasonable
3894	expenses for medically necessary medical, surgical, X-ray,
3895	dental, and rehabilitative services, including prosthetic
3896	devices, and medically necessary ambulance, hospital, and
3897	nursing services. However, the medical benefits shall provide
3898	reimbursement only for such services and care that are lawfully
3899	provided, supervised, ordered, or prescribed by a physician
3900	licensed under chapter 458 or chapter 459, a dentist licensed
3901	under chapter 466, or a chiropractic physician licensed under
3902	chapter 460 or that are provided by any of the following persons
3903	or entities:
3904	1.  A hospital or ambulatory surgical center licensed under
3905	chapter 395.
3906	2.  A person or entity licensed under ss. 401.2101-401.45
3907	that provides emergency transportation and treatment.
3908	3.  An entity wholly owned by one or more physicians
3909	licensed under chapter 458 or chapter 459, chiropractic
3910	physicians licensed under chapter 460, or dentists licensed
3911	under chapter 466 or by such practitioner or practitioners and
3912	the spouse, parent, child, or sibling of that practitioner or
3913	those practitioners.
3914	4.  An entity wholly owned, directly or indirectly, by a
3915	hospital or hospitals.
3916	5.  A health care clinic licensed under ss. 400.990-400.995
3917	that is:
3918	a.  Accredited by the Joint Commission on Accreditation of
3919	Healthcare Organizations, the American Osteopathic Association,
3920	the Commission on Accreditation of Rehabilitation Facilities, or
3921	the Accreditation Association for Ambulatory Health Care, Inc.;
3922	or
3923	b.  A health care clinic that:
3924	(I)  Has a medical director licensed under chapter 458,
3925	chapter 459, or chapter 460;
3926	(II)  Has been continuously licensed for more than 3 years
3927	or is a publicly traded corporation that issues securities
3928	traded on an exchange registered with the United States
3929	Securities and Exchange Commission as a national securities
3930	exchange; and
3931	(III)  Provides at least four of the following medical
3932	specialties:
3933	(A)  General medicine.
3934	(B)  Radiography.
3935	(C)  Orthopedic medicine.
3936	(D)  Physical medicine.
3937	(E)  Physical therapy.
3938	(F)  Physical rehabilitation.
3939	(G)  Prescribing or dispensing outpatient prescription
3940	medication.
3941	(H)  Laboratory services.
3942
3943	The Financial Services Commission shall adopt by rule the form
3944	that must be used by an insurer and a health care provider
3945	specified in subparagraph 3., subparagraph 4., or subparagraph
3946	5. to document that the health care provider meets the criteria
3947	of this paragraph, which rule must include a requirement for a
3948	sworn statement or affidavit.
3949
3950	Only insurers writing motor vehicle liability insurance in this
3951	state may provide the required benefits of this section, and no
3952	such insurer shall require the purchase of any other motor
3953	vehicle coverage other than the purchase of property damage
3954	liability coverage as required by s. 627.7275 as a condition for
3955	providing such required benefits. Insurers may not require that
3956	property damage liability insurance in an amount greater than
3957	$10,000 be purchased in conjunction with personal injury
3958	protection. Such insurers shall make benefits and required
3959	property damage liability insurance coverage available through
3960	normal marketing channels. Any insurer writing motor vehicle
3961	liability insurance in this state who fails to comply with such
3962	availability requirement as a general business practice shall be
3963	deemed to have violated part IX of chapter 626, and such
3964	violation shall constitute an unfair method of competition or an
3965	unfair or deceptive act or practice involving the business of
3966	insurance; and any such insurer committing such violation shall
3967	be subject to the penalties afforded in such part, as well as
3968	those which may be afforded elsewhere in the insurance code.
3969	Section 98.  Section 633.081, Florida Statutes, is amended
3970	to read:
3971	633.081  Inspection of buildings and equipment; orders;
3972	firesafety inspection training requirements; certification;
3973	disciplinary action.-The State Fire Marshal and her or his
3974	agents shall, at any reasonable hour, when the State Fire
3975	Marshal has reasonable cause to believe that a violation of this
3976	chapter or s. 509.215, or a rule promulgated thereunder, or a
3977	minimum firesafety code adopted by a local authority, may exist,
3978	inspect any and all buildings and structures which are subject
3979	to the requirements of this chapter or s. 509.215 and rules
3980	promulgated thereunder. The authority to inspect shall extend to
3981	all equipment, vehicles, and chemicals which are located within
3982	the premises of any such building or structure. The State Fire
3983	Marshal and her or his agents shall inspect nursing homes
3984	licensed under part II of chapter 400 only once every calendar
3985	year and upon receiving a complaint forming the basis of a
3986	reasonable cause to believe that a violation of this chapter or
3987	s. 509.215, or a rule promulgated thereunder, or a minimum
3988	firesafety code adopted by a local authority may exist and upon
3989	identifying such a violation in the course of conducting
3990	orientation or training activities within a nursing home.
3991	(1)  Each county, municipality, and special district that
3992	has firesafety enforcement responsibilities shall employ or
3993	contract with a firesafety inspector. Except as provided in s.
3994	633.082(2), the firesafety inspector must conduct all firesafety
3995	inspections that are required by law. The governing body of a
3996	county, municipality, or special district that has firesafety
3997	enforcement responsibilities may provide a schedule of fees to
3998	pay only the costs of inspections conducted pursuant to this
3999	subsection and related administrative expenses. Two or more
4000	counties, municipalities, or special districts that have
4001	firesafety enforcement responsibilities may jointly employ or
4002	contract with a firesafety inspector.
4003	(2)  Except as provided in s. 633.082(2), every firesafety
4004	inspection conducted pursuant to state or local firesafety
4005	requirements shall be by a person certified as having met the
4006	inspection training requirements set by the State Fire Marshal.
4007	Such person shall:
4008	(a)  Be a high school graduate or the equivalent as
4009	determined by the department;
4010	(b)  Not have been found guilty of, or having pleaded
4011	guilty or nolo contendere to, a felony or a crime punishable by
4012	imprisonment of 1 year or more under the law of the United
4013	States, or of any state thereof, which involves moral turpitude,
4014	without regard to whether a judgment of conviction has been
4015	entered by the court having jurisdiction of such cases;
4016	(c)  Have her or his fingerprints on file with the
4017	department or with an agency designated by the department;
4018	(d)  Have good moral character as determined by the
4019	department;
4020	(e)  Be at least 18 years of age;
4021	(f)  Have satisfactorily completed the firesafety inspector
4022	certification examination as prescribed by the department; and
4023	(g)1.  Have satisfactorily completed, as determined by the
4024	department, a firesafety inspector training program of not less
4025	than 200 hours established by the department and administered by
4026	agencies and institutions approved by the department for the
4027	purpose of providing basic certification training for firesafety
4028	inspectors; or
4029	2.  Have received in another state training which is
4030	determined by the department to be at least equivalent to that
4031	required by the department for approved firesafety inspector
4032	education and training programs in this state.
4033	(3)  Each special state firesafety inspection which is
4034	required by law and is conducted by or on behalf of an agency of
4035	the state must be performed by an individual who has met the
4036	provision of subsection (2), except that the duration of the
4037	training program shall not exceed 120 hours of specific training
4038	for the type of property that such special state firesafety
4039	inspectors are assigned to inspect.
4040	(4)  A firefighter certified pursuant to s. 633.35 may
4041	conduct firesafety inspections, under the supervision of a
4042	certified firesafety inspector, while on duty as a member of a
4043	fire department company conducting inservice firesafety
4044	inspections without being certified as a firesafety inspector,
4045	if such firefighter has satisfactorily completed an inservice
4046	fire department company inspector training program of at least
4047	24 hours' duration as provided by rule of the department.
4048	(5)  Every firesafety inspector or special state firesafety
4049	inspector certificate is valid for a period of 3 years from the
4050	date of issuance. Renewal of certification shall be subject to
4051	the affected person's completing proper application for renewal
4052	and meeting all of the requirements for renewal as established
4053	under this chapter or by rule promulgated thereunder, which
4054	shall include completion of at least 40 hours during the
4055	preceding 3-year period of continuing education as required by
4056	the rule of the department or, in lieu thereof, successful
4057	passage of an examination as established by the department.
4058	(6)  The State Fire Marshal may deny, refuse to renew,
4059	suspend, or revoke the certificate of a firesafety inspector or
4060	special state firesafety inspector if it finds that any of the
4061	following grounds exist:
4062	(a)  Any cause for which issuance of a certificate could
4063	have been refused had it then existed and been known to the
4064	State Fire Marshal.
4065	(b)  Violation of this chapter or any rule or order of the
4066	State Fire Marshal.
4067	(c)  Falsification of records relating to the certificate.
4068	(d)  Having been found guilty of or having pleaded guilty
4069	or nolo contendere to a felony, whether or not a judgment of
4070	conviction has been entered.
4071	(e)  Failure to meet any of the renewal requirements.
4072	(f)  Having been convicted of a crime in any jurisdiction
4073	which directly relates to the practice of fire code inspection,
4074	plan review, or administration.
4075	(g)  Making or filing a report or record that the
4076	certificateholder knows to be false, or knowingly inducing
4077	another to file a false report or record, or knowingly failing
4078	to file a report or record required by state or local law, or
4079	knowingly impeding or obstructing such filing, or knowingly
4080	inducing another person to impede or obstruct such filing.
4081	(h)  Failing to properly enforce applicable fire codes or
4082	permit requirements within this state which the
4083	certificateholder knows are applicable by committing willful
4084	misconduct, gross negligence, gross misconduct, repeated
4085	negligence, or negligence resulting in a significant danger to
4086	life or property.
4087	(i)  Accepting labor, services, or materials at no charge
4088	or at a noncompetitive rate from any person who performs work
4089	that is under the enforcement authority of the certificateholder
4090	and who is not an immediate family member of the
4091	certificateholder. For the purpose of this paragraph, the term
4092	"immediate family member" means a spouse, child, parent,
4093	sibling, grandparent, aunt, uncle, or first cousin of the person
4094	or the person's spouse or any person who resides in the primary
4095	residence of the certificateholder.
4096	(7)  The Division of State Fire Marshal and the Florida
4097	Building Code Administrators and Inspectors Board, established
4098	pursuant to s. 468.605, shall enter into a reciprocity agreement
4099	to facilitate joint recognition of continuing education
4100	recertification hours for certificateholders licensed under s.
4101	468.609 and firesafety inspectors certified under subsection
4102	(2).
4103	(8)  The State Fire Marshal shall develop by rule an
4104	advanced training and certification program for firesafety
4105	inspectors having fire code management responsibilities. The
4106	program must be consistent with the appropriate provisions of
4107	NFPA 1037, or similar standards adopted by the division, and
4108	establish minimum training, education, and experience levels for
4109	firesafety inspectors having fire code management
4110	responsibilities.
4111	(9)  The department shall provide by rule for the
4112	certification of firesafety inspectors.
4113	Section 99.  Subsection (12) of section 641.495, Florida
4114	Statutes, is amended to read:
4115	641.495  Requirements for issuance and maintenance of
4116	certificate.-
4117	(12)  The provisions of part I of chapter 395 do not apply
4118	to a health maintenance organization that, on or before January
4119	1, 1991, provides not more than 10 outpatient holding beds for
4120	short-term and hospice-type patients in an ambulatory care
4121	facility for its members, provided that such health maintenance
4122	organization maintains current accreditation by the Joint
4123	Commission on Accreditation of Health Care Organizations, the
4124	Accreditation Association for Ambulatory Health Care, or the
4125	National Committee for Quality Assurance.
4126	Section 100.  Subsection (13) of section 651.118, Florida
4127	Statutes, is amended to read:
4128	651.118  Agency for Health Care Administration;
4129	certificates of need; sheltered beds; community beds.-
4130	(13)  Residents, as defined in this chapter, are not
4131	considered new admissions for the purpose of s.
4132	400.141(1)(n)(o)1.d.
4133	Section 101.  Subsection (2) of section 766.1015, Florida
4134	Statutes, is amended to read:
4135	766.1015  Civil immunity for members of or consultants to
4136	certain boards, committees, or other entities.-
4137	(2)  Such committee, board, group, commission, or other
4138	entity must be established in accordance with state law or in
4139	accordance with requirements of the Joint Commission on
4140	Accreditation of Healthcare Organizations, established and duly
4141	constituted by one or more public or licensed private hospitals
4142	or behavioral health agencies, or established by a governmental
4143	agency. To be protected by this section, the act, decision,
4144	omission, or utterance may not be made or done in bad faith or
4145	with malicious intent.
4146	Section 102.  Subsection (4) of section 766.202, Florida
4147	Statutes, is amended to read:
4148	766.202  Definitions; ss. 766.201-766.212.-As used in ss.
4149	766.201-766.212, the term:
4150	(4)  "Health care provider" means any hospital, ambulatory
4151	surgical center, or mobile surgical facility as defined and
4152	licensed under chapter 395; a birth center licensed under
4153	chapter 383; any person licensed under chapter 458, chapter 459,
4154	chapter 460, chapter 461, chapter 462, chapter 463, part I of
4155	chapter 464, chapter 466, chapter 467, part XIV of chapter 468,
4156	or chapter 486; a clinical lab licensed under chapter 483; a
4157	health maintenance organization certificated under part I of
4158	chapter 641; a blood bank; a plasma center; an industrial
4159	clinic; a renal dialysis facility; or a professional association
4160	partnership, corporation, joint venture, or other association
4161	for professional activity by health care providers.
4162	Section 103.  Paragraph (j) is added to subsection (3) of
4163	section 817.505, Florida Statutes, to read:
4164	817.505  Patient brokering prohibited; exceptions;
4165	penalties.-
4166	(3)  This section shall not apply to:
4167	(j)  Any payments by an assisted living facility, as
4168	defined in s. 429.02, or any agreement for or solicitation,
4169	offer, or receipt of such payment by a referral service, which
4170	is permitted under s. 429.195(3).
4171	Section 104.  The per-bed standard assisted living facility
4172	licensure fees, including the total fee, have been adjusted by
4173	the Consumer Price Index annually since 1998 and are not
4174	intended to be reset by this act. In addition to the Consumer
4175	Price Index adjustment, the per-bed fee is increased by $9 to
4176	neutralize the elimination of the limited nursing services
4177	specialty license fee.
4178	Section 105.  This act shall take effect July 1, 2011.

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