Florida Senate - 2011 PROPOSED COMMITTEE SUBSTITUTE
Bill No. SB 1838
Barcode 548162
588-03952D-11
Proposed Committee Substitute by the Committee on Health
Regulation
1 A bill to be entitled
2 An act relating to assisted living facilities;
3 creating the Florida Assisted Living Quality
4 Improvement Initiative Pilot Project; providing a
5 purpose; providing definitions; creating the pilot
6 project in area offices of the Agency for Health Care
7 Administration; providing an expiration date for the
8 pilot project; providing requirements for facilities
9 to be eligible to participate in the pilot project;
10 authorizing the Department of Elderly Affairs to adopt
11 rules; providing duties of the department with regard
12 to the pilot project; requiring the administrator of a
13 facility that is eligible to participate in the pilot
14 project to notify the Agency for Health Care
15 Administration when the facility agrees to enroll;
16 providing that enrollment in the pilot project is
17 voluntary; requiring each facility to execute an
18 agreement that includes a provision authorizing the
19 agency to terminate the facility’s participation in
20 the pilot project; providing for open enrollment each
21 year; providing that a facility’s enrollment in the
22 pilot project does not prohibit the facility from
23 seeking alternative accreditation; requiring the owner
24 or administrator of a facility that is enrolled in the
25 pilot project to enter into a contract with a quality
26 improvement team; providing for the composition and
27 duties of a quality improvement team; providing for
28 termination of the contract with a quality improvement
29 team; providing for the resumption of inspections by
30 the agency if a facility terminates enrollment in the
31 pilot project; authorizing a facility to terminate its
32 contract with a quality improvement team and execute a
33 contract with a another team; requiring the agency to
34 refer certain complaints regarding a facility to the
35 quality improvement team; authorizing the agency to
36 investigate repeated complaints and refer them to the
37 appropriate law enforcement agency; authorizing the
38 agency to investigate and conduct periodic appraisal
39 visits of a facility; authorizing the agency to
40 terminate a facility from the pilot project and
41 require that the facility be subject to survey,
42 inspection, and monitoring visits by the agency;
43 requiring each quality improvement team to make
44 available to the agency certain reports; authorizing a
45 quality improvement team to use electronic means of
46 capturing data and generating reports; providing that
47 reports and documents of the quality improvement team
48 may not be used in certain tort actions; prohibiting
49 conflicts of interests between a facility owner,
50 administrator, or employee and the members of a
51 quality improvement team; providing an effective date.
52
53 Be It Enacted by the Legislature of the State of Florida:
54
55 Section 1. Florida Assisted Living Quality Improvement
56 Initiative Pilot Project.—
57 (1) The purpose of the pilot project is to identify best
58 practices for providing care to residents of licensed assisted
59 living facilities, provide caregivers with the competencies and
60 skills necessary to implement best practices, and develop, in
61 collaboration with the facility, a quality improvement plan to
62 reduce the need for institutional care.
63 (2) As used in this section, the term:
64 (a) “Agency” means the Agency for Health Care
65 Administration.
66 (b) “Department” means the Department of Elderly Affairs.
67 (3)(a) The pilot project shall be limited to no more than
68 four approved quality improvement teams throughout the pilot
69 areas and 20 facilities in each of the area office locations of
70 the agency which are identified as areas 4, 5, 6, 8, and 11.
71 This pilot project shall expire in 2016 unless reenacted by the
72 Legislature.
73 (b) Eligibility for participation is limited to facilities
74 that have a good survey track record, have not been cited for
75 any class I or class II violations, and have no more than five
76 uncorrected class III violations on the prior two annual surveys
77 and on any survey that resulted from a complaint.
78 (4) The department may adopt rules as needed to administer
79 the pilot project, with input from providers, advocates, the
80 agency, or others. The department shall:
81 (a) Establish a method to measure facility improvement and
82 collect data.
83 (b) Create criteria for quality improvement plans.
84 (c) Establish standards and requirements for quality
85 improvement teams.
86 (d) Establish the procedures for the agency to use in
87 approving or revoking approval of quality improvement teams.
88 (e) Create an enrollment process and implementation
89 timeline for the pilot project.
90 (f) Establish a process to notify residents and the local
91 long-term care ombudsman council of each assisted living
92 facility that is enrolled in the pilot project.
93 (g) Establish the components and provisions that must be
94 contained in a contract between the facility and the approved
95 quality improvement team.
96 (h) Establish the procedures for resolving complaints that
97 are filed against a facility that is enrolled in the pilot
98 project.
99 (5) The administrator of a licensed facility that is
100 eligible to participate in the pilot project shall notify the
101 agency when the facility agrees to enroll. Enrollment in the
102 pilot project is voluntary. The agency shall enroll the first 20
103 eligible facilities in each area that seek enrollment. Before
104 enrollment, each facility must execute a memorandum of agreement
105 with the agency which includes a provision authorizing the
106 agency to terminate the facility’s participation in the pilot
107 project at will. The agency’s termination of a facility from the
108 pilot project may not be challenged or appealed under chapter
109 120, Florida Statutes.
110 (6) Open enrollment in the pilot project shall begin on
111 January 1 of each year. A facility’s enrollment in the pilot
112 project does not prohibit the facility from seeking alternative
113 accreditation from a recognized health care accreditation
114 organization, such as the Commission on Accreditation of
115 Rehabilitative Facilities or The Joint Commission.
116 (7) The owner or administrator of each facility enrolled in
117 the pilot project shall enter into a contract with an approved
118 quality improvement team to develop, in accordance with the
119 department’s rules, and implement a quality improvement plan for
120 that facility. The facility must pay the quality improvement
121 team reasonable compensation for the services provided under the
122 contract. The quality improvement plan must be approved by the
123 agency prior to any implementation of the plan. The owner or
124 administrator shall consult with the quality improvement team
125 for the purpose of meeting the goals outlined in the quality
126 improvement plan.
127 (8) Each quality improvement team must evaluate the
128 progress of the facility in meeting the goals of the quality
129 improvement plan. A quality improvement team shall include a
130 quality improvement specialist who has professional expertise or
131 a background in working with behavioral health needs or aging
132 related needs, a licensed registered nurse, a licensed
133 dietician, and a staff development representative.
134 (9) Each quality improvement team must be approved by the
135 agency prior to entering into any contract with a facility. The
136 agency may revoke the approval of the quality improvement team
137 if the quality improvement team does not meet the requirements
138 or standards established by department rule. If such approval is
139 revoked, the quality improvement team may no longer provide
140 contract services to the facility and the facility must, within
141 30 days, enter into a contract with another approved quality
142 improvement team in order to remain enrolled in the pilot
143 project.
144 (10) Each quality improvement team shall:
145 (a) Conduct an annual assessment and followup visits as
146 needed to monitor the progress of the facility in meeting the
147 goals of the quality improvement plan.
148 (b) Consult with the owner and administrator of the
149 facility in meeting plan requirements, create systems to monitor
150 compliance with agency rules, ensure that training standards
151 established under s. 429.52, Florida Statutes, are met, and
152 provide access to community-based services that would improve
153 the care of the residents and the conditions in the facility.
154 (c) Maintain records of the assessments and ongoing efforts
155 to help the facility meet quality improvement goals.
156 (d) Issue a certification to each facility that meets
157 agency standards and is in compliance with the goals of its
158 quality improvement plan.
159 (11) A quality improvement team may terminate, without
160 penalty, the contract executed under subsection (7) with a
161 facility that has failed to meet the goals of the plan after
162 reasonable efforts are made to seek cooperation and assistance
163 from the owner and the administrator of the facility. If a
164 contract is terminated under these conditions, the facility is
165 automatically terminated from the pilot project.
166 (12) If a facility’s enrollment in the pilot project is
167 terminated, the quality improvement team shall notify the agency
168 and that facility shall be subject to the survey, inspection,
169 and monitoring visits conducted under s. 408.811, Florida
170 Statutes. The facility is not eligible to reenroll in the pilot
171 project until the agency has certified that the facility is in
172 substantial compliance with agency rules.
173 (13) A facility that has entered into a contract with an
174 approved quality improvement team may terminate that contract
175 without penalty and enter into a contract with another approved
176 team. If such termination is sought, the facility administrator
177 shall notify the agency area office in writing and specify the
178 reasons the facility seeks to terminate the contract. The area
179 office supervisor shall approve or reject the request under the
180 terms and conditions of the memorandum of agreement completed by
181 the facility before enrolling in the pilot project.
182 (14) The agency shall refer any complaint concerning the
183 facility to the quality improvement team if the complaint does
184 not allege immediate jeopardy to a resident of the facility,
185 serious substandard care, or actual harm to a resident of the
186 facility. The team shall investigate the complaint and work with
187 the owner or administrator to address the complaint. If there is
188 a pattern of repeated complaints, the agency may investigate
189 those complaints and refer the complaints to the appropriate law
190 enforcement agency in the local jurisdiction for investigation
191 to ensure the health, safety, and well-being of the facility’s
192 residents.
193 (15) The agency may investigate and conduct periodic
194 appraisal visits at any time in order to ensure compliance with
195 Florida law and the approved quality improvement plan and assess
196 the quality improvement team and the facility. If the agency
197 finds that the facility is in substantial noncompliance with the
198 quality improvement plan or state law, the agency may terminate
199 the facility from the pilot project and shall require the
200 facility to be subject to the survey, inspection, and monitoring
201 visits conducted under s. 408.811, Florida Statutes.
202 (16)(a) Each quality improvement team shall make available
203 to the agency reports generated following a visit to an enrolled
204 facility.
205 (b) Each quality improvement team may use electronic means
206 of capturing data and generating reports relating to compliance
207 with the quality improvement plan.
208 (17) Reports and documents generated by the quality
209 improvement teams may not be used in any tort action sought
210 against the licenseholder of an enrolled facility.
211 (18) A facility owner, administrator, or employee may not
212 have an ownership interest in, or provide services to, any
213 business owned by a member of a quality improvement team, and an
214 owner, administrator, or employee may not participate as a
215 member of a quality improvement team. The agency shall ensure
216 that there are no conflicts of interest between the members of a
217 quality improvement team and a facility that seeks to enroll or
218 that is enrolled in the pilot project.
219 Section 2. This act shall take effect July 1, 2011.