HB 787

1
A bill to be entitled
2An act relating to nursing home facilities; amending
3s. 400.021, F.S.; revising definitions of the terms
4"geriatric outpatient clinic" and "resident care plan"
5and defining the term "therapeutic spa services";
6amending s. 400.141, F.S.; revising provisions
7relating to facilities eligible to share programming
8and staff; deleting requirements for the submission of
9certain reports to the Agency for Health Care
10Administration; creating s. 400.172, F.S.; providing
11requirements for a nursing home facility operated by a
12licensee that provides respite care services;
13providing for rights of persons receiving respite care
14in nursing home facilities; requiring a prospective
15respite care recipient to provide certain information
16to the nursing home facility; amending s. 400.141,
17F.S.; revising provisions relating to other needed
18services provided by licensed nursing home facilities,
19including respite care, adult day, and therapeutic spa
20services; amending s. 408.0435, F.S.; revising the
21period of time allotted for approval of the nursing
22home moratorium on a certificate of need for
23additional community nursing home beds; amending s.
24429.905, F.S.; defining the term "day" for purposes of
25day care services provided to adults who are not
26residents; amending s. 651.118, F.S.; providing a
27funding limitation on sheltered nursing home beds used
28to provide assisted living, rather than extended
29congregate care services; authorizing certain sharing
30of areas, services, and staff between such sheltered
31beds and nursing home beds in those facilities;
32providing an effective date.
33
34     WHEREAS, the Legislature recognizes that the use of nursing
35homes has decreased over the past decade because of alternatives
36that are now available to consumers, and
37     WHEREAS, nursing homes continue to be a valuable resource
38and should be used to the fullest extent possible to provide
39traditional nursing care to the most impaired persons as well as
40providing services to frail or disabled persons who choose to
41remain in the community or who may need a less skilled level of
42care, and
43     WHEREAS, regulatory requirements should be flexible enough
44to allow nursing homes to diversify but continue to include
45sufficient protections to ensure the best care possible to
46consumers, NOW, THEREFORE,
47
48Be It Enacted by the Legislature of the State of Florida:
49
50     Section 1.  Subsections (8) and (16) of section 400.021,
51Florida Statutes, are amended, and subsection (19) is added to
52that section, to read:
53     400.021  Definitions.-When used in this part, unless the
54context otherwise requires, the term:
55     (8)  "Geriatric outpatient clinic" means a site for
56providing outpatient health care to persons 60 years of age or
57older, which is staffed by a registered nurse, or a physician
58assistant, or a licensed practical nurse under the direct
59supervision of a registered nurse, advanced registered nurse
60practitioner, physician assistant, or physician.
61     (16)  "Resident care plan" means a written plan developed,
62maintained, and reviewed not less than quarterly by a registered
63nurse, with participation from other facility staff and the
64resident or his or her designee or legal representative, which
65includes a comprehensive assessment of the needs of an
66individual resident; the type and frequency of services required
67to provide the necessary care for the resident to attain or
68maintain the highest practicable physical, mental, and
69psychosocial well-being; a listing of services provided within
70or outside the facility to meet those needs; and an explanation
71of service goals. The resident care plan must be signed by the
72director of nursing or another registered nurse employed by the
73facility to whom institutional responsibilities have been
74delegated and by the resident, the resident's designee, or the
75resident's legal representative. The facility may not use an
76agency or temporary registered nurse to satisfy the foregoing
77requirement and must document the institutional responsibilities
78that have been delegated to the registered nurse.
79     (19)  "Therapeutic spa services" means bathing, nail, and
80hair care services and other similar services related to
81personal hygiene.
82     Section 2.  Paragraph (g) of subsection (1) of section
83400.141, Florida Statutes, is amended to read:
84     400.141  Administration and management of nursing home
85facilities.-
86     (1)  Every licensed facility shall comply with all
87applicable standards and rules of the agency and shall:
88     (g)  If the facility has a standard license or is a Gold
89Seal facility, exceeds the minimum required hours of licensed
90nursing and certified nursing assistant direct care per resident
91per day, and is part of a continuing care facility licensed
92under chapter 651 or a retirement community that offers other
93services pursuant to part III of this chapter or part I or part
94III of chapter 429 on a single campus, be allowed to share
95programming and staff. At the time of inspection and in the
96semiannual report required pursuant to paragraph (o), a
97continuing care facility or retirement community that uses this
98option must demonstrate through staffing records that minimum
99staffing requirements for the facility were met. Licensed nurses
100and certified nursing assistants who work in the nursing home
101facility may be used to provide services elsewhere on campus if
102the facility exceeds the minimum number of direct care hours
103required per resident per day and the total number of residents
104receiving direct care services from a licensed nurse or a
105certified nursing assistant does not cause the facility to
106violate the staffing ratios required under s. 400.23(3)(a).
107Compliance with the minimum staffing ratios must shall be based
108on the total number of residents receiving direct care services,
109regardless of where they reside on campus. If the facility
110receives a conditional license, it may not share staff until the
111conditional license status ends. This paragraph does not
112restrict the agency's authority under federal or state law to
113require additional staff if a facility is cited for deficiencies
114in care which are caused by an insufficient number of certified
115nursing assistants or licensed nurses. The agency may adopt
116rules for the documentation necessary to determine compliance
117with this provision.
118     Section 3.  Section 400.172, Florida Statutes, is created
119to read:
120     400.172  Respite care provided in nursing home facilities.-
121     (1)  For each person admitted for respite care as
122authorized under s. 400.141(1)(f), a nursing home facility
123operated by a licensee must:
124     (a)  Have a written abbreviated plan of care that, at a
125minimum, includes nutritional requirements, medication orders,
126physician orders, nursing assessments, and dietary preferences.
127The nursing or physician assessments may take the place of all
128other assessments required for full-time residents.
129     (b)  Have a contract that, at a minimum, specifies the
130services to be provided to a resident receiving respite care,
131including charges for services, activities, equipment, emergency
132medical services, and the administration of medications. If
133multiple admissions for a single person for respite care are
134anticipated, the original contract is valid for 1 year after the
135date the contract is executed.
136     (c)  Ensure that each resident is released to his or her
137caregiver or an individual designated in writing by the
138caregiver.
139     (2)  A person admitted under the respite care program
140shall:
141     (a)  Be exempt from department rules relating to the
142discharge planning process.
143     (b)  Be covered by the residents' rights specified in s.
144400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident
145are not be considered trust funds subject to the requirements of
146s. 400.022(1)(h) until the resident has been in the facility for
147more than 14 consecutive days.
148     (c)  Be allowed to use his or her personal medications
149during the respite stay if permitted by facility policy. The
150facility must obtain a physician's order for the medications.
151The caregiver may provide information regarding the medications
152as part of the nursing assessment and that information must
153agree with the physician's order. Medications shall be released
154with the resident upon discharge in accordance with current
155physician's orders.
156     (d)  Be entitled to reside in the facility for a total of
15760 days within a contract year or for a total of 60 days within
158a calendar year if the contract is for less than 12 months.
159However, each single stay may not exceed 14 days. If a stay
160exceeds 14 consecutive days, the facility must comply with all
161assessment and care planning requirements applicable to nursing
162home residents.
163     (e)  Reside in a licensed nursing home bed.
164     (3)  A prospective respite care resident must provide
165medical information from a physician, physician assistant, or
166nurse practitioner and any other information provided by the
167primary caregiver required by the facility before or when the
168person is admitted to receive respite care. The medical
169information must include a physician's order for respite care
170and proof of a physical examination by a licensed physician,
171physician assistant, or nurse practitioner. The physician's
172order and physical examination may be used to provide
173intermittent respite care for up to 12 months after the date the
174order is written.
175     (4)  The facility shall assume the duties of the primary
176caregiver. To ensure continuity of care and services, the
177resident may retain his or her personal physician and shall have
178access to medically necessary services such as physical therapy,
179occupational therapy, or speech therapy, as needed. The facility
180shall arrange for transportation of the resident to these
181services, if necessary.
182     Section 4.  Paragraph (f) of subsection (1) of section
183400.141, Florida Statutes, is amended to read:
184     400.141  Administration and management of nursing home
185facilities.-
186     (1)  Every licensed facility shall comply with all
187applicable standards and rules of the agency and shall:
188     (f)  Be allowed and encouraged by the agency to provide
189other needed services under certain conditions. If the facility
190has a standard licensure status, and has had no class I or class
191II deficiencies during the past 2 years or has been awarded a
192Gold Seal under the program established in s. 400.235, it may be
193encouraged by the agency to provide services, including, but not
194limited to, respite, therapeutic spa, and adult day services to
195nonresidents, which enable individuals to move in and out of the
196facility. A facility is not subject to any additional licensure
197requirements for providing these services. Respite care may be
198offered to persons in need of short-term or temporary nursing
199home services. Respite care must be provided in accordance with
200this part and rules adopted by the agency. However, the agency
201shall, by rule, adopt modified requirements for resident
202assessment, resident care plans, resident contracts, physician
203orders, and other provisions, as appropriate, for short-term or
204temporary nursing home services. Providers of adult day services
205must comply with the requirements of s. 429.905(2). The agency
206shall allow for shared programming and staff in a facility which
207meets minimum standards and offers services pursuant to this
208paragraph, but, if the facility is cited for deficiencies in
209patient care, may require additional staff and programs
210appropriate to the needs of service recipients. A person who
211receives respite care may not be counted as a resident of the
212facility for purposes of the facility's licensed capacity unless
213that person receives 24-hour respite care. A person receiving
214either respite care for 24 hours or longer or adult day services
215must be included when calculating minimum staffing for the
216facility. Any costs and revenues generated by a nursing home
217facility from nonresidential programs or services shall be
218excluded from the calculations of Medicaid per diems for nursing
219home institutional care reimbursement.
220     Section 5.  Subsection (1) of section 408.0435, Florida
221Statutes, is amended to read:
222     408.0435  Moratorium on nursing home certificates of need.-
223     (1)  Notwithstanding the establishment of need as provided
224for in this chapter, a certificate of need for additional
225community nursing home beds may not be approved by the agency
226until Medicaid managed care is implemented statewide pursuant to
227ss. 409.961-409.985 or October 1, 2016, whichever is later
228earlier.
229     Section 6.  Subsection (2) of section 429.905, Florida
230Statutes, is amended to read:
231     429.905  Exemptions; monitoring of adult day care center
232programs colocated with assisted living facilities or licensed
233nursing home facilities.-
234     (2)  A licensed assisted living facility, a licensed
235hospital, or a licensed nursing home facility may provide
236services during the day which include, but are not limited to,
237social, health, therapeutic, recreational, nutritional, and
238respite services, to adults who are not residents. Such a
239facility need not be licensed as an adult day care center;
240however, the agency must monitor the facility during the regular
241inspection and at least biennially to ensure adequate space and
242sufficient staff. If an assisted living facility, a hospital, or
243a nursing home holds itself out to the public as an adult day
244care center, it must be licensed as such and meet all standards
245prescribed by statute and rule. For the purpose of this
246subsection, the term "day" means any portion of a 24-hour day.
247     Section 7.  Subsection (8) of section 651.118, Florida
248Statutes, is amended to read:
249     651.118  Agency for Health Care Administration;
250certificates of need; sheltered beds; community beds.-
251     (8)  A provider may petition the Agency for Health Care
252Administration to use a designated number of sheltered nursing
253home beds to provide assisted living extended congregate care as
254defined in s. 429.02 if the beds are in a distinct area of the
255nursing home which can be adapted to meet the requirements for
256an assisted living facility as defined in s. 429.02 extended
257congregate care. The provider may subsequently use such beds as
258sheltered beds after notifying the agency of the intended
259change. Any sheltered beds used to provide assisted living
260extended congregate care pursuant to this subsection may not
261qualify for funding under the Medicaid waiver. Any sheltered
262beds used to provide assisted living extended congregate care
263pursuant to this subsection may share common areas, services,
264and staff with beds designated for nursing home care, provided
265that all of the beds are under common ownership. For the
266purposes of this subsection, fire and life safety codes
267applicable to nursing home facilities shall apply.
268     Section 8.  This act shall take effect July 1, 2012.


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