Florida Senate - 2013                        COMMITTEE AMENDMENT
       Bill No. SB 1724
                                Barcode 791768                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/02/2013           .                                

       The Committee on Children, Families, and Elder Affairs
       (Grimsley) recommended the following:
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Sections 400.9970 through 400.9984, Florida
    6  Statutes, are designated as part XI of chapter 400, Florida
    7  Statutes, entitled “Transitional Living Facilities.”
    8         Section 2. Section 400.9970, Florida Statutes, is created
    9  to read:
   10         400.9970 Legislative intent.—It is the intent of the
   11  Legislature to provide for the licensure of transitional living
   12  facilities and require the development, establishment, and
   13  enforcement of basic standards by the Agency for Health Care
   14  Administration to ensure quality of care and services to clients
   15  in transitional living facilities. It is the policy of the state
   16  that the least restrictive appropriate available treatment be
   17  used based on the individual needs and best interest of the
   18  client and consistent with optimum improvement of the client’s
   19  condition. The goal of a transitional living program for
   20  individuals who have brain or spinal cord injuries is to assist
   21  each individual who has such an injury to achieve a higher level
   22  of independent functioning and to enable that individual to
   23  reenter the community.
   24         Section 3. Section 400.9971, Florida Statutes, is created
   25  to read:
   26         400.9971 Definitions.—As used in this part, the term:
   27         (1) “Agency” means the Agency for Health Care
   28  Administration.
   29         (2) “Chemical restraint” means a pharmacologic drug that
   30  physically limits, restricts, or deprives an individual of
   31  movement or mobility, is used for client protection or safety,
   32  and is not required for the treatment of medical conditions or
   33  symptoms.
   34         (3) “Client’s representative” means the parent of a child
   35  client or the client’s guardian, designated representative or
   36  designee, surrogate, or attorney in fact.
   37         (4) “Department” means the Department of Health.
   38         (5) “Licensee” means an individual issued a license by the
   39  agency.
   40         (6) “Physical restraint” means any manual method to
   41  restrict freedom of movement of or normal access to an
   42  individual’s body or a physical or mechanical device, material,
   43  or equipment attached or adjacent to the individual’s body so
   44  that he or she cannot easily remove the restraint and which
   45  restricts freedom of movement of or normal access to one’s body,
   46  including, but not limited to, a half-bed rail, a full-bed rail,
   47  a geriatric chair, and a posey restraint. The term includes any
   48  device that was not specifically manufactured as a restraint but
   49  which has been altered, arranged, or otherwise used for this
   50  purpose. The term does not include bandage material used for the
   51  purpose of binding a wound or injury.
   52         (7) “Transitional living facility” means a site where
   53  specialized health care services are provided, including, but
   54  not limited to, rehabilitative services, behavior modification,
   55  community reentry training, aids for independent living, and
   56  counseling to individuals who have brain injuries or spinal cord
   57  injuries. The term does not require a provider that is licensed
   58  by the agency to obtain a separate transitional living facility
   59  license to serve persons who have brain injuries or spinal cord
   60  injuries as long as the services provided are within the scope
   61  of the provider’s license.
   62         Section 4. Section 400.9972, Florida Statutes, is created
   63  to read:
   64         400.9972 License required; fee; application.—
   65         (1) The requirements of part II of chapter 408 apply to the
   66  provision of services that require licensure pursuant to this
   67  part and part II of chapter 408 and to entities licensed by or
   68  applying for such licensure from the agency pursuant to this
   69  part. A license issued by the agency is required for the
   70  operation of a transitional living facility in this state.
   71         (2) In accordance with this part, an applicant or a
   72  licensee shall pay a fee for each license application submitted
   73  under this part. The license fee shall consist of a $4,588
   74  license fee and a $90 per-bed fee per biennium and shall conform
   75  to the annual adjustment authorized in s. 408.805.
   76         (3) Each applicant for licensure must provide the
   77  following:
   78         (a) The location of the facility for which a license is
   79  sought and documentation, signed by the appropriate local
   80  government official, which states that the applicant has met
   81  local zoning requirements.
   82         (b) Proof of liability insurance as provided in s. 624.605.
   83         (c) Proof of compliance with local zoning requirements,
   84  including compliance with the requirements of chapter 419 if the
   85  proposed facility is a community residential home.
   86         (d) Proof that the facility has received a satisfactory
   87  firesafety inspection.
   88         (e) Documentation of a satisfactory sanitation inspection
   89  of the facility by the county health department.
   91  The applicant’s proposed facility must attain and continuously
   92  maintain accreditation by an accrediting organization
   93  specializing in evaluating rehabilitation facilities whose
   94  standards incorporate comparable licensure regulations required
   95  by the state. An applicant for licensure as a transitional
   96  living facility must acquire accreditation within 12 months
   97  after the issuance of an initial license. The agency shall
   98  accept the accreditation survey report of the accrediting
   99  organization in lieu of conducting a licensure inspection if the
  100  standards included in the survey report are determined by the
  101  agency to document that the facility is in substantial
  102  compliance with state licensure requirements. The applicant
  103  shall submit to the agency within 10 days after receipt a copy
  104  of any accreditation survey report and evidence of the
  105  accreditation decision subsequent to a survey by the accrediting
  106  organization on the facility. This part does not preclude the
  107  agency from conducting periodic inspections of a transitional
  108  living facility to ensure compliance with all licensure
  109  requirements, and as it deems necessary to carry out the
  110  functions of the agency. An inspection may be conducted to
  111  ensure compliance with licensure requirements of this part, to
  112  validate the inspection process of accrediting organizations, to
  113  respond to licensure complaints, or to protect the public health
  114  and safety.
  115         Section 5. Section 400.9973, Florida Statutes, is created
  116  to read:
  117         400.9973 Client admission, transfer, and discharge.—
  118         (1) Each transitional living facility must have written
  119  policies and procedures governing the admission, transfer, and
  120  discharge of clients.
  121         (2) The admission of each client to a transitional living
  122  facility must be in accordance with the licensee’s policies and
  123  procedures.
  124         (3) A client admitted to a transitional living facility
  125  must have a brain or spinal cord injury, such as a lesion to the
  126  spinal cord or cauda equina syndrome, with evidence of
  127  significant involvement of two of the following deficits or
  128  dysfunctions:
  129         (a) A motor deficit.
  130         (b) A sensory deficit.
  131         (c) Bowel and bladder dysfunction.
  132         (d) An acquired internal or external injury to the skull,
  133  the brain, or the brain’s covering, whether caused by a
  134  traumatic or nontraumatic event, which produces an altered state
  135  of consciousness or an anatomic motor, sensory, cognitive, or
  136  behavioral deficit.
  137         (4) A client whose medical diagnosis does not positively
  138  identify a cause of the client’s condition, whose symptoms are
  139  inconsistent with the known cause of injury, or whose recovery
  140  is inconsistent with the known medical condition may be admitted
  141  to a transitional living facility for evaluation for a period
  142  not to exceed 90 days.
  143         (5) A client admitted to a transitional living facility
  144  must be admitted upon prescription by a licensed physician and
  145  must remain under the care of a licensed physician for the
  146  duration of the client’s stay in the facility.
  147         (6) A transitional living facility may not admit a client
  148  whose primary admitting diagnosis is mental illness or an
  149  intellectual or a developmental disability.
  150         (7) An individual may not be admitted to a transitional
  151  living facility if the individual:
  152         (a) Presents significant risk of infection to other clients
  153  or personnel. A health care practitioner must provide
  154  documentation that the individual is free of apparent signs and
  155  symptoms of communicable disease;
  156         (b) Is a danger to self or others as determined by a
  157  physician or mental health practitioner licensed under chapter
  158  490 or chapter 491, unless the facility provides adequate
  159  staffing and support to ensure patient safety;
  160         (c) Is bedridden; or
  161         (d) Requires 24-hour nursing supervision.
  162         (8) If the client meets the admission criteria, the medical
  163  or nursing director of the facility must complete an initial
  164  evaluation of the client’s functional skills, behavioral status,
  165  cognitive status, educational or vocational potential, medical
  166  status, psychosocial status, sensorimotor capacity, and other
  167  related skills and abilities within the first 72 hours after the
  168  client’s admission to the facility. An initial comprehensive
  169  treatment plan that delineates services to be provided and
  170  appropriate sources for such services must be implemented within
  171  the first 4 days after admission.
  172         (9) Each transitional living facility shall develop a
  173  discharge plan for each client before or upon admission to the
  174  facility. The discharge plan must identify the intended
  175  discharge site and possible alternative discharge sites. For
  176  each discharge site identified, the discharge plan must identify
  177  the skills, behaviors, and other conditions that the client must
  178  achieve to be appropriate for discharge. Discharge plans must be
  179  reviewed and updated as necessary, but no less often than once
  180  monthly.
  181         (10) As soon as practicable, a transitional living facility
  182  shall discharge a client when he or she no longer requires any
  183  of the specialized services described in s. 400.9971(7) or is
  184  not making measurable progress in accordance with his or her
  185  comprehensive treatment plan, or if the transitional living
  186  facility is no longer the most appropriate, least restrictive
  187  treatment option.
  188         (11) Each transitional living facility shall provide at
  189  least 30 days’ notice to clients of transfer or discharge plans,
  190  including the location of an acceptable transfer location if the
  191  client is unable to live independently. This requirement does
  192  not apply if a client voluntarily terminates residency.
  193         Section 6. Section 400.9974, Florida Statutes, is created
  194  to read:
  195         400.9974 Client comprehensive treatment plans; client
  196  services.—
  197         (1) Each transitional living facility shall develop a
  198  comprehensive treatment plan for each client as soon as
  199  possible, but no later than 30 days following development of the
  200  initial comprehensive treatment plan. Comprehensive treatment
  201  plans must be reviewed and updated if the client fails to meet
  202  projected improvements in the plan or if a significant change in
  203  the client’s condition occurs. Comprehensive treatment plans
  204  must be reviewed and updated at least once monthly.
  205  Comprehensive treatment plans must be developed by an
  206  interdisciplinary team consisting of the case manager, the
  207  program director, the nurse, and appropriate therapists. The
  208  client or, if appropriate, the client’s representative must be
  209  included in developing the comprehensive treatment plan.
  210         (2) The comprehensive treatment plan must include the
  211  following:
  212         (a) The physician’s orders and the client’s diagnosis,
  213  medical history, physical examination, and rehabilitative or
  214  restorative needs.
  215         (b) A preliminary nursing evaluation with physician’s
  216  orders for immediate care, completed on admission.
  217         (c) A comprehensive, accurate, reproducible, and
  218  standardized assessment of the client’s functional capability;
  219  the treatments designed to achieve skills, behaviors, and other
  220  conditions necessary to return to the community; and specific
  221  measurable goals.
  222         (d) Steps necessary for the client to achieve transition to
  223  the community and estimated length of time to achieve the goals.
  224         (3) The client or, if appropriate, the client’s
  225  representative shall consent to the continued treatment at the
  226  transitional living facility. If such consent is not given, the
  227  transitional living facility shall discharge the client as soon
  228  as practicable.
  229         (4) Each client must receive the professional program
  230  services needed to implement the client’s comprehensive
  231  treatment plan.
  232         (5) The licensee must employ qualified professional staff
  233  to carry out and monitor the various professional interventions
  234  in accordance with the stated goals and objectives of every
  235  client’s comprehensive treatment plan.
  236         (6) Each client must receive a continuous treatment program
  237  that includes appropriate, consistent implementation of a
  238  program of specialized and general training, treatment, health
  239  services, and related services which is directed toward:
  240         (a) The acquisition of the behaviors and skills necessary
  241  for the client to function with as much self-determination and
  242  independence as possible;
  243         (b) The prevention or deceleration of regression or loss of
  244  current optimal functional status; and
  245         (c) The management of behavioral issues that preclude
  246  independent functioning in the community.
  247         Section 7. Section 400.9975, Florida Statutes, is created
  248  to read:
  249         400.9975 Licensee responsibilities.—
  250         (1) The licensee shall ensure that each client:
  251         (a) Lives in a safe environment free from abuse, neglect,
  252  and exploitation.
  253         (b) Is treated with consideration and respect and with due
  254  recognition of personal dignity, individuality, and the need for
  255  privacy.
  256         (c) Retains and uses his or her own clothes and other
  257  personal property in his or her immediate living quarters, so as
  258  to maintain individuality and personal dignity, except when the
  259  licensee can demonstrate that such retention and use would be
  260  unsafe, impractical, or an infringement upon the rights of other
  261  clients.
  262         (d) Has unrestricted private communication, including
  263  receiving and sending unopened correspondence, access to a
  264  telephone, and visiting with any person of his or her choice.
  265  Upon request, the licensee shall make provisions to modify
  266  visiting hours for caregivers and guests. The facility shall
  267  restrict communication in accordance with any court order or
  268  written instruction of a client’s representative. Any
  269  restriction on a client’s communication for therapeutic reasons
  270  shall be documented and reviewed at least weekly and shall be
  271  removed as soon as it is no longer clinically indicated. The
  272  basis for the restriction shall be explained to the client and,
  273  if applicable, the client’s representative. The client shall
  274  nonetheless retain the right to call the abuse hotline, the
  275  agency, and Disability Rights Florida at any and all times.
  276         (e) Participates in and benefits from community services
  277  and activities to achieve the highest possible level of
  278  independence, autonomy, and interaction within the community.
  279         (f) Manages his or her financial affairs unless the client
  280  or, if applicable, the client’s representative authorizes the
  281  administrator of the facility to provide safekeeping for funds
  282  as provided in this part.
  283         (g) Has reasonable opportunity for regular exercise several
  284  times a week and to be outdoors at regular and frequent
  285  intervals except when prevented by inclement weather.
  286         (h) Exercises civil and religious liberties, including the
  287  right to independent personal decisions. No religious belief or
  288  practice, including attendance at religious services, shall be
  289  imposed upon any client.
  290         (i) Has access to adequate and appropriate health care
  291  consistent with established and recognized standards within the
  292  community.
  293         (j) Has the ability to present grievances and recommend
  294  changes in policies, procedures, and services to the staff of
  295  the licensee, governing officials, or any other person without
  296  restraint, interference, coercion, discrimination, or reprisal.
  297  Each licensee shall establish a grievance procedure to
  298  facilitate a client’s ability to present grievances, including a
  299  system for investigating, tracking, managing, and responding to
  300  complaints by persons receiving services or individuals acting
  301  on their behalf, and an appeals process. This process must
  302  include access to Disability Rights Florida and other advocates
  303  and the right to be a member of, be active in, and associate
  304  with advocacy or special interest groups.
  305         (2) The licensee shall:
  306         (a) Promote participation of each client’s representative
  307  in the process of providing treatment to the client unless the
  308  representative’s participation is unobtainable or inappropriate.
  309         (b) Answer communications from each client’s family,
  310  guardians, and friends promptly and appropriately.
  311         (c) Promote visits by individuals with a relationship to
  312  the client at any reasonable hour, without requiring prior
  313  notice, or in any area of the facility which provides direct
  314  client care services to the client, consistent with the client’s
  315  and other clients’ privacy, unless the interdisciplinary team
  316  determines that such a visit would not be appropriate.
  317         (d) Promote leave from the facility for visits, trips, or
  318  vacations.
  319         (e) Promptly notify the client’s representative of any
  320  significant incidents or changes in the client’s condition,
  321  including, but not limited to, serious illness, accident, abuse,
  322  unauthorized absence, or death.
  323         (3) The administrator of a facility shall ensure that a
  324  written notice of licensee responsibilities is posted in a
  325  prominent place in each building where clients reside and read
  326  or explained to clients who cannot read. This notice shall
  327  include the statewide toll-free telephone number for reporting
  328  complaints to the agency, must be provided to clients in a
  329  manner that is clearly legible, and must include the words: “To
  330  report a complaint regarding the services you receive, please
  331  call toll-free ...[telephone number]... or Disability Rights
  332  Florida ...[telephone number]...”; and the statewide toll-free
  333  telephone number for the central abuse hotline must be provided
  334  to clients in a manner that is clearly legible and must include
  335  the words: “To report abuse, neglect or exploitation, please
  336  call toll-free ...[telephone number where complaints may be
  337  lodged]....” The licensee must ensure a client’s access to a
  338  telephone, where telephone numbers required in this subsection
  339  are readily available, to call the agency, central abuse
  340  hotline, or Disability Rights Florida.
  341         (4) A licensee or employee of a facility may not serve
  342  notice upon a client to leave the premises or take any other
  343  retaliatory action against any person solely due to the
  344  following:
  345         (a) The client or other person files an internal or
  346  external complaint or grievance regarding the facility.
  347         (b) The client or other person appears as a witness in any
  348  hearing inside or outside the facility.
  349         (5) Before or at the time of admission, the client and the
  350  client’s representative shall be provided with a copy of the
  351  licensee’s responsibilities as provided in this section,
  352  including grievance procedures and the telephone numbers
  353  provided in this section.
  354         (6) The licensee must develop and implement policies and
  355  procedures governing the release of any client information,
  356  including consent necessary from the client or the client’s
  357  representative.
  358         Section 8. Section 400.9976, Florida Statutes, is created
  359  to read:
  360         400.9976 Medication practices.—
  361         (1) An individual medication administration record must be
  362  maintained for each client. Each dose of medication, including a
  363  self-administered dose, shall be properly recorded in the
  364  client’s record. Each client who self-administers medication
  365  shall be given a pill organizer. Medication must be placed in
  366  the pill organizer by a nurse. A nurse shall document the date
  367  and time medication is placed into each client’s pill organizer.
  368  All medications must be administered in compliance with the
  369  physician’s orders.
  370         (2) If the interdisciplinary team determines that self
  371  administration of medications is an appropriate objective, and
  372  if the physician does not specify otherwise, a client must be
  373  taught to self-administer his or her medication without a staff
  374  person. This includes all forms of administration, including
  375  orally, via injection, and via suppository. The client’s
  376  physician must be informed of the interdisciplinary team’s
  377  decision that self-administration of medications is an objective
  378  for the client. A client may not self-administer medication
  379  until he or she demonstrates the competency to take the correct
  380  medication in the correct dosage at the correct time, to respond
  381  to missed doses, and to contact an appropriate person with
  382  questions.
  383         (3) Medication administration discrepancies and adverse
  384  drug reactions must be recorded and reported immediately to a
  385  physician.
  386         Section 9. Section 400.9977, Florida Statutes, is created
  387  to read:
  388         400.9977 Protection from abuse, neglect, mistreatment, and
  389  exploitation.—The licensee must develop and implement policies
  390  and procedures for the screening and training of employees, the
  391  protection of clients, and the prevention, identification,
  392  investigation, and reporting of abuse, neglect, and
  393  exploitation. This includes the licensee’s identification of
  394  clients whose personal histories render them at risk for abusing
  395  other clients, development of intervention strategies to prevent
  396  occurrences, monitoring for changes that would trigger abusive
  397  behavior, and reassessment of the interventions on a regular
  398  basis. A licensee shall implement procedures to:
  399         (1) Screen potential employees for a history of abuse,
  400  neglect, or mistreatment of clients. The screening shall include
  401  an attempt to obtain information from previous employers and
  402  current employers and verification with the appropriate
  403  licensing boards and registries.
  404         (2) Train employees, through orientation and ongoing
  405  sessions, on issues related to abuse prohibition practices,
  406  including identification of abuse, neglect, mistreatment, and
  407  exploitation, appropriate interventions to deal with aggressive
  408  or catastrophic reactions of clients, the process to report
  409  allegations without fear of reprisal, and recognition of signs
  410  of frustration and stress that may lead to abuse.
  411         (3) Provide clients, families, and staff with information
  412  on how and to whom they may report concerns, incidents, and
  413  grievances without the fear of retribution and provide feedback
  414  regarding the concerns that have been expressed. A licensee must
  415  identify, correct, and intervene in situations in which abuse,
  416  neglect, mistreatment, or exploitation is likely to occur,
  417  including:
  418         (a) Evaluating the physical environment of the facility to
  419  identify characteristics that may make abuse or neglect more
  420  likely to occur, such as secluded areas.
  421         (b) Providing sufficient staff on each shift to meet the
  422  needs of the clients, and ensuring that the staff assigned have
  423  knowledge of the individual clients’ care needs. The licensee
  424  shall identify inappropriate behaviors of its staff, such as
  425  using derogatory language, rough handling, ignoring clients
  426  while giving care, and directing clients who need toileting
  427  assistance to urinate or defecate in their beds.
  428         (c) Assessing, planning care for, and monitoring clients
  429  with needs and behaviors that might lead to conflict or neglect,
  430  such as clients with a history of aggressive behaviors, clients
  431  who have behaviors such as entering other clients’ rooms,
  432  clients with self-injurious behaviors, clients with
  433  communication disorders, and clients who require heavy nursing
  434  care or are totally dependent on staff.
  435         (4) Identify events, such as suspicious bruising of
  436  clients, occurrences, patterns, and trends that may constitute
  437  abuse and determine the direction of the investigation.
  438         (5) Investigate different types of incidents, identify the
  439  staff member responsible for the initial reporting, investigate
  440  alleged violations, and report results to the proper
  441  authorities. The licensee must analyze the occurrences to
  442  determine what changes are needed, if any, to policies and
  443  procedures to prevent further occurrences and to take all
  444  necessary corrective action depending on the results of the
  445  investigation.
  446         (6) Protect clients from harm during an investigation.
  447         (7) Report all alleged violations and all substantiated
  448  incidents, as required under chapters 39 and 415, to the
  449  licensing authorities and all other agencies as required and to
  450  report any knowledge it has of any actions by a court of law
  451  that would indicate an employee is unfit for service.
  452         Section 10. Section 400.9978, Florida Statutes, is created
  453  to read:
  454         400.9978 Restraints and seclusion; client safety.—
  455         (1) The use of physical restraints must be ordered and
  456  documented by a physician and must be consistent with policies
  457  and procedures adopted by the facility. The client or, if
  458  applicable, the client’s representative must be informed of the
  459  facility’s physical restraint policies and procedures at the
  460  time of the client’s admission.
  461         (2) The use of chemical restraints is limited to prescribed
  462  dosages of medications as ordered by a physician and must be
  463  consistent with the client’s diagnosis and the policies and
  464  procedures adopted by the facility. The client or, if
  465  applicable, the client’s representative must be informed of the
  466  facility’s chemical restraint policies and procedures at the
  467  time of the client’s admission.
  468         (3) Based on a physician’s assessment, if a client exhibits
  469  symptoms that present an immediate risk of injury or death to
  470  self or others, a physician may issue an emergency treatment
  471  order to immediately administer rapid response psychotropic
  472  medications or other chemical restraints. Each emergency
  473  treatment order must be documented and maintained in the
  474  client’s record.
  475         (a) An emergency treatment order is effective for no more
  476  than 24 hours.
  477         (b) Whenever a client is medicated in accordance with this
  478  subsection, the client’s representative or responsible party and
  479  the client’s physician must be notified as soon as practicable.
  480         (4) A client who is prescribed and receiving a medication
  481  that can serve as a chemical restraint for a purpose other than
  482  an emergency treatment order must be evaluated by his or her
  483  physician at least monthly to assess the following:
  484         (a) The continued need for the medication.
  485         (b) The level of the medication in the client’s blood, as
  486  appropriate.
  487         (c) The need for adjustments in the prescription.
  488         (5) The licensee shall ensure that clients are free from
  489  unnecessary drugs and physical restraints and are provided
  490  treatment to reduce dependency on drugs and physical restraints.
  491         (6) The licensee may use physical restraints only as an
  492  integral part of a client’s comprehensive treatment plan which
  493  is intended to lead to less restrictive means of managing and
  494  eliminating the behavior for which the restraint is applied.
  495         (7) Interventions to manage inappropriate client behavior
  496  must be employed with sufficient safeguards and supervision to
  497  ensure that the safety, welfare, and civil and human rights of
  498  each client are adequately protected.
  499         Section 11. Section 400.9979, Florida Statutes, is created
  500  to read:
  501         400.9979 Background screening; administration and
  502  management.—
  503         (1) The agency shall require level 2 background screening
  504  for personnel as required in s. 408.809(1)(e) pursuant to
  505  chapter 435 and s. 408.809.
  506         (2) The licensee shall maintain personnel records for each
  507  staff member which contain, at a minimum, documentation of
  508  background screening, if applicable, a job description,
  509  documentation of compliance with all training requirements of
  510  this part or applicable rule, the employment application,
  511  references, a copy of all job performance evaluations, and, for
  512  each staff member who performs services for which licensure or
  513  certification is required, a copy of all licenses or
  514  certification held by the staff member.
  515         (3) The licensee must:
  516         (a) Develop and implement infection control policies and
  517  procedures and include such policies and procedures in the
  518  licensee’s policy manual.
  519         (b) Maintain liability insurance as defined in s. 624.605.
  520         (c) Designate one person as an administrator who is
  521  responsible and accountable for the overall management of the
  522  facility.
  523         (d) Designate a person in writing to be responsible for the
  524  facility when the administrator is absent from the facility for
  525  more than 24 hours.
  526         (e) Designate in writing a program director who is
  527  responsible for supervising the therapeutic and behavioral
  528  staff, determining the levels of supervision, and determining
  529  room placement for each client.
  530         (f) Designate in writing a person to be responsible when
  531  the program director is absent from the facility for more than
  532  24 hours.
  533         (g) Obtain approval of the comprehensive emergency
  534  management plan, pursuant to s. 400.9981(2)(e), from the local
  535  emergency management agency. Pending the approval of the plan,
  536  the local emergency management agency shall ensure that the
  537  following agencies, at a minimum, are given the opportunity to
  538  review the plan: the Department of Health, the Agency for Health
  539  Care Administration, and the Division of Emergency Management.
  540  Appropriate volunteer organizations must also be given the
  541  opportunity to review the plan. The local emergency management
  542  agency shall complete its review within 60 days and either
  543  approve the plan or advise the licensee of necessary revisions.
  544         (h) Maintain written records in a form and system that
  545  comply with medical and business practices and make such records
  546  available in the facility for review or submission to the agency
  547  upon request. The records shall include:
  548         1. A daily census record that indicates the number of
  549  clients currently receiving services in the facility, including
  550  information regarding any public funding of such clients.
  551         2. A record of all accidents or unusual incidents involving
  552  any client or staff member that caused, or had the potential to
  553  cause, injury or harm to any person or property within the
  554  facility. Such records must contain a clear description of each
  555  accident or incident, the names of the persons involved, a
  556  description of all medical or other services provided to these
  557  persons specifying who provided such services, and the steps
  558  taken to prevent recurrence of such accidents or incidents.
  559         3. A copy of current agreements with third-party providers.
  560         4. A copy of current agreements with each consultant
  561  employed by the licensee and documentation of each consultant’s
  562  visits and required written, dated reports.
  563         Section 12. Section 400.9980, Florida Statutes, is created
  564  to read:
  565         400.9980 Property and personal affairs of clients.—
  566         (1) A client shall be given the option of using his or her
  567  own belongings, as space permits; choosing his or her roommate
  568  if practical and not clinically contraindicated; and, whenever
  569  possible, unless the client is adjudicated incompetent or
  570  incapacitated under state law, managing his or her own affairs.
  571         (2) The admission of a client to a facility and his or her
  572  presence therein shall not confer on a licensee, administrator,
  573  employee, or representative thereof any authority to manage,
  574  use, or dispose of any property of the client, nor shall such
  575  admission or presence confer on any of such persons any
  576  authority or responsibility for the personal affairs of the
  577  client except that which may be necessary for the safe
  578  management of the facility or for the safety of the client.
  579         (3) A licensee, administrator, employee, or representative
  580  thereof may:
  581         (a) Not act as the guardian, trustee, or conservator for
  582  any client or any of such client’s property.
  583         (b) Act as a competent client’s payee for social security,
  584  veteran’s, or railroad benefits if the client provides consent
  585  and the licensee files a surety bond with the agency in an
  586  amount equal to twice the average monthly aggregate income or
  587  personal funds due to the client, or expendable for the client’s
  588  account, that are received by a licensee.
  589         (c) Act as the power of attorney for a client if the
  590  licensee has filed a surety bond with the agency in an amount
  591  equal to twice the average monthly income of the client, plus
  592  the value of any client’s property under the control of the
  593  attorney in fact.
  595  The bond under paragraph (b) or paragraph (c) shall be executed
  596  by the licensee as principal and a licensed surety company. The
  597  bond shall be conditioned upon the faithful compliance of the
  598  licensee with the requirements of licensure and shall be payable
  599  to the agency for the benefit of any client who suffers a
  600  financial loss as a result of the misuse or misappropriation of
  601  funds held pursuant to this subsection. Any surety company that
  602  cancels or does not renew the bond of any licensee shall notify
  603  the agency in writing not less than 30 days in advance of such
  604  action, giving the reason for the cancellation or nonrenewal.
  605  Any licensee, administrator, employee, or representative thereof
  606  who is granted power of attorney for any client of the facility
  607  shall, on a monthly basis, notify the client in writing of any
  608  transaction made on behalf of the client pursuant to this
  609  subsection, and a copy of such notification given to the client
  610  shall be retained in each client’s file and available for agency
  611  inspection.
  612         (4) A licensee, upon mutual consent with the client, shall
  613  provide for the safekeeping in the facility of the client’s
  614  personal effects of a value not in excess of $1,000 and the
  615  client’s funds not in excess of $500 cash and shall keep
  616  complete and accurate records of all such funds and personal
  617  effects received. If a client is absent from a facility for 24
  618  hours or more, the licensee may provide for the safekeeping of
  619  the client’s personal effects of a value in excess of $1,000.
  620         (5) Any funds or other property belonging to or due to a
  621  client or expendable for his or her account that is received by
  622  licensee shall be trust funds and shall be kept separate from
  623  the funds and property of the licensee and other clients or
  624  shall be specifically credited to such client. Such trust funds
  625  shall be used or otherwise expended only for the account of the
  626  client. At least once every month, unless upon order of a court
  627  of competent jurisdiction, the licensee shall furnish the client
  628  and the client’s representative a complete and verified
  629  statement of all funds and other property to which this
  630  subsection applies, detailing the amount and items received,
  631  together with their sources and disposition. In any event, the
  632  licensee shall furnish such statement annually and upon the
  633  discharge or transfer of a client. Any governmental agency or
  634  private charitable agency contributing funds or other property
  635  to the account of a client shall also be entitled to receive
  636  such statement monthly and upon the discharge or transfer of the
  637  client.
  638         (6)(a) In addition to any damages or civil penalties to
  639  which a person is subject, any person who:
  640         1. Intentionally withholds a client’s personal funds,
  641  personal property, or personal needs allowance, or who demands,
  642  beneficially receives, or contracts for payment of all or any
  643  part of a client’s personal property or personal needs allowance
  644  in satisfaction of the facility rate for supplies and services;
  645  or
  646         2. Borrows from or pledges any personal funds of a client,
  647  other than the amount agreed to by written contract under s.
  648  429.24,
  650  commits a misdemeanor of the first degree, punishable as
  651  provided in s. 775.082 or s. 775.083.
  652         (b) Any licensee, administrator, employee, or
  653  representative thereof who is granted power of attorney for any
  654  client of the facility and who misuses or misappropriates funds
  655  obtained through this power commits a felony of the third
  656  degree, punishable as provided in s. 775.082, s. 775.083, or s.
  657  775.084.
  658         (7) In the event of the death of a client, a licensee shall
  659  return all refunds, funds, and property held in trust to the
  660  client’s personal representative, if one has been appointed at
  661  the time the licensee disburses such funds, or, if not, to the
  662  client’s spouse or adult next of kin named in a beneficiary
  663  designation form provided by the licensee to the client. If the
  664  client has no spouse or adult next of kin or such person cannot
  665  be located, funds due the client shall be placed in an interest
  666  bearing account and all property held in trust by the licensee
  667  shall be safeguarded until such time as the funds and property
  668  are disbursed pursuant to the Florida Probate Code. Such funds
  669  shall be kept separate from the funds and property of the
  670  licensee and other clients of the facility. If the funds of the
  671  deceased client are not disbursed pursuant to the Florida
  672  Probate Code within 2 years after the client’s death, the funds
  673  shall be deposited in the Health Care Trust Fund administered by
  674  the agency.
  675         (8) The agency, by rule, may clarify terms and specify
  676  procedures and documentation necessary to administer the
  677  provisions of this section relating to the proper management of
  678  clients’ funds and personal property and the execution of surety
  679  bonds.
  680         Section 13. Section 400.9981, Florida Statutes, is created
  681  to read:
  682         400.9981 Rules establishing standards.—
  683         (1) It is the intent of the Legislature that rules
  684  published and enforced pursuant to this part and part II of
  685  chapter 408 include criteria to ensure reasonable and consistent
  686  quality of care and client safety. Rules should make reasonable
  687  efforts to accommodate the needs and preferences of clients to
  688  enhance the quality of life in transitional living facilities.
  689         (2) The agency may adopt and enforce rules to implement
  690  this part and part II of chapter 408, which shall include
  691  reasonable and fair criteria in relation to the following:
  692         (a) The location of transitional living facilities.
  693         (b) The number of qualifications of all personnel,
  694  including management, medical, nursing, and other professional
  695  personnel and nursing assistants and support personnel having
  696  responsibility for any part of the care given to clients. The
  697  licensee must have enough qualified professional staff available
  698  to carry out and monitor the various professional interventions
  699  in accordance with the stated goals and objectives of each
  700  comprehensive treatment plan.
  701         (c) Requirements for personnel procedures, insurance
  702  coverage, reporting procedures, and documentation necessary to
  703  implement this part.
  704         (d) Services provided to clients of transitional living
  705  facilities.
  706         (e) The preparation and annual update of a comprehensive
  707  emergency management plan in consultation with the Division of
  708  Emergency Management. At a minimum, the rules must provide for
  709  plan components that address emergency evacuation
  710  transportation; adequate sheltering arrangements; postdisaster
  711  activities, including provision of emergency power, food, and
  712  water; postdisaster transportation; supplies; staffing;
  713  emergency equipment; individual identification of clients and
  714  transfer of records; communication with families; and responses
  715  to family inquiries.
  716         Section 14. Section 400.9982, Florida Statutes, is created
  717  to read:
  718         400.9982 Violations; penalties.—
  719         (1) Each violation of this part and rules adopted pursuant
  720  thereto shall be classified according to the nature of the
  721  violation and the gravity of its probable effect on facility
  722  clients. The agency shall indicate the classification on the
  723  written notice of the violation as follows:
  724         (a) Class “I” violations are defined in s. 408.813. The
  725  agency shall issue a citation regardless of correction and
  726  impose an administrative fine of $5,000 for an isolated
  727  violation, $7,500 for a patterned violation, and $10,000 for a
  728  widespread violation. Violations may be identified and a fine
  729  must be levied notwithstanding the correction of the deficiency
  730  giving rise to the violation.
  731         (b) Class “II” violations are defined in s. 408.813. The
  732  agency shall impose an administrative fine of $1,000 for an
  733  isolated violation, $2,500 for a patterned violation, and $5,000
  734  for a widespread violation. A fine must be levied
  735  notwithstanding the correction of the deficiency giving rise to
  736  the violation.
  737         (c) Class “III” violations are defined in s. 408.813. The
  738  agency shall impose an administrative fine of $500 for an
  739  isolated violation, $750 for a patterned violation, and $1,000
  740  for a widespread violation. If a deficiency giving rise to a
  741  class “III” violation is corrected within the time specified by
  742  the agency, a fine may not be imposed.
  743         (d) Class “IV” violations are defined in s. 408.813. The
  744  agency shall impose an administrative fine for a cited class IV
  745  violation in an amount not less than $100 and not exceeding $200
  746  for each violation.
  747         Section 15. Section 400.9983, Florida Statutes, is created
  748  to read:
  749         400.9983 Receivership proceedings.—The agency may apply s.
  750  429.22 with regard to receivership proceedings for transitional
  751  living facilities.
  752         Section 16. Section 400.9984, Florida Statutes, is created
  753  to read:
  754         400.9984 Interagency communication.—The agency, the
  755  department, the Agency for Persons with Disabilities, and the
  756  Department of Children and Families shall develop electronic
  757  systems to ensure that relevant information pertaining to the
  758  regulation of transitional living facilities and clients is
  759  timely and effectively communicated among agencies in order to
  760  facilitate the protection of clients. Electronic sharing of
  761  information shall include, at a minimum, a brain and spinal cord
  762  injury registry and a client abuse registry.
  763         Section 17. Section 400.805, Florida Statutes, is repealed.
  764  Every transitional living facility licensed under s. 400.805 on
  765  or before July 1, 2013, shall be licensed under the provisions
  766  of this act.
  767         Section 18. Subsection (9) of section 381.745, Florida
  768  Statutes, is amended to read:
  769         381.745 Definitions; ss. 381.739-381.79.—As used in ss.
  770  381.739-381.79, the term:
  771         (9) “Transitional living facility” means a state-approved
  772  facility, as defined and licensed under chapter 400 or chapter
  773  429, or a facility approved by the brain and spinal cord injury
  774  program in accordance with this chapter.
  775         Section 19. Section 381.75, Florida Statutes, is amended to
  776  read:
  777         381.75 Duties and responsibilities of the department, of
  778  transitional living facilities, and of residents.—Consistent
  779  with the mandate of s. 381.7395, the department shall develop
  780  and administer a multilevel treatment program for individuals
  781  who sustain brain or spinal cord injuries and who are referred
  782  to the brain and spinal cord injury program.
  783         (1) Within 15 days after any report of an individual who
  784  has sustained a brain or spinal cord injury, the department
  785  shall notify the individual or the most immediate available
  786  family members of their right to assistance from the state, the
  787  services available, and the eligibility requirements.
  788         (2) The department shall refer individuals who have brain
  789  or spinal cord injuries to other state agencies to assure that
  790  rehabilitative services, if desired, are obtained by that
  791  individual.
  792         (3) The department, in consultation with emergency medical
  793  service, shall develop standards for an emergency medical
  794  evacuation system that will ensure that all individuals who
  795  sustain traumatic brain or spinal cord injuries are transported
  796  to a department-approved trauma center that meets the standards
  797  and criteria established by the emergency medical service and
  798  the acute-care standards of the brain and spinal cord injury
  799  program.
  800         (4) The department shall develop standards for designation
  801  of rehabilitation centers to provide rehabilitation services for
  802  individuals who have brain or spinal cord injuries.
  803         (5) The department shall determine the appropriate number
  804  of designated acute-care facilities, inpatient rehabilitation
  805  centers, and outpatient rehabilitation centers, needed based on
  806  incidence, volume of admissions, and other appropriate criteria.
  807         (6) The department shall develop standards for designation
  808  of transitional living facilities to provide transitional living
  809  services for individuals who participate in the brain and spinal
  810  cord injury program the opportunity to adjust to their
  811  disabilities and to develop physical and functional skills in a
  812  supported living environment.
  813         (a) The Agency for Health Care Administration, in
  814  consultation with the department, shall develop rules for the
  815  licensure of transitional living facilities for individuals who
  816  have brain or spinal cord injuries.
  817         (b) The goal of a transitional living program for
  818  individuals who have brain or spinal cord injuries is to assist
  819  each individual who has such a disability to achieve a higher
  820  level of independent functioning and to enable that person to
  821  reenter the community. The program shall be focused on preparing
  822  participants to return to community living.
  823         (c) A transitional living facility for an individual who
  824  has a brain or spinal cord injury shall provide to such
  825  individual, in a residential setting, a goal-oriented treatment
  826  program designed to improve the individual’s physical,
  827  cognitive, communicative, behavioral, psychological, and social
  828  functioning, as well as to provide necessary support and
  829  supervision. A transitional living facility shall offer at least
  830  the following therapies: physical, occupational, speech,
  831  neuropsychology, independent living skills training, behavior
  832  analysis for programs serving brain-injured individuals, health
  833  education, and recreation.
  834         (d) All residents shall use the transitional living
  835  facility as a temporary measure and not as a permanent home or
  836  domicile. The transitional living facility shall develop an
  837  initial treatment plan for each resident within 3 days after the
  838  resident’s admission. The transitional living facility shall
  839  develop a comprehensive plan of treatment and a discharge plan
  840  for each resident as soon as practical, but no later than 30
  841  days after the resident’s admission. Each comprehensive
  842  treatment plan and discharge plan must be reviewed and updated
  843  as necessary, but no less often than quarterly. This subsection
  844  does not require the discharge of an individual who continues to
  845  require any of the specialized services described in paragraph
  846  (c) or who is making measurable progress in accordance with that
  847  individual’s comprehensive treatment plan. The transitional
  848  living facility shall discharge any individual who has an
  849  appropriate discharge site and who has achieved the goals of his
  850  or her discharge plan or who is no longer making progress toward
  851  the goals established in the comprehensive treatment plan and
  852  the discharge plan. The discharge location must be the least
  853  restrictive environment in which an individual’s health, well
  854  being, and safety is preserved.
  855         (7) Recipients of services, under this section, from any of
  856  the facilities referred to in this section shall pay a fee based
  857  on ability to pay.
  858         Section 20. Subsection (4) of section 381.78, Florida
  859  Statutes, is amended to read:
  860         381.78 Advisory council on brain and spinal cord injuries.—
  861         (4) The council shall:
  862         (a) provide advice and expertise to the department in the
  863  preparation, implementation, and periodic review of the brain
  864  and spinal cord injury program.
  865         (b) Annually appoint a five-member committee composed of
  866  one individual who has a brain injury or has a family member
  867  with a brain injury, one individual who has a spinal cord injury
  868  or has a family member with a spinal cord injury, and three
  869  members who shall be chosen from among these representative
  870  groups: physicians, other allied health professionals,
  871  administrators of brain and spinal cord injury programs, and
  872  representatives from support groups with expertise in areas
  873  related to the rehabilitation of individuals who have brain or
  874  spinal cord injuries, except that one and only one member of the
  875  committee shall be an administrator of a transitional living
  876  facility. Membership on the council is not a prerequisite for
  877  membership on this committee.
  878         1. The committee shall perform onsite visits to those
  879  transitional living facilities identified by the Agency for
  880  Health Care Administration as being in possible violation of the
  881  statutes and rules regulating such facilities. The committee
  882  members have the same rights of entry and inspection granted
  883  under s. 400.805(4) to designated representatives of the agency.
  884         2. Factual findings of the committee resulting from an
  885  onsite investigation of a facility pursuant to subparagraph 1.
  886  shall be adopted by the agency in developing its administrative
  887  response regarding enforcement of statutes and rules regulating
  888  the operation of the facility.
  889         3. Onsite investigations by the committee shall be funded
  890  by the Health Care Trust Fund.
  891         4. Travel expenses for committee members shall be
  892  reimbursed in accordance with s. 112.061.
  893         5. Members of the committee shall recuse themselves from
  894  participating in any investigation that would create a conflict
  895  of interest under state law, and the council shall replace the
  896  member, either temporarily or permanently.
  897         Section 21. This act shall take effect July 1, 2013.
  899  ================= T I T L E  A M E N D M E N T ================
  900         And the title is amended as follows:
  901         Delete everything before the enacting clause
  902  and insert:
  903                        A bill to be entitled                      
  904         An act relating to transitional living facilities;
  905         creating part XI of ch. 400, F.S., entitled
  906         “Transitional Living Facilities”; creating s.
  907         400.9970, F.S.; providing legislative intent; creating
  908         s. 400.9971, F.S.; providing definitions; creating s.
  909         400.9972, F.S.; requiring the licensure of
  910         transitional living facilities; providing fees;
  911         providing license application requirements; creating
  912         s. 400.9973, F.S.; providing requirements for
  913         transitional living facilities relating to client
  914         admission, transfer, and discharge; creating s.
  915         400.9974, F.S.; requiring a comprehensive treatment
  916         plan to be developed for each client; providing plan
  917         requirements; creating s. 400.9975, F.S.; providing
  918         licensee responsibilities; providing notice
  919         requirements; prohibiting a licensee or employee of a
  920         facility from serving notice upon a client to leave
  921         the premises or take other retaliatory action;
  922         requiring the client and client’s representative to be
  923         provided with certain information; requiring the
  924         licensee to develop and implement certain policies and
  925         procedures; creating s. 400.9976, F.S.; providing
  926         licensee requirements relating to medication
  927         practices; creating s. 400.9977, F.S.; providing
  928         requirements for the screening of potential employees
  929         and monitoring of employees for the protection of
  930         clients; requiring licensees to implement certain
  931         procedures; creating s. 400.9978, F.S.; providing
  932         requirements for the use of physical restraints and
  933         chemical restraint medication on clients; creating s.
  934         400.9979, F.S.; providing background screening
  935         requirements; requiring the licensee to maintain
  936         certain personnel records; providing administrative
  937         responsibilities for licensees; providing
  938         recordkeeping requirements; creating s. 400.9980,
  939         F.S.; providing requirements relating to property and
  940         personal affairs of clients; providing requirements
  941         for a licensee with respect to obtaining surety bonds;
  942         providing recordkeeping requirements relating to the
  943         safekeeping of personal effects; providing
  944         requirements for trust funds received by licensee and
  945         credited to the client; providing a penalty for
  946         certain misuse of a resident’s personal needs
  947         allowance; providing criminal penalties for
  948         violations; providing for the disposition of property
  949         in the event of the death of a client; authorizing the
  950         Agency for Health Care Administration to adopt rules;
  951         creating s. 400.9981, F.S.; authorizing the agency to
  952         adopt and enforce certain rules; creating s. 400.9982,
  953         F.S.; providing procedures relating to violations and
  954         penalties; providing administrative fines for
  955         specified classes of violations; creating s. 400.9983,
  956         F.S.; authorizing the agency to apply certain
  957         provisions with regard to receivership proceedings;
  958         creating s. 400.9984, F.S.; requiring the Agency for
  959         Health Care Administration, the Department of Health,
  960         the Agency for Persons with Disabilities, and the
  961         Department of Children and Families to develop
  962         electronic systems for certain purposes; repealing s.
  963         400.805, F.S., relating to transitional living
  964         facilities; providing that every transitional living
  965         facilities licensed under s. 400.805, F.S., on or
  966         before a specified date is licensed under the
  967         provisions of the act; amending s. 381.745, F.S.;
  968         revising a definition; amending s. 381.75, F.S.;
  969         revising the duties of the Department of Health as
  970         they relate to transitional living facilities;
  971         amending s. 381.78, F.S.; conforming provisions to
  972         changes made by the act; providing an effective date.