HB 621

1	A bill to be entitled
2	An act relating to nursing homes and related health
3	care facilities; amending s. 83.42, F.S.; clarifying
4	that the transfer and discharge of facility residents
5	are governed by nursing home law; amending s. 400.021,
6	F.S.; deleting a requirement that a resident care plan
7	be signed by certain persons; amending ss. 400.0234
8	and 400.0239, F.S.; conforming provisions to changes
9	made by the act; amending s. 400.0255, F.S.; revising
10	provisions relating to hearings on resident transfer
11	or discharge; amending s. 400.063, F.S.; deleting an
12	obsolete cross-reference; amending s. 400.071, F.S.;
13	deleting provisions requiring a license applicant to
14	submit a signed affidavit relating to financial or
15	ownership interests, the number of beds, copies of
16	civil verdicts or judgments involving the applicant,
17	and a plan for quality assurance and risk management;
18	amending s. 400.0712, F.S.; revising provisions
19	relating to the issuance of inactive licenses;
20	amending s. 400.111, F.S.; providing that a licensee
21	must provide certain information relating to financial
22	or ownership interests if requested by the Agency for
23	Health Care Administration; amending s. 400.1183,
24	F.S.; revising requirements relating to facility
25	grievance reports; amending s. 400.141, F.S.; revising
26	provisions relating to the provision of respite care
27	in a facility; deleting requirements for the
28	submission of certain reports to the agency relating
29	to ownership interests, staffing ratios, and
30	bankruptcy; deleting an obsolete provision; amending
31	s. 400.142, F.S.; deleting the agency's authority to
32	adopt rules relating to orders not to resuscitate;
33	repealing s. 400.145, F.S., relating to resident
34	records; amending s. 400.147, F.S.; revising
35	provisions relating to incident reports; deleting
36	certain reporting requirements; repealing s. 400.148,
37	F.S., relating to the Medicaid "Up-or-Out" Quality of
38	Care Contract Management Program; amending s. 400.19,
39	F.S.; revising provisions relating to agency
40	inspections; amending s. 400.191, F.S.; authorizing
41	the facility to charge a fee for copies of resident
42	records; amending s. 400.23, F.S.; specifying the
43	content of rules relating to staffing requirements for
44	residents under 21 years of age; amending s. 400.462,
45	F.S.; revising the definition of "remuneration" to
46	exclude items having a value of $10 or less; amending
47	ss. 429.294, 430.80, 430.81, and 651.118, F.S.;
48	conforming cross-references; providing an effective
49	date.
50
51	Be It Enacted by the Legislature of the State of Florida:
52
53	Section 1.  Subsection (1) of section 83.42, Florida
54	Statutes, is amended to read:
55	83.42  Exclusions from application of part.-This part does
56	not apply to:
57	(1)  Residency or detention in a facility, whether public
58	or private, where when residence or detention is incidental to
59	the provision of medical, geriatric, educational, counseling,
60	religious, or similar services. For residents of a facility
61	licensed under part II of chapter 400, the procedures provided
62	under s. 400.0255 govern all transfers or discharges from such
63	facilities.
64	Section 2.  Subsection (16) of section 400.021, Florida
65	Statutes, is amended to read:
66	400.021  Definitions.-When used in this part, unless the
67	context otherwise requires, the term:
68	(16)  "Resident care plan" means a written plan developed,
69	maintained, and reviewed at least not less than quarterly by a
70	registered nurse, with participation from other facility staff
71	and the resident or his or her designee or legal representative,
72	which includes a comprehensive assessment of the needs of an
73	individual resident; the type and frequency of services required
74	to provide the necessary care for the resident to attain or
75	maintain the highest practicable physical, mental, and
76	psychosocial well-being; a listing of services provided within
77	or outside the facility to meet those needs; and an explanation
78	of service goals. The resident care plan must be signed by the
79	director of nursing or another registered nurse employed by the
80	facility to whom institutional responsibilities have been
81	delegated and by the resident, the resident's designee, or the
82	resident's legal representative. The facility may not use an
83	agency or temporary registered nurse to satisfy the foregoing
84	requirement and must document the institutional responsibilities
85	that have been delegated to the registered nurse.
86	Section 3.  Subsection (1) of section 400.0234, Florida
87	Statutes, is amended to read:
88	400.0234  Availability of facility records for
89	investigation of resident's rights violations and defenses;
90	penalty.-
91	(1)  Failure to provide complete copies of a resident's
92	records, including, but not limited to, all medical records and
93	the resident's chart, within the control or possession of the
94	facility is in accordance with s. 400.145 shall constitute
95	evidence of failure of that party to comply with good faith
96	discovery requirements and waives shall waive the good faith
97	certificate and presuit notice requirements under this part by
98	the requesting party.
99	Section 4.  Paragraph (g) of subsection (2) of section
100	400.0239, Florida Statutes, is amended to read:
101	400.0239  Quality of Long-Term Care Facility Improvement
102	Trust Fund.-
103	(2)  Expenditures from the trust fund shall be allowable
104	for direct support of the following:
105	(g)  Other initiatives authorized by the Centers for
106	Medicare and Medicaid Services for the use of federal civil
107	monetary penalties, including projects recommended through the
108	Medicaid "Up-or-Out" Quality of Care Contract Management Program
109	pursuant to s. 400.148.
110	Section 5.  Subsection (15) of section 400.0255, Florida
111	Statutes, is amended to read:
112	400.0255  Resident transfer or discharge; requirements and
113	procedures; hearings.-
114	(15)(a)  The department's Office of Appeals Hearings shall
115	conduct hearings requested under this section.
116	(a)  The office shall notify the facility of a resident's
117	request for a hearing.
118	(b)  The department shall, by rule, establish procedures to
119	be used for fair hearings requested by residents. The These
120	procedures must shall be equivalent to the procedures used for
121	fair hearings for other Medicaid cases brought pursuant to s.
122	409.285 and applicable rules, chapter 10-2, part VI, Florida
123	Administrative Code. The burden of proof must be clear and
124	convincing evidence. A hearing decision must be rendered within
125	90 days after receipt of the request for hearing.
126	(c)  If the hearing decision is favorable to the resident
127	who has been transferred or discharged, the resident must be
128	readmitted to the facility's first available bed.
129	(d)  The decision of the hearing officer is shall be final.
130	Any aggrieved party may appeal the decision to the district
131	court of appeal in the appellate district where the facility is
132	located. Review procedures shall be conducted in accordance with
133	the Florida Rules of Appellate Procedure.
134	Section 6.  Subsection (2) of section 400.063, Florida
135	Statutes, is amended to read:
136	400.063  Resident protection.-
137	(2)  The agency is authorized to establish for each
138	facility, subject to intervention by the agency, may establish a
139	separate bank account for the deposit to the credit of the
140	agency of any moneys received from the Health Care Trust Fund or
141	any other moneys received for the maintenance and care of
142	residents in the facility, and may the agency is authorized to
143	disburse moneys from such account to pay obligations incurred
144	for the purposes of this section. The agency may is authorized
145	to requisition moneys from the Health Care Trust Fund in advance
146	of an actual need for cash on the basis of an estimate by the
147	agency of moneys to be spent under the authority of this
148	section. A Any bank account established under this section need
149	not be approved in advance of its creation as required by s.
150	17.58, but must shall be secured by depository insurance equal
151	to or greater than the balance of such account or by the pledge
152	of collateral security in conformance with criteria established
153	in s. 18.11. The agency shall notify the Chief Financial Officer
154	of an any such account so established and shall make a quarterly
155	accounting to the Chief Financial Officer for all moneys
156	deposited in such account.
157	Section 7.  Subsections (1) and (5) of section 400.071,
158	Florida Statutes, are amended to read:
159	400.071  Application for license.-
160	(1)  In addition to the requirements of part II of chapter
161	408, the application for a license must shall be under oath and
162	must contain the following:
163	(a)  The location of the facility for which a license is
164	sought and an indication, as in the original application, that
165	such location conforms to the local zoning ordinances.
166	(b)  A signed affidavit disclosing any financial or
167	ownership interest that a controlling interest as defined in
168	part II of chapter 408 has held in the last 5 years in any
169	entity licensed by this state or any other state to provide
170	health or residential care which has closed voluntarily or
171	involuntarily; has filed for bankruptcy; has had a receiver
172	appointed; has had a license denied, suspended, or revoked; or
173	has had an injunction issued against it which was initiated by a
174	regulatory agency. The affidavit must disclose the reason any
175	such entity was closed, whether voluntarily or involuntarily.
176	(c)  The total number of beds and the total number of
177	Medicare and Medicaid certified beds.
178	(b)(d)  Information relating to the applicant and employees
179	which the agency requires by rule. The applicant must
180	demonstrate that sufficient numbers of qualified staff, by
181	training or experience, will be employed to properly care for
182	the type and number of residents who will reside in the
183	facility.
184	(e)  Copies of any civil verdict or judgment involving the
185	applicant rendered within the 10 years preceding the
186	application, relating to medical negligence, violation of
187	residents' rights, or wrongful death. As a condition of
188	licensure, the licensee agrees to provide to the agency copies
189	of any new verdict or judgment involving the applicant, relating
190	to such matters, within 30 days after filing with the clerk of
191	the court. The information required in this paragraph shall be
192	maintained in the facility's licensure file and in an agency
193	database which is available as a public record.
194	(5)  As a condition of licensure, each facility must
195	establish and submit with its application a plan for quality
196	assurance and for conducting risk management.
197	Section 8.  Section 400.0712, Florida Statutes, is amended
198	to read:
199	400.0712  Application for Inactive license.-
200	(1)  As specified in this section, the agency may issue an
201	inactive license to a nursing home facility for all or a portion
202	of its beds. Any request by a licensee that a nursing home or
203	portion of a nursing home become inactive must be submitted to
204	the agency in the approved format. The facility may not initiate
205	any suspension of services, notify residents, or initiate
206	inactivity before receiving approval from the agency; and a
207	licensee that violates this provision may not be issued an
208	inactive license.
209	(1)(2)  In addition to the powers granted under part II of
210	chapter 408, the agency may issue an inactive license for a
211	portion of the total beds of to a nursing home facility that
212	chooses to use an unoccupied contiguous portion of the facility
213	for an alternative use to meet the needs of elderly persons
214	through the use of less restrictive, less institutional
215	services.
216	(a)  The An inactive license issued under this subsection
217	may be granted for a period not to exceed the current licensure
218	expiration date but may be renewed by the agency at the time of
219	licensure renewal.
220	(b)  A request to extend the inactive license must be
221	submitted to the agency in the approved format and approved by
222	the agency in writing.
223	(c)  A facility Nursing homes that receives receive an
224	inactive license to provide alternative services may shall not
225	be given receive preference for participation in the Assisted
226	Living for the Elderly Medicaid waiver.
227	(2)(3)  The agency shall adopt rules pursuant to ss.
228	120.536(1) and 120.54 necessary to administer implement this
229	section.
230	Section 9.  Section 400.111, Florida Statutes, is amended
231	to read:
232	400.111  Disclosure of controlling interest.-In addition to
233	the requirements of part II of chapter 408, the nursing home
234	facility, if requested by the agency, licensee shall submit a
235	signed affidavit disclosing any financial or ownership interest
236	that a controlling interest has held within the last 5 years in
237	any entity licensed by the state or any other state to provide
238	health or residential care which entity has closed voluntarily
239	or involuntarily; has filed for bankruptcy; has had a receiver
240	appointed; has had a license denied, suspended, or revoked; or
241	has had an injunction issued against it which was initiated by a
242	regulatory agency. The affidavit must disclose the reason such
243	entity was closed, whether voluntarily or involuntarily.
244	Section 10.  Subsection (2) of section 400.1183, Florida
245	Statutes, is amended to read:
246	400.1183  Resident grievance procedures.-
247	(2)  Each nursing home facility shall maintain records of
248	all grievances and a shall report, subject to agency inspection,
249	of to the agency at the time of relicensure the total number of
250	grievances handled during the prior licensure period, a
251	categorization of the cases underlying the grievances, and the
252	final disposition of the grievances.
253	Section 11.  Section 400.141, Florida Statutes, is amended
254	to read:
255	400.141  Administration and management of nursing home
256	facilities.-
257	(1)  A nursing home facility must Every licensed facility
258	shall comply with all applicable standards and rules of the
259	agency and must shall:
260	(a)  Be under the administrative direction and charge of a
261	licensed administrator.
262	(b)  Appoint a medical director licensed pursuant to
263	chapter 458 or chapter 459. The agency may establish by rule
264	more specific criteria for the appointment of a medical
265	director.
266	(c)  Have available the regular, consultative, and
267	emergency services of state licensed physicians licensed by the
268	state.
269	(d)  Provide for resident use of a community pharmacy as
270	specified in s. 400.022(1)(q). Any other law to the contrary
271	Notwithstanding any other law, a registered pharmacist licensed
272	in this state who in Florida, that is under contract with a
273	facility licensed under this chapter or chapter 429 must, shall
274	repackage a nursing facility resident's bulk prescription
275	medication, which was has been packaged by another pharmacist
276	licensed in any state, in the United States into a unit dose
277	system compatible with the system used by the nursing home
278	facility, if the pharmacist is requested to offer such service.
279	1.  In order to be eligible for the repackaging, a resident
280	or the resident's spouse must receive prescription medication
281	benefits provided through a former employer as part of his or
282	her retirement benefits, a qualified pension plan as specified
283	in s. 4972 of the Internal Revenue Code, a federal retirement
284	program as specified under 5 C.F.R. s. 831, or a long-term care
285	policy as defined in s. 627.9404(1).
286	2.  A pharmacist who correctly repackages and relabels the
287	medication and the nursing facility that which correctly
288	administers such repackaged medication under this paragraph may
289	not be held liable in any civil or administrative action arising
290	from the repackaging.
291	3.  In order to be eligible for the repackaging, a nursing
292	facility resident for whom the medication is to be repackaged
293	must shall sign an informed consent form provided by the
294	facility which includes an explanation of the repackaging
295	process and which notifies the resident of the immunities from
296	liability provided under in this paragraph.
297	4.  A pharmacist who repackages and relabels the
298	prescription medications, as authorized under this paragraph,
299	may charge a reasonable fee for costs resulting from the
300	implementation of this provision.
301	(e)  Provide for the access of the facility residents with
302	access to dental and other health-related services, recreational
303	services, rehabilitative services, and social work services
304	appropriate to their needs and conditions and not directly
305	furnished by the licensee. If When a geriatric outpatient nurse
306	clinic is conducted in accordance with rules adopted by the
307	agency, outpatients attending such clinic may shall not be
308	counted as part of the general resident population of the
309	nursing home facility, nor may shall the nursing staff of the
310	geriatric outpatient clinic be counted as part of the nursing
311	staff of the facility, until the outpatient clinic load exceeds
312	15 a day.
313	(f)  Be allowed and encouraged by the agency to provide
314	other needed services under certain conditions. If the facility
315	has a standard licensure status, and has had no class I or class
316	II deficiencies during the past 2 years or has been awarded a
317	Gold Seal under the program established in s. 400.235, it may be
318	encouraged by the agency to provide services, including, but not
319	limited to, respite and adult day services, which enable
320	individuals to move in and out of the facility. A facility is
321	not subject to any additional licensure requirements for
322	providing these services, under the following conditions:.
323	1.  Respite care may be offered to persons in need of
324	short-term or temporary nursing home services, if for each
325	person admitted under the respite care program, the licensee:.
326	a.  Has a contract that, at a minimum, specifies the
327	services to be provided to the respite resident, and includes
328	the charges for services, activities, equipment, emergency
329	medical services, and the administration of medications. If
330	multiple respite admissions for a single individual are
331	anticipated, the original contract is valid for 1 year after the
332	date of execution;
333	b.  Has a written abbreviated plan of care that, at a
334	minimum, includes nutritional requirements, medication orders,
335	physician assessments and orders, nursing assessments, and
336	dietary preferences. The physician or nursing assessments may
337	take the place of all other assessments required for full-time
338	residents; and
339	c.  Ensures that each respite resident is released to his
340	or her caregiver or an individual designated in writing by the
341	caregiver.
342	2.  A person admitted under a respite care program is:
343	a.  Covered by the residents' rights set forth in s.
344	400.022(1)(a)-(o) and (r)-(t). Funds or property of the respite
345	resident are not considered trust funds subject to s.
346	400.022(1)(h) until the resident has been in the facility for
347	more than 14 consecutive days;
348	b.  Allowed to use his or her personal medications for the
349	respite stay if permitted by facility policy. The facility must
350	obtain a physician's order for the medications. The caregiver
351	may provide information regarding the medications as part of the
352	nursing assessment which must agree with the physician's order.
353	Medications shall be released with the respite resident upon
354	discharge in accordance with current physician's orders; and
355	c.  Exempt from rule requirements related to discharge
356	planning.
357	3.  A person receiving respite care is entitled to reside
358	in the facility for a total of 60 days within a contract year or
359	calendar year if the contract is for less than 12 months.
360	However, each single stay may not exceed 14 days. If a stay
361	exceeds 14 consecutive days, the facility must comply with all
362	assessment and care planning requirements applicable to nursing
363	home residents.
364	4.  The respite resident provided medical information from
365	a physician, physician assistant, or nurse practitioner and
366	other information from the primary caregiver as may be required
367	by the facility before or at the time of admission. The medical
368	information must include a physician's order for respite care
369	and proof of a physical examination by a licensed physician,
370	physician assistant, or nurse practitioner. The physician's
371	order and physical examination may be used to provide
372	intermittent respite care for up to 12 months after the date the
373	order is written.
374	5.  A person receiving respite care resides in a licensed
375	nursing home bed.
376	6.  The facility assumes the duties of the primary
377	caregiver. To ensure continuity of care and services, the
378	respite resident is entitled to retain his or her personal
379	physician and must have access to medically necessary services
380	such as physical therapy, occupational therapy, or speech
381	therapy, as needed. The facility must arrange for transportation
382	to these services if necessary. Respite care must be provided in
383	accordance with this part and rules adopted by the agency.
384	However, the agency shall, by rule, adopt modified requirements
385	for resident assessment, resident care plans, resident
386	contracts, physician orders, and other provisions, as
387	appropriate, for short-term or temporary nursing home services.
388	7.  The agency allows shall allow for shared programming
389	and staff in a facility that which meets minimum standards and
390	offers services pursuant to this paragraph, but, if the facility
391	is cited for deficiencies in patient care, the agency may
392	require additional staff and programs appropriate to the needs
393	of service recipients. A person who receives respite care may
394	not be counted as a resident of the facility for purposes of the
395	facility's licensed capacity unless that person receives 24-hour
396	respite care. A person receiving either respite care for 24
397	hours or longer or adult day services must be included when
398	calculating minimum staffing for the facility. Any costs and
399	revenues generated by a nursing home facility from
400	nonresidential programs or services must shall be excluded from
401	the calculations of Medicaid per diems for nursing home
402	institutional care reimbursement.
403	(g)  If the facility has a standard license or is a Gold
404	Seal facility, exceeds the minimum required hours of licensed
405	nursing and certified nursing assistant direct care per resident
406	per day, and is part of a continuing care facility licensed
407	under chapter 651 or a retirement community that offers other
408	services pursuant to part III of this chapter or part I or part
409	III of chapter 429 on a single campus, be allowed to share
410	programming and staff. At the time of inspection and in the
411	semiannual report required pursuant to paragraph (o), a
412	continuing care facility or retirement community that uses this
413	option must demonstrate through staffing records that minimum
414	staffing requirements for the facility were met. Licensed nurses
415	and certified nursing assistants who work in the nursing home
416	facility may be used to provide services elsewhere on campus if
417	the facility exceeds the minimum number of direct care hours
418	required per resident per day and the total number of residents
419	receiving direct care services from a licensed nurse or a
420	certified nursing assistant does not cause the facility to
421	violate the staffing ratios required under s. 400.23(3)(a).
422	Compliance with the minimum staffing ratios must shall be based
423	on the total number of residents receiving direct care services,
424	regardless of where they reside on campus. If the facility
425	receives a conditional license, it may not share staff until the
426	conditional license status ends. This paragraph does not
427	restrict the agency's authority under federal or state law to
428	require additional staff if a facility is cited for deficiencies
429	in care which are caused by an insufficient number of certified
430	nursing assistants or licensed nurses. The agency may adopt
431	rules for the documentation necessary to determine compliance
432	with this provision.
433	(h)  Maintain the facility premises and equipment and
434	conduct its operations in a safe and sanitary manner.
435	(i)  If the licensee furnishes food service, provide a
436	wholesome and nourishing diet sufficient to meet generally
437	accepted standards of proper nutrition for its residents and
438	provide such therapeutic diets as may be prescribed by attending
439	physicians. In adopting making rules to implement this
440	paragraph, the agency shall be guided by standards recommended
441	by nationally recognized professional groups and associations
442	with knowledge of dietetics.
443	(j)  Keep full records of resident admissions and
444	discharges; medical and general health status, including medical
445	records, personal and social history, and identity and address
446	of next of kin or other persons who may have responsibility for
447	the affairs of the resident residents; and individual resident
448	care plans, including, but not limited to, prescribed services,
449	service frequency and duration, and service goals. The records
450	must shall be open to agency inspection by the agency. The
451	licensee shall maintain clinical records on each resident in
452	accordance with accepted professional standards and practices,
453	which must be complete, accurately documented, readily
454	accessible, and systematically organized.
455	(k)  Keep such fiscal records of its operations and
456	conditions as may be necessary to provide information pursuant
457	to this part.
458	(l)  Furnish copies of personnel records for employees
459	affiliated with such facility, to any other facility licensed by
460	this state requesting this information pursuant to this part.
461	Such information contained in the records may include, but is
462	not limited to, disciplinary matters and reasons any reason for
463	termination. A Any facility releasing such records pursuant to
464	this part is shall be considered to be acting in good faith and
465	may not be held liable for information contained in such
466	records, absent a showing that the facility maliciously
467	falsified such records.
468	(m)  Publicly display a poster provided by the agency
469	containing the names, addresses, and telephone numbers for the
470	state's abuse hotline, the State Long-Term Care Ombudsman, the
471	Agency for Health Care Administration consumer hotline, the
472	Advocacy Center for Persons with Disabilities, the Florida
473	Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
474	with a clear description of the assistance to be expected from
475	each.
476	(n)  Submit to the agency the information specified in s.
477	400.071(1)(b) for a management company within 30 days after the
478	effective date of the management agreement.
479	(o)1.  Submit semiannually to the agency, or more
480	frequently if requested by the agency, information regarding
481	facility staff-to-resident ratios, staff turnover, and staff
482	stability, including information regarding certified nursing
483	assistants, licensed nurses, the director of nursing, and the
484	facility administrator. For purposes of this reporting:
485	a.  Staff-to-resident ratios must be reported in the
486	categories specified in s. 400.23(3)(a) and applicable rules.
487	The ratio must be reported as an average for the most recent
488	calendar quarter.
489	b.  Staff turnover must be reported for the most recent 12-
490	month period ending on the last workday of the most recent
491	calendar quarter prior to the date the information is submitted.
492	The turnover rate must be computed quarterly, with the annual
493	rate being the cumulative sum of the quarterly rates. The
494	turnover rate is the total number of terminations or separations
495	experienced during the quarter, excluding any employee
496	terminated during a probationary period of 3 months or less,
497	divided by the total number of staff employed at the end of the
498	period for which the rate is computed, and expressed as a
499	percentage.
500	c.  The formula for determining staff stability is the
501	total number of employees that have been employed for more than
502	12 months, divided by the total number of employees employed at
503	the end of the most recent calendar quarter, and expressed as a
504	percentage.
505	(n)  Comply with state minimum-staffing requirements:
506	1.d.  A nursing facility that has failed to comply with
507	state minimum-staffing requirements for 2 consecutive days is
508	prohibited from accepting new admissions until the facility has
509	achieved the minimum-staffing requirements for a period of 6
510	consecutive days. For the purposes of this subparagraph sub-
511	subparagraph, any person who was a resident of the facility and
512	was absent from the facility for the purpose of receiving
513	medical care at a separate location or was on a leave of absence
514	is not considered a new admission. Failure by the facility to
515	impose such an admissions moratorium is subject to a $1,000 fine
516	constitutes a class II deficiency.
517	2.e.  A nursing facility that which does not have a
518	conditional license may be cited for failure to comply with the
519	standards in s. 400.23(3)(a)1.b. and c. only if it has failed to
520	meet those standards on 2 consecutive days or if it has failed
521	to meet at least 97 percent of those standards on any one day.
522	3.f.  A facility that which has a conditional license must
523	be in compliance with the standards in s. 400.23(3)(a) at all
524	times.
525	2.  This paragraph does not limit the agency's ability to
526	impose a deficiency or take other actions if a facility does not
527	have enough staff to meet the residents' needs.
528	(o)(p)  Notify a licensed physician when a resident
529	exhibits signs of dementia or cognitive impairment or has a
530	change of condition in order to rule out the presence of an
531	underlying physiological condition that may be contributing to
532	such dementia or impairment. The notification must occur within
533	30 days after the acknowledgment of such signs by facility
534	staff. If an underlying condition is determined to exist, the
535	facility shall arrange, with the appropriate health care
536	provider, arrange for the necessary care and services to treat
537	the condition.
538	(p)(q)  If the facility implements a dining and hospitality
539	attendant program, ensure that the program is developed and
540	implemented under the supervision of the facility director of
541	nursing. A licensed nurse, licensed speech or occupational
542	therapist, or a registered dietitian must conduct training of
543	dining and hospitality attendants. A person employed by a
544	facility as a dining and hospitality attendant must perform
545	tasks under the direct supervision of a licensed nurse.
546	(r)  Report to the agency any filing for bankruptcy
547	protection by the facility or its parent corporation,
548	divestiture or spin-off of its assets, or corporate
549	reorganization within 30 days after the completion of such
550	activity.
551	(q)(s)  Maintain general and professional liability
552	insurance coverage that is in force at all times. In lieu of
553	such general and professional liability insurance coverage, a
554	state-designated teaching nursing home and its affiliated
555	assisted living facilities created under s. 430.80 may
556	demonstrate proof of financial responsibility as provided in s.
557	430.80(3)(g).
558	(r)(t)  Maintain in the medical record for each resident a
559	daily chart of certified nursing assistant services provided to
560	the resident. The certified nursing assistant who is caring for
561	the resident must complete this record by the end of his or her
562	shift. The This record must indicate assistance with activities
563	of daily living, assistance with eating, and assistance with
564	drinking, and must record each offering of nutrition and
565	hydration for those residents whose plan of care or assessment
566	indicates a risk for malnutrition or dehydration.
567	(s)(u)  Before November 30 of each year, subject to the
568	availability of an adequate supply of the necessary vaccine,
569	provide for immunizations against influenza viruses to all its
570	consenting residents in accordance with the recommendations of
571	the United States Centers for Disease Control and Prevention,
572	subject to exemptions for medical contraindications and
573	religious or personal beliefs. Subject to these exemptions, any
574	consenting person who becomes a resident of the facility after
575	November 30 but before March 31 of the following year must be
576	immunized within 5 working days after becoming a resident.
577	Immunization may shall not be provided to any resident who
578	provides documentation that he or she has been immunized as
579	required by this paragraph. This paragraph does not prohibit a
580	resident from receiving the immunization from his or her
581	personal physician if he or she so chooses. A resident who
582	chooses to receive the immunization from his or her personal
583	physician shall provide proof of immunization to the facility.
584	The agency may adopt and enforce any rules necessary to
585	administer comply with or implement this paragraph.
586	(t)(v)  Assess all residents for eligibility for
587	pneumococcal polysaccharide vaccination (PPV) and vaccinate
588	residents when indicated within 60 days after the effective date
589	of this act in accordance with the recommendations of the United
590	States Centers for Disease Control and Prevention, subject to
591	exemptions for medical contraindications and religious or
592	personal beliefs. Residents admitted after the effective date of
593	this act shall be assessed within 5 working days after of
594	admission and, if when indicated, vaccinate such residents
595	vaccinated within 60 days in accordance with the recommendations
596	of the United States Centers for Disease Control and Prevention,
597	subject to exemptions for medical contraindications and
598	religious or personal beliefs. Immunization may shall not be
599	provided to any resident who provides documentation that he or
600	she has been immunized as required by this paragraph. This
601	paragraph does not prohibit a resident from receiving the
602	immunization from his or her personal physician if he or she so
603	chooses. A resident who chooses to receive the immunization from
604	his or her personal physician shall provide proof of
605	immunization to the facility. The agency may adopt and enforce
606	any rules necessary to administer comply with or implement this
607	paragraph.
608	(u)(w)  Annually encourage and promote to its employees the
609	benefits associated with immunizations against influenza viruses
610	in accordance with the recommendations of the United States
611	Centers for Disease Control and Prevention. The agency may adopt
612	and enforce any rules necessary to administer comply with or
613	implement this paragraph.
614
615	This subsection does not limit the agency's ability to impose a
616	deficiency or take other actions if a facility does not have
617	enough staff to meet residents' needs.
618	(2)  Facilities that have been awarded a Gold Seal under
619	the program established in s. 400.235 may develop a plan to
620	provide certified nursing assistant training as prescribed by
621	federal regulations and state rules and may apply to the agency
622	for approval of their program.
623	Section 12.  Subsection (3) of section 400.142, Florida
624	Statutes, is amended to read:
625	400.142  Emergency medication kits; orders not to
626	resuscitate.-
627	(3)  Facility staff may withhold or withdraw
628	cardiopulmonary resuscitation if presented with an order not to
629	resuscitate executed pursuant to s. 401.45. The agency shall
630	adopt rules providing for the implementation of such orders.
631	Facility staff and facilities are shall not be subject to
632	criminal prosecution or civil liability, or nor be considered to
633	have engaged in negligent or unprofessional conduct, for
634	withholding or withdrawing cardiopulmonary resuscitation
635	pursuant to such an order and rules adopted by the agency. The
636	absence of an order not to resuscitate executed pursuant to s.
637	401.45 does not preclude a physician from withholding or
638	withdrawing cardiopulmonary resuscitation as otherwise permitted
639	by law.
640	Section 13.  Section 400.145, Florida Statutes, is
641	repealed.
642	Section 14.  Subsections (7) through (10) of section
643	400.147, Florida Statutes, are amended, and present subsections
644	(11) through (15) of that section are redesignated as
645	subsections (9) through (13), respectively, to read:
646	400.147  Internal risk management and quality assurance
647	program.-
648	(7)  The nursing home facility shall initiate an
649	investigation and shall notify the agency within 1 business day
650	after the risk manager or his or her designee has received a
651	report pursuant to paragraph (1)(d). The facility must complete
652	the investigation and submit a report to the agency within 15
653	calendar days after an incident is determined to be an adverse
654	incident. The notification must be made in writing and be
655	provided electronically, by facsimile device or overnight mail
656	delivery. The agency shall develop a form for the report which
657	notification must include the name of the risk manager,
658	information regarding the identity of the affected resident, the
659	type of adverse incident, the initiation of an investigation by
660	the facility, and whether the events causing or resulting in the
661	adverse incident represent a potential risk to any other
662	resident. The report notification is confidential as provided by
663	law and is not discoverable or admissible in any civil or
664	administrative action, except in disciplinary proceedings by the
665	agency or the appropriate regulatory board. The agency may
666	investigate, as it deems appropriate, any such incident and
667	prescribe measures that must or may be taken in response to the
668	incident. The agency shall review each report incident and
669	determine whether it potentially involved conduct by the health
670	care professional who is subject to disciplinary action, in
671	which case the provisions of s. 456.073 shall apply.
672	(8)(a)  Each facility shall complete the investigation and
673	submit an adverse incident report to the agency for each adverse
674	incident within 15 calendar days after its occurrence. If, after
675	a complete investigation, the risk manager determines that the
676	incident was not an adverse incident as defined in subsection
677	(5), the facility shall include this information in the report.
678	The agency shall develop a form for reporting this information.
679	(b)  The information reported to the agency pursuant to
680	paragraph (a) which relates to persons licensed under chapter
681	458, chapter 459, chapter 461, or chapter 466 shall be reviewed
682	by the agency. The agency shall determine whether any of the
683	incidents potentially involved conduct by a health care
684	professional who is subject to disciplinary action, in which
685	case the provisions of s. 456.073 shall apply.
686	(c)  The report submitted to the agency must also contain
687	the name of the risk manager of the facility.
688	(d)  The adverse incident report is confidential as
689	provided by law and is not discoverable or admissible in any
690	civil or administrative action, except in disciplinary
691	proceedings by the agency or the appropriate regulatory board.
692	(8)(9)  Abuse, neglect, or exploitation must be reported to
693	the agency as required by 42 C.F.R. s. 483.13(c) and to the
694	department as required by chapters 39 and 415.
695	(10)  By the 10th of each month, each facility subject to
696	this section shall report any notice received pursuant to s.
697	400.0233(2) and each initial complaint that was filed with the
698	clerk of the court and served on the facility during the
699	previous month by a resident or a resident's family member,
700	guardian, conservator, or personal legal representative. The
701	report must include the name of the resident, the resident's
702	date of birth and social security number, the Medicaid
703	identification number for Medicaid-eligible persons, the date or
704	dates of the incident leading to the claim or dates of
705	residency, if applicable, and the type of injury or violation of
706	rights alleged to have occurred. Each facility shall also submit
707	a copy of the notices received pursuant to s. 400.0233(2) and
708	complaints filed with the clerk of the court. This report is
709	confidential as provided by law and is not discoverable or
710	admissible in any civil or administrative action, except in such
711	actions brought by the agency to enforce the provisions of this
712	part.
713	Section 15.  Section 400.148, Florida Statutes, is
714	repealed.
715	Section 16.  Subsection (3) of section 400.19, Florida
716	Statutes, is amended to read:
717	400.19  Right of entry and inspection.-
718	(3)  The agency shall every 15 months conduct at least one
719	unannounced inspection every 15 months to determine the
720	licensee's compliance by the licensee with statutes, and related
721	with rules promulgated under the provisions of those statutes,
722	governing minimum standards of construction, quality and
723	adequacy of care, and rights of residents. The survey must shall
724	be conducted every 6 months for the next 2-year period if the
725	nursing home facility has been cited for a class I deficiency,
726	has been cited for two or more class II deficiencies arising
727	from separate surveys or investigations within a 60-day period,
728	or has had three or more substantiated complaints within a 6-
729	month period, each resulting in at least one class I or class II
730	deficiency. In addition to any other fees or fines under in this
731	part, the agency shall assess a fine for each facility that is
732	subject to the 6-month survey cycle. The fine for the 2-year
733	period is shall be $6,000, one-half to be paid at the completion
734	of each survey. The agency may adjust this fine by the change in
735	the Consumer Price Index, based on the 12 months immediately
736	preceding the increase, to cover the cost of the additional
737	surveys. The agency shall verify through subsequent inspection
738	that any deficiency identified during inspection is corrected.
739	However, the agency may verify the correction of a class III or
740	class IV deficiency unrelated to resident rights or resident
741	care without reinspecting the facility if adequate written
742	documentation has been received from the facility, which
743	provides assurance that the deficiency has been corrected. The
744	giving or causing to be given of advance notice of such
745	unannounced inspections by an employee of the agency to any
746	unauthorized person shall constitute cause for suspension of at
747	least not fewer than 5 working days according to the provisions
748	of chapter 110.
749	Section 17.  Present subsection (6) of section 400.191,
750	Florida Statutes, is renumbered as subsection (7), and a new
751	subsection (6) is added to that section, to read:
752	400.191  Availability, distribution, and posting of reports
753	and records.-
754	(6)  A nursing home facility may charge a reasonable fee
755	for copying resident records. The fee may not exceed $1 per page
756	for the first 25 pages and 25 cents per page for each page in
757	excess of 25 pages.
758	Section 18.  Subsection (5) of section 400.23, Florida
759	Statutes, is amended to read:
760	400.23  Rules; evaluation and deficiencies; licensure
761	status.-
762	(5)  The agency, in collaboration with the Division of
763	Children's Medical Services of the Department of Health, must,
764	no later than December 31, 1993, adopt rules for:
765	(a)  Minimum standards of care for persons under 21 years
766	of age who reside in nursing home facilities. The rules must
767	include a methodology for reviewing a nursing home facility
768	under ss. 408.031-408.045 which serves only persons under 21
769	years of age. A facility may be exempted exempt from these
770	standards for specific persons between 18 and 21 years of age,
771	if the person's physician agrees that minimum standards of care
772	based on age are not necessary.
773	(b)  Minimum staffing requirements for each nursing home
774	facility that serves persons under 21 years of age, which apply
775	in lieu of the standards contained in subsection (3).
776	1.  For persons under 21 years of age who require skilled
777	care, the requirements must include a minimum combined average
778	of 3.9 hours of direct care per resident per day provided by
779	licensed nurses, respiratory therapists, respiratory care
780	practitioners, and certified nursing assistants.
781	2.  For persons under 21 years of age who are medically
782	fragile, the requirements must include a minimum combined
783	average of 5 hours of direct care per resident per day provided
784	by licensed nurses, respiratory therapists, respiratory care
785	practitioners, and certified nursing assistants.
786	Section 19.  Subsection (27) of section 400.462, Florida
787	Statutes, is amended to read:
788	400.462  Definitions.-As used in this part, the term:
789	(27)  "Remuneration" means any payment or other benefit
790	made directly or indirectly, overtly or covertly, in cash or in
791	kind. However, if the term is used in any provision of law
792	relating to health care providers, the term does not apply to an
793	item that has an individual value of up to $15, including, but
794	not limited to, a plaque, a certificate, a trophy, or a novelty
795	item that is intended solely for presentation or is customarily
796	given away solely for promotional, recognition, or advertising
797	purposes.
798	Section 20.  Subsection (1) of section 429.294, Florida
799	Statutes, is amended to read:
800	429.294  Availability of facility records for investigation
801	of resident's rights violations and defenses; penalty.-
802	(1)  Failure to provide complete copies of a resident's
803	records, including, but not limited to, all medical records and
804	the resident's chart, within the control or possession of the
805	facility within 10 days, is in accordance with the provisions of
806	s. 400.145, shall constitute evidence of failure of that party
807	to comply with good faith discovery requirements and waives
808	shall waive the good faith certificate and presuit notice
809	requirements under this part by the requesting party.
810	Section 21.  Paragraph (g) of subsection (3) of section
811	430.80, Florida Statutes, is amended to read:
812	430.80  Implementation of a teaching nursing home pilot
813	project.-
814	(3)  To be designated as a teaching nursing home, a nursing
815	home licensee must, at a minimum:
816	(g)  Maintain insurance coverage pursuant to s.
817	400.141(1)(q) 400.141(1)(s) or proof of financial responsibility
818	in a minimum amount of $750,000. Such proof of financial
819	responsibility may include:
820	1.  Maintaining an escrow account consisting of cash or
821	assets eligible for deposit in accordance with s. 625.52; or
822	2.  Obtaining and maintaining pursuant to chapter 675 an
823	unexpired, irrevocable, nontransferable and nonassignable letter
824	of credit issued by any bank or savings association organized
825	and existing under the laws of this state or any bank or savings
826	association organized under the laws of the United States which
827	that has its principal place of business in this state or has a
828	branch office that which is authorized to receive deposits in
829	this state. The letter of credit shall be used to satisfy the
830	obligation of the facility to the claimant upon presentment of a
831	final judgment indicating liability and awarding damages to be
832	paid by the facility or upon presentment of a settlement
833	agreement signed by all parties to the agreement if when such
834	final judgment or settlement is a result of a liability claim
835	against the facility.
836	Section 22.  Paragraph (h) of subsection (2) of section
837	430.81, Florida Statutes, is amended to read:
838	430.81  Implementation of a teaching agency for home and
839	community-based care.-
840	(2)  The Department of Elderly Affairs may designate a home
841	health agency as a teaching agency for home and community-based
842	care if the home health agency:
843	(h)  Maintains insurance coverage pursuant to s.
844	400.141(1)(q) 400.141(1)(s) or proof of financial responsibility
845	in a minimum amount of $750,000. Such proof of financial
846	responsibility may include:
847	1.  Maintaining an escrow account consisting of cash or
848	assets eligible for deposit in accordance with s. 625.52; or
849	2.  Obtaining and maintaining, pursuant to chapter 675, an
850	unexpired, irrevocable, nontransferable, and nonassignable
851	letter of credit issued by any bank or savings association
852	authorized to do business in this state. This letter of credit
853	shall be used to satisfy the obligation of the agency to the
854	claimant upon presentation of a final judgment indicating
855	liability and awarding damages to be paid by the facility or
856	upon presentment of a settlement agreement signed by all parties
857	to the agreement if when such final judgment or settlement is a
858	result of a liability claim against the agency.
859	Section 23.  Subsection (13) of section 651.118, Florida
860	Statutes, is amended to read:
861	651.118  Agency for Health Care Administration;
862	certificates of need; sheltered beds; community beds.-
863	(13)  Residents, as defined in this chapter, are not
864	considered new admissions for the purpose of s. 400.141(1)(n)
865	400.141(1)(o)1.d.
866	Section 24.  This act shall take effect July 1, 2012.

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