Florida Senate - 2013                      CS for CS for SB 1724
       By the Committees on Health Policy; and Children, Families, and
       Elder Affairs; and Senators Garcia and Grimsley
       588-03975-13                                          20131724c2
    1                        A bill to be entitled                      
    2         An act relating to transitional living facilities;
    3         creating part XI of ch. 400, F.S., entitled
    4         “Transitional Living Facilities”; creating s.
    5         400.9970, F.S.; providing legislative intent; creating
    6         s. 400.9971, F.S.; providing definitions; creating s.
    7         400.9972, F.S.; requiring the licensure of
    8         transitional living facilities; providing fees;
    9         providing license application requirements; creating
   10         s. 400.9973, F.S.; providing requirements for
   11         transitional living facilities relating to client
   12         admission, transfer, and discharge; creating s.
   13         400.9974, F.S.; requiring a comprehensive treatment
   14         plan to be developed for each client; providing plan
   15         requirements; creating s. 400.9975, F.S.; providing
   16         licensee responsibilities; providing notice
   17         requirements; prohibiting a licensee or employee of a
   18         facility from serving notice upon a client to leave
   19         the premises or take other retaliatory action;
   20         requiring the client and client’s representative to be
   21         provided with certain information; requiring the
   22         licensee to develop and implement certain policies and
   23         procedures; creating s. 400.9976, F.S.; providing
   24         licensee requirements relating to medication
   25         practices; creating s. 400.9977, F.S.; providing
   26         requirements for the screening of potential employees
   27         and monitoring of employees for the protection of
   28         clients; requiring licensees to implement certain
   29         procedures; creating s. 400.9978, F.S.; requiring a
   30         facility to provide a therapeutic milieu that supports
   31         a culture of individual empowerment and
   32         responsibility; providing that the health and safety
   33         of the client is the primary concern of the facility;
   34         providing requirements and limitations for the use of
   35         physical restraints, seclusion, and chemical restraint
   36         medication on clients; requiring the Agency for Health
   37         Care Administration to adopt rules; creating s.
   38         400.9979, F.S.; providing background screening
   39         requirements; requiring the licensee to maintain
   40         certain personnel records; providing administrative
   41         responsibilities for licensees; providing
   42         recordkeeping requirements; creating s. 400.9980,
   43         F.S.; providing requirements relating to property and
   44         personal affairs of clients; providing requirements
   45         for a licensee with respect to obtaining surety bonds;
   46         providing recordkeeping requirements relating to the
   47         safekeeping of personal effects; providing
   48         requirements for trust funds received by licensee and
   49         credited to the client; providing a penalty for
   50         certain misuse of a resident’s personal needs
   51         allowance; providing criminal penalties for
   52         violations; providing for the disposition of property
   53         in the event of the death of a client; authorizing the
   54         Agency for Health Care Administration to adopt rules;
   55         creating s. 400.9981, F.S.; authorizing the agency to
   56         adopt and enforce certain rules; creating s. 400.9982,
   57         F.S.; providing procedures relating to violations and
   58         penalties; providing administrative fines for
   59         specified classes of violations; creating s. 400.9983,
   60         F.S.; authorizing the agency to apply certain
   61         provisions with regard to receivership proceedings;
   62         creating s. 400.9984, F.S.; requiring the Agency for
   63         Health Care Administration, the Department of Health,
   64         the Agency for Persons with Disabilities, and the
   65         Department of Children and Families to develop
   66         electronic systems for certain purposes; repealing s.
   67         400.805, F.S., relating to transitional living
   68         facilities; providing that every transitional living
   69         facility licensed under s. 400.805, F.S., on or before
   70         a specified date is licensed under the provisions of
   71         the act; amending s. 381.745, F.S.; revising a
   72         definition; amending s. 381.75, F.S.; revising the
   73         duties of the Department of Health as they relate to
   74         transitional living facilities; amending s. 381.78,
   75         F.S.; conforming provisions to changes made by the
   76         act; amending ss. 408.802 and 408.820, F.S.;
   77         conforming a provision to changes made by the act;
   78         amending s. 400.93, F.S.; providing that transitional
   79         living facilities licensed under part XI of ch. 400,
   80         F.S., are exempt from home medical equipment provider
   81         licensure; amending s. 400.9905, F.S.; revising a
   82         definition; providing an effective date.
   84  Be It Enacted by the Legislature of the State of Florida:
   86         Section 1. Sections 400.9970 through 400.9984, Florida
   87  Statutes, are designated as part XI of chapter 400, Florida
   88  Statutes, entitled “Transitional Living Facilities.”
   89         Section 2. Section 400.9970, Florida Statutes, is created
   90  to read:
   91         400.9970 Legislative intent.—It is the intent of the
   92  Legislature to provide for the licensure of transitional living
   93  facilities and require the development, establishment, and
   94  enforcement of basic standards by the Agency for Health Care
   95  Administration to ensure quality of care and services to clients
   96  in transitional living facilities. It is the policy of the state
   97  that the least restrictive appropriate available treatment be
   98  used based on the individual needs and best interest of the
   99  client and consistent with optimum improvement of the client’s
  100  condition. The goal of a transitional living program for
  101  individuals who have brain or spinal cord injuries is to assist
  102  each individual who has such an injury to achieve a higher level
  103  of independent functioning and to enable that individual to
  104  reenter the community. It is also the policy of this state that
  105  the use of restraints and seclusion on clients is justified only
  106  as an emergency safety measure to be used in response to danger
  107  to the client or others. It is, therefore, the intent of the
  108  Legislature to achieve an ongoing reduction in the use of
  109  restraints and seclusion in programs and facilities that serve
  110  persons who have brain injury or spinal cord injuries.
  111         Section 3. Section 400.9971, Florida Statutes, is created
  112  to read:
  113         400.9971 Definitions.—As used in this part, the term:
  114         (1) “Agency” means the Agency for Health Care
  115  Administration.
  116         (2) “Chemical restraint” means a pharmacologic drug that
  117  physically limits, restricts, or deprives an individual of
  118  movement or mobility, is used for client protection or safety,
  119  and is not required for the treatment of medical conditions or
  120  symptoms.
  121         (3) “Client’s representative” means the parent of a child
  122  client or the client’s guardian, designated representative or
  123  designee, surrogate, or attorney in fact.
  124         (4) “Department” means the Department of Health.
  125         (5) “Physical restraint” means any manual method to
  126  restrict freedom of movement of or normal access to an
  127  individual’s body or a physical or mechanical device, material,
  128  or equipment attached or adjacent to the individual’s body so
  129  that he or she cannot easily remove the restraint and which
  130  restricts freedom of movement of or normal access to one’s body,
  131  including, but not limited to, a half-bed rail, a full-bed rail,
  132  a geriatric chair, and a posey restraint. The term includes any
  133  device that was not specifically manufactured as a restraint but
  134  which has been altered, arranged, or otherwise used for this
  135  purpose. The term does not include bandage material used for the
  136  purpose of binding a wound or injury.
  137         (6)“Seclusion” means the physical segregation of a person
  138  in any fashion or the involuntary isolation of a person in a
  139  room or area from which the person is prevented from leaving.
  140  The prevention may be by physical barrier or by a staff member
  141  who is acting in a manner, or who is physically situated, so as
  142  to prevent the person from leaving the room or area. For
  143  purposes of this chapter, the term does not mean isolation due
  144  to a person’s medical condition or symptoms.
  145         (7) “Transitional living facility” means a site where
  146  specialized health care services are provided, including, but
  147  not limited to, rehabilitative services, behavior modification,
  148  community reentry training, aids for independent living, and
  149  counseling to individuals who have brain injuries or spinal cord
  150  injuries. The term does not require a provider that is licensed
  151  by the agency to obtain a separate transitional living facility
  152  license to serve persons who have brain injuries or spinal cord
  153  injuries as long as the services provided are within the scope
  154  of the provider’s license.
  155         Section 4. Section 400.9972, Florida Statutes, is created
  156  to read:
  157         400.9972 License required; fee; application.—
  158         (1) The requirements of part II of chapter 408 apply to the
  159  provision of services that require licensure pursuant to this
  160  part and part II of chapter 408 and to entities licensed by or
  161  applying for such licensure from the agency pursuant to this
  162  part. A license issued by the agency is required for the
  163  operation of a transitional living facility in this state.
  164         (2) In accordance with this part, an applicant or a
  165  licensee shall pay a fee for each license application submitted
  166  under this part. The license fee shall consist of a $4,588
  167  license fee and a $90 per-bed fee per biennium and shall conform
  168  to the annual adjustment authorized in s. 408.805.
  169         (3) Each applicant for licensure must provide the
  170  following:
  171         (a) The location of the facility for which a license is
  172  sought and documentation, signed by the appropriate local
  173  government official, which states that the applicant has met
  174  local zoning requirements.
  175         (b) Proof of liability insurance as provided in s. 624.605.
  176         (c) Proof of compliance with local zoning requirements,
  177  including compliance with the requirements of chapter 419 if the
  178  proposed facility is a community residential home.
  179         (d) Proof that the facility has received a satisfactory
  180  firesafety inspection.
  181         (e) Documentation of a satisfactory sanitation inspection
  182  of the facility by the county health department.
  184  The applicant’s proposed facility must attain and continuously
  185  maintain accreditation by an accrediting organization
  186  specializing in evaluating rehabilitation facilities whose
  187  standards incorporate comparable licensure regulations required
  188  by the state. An applicant for licensure as a transitional
  189  living facility must acquire accreditation within 12 months
  190  after the issuance of an initial license. The agency shall
  191  accept the accreditation survey report of the accrediting
  192  organization in lieu of conducting a licensure inspection if the
  193  standards included in the survey report are determined by the
  194  agency to document that the facility is in substantial
  195  compliance with state licensure requirements. The applicant
  196  shall submit to the agency within 10 days after receipt a copy
  197  of any accreditation survey report and evidence of the
  198  accreditation decision subsequent to a survey by the accrediting
  199  organization on the facility. This part does not preclude the
  200  agency from conducting periodic inspections of a transitional
  201  living facility to ensure compliance with all licensure
  202  requirements, and as it deems necessary to carry out the
  203  functions of the agency. An inspection may be conducted to
  204  ensure compliance with licensure requirements of this part, to
  205  validate the inspection process of accrediting organizations, to
  206  respond to licensure complaints, or to protect the public health
  207  and safety.
  208         Section 5. Section 400.9973, Florida Statutes, is created
  209  to read:
  210         400.9973 Client admission, transfer, and discharge.—
  211         (1) Each transitional living facility must have written
  212  policies and procedures governing the admission, transfer, and
  213  discharge of clients.
  214         (2) The admission of each client to a transitional living
  215  facility must be in accordance with the licensee’s policies and
  216  procedures.
  217         (3) A client admitted to a transitional living facility
  218  must have a brain or spinal cord injury, such as a lesion to the
  219  spinal cord or cauda equina syndrome, with evidence of
  220  significant involvement of two of the following deficits or
  221  dysfunctions:
  222         (a) A motor deficit.
  223         (b) A sensory deficit.
  224         (c) Bowel and bladder dysfunction.
  225         (d) An acquired internal or external injury to the skull,
  226  the brain, or the brain’s covering, whether caused by a
  227  traumatic or nontraumatic event, which produces an altered state
  228  of consciousness or an anatomic motor, sensory, cognitive, or
  229  behavioral deficit.
  230         (4) A client whose medical condition and diagnosis does not
  231  positively identify a cause of the client’s condition, whose
  232  symptoms are inconsistent with the known cause of injury, or
  233  whose recovery is inconsistent with the known medical condition
  234  may be admitted to a transitional living facility for evaluation
  235  for a period not to exceed 90 days.
  236         (5) A client admitted to a transitional living facility
  237  must be admitted upon prescription by a licensed physician and
  238  must remain under the care of a licensed physician for the
  239  duration of the client’s stay in the facility.
  240         (6) A transitional living facility may not admit a client
  241  whose primary admitting diagnosis is mental illness or an
  242  intellectual or a developmental disability.
  243         (7) An individual may not be admitted to a transitional
  244  living facility if the individual:
  245         (a) Presents significant risk of infection to other clients
  246  or personnel. A health care practitioner must provide
  247  documentation that the individual is free of apparent signs and
  248  symptoms of communicable disease;
  249         (b) Is a danger to self or others as determined by a
  250  physician or mental health practitioner licensed under chapter
  251  490 or chapter 491, unless the facility provides adequate
  252  staffing and support to ensure patient safety;
  253         (c) Is bedridden; or
  254         (d) Requires 24-hour nursing supervision.
  255         (8) If the client meets the admission criteria, the medical
  256  or nursing director of the facility must complete an initial
  257  evaluation of the client’s functional skills, behavioral status,
  258  cognitive status, educational or vocational potential, medical
  259  status, psychosocial status, sensorimotor capacity, and other
  260  related skills and abilities within the first 72 hours after the
  261  client’s admission to the facility. An initial comprehensive
  262  treatment plan that delineates services to be provided and
  263  appropriate sources for such services must be implemented within
  264  the first 4 days after admission.
  265         (9) Each transitional living facility shall develop a
  266  discharge plan for each client before or upon admission to the
  267  facility. The discharge plan must identify the intended
  268  discharge site and possible alternative discharge sites. For
  269  each discharge site identified, the discharge plan must identify
  270  the skills, behaviors, and other conditions that the client must
  271  achieve to be appropriate for discharge. Discharge plans must be
  272  reviewed and updated as necessary, but no less often than once
  273  monthly.
  274         (10) As soon as practicable, a transitional living facility
  275  shall discharge a client when he or she no longer requires any
  276  of the specialized services described in s. 400.9971(7) or is
  277  not making measurable progress in accordance with his or her
  278  comprehensive treatment plan, or if the transitional living
  279  facility is no longer the most appropriate, least restrictive
  280  treatment option.
  281         (11) Each transitional living facility shall provide at
  282  least 30 days’ notice to clients of transfer or discharge plans,
  283  including the location of an acceptable transfer location if the
  284  client is unable to live independently. This requirement does
  285  not apply if a client voluntarily terminates residency.
  286         Section 6. Section 400.9974, Florida Statutes, is created
  287  to read:
  288         400.9974 Client comprehensive treatment plans; client
  289  services.—
  290         (1) Each transitional living facility shall develop a
  291  comprehensive treatment plan for each client as soon as
  292  possible, but no later than 30 days following development of the
  293  initial comprehensive treatment plan. Comprehensive treatment
  294  plans must be reviewed and updated if the client fails to meet
  295  projected improvements in the plan or if a significant change in
  296  the client’s condition occurs. Comprehensive treatment plans
  297  must be reviewed and updated at least once monthly.
  298  Comprehensive treatment plans must be developed by an
  299  interdisciplinary team consisting of the case manager, the
  300  program director, the nurse, and appropriate therapists. The
  301  client or, if appropriate, the client’s representative must be
  302  included in developing the comprehensive treatment plan.
  303         (2) The comprehensive treatment plan must include the
  304  following:
  305         (a) The physician’s orders and the client’s diagnosis,
  306  medical history, physical examination, and rehabilitative or
  307  restorative needs.
  308         (b) A preliminary nursing evaluation with physician’s
  309  orders for immediate care, completed on admission.
  310         (c) A comprehensive, accurate, reproducible, and
  311  standardized assessment of the client’s functional capability;
  312  the treatments designed to achieve skills, behaviors, and other
  313  conditions necessary to return to the community; and specific
  314  measurable goals.
  315         (d) Steps necessary for the client to achieve transition to
  316  the community and estimated length of time to achieve the goals.
  317         (3) The client or, if appropriate, the client’s
  318  representative must consent to the continued treatment at the
  319  transitional living facility. Consent may be for a period of up
  320  to 3 months. If such consent is not given, the transitional
  321  living facility shall discharge the client as soon as
  322  practicable.
  323         (4) Each client must receive the professional program
  324  services needed to implement the client’s comprehensive
  325  treatment plan.
  326         (5) The licensee must employ qualified professional staff
  327  to carry out and monitor the various professional interventions
  328  in accordance with the stated goals and objectives of every
  329  client’s comprehensive treatment plan.
  330         (6) Each client must receive a continuous treatment program
  331  that includes appropriate, consistent implementation of a
  332  program of specialized and general training, treatment, health
  333  services, and related services which is directed toward:
  334         (a) The acquisition of the behaviors and skills necessary
  335  for the client to function with as much self-determination and
  336  independence as possible;
  337         (b) The prevention or deceleration of regression or loss of
  338  current optimal functional status; and
  339         (c) The management of behavioral issues that preclude
  340  independent functioning in the community.
  341         Section 7. Section 400.9975, Florida Statutes, is created
  342  to read:
  343         400.9975 Licensee responsibilities.—
  344         (1) The licensee shall ensure that each client:
  345         (a) Lives in a safe environment free from abuse, neglect,
  346  and exploitation.
  347         (b) Is treated with consideration and respect and with due
  348  recognition of personal dignity, individuality, and the need for
  349  privacy.
  350         (c) Retains and uses his or her own clothes and other
  351  personal property in his or her immediate living quarters, so as
  352  to maintain individuality and personal dignity, except when the
  353  licensee can demonstrate that such retention and use would be
  354  unsafe, impractical, or an infringement upon the rights of other
  355  clients.
  356         (d) Has unrestricted private communication, including
  357  receiving and sending unopened correspondence, access to a
  358  telephone, and visiting with any person of his or her choice.
  359  Upon request, the licensee shall make provisions to modify
  360  visiting hours for caregivers and guests. The facility shall
  361  restrict communication in accordance with any court order or
  362  written instruction of a client’s representative. Any
  363  restriction on a client’s communication for therapeutic reasons
  364  shall be documented and reviewed at least weekly and shall be
  365  removed as soon as it is no longer clinically indicated. The
  366  basis for the restriction shall be explained to the client and,
  367  if applicable, the client’s representative. The client shall
  368  nonetheless retain the right to call the abuse hotline, the
  369  agency, and Disability Rights Florida at any and all times.
  370         (e) Has the opportunity to participate in and benefits from
  371  community services and activities to achieve the highest
  372  possible level of independence, autonomy, and interaction within
  373  the community.
  374         (f) Has the opportunity to manage his or her financial
  375  affairs unless the client or, if applicable, the client’s
  376  representative authorizes the administrator of the facility to
  377  provide safekeeping for funds as provided in this part.
  378         (g) Has reasonable opportunity for regular exercise several
  379  times a week and to be outdoors at regular and frequent
  380  intervals except when prevented by inclement weather.
  381         (h) Has the opportunity to exercise civil and religious
  382  liberties, including the right to independent personal
  383  decisions. No religious belief or practice, including attendance
  384  at religious services, shall be imposed upon any client.
  385         (i) Has access to adequate and appropriate health care
  386  consistent with established and recognized standards within the
  387  community.
  388         (j) Has the ability to present grievances and recommend
  389  changes in policies, procedures, and services to the staff of
  390  the licensee, governing officials, or any other person without
  391  restraint, interference, coercion, discrimination, or reprisal.
  392  Each licensee shall establish a grievance procedure to
  393  facilitate a client’s ability to present grievances, including a
  394  system for investigating, tracking, managing, and responding to
  395  complaints by persons receiving services or individuals acting
  396  on their behalf, and an appeals process. This process must
  397  include access to Disability Rights Florida and other advocates
  398  and the right to be a member of, be active in, and associate
  399  with advocacy or special interest groups.
  400         (2) The licensee shall:
  401         (a) Promote participation of each client’s representative
  402  in the process of providing treatment to the client unless the
  403  representative’s participation is unobtainable or inappropriate.
  404         (b) Answer communications from each client’s family,
  405  guardians, and friends promptly and appropriately.
  406         (c) Promote visits by individuals with a relationship to
  407  the client at any reasonable hour, without requiring prior
  408  notice, or in any area of the facility which provides direct
  409  client care services to the client, consistent with the client’s
  410  and other clients’ privacy, unless the interdisciplinary team
  411  determines that such a visit would not be appropriate.
  412         (d) Promote leave from the facility for visits, trips, or
  413  vacations.
  414         (e) Promptly notify the client’s representative of any
  415  significant incidents or changes in the client’s condition,
  416  including, but not limited to, serious illness, accident, abuse,
  417  unauthorized absence, or death.
  418         (3) The administrator of a facility shall ensure that a
  419  written notice of licensee responsibilities is posted in a
  420  prominent place in each building where clients reside and read
  421  or explained to clients who cannot read. This notice shall
  422  include the statewide toll-free telephone number for reporting
  423  complaints to the agency, must be provided to clients in a
  424  manner that is clearly legible, and must include the words: “To
  425  report a complaint regarding the services you receive, please
  426  call toll-free ...[telephone number]... or Disability Rights
  427  Florida ...[telephone number]...”; and the statewide toll-free
  428  telephone number for the central abuse hotline must be provided
  429  to clients in a manner that is clearly legible and must include
  430  the words: “To report abuse, neglect or exploitation, please
  431  call toll-free ...[telephone number where complaints may be
  432  lodged]....” The licensee must ensure a client’s access to a
  433  telephone, where telephone numbers required in this subsection
  434  are readily available to call the agency, central abuse hotline,
  435  or Disability Rights Florida.
  436         (4) A licensee or employee of a facility may not serve
  437  notice upon a client to leave the premises or take any other
  438  retaliatory action against any person solely due to the
  439  following:
  440         (a) The client or other person files an internal or
  441  external complaint or grievance regarding the facility.
  442         (b) The client or other person appears as a witness in any
  443  hearing inside or outside the facility.
  444         (5) Before or at the time of admission, the client and the
  445  client’s representative shall be provided with a copy of the
  446  licensee’s responsibilities as provided in this section,
  447  including grievance procedures and the telephone numbers
  448  provided in this section.
  449         (6) The licensee must develop and implement policies and
  450  procedures governing the release of any client information,
  451  including consent necessary from the client or the client’s
  452  representative.
  453         Section 8. Section 400.9976, Florida Statutes, is created
  454  to read:
  455         400.9976 Medication practices.—
  456         (1) An individual medication administration record must be
  457  maintained for each client. Each dose of medication, including a
  458  self-administered dose, shall be properly recorded in the
  459  client’s record. Each client who self-administers medication
  460  shall be given a pill organizer. Medication must be placed in
  461  the pill organizer by a nurse. A nurse shall document the date
  462  and time medication is placed into each client’s pill organizer.
  463  All medications must be administered in compliance with the
  464  physician’s orders.
  465         (2) If the interdisciplinary team determines that self
  466  administration of medications is an appropriate objective, and
  467  if the physician does not specify otherwise, a client must be
  468  taught to self-administer his or her medication without a staff
  469  person. This includes all forms of administration, including
  470  orally, via injection, and via suppository. The client’s
  471  physician must be informed of the interdisciplinary team’s
  472  decision that self-administration of medications is an objective
  473  for the client. A client may not self-administer medication
  474  until he or she demonstrates the competency to take the correct
  475  medication in the correct dosage at the correct time, to respond
  476  to missed doses, and to contact an appropriate person with
  477  questions.
  478         (3) Medication administration discrepancies and adverse
  479  drug reactions must be recorded and reported immediately to a
  480  physician.
  481         Section 9. Section 400.9977, Florida Statutes, is created
  482  to read:
  483         400.9977 Protection from abuse, neglect, mistreatment, and
  484  exploitation.—The licensee must develop and implement policies
  485  and procedures for the screening and training of employees, the
  486  protection of clients, and the prevention, identification,
  487  investigation, and reporting of abuse, neglect, and
  488  exploitation. This includes the licensee’s identification of
  489  clients whose personal histories render them at risk for abusing
  490  other clients, development of intervention strategies to prevent
  491  occurrences, monitoring for changes that would trigger abusive
  492  behavior, and reassessment of the interventions on a regular
  493  basis. A licensee shall implement procedures to:
  494         (1) Screen potential employees for a history of abuse,
  495  neglect, or mistreatment of clients. The screening shall include
  496  an attempt to obtain information from previous employers and
  497  current employers and verification with the appropriate
  498  licensing boards.
  499         (2) Train employees, through orientation and ongoing
  500  sessions, on issues related to abuse prohibition practices,
  501  including identification of abuse, neglect, mistreatment, and
  502  exploitation, appropriate interventions to deal with aggressive
  503  or catastrophic reactions of clients, the process to report
  504  allegations without fear of reprisal, and recognition of signs
  505  of frustration and stress that may lead to abuse.
  506         (3) Provide clients, families, and staff with information
  507  on how and to whom they may report concerns, incidents, and
  508  grievances without the fear of retribution and provide feedback
  509  regarding the concerns that have been expressed. A licensee must
  510  identify, correct, and intervene in situations in which abuse,
  511  neglect, mistreatment, or exploitation is likely to occur,
  512  including:
  513         (a) Evaluating the physical environment of the facility to
  514  identify characteristics that may make abuse or neglect more
  515  likely to occur, such as secluded areas.
  516         (b) Providing sufficient staff on each shift to meet the
  517  needs of the clients, and ensuring that the staff assigned have
  518  knowledge of the individual clients’ care needs. The licensee
  519  shall identify inappropriate behaviors of its staff, such as
  520  using derogatory language, rough handling, ignoring clients
  521  while giving care, and directing clients who need toileting
  522  assistance to urinate or defecate in their beds.
  523         (c) Assessing, planning care for, and monitoring clients
  524  with needs and behaviors that might lead to conflict or neglect,
  525  such as clients with a history of aggressive behaviors, clients
  526  who have behaviors such as entering other clients’ rooms,
  527  clients with self-injurious behaviors, clients with
  528  communication disorders, and clients who require heavy nursing
  529  care or are totally dependent on staff.
  530         (4) Identify events, such as suspicious bruising of
  531  clients, occurrences, patterns, and trends that may constitute
  532  abuse and determine the direction of the investigation.
  533         (5) Investigate different types of incidents, identify the
  534  staff member responsible for the initial reporting, investigate
  535  alleged violations, and report results to the proper
  536  authorities. The licensee must analyze the occurrences to
  537  determine what changes are needed, if any, to policies and
  538  procedures to prevent further occurrences and to take all
  539  necessary corrective action depending on the results of the
  540  investigation.
  541         (6) Protect clients from harm during an investigation.
  542         (7) Report all alleged violations and all substantiated
  543  incidents, as required under chapters 39 and 415, to the
  544  licensing authorities and all other agencies as required and to
  545  report any knowledge it has of any actions by a court of law
  546  that would indicate an employee is unfit for service.
  547         Section 10. Section 400.9978, Florida Statutes, is created
  548  to read:
  549         400.9978 Restraints and seclusion; client safety.—
  550         (1) Each facility shall provide a therapeutic milieu that
  551  supports a culture of individual empowerment and responsibility.
  552  The health and safety of the client shall be the primary concern
  553  at all times.
  554         (2) The use of physical restraints must be ordered and
  555  documented by a physician and must be consistent with policies
  556  and procedures adopted by the facility. The client or, if
  557  applicable, the client’s representative must be informed of the
  558  facility’s physical restraint policies and procedures at the
  559  time of the client’s admission.
  560         (3) The use of chemical restraints is limited to prescribed
  561  dosages of medications as ordered by a physician and must be
  562  consistent with the client’s diagnosis and the policies and
  563  procedures adopted by the facility. The client and, if
  564  applicable, the client’s representative must be informed of the
  565  facility’s chemical restraint policies and procedures at the
  566  time of the client’s admission.
  567         (4) Based on a physician’s assessment, if a client exhibits
  568  symptoms that present an immediate risk of injury or death to
  569  self or others, a physician may issue an emergency treatment
  570  order to immediately administer rapid response psychotropic
  571  medications or other chemical restraints. Each emergency
  572  treatment order must be documented and maintained in the
  573  client’s record.
  574         (a) An emergency treatment order is effective for no more
  575  than 24 hours.
  576         (b) Whenever a client is medicated in accordance with this
  577  subsection, the client’s representative or responsible party and
  578  the client’s physician must be notified as soon as practicable.
  579         (5) A client who is prescribed and receiving a medication
  580  that can serve as a chemical restraint for a purpose other than
  581  an emergency treatment order must be evaluated by his or her
  582  physician at least monthly to assess the following:
  583         (a) The continued need for the medication.
  584         (b) The level of the medication in the client’s blood, as
  585  appropriate.
  586         (c) The need for adjustments in the prescription.
  587         (6) The licensee shall ensure that clients are free from
  588  unnecessary drugs and physical restraints and are provided
  589  treatment to reduce dependency on drugs and physical restraints.
  590         (7) The licensee may use physical restraints and seclusion
  591  only as authorized by the facility’s written physical restraint
  592  and seclusion policies, which must be in compliance with this
  593  section and applicable rules.
  594         (8) Interventions to manage dangerous client behavior must
  595  be employed with sufficient safeguards and supervision to ensure
  596  that the safety, welfare, and civil and human rights of each
  597  client are adequately protected.
  598         (9) A facility shall notify the parent or guardian of a
  599  client each time restraint or seclusion is used. Such
  600  notification must be within 24 hours from the time the restraint
  601  or seclusion occurs. Reasonable efforts must be taken to notify
  602  the parent or guardian by telephone or e-mail, or both, and
  603  these efforts must be documented.
  604         (10) The agency may adopt by rule standards and procedures
  605  relating to the use of restraints, restraint positioning,
  606  seclusion, and emergency treatment orders for psychotropic
  607  medications, restraint, and seclusion. These rules must include
  608  duration of restraint use, staff training, client observation
  609  during restraint, and documentation and reporting standards.
  610         Section 11. Section 400.9979, Florida Statutes, is created
  611  to read:
  612         400.9979 Background screening; administration and
  613  management.—
  614         (1) The agency shall require level 2 background screening
  615  for personnel as required in s. 408.809(1)(e) pursuant to
  616  chapter 435 and s. 408.809.
  617         (2) The licensee shall maintain personnel records for each
  618  staff member which contain, at a minimum, documentation of
  619  background screening, if applicable, a job description,
  620  documentation of compliance with all training requirements of
  621  this part or applicable rule, the employment application,
  622  references, a copy of all job performance evaluations, and, for
  623  each staff member who performs services for which licensure or
  624  certification is required, a copy of all licenses or
  625  certification held by the staff member.
  626         (3) The licensee must:
  627         (a) Develop and implement infection control policies and
  628  procedures and include such policies and procedures in the
  629  licensee’s policy manual.
  630         (b) Maintain liability insurance as defined in s. 624.605.
  631         (c) Designate one person as an administrator who is
  632  responsible and accountable for the overall management of the
  633  facility.
  634         (d) Designate a person in writing to be responsible for the
  635  facility when the administrator is absent from the facility for
  636  more than 24 hours.
  637         (e) Designate in writing a program director who is
  638  responsible for supervising the therapeutic and behavioral
  639  staff, determining the levels of supervision, and determining
  640  room placement for each client.
  641         (f) Designate in writing a person to be responsible when
  642  the program director is absent from the facility for more than
  643  24 hours.
  644         (g) Obtain approval of the comprehensive emergency
  645  management plan, pursuant to s. 400.9981(2)(e), from the local
  646  emergency management agency. Pending the approval of the plan,
  647  the local emergency management agency shall ensure that the
  648  following agencies, at a minimum, are given the opportunity to
  649  review the plan: the Department of Health, the Agency for Health
  650  Care Administration, and the Division of Emergency Management.
  651  Appropriate volunteer organizations must also be given the
  652  opportunity to review the plan. The local emergency management
  653  agency shall complete its review within 60 days and either
  654  approve the plan or advise the licensee of necessary revisions.
  655         (h) Maintain written records in a form and system that
  656  comply with medical and business practices and make such records
  657  available in the facility for review or submission to the agency
  658  upon request. The records shall include:
  659         1. A daily census record that indicates the number of
  660  clients currently receiving services in the facility, including
  661  information regarding any public funding of such clients.
  662         2. A record of all accidents or unusual incidents involving
  663  any client or staff member that caused, or had the potential to
  664  cause, injury or harm to any person or property within the
  665  facility. Such records must contain a clear description of each
  666  accident or incident, the names of the persons involved, a
  667  description of all medical or other services provided to these
  668  persons specifying who provided such services, and the steps
  669  taken to prevent recurrence of such accidents or incidents.
  670         3. A copy of current agreements with third-party providers.
  671         4. A copy of current agreements with each consultant
  672  employed by the licensee and documentation of each consultant’s
  673  visits and required written, dated reports.
  674         Section 12. Section 400.9980, Florida Statutes, is created
  675  to read:
  676         400.9980 Property and personal affairs of clients.—
  677         (1) A client shall be given the option of using his or her
  678  own belongings, as space permits; choosing his or her roommate
  679  if practical and not clinically contraindicated; and, whenever
  680  possible, unless the client is adjudicated incompetent or
  681  incapacitated under state law, managing his or her own affairs.
  682         (2) The admission of a client to a facility and his or her
  683  presence therein shall not confer on a licensee, administrator,
  684  employee, or representative thereof any authority to manage,
  685  use, or dispose of any property of the client, nor shall such
  686  admission or presence confer on any of such persons any
  687  authority or responsibility for the personal affairs of the
  688  client except that which may be necessary for the safe
  689  management of the facility or for the safety of the client.
  690         (3) A licensee, administrator, employee, or representative
  691  thereof may:
  692         (a) Not act as the guardian, trustee, or conservator for
  693  any client or any of such client’s property.
  694         (b) Act as a competent client’s payee for social security,
  695  veteran’s, or railroad benefits if the client provides consent
  696  and the licensee files a surety bond with the agency in an
  697  amount equal to twice the average monthly aggregate income or
  698  personal funds due to the client, or expendable for the client’s
  699  account, that are received by a licensee.
  700         (c) Act as the power of attorney for a client if the
  701  licensee has filed a surety bond with the agency in an amount
  702  equal to twice the average monthly income of the client, plus
  703  the value of any client’s property under the control of the
  704  attorney in fact.
  706  The bond under paragraph (b) or paragraph (c) shall be executed
  707  by the licensee as principal and a licensed surety company. The
  708  bond shall be conditioned upon the faithful compliance of the
  709  licensee with the requirements of licensure and shall be payable
  710  to the agency for the benefit of any client who suffers a
  711  financial loss as a result of the misuse or misappropriation of
  712  funds held pursuant to this subsection. Any surety company that
  713  cancels or does not renew the bond of any licensee shall notify
  714  the agency in writing not less than 30 days in advance of such
  715  action, giving the reason for the cancellation or nonrenewal.
  716  Any licensee, administrator, employee, or representative thereof
  717  who is granted power of attorney for any client of the facility
  718  shall, on a monthly basis, notify the client in writing of any
  719  transaction made on behalf of the client pursuant to this
  720  subsection, and a copy of such notification given to the client
  721  shall be retained in each client’s file and available for agency
  722  inspection.
  723         (4) A licensee, upon mutual consent with the client, shall
  724  provide for the safekeeping in the facility of the client’s
  725  personal effects of a value not in excess of $1,000 and the
  726  client’s funds not in excess of $500 cash and shall keep
  727  complete and accurate records of all such funds and personal
  728  effects received. If a client is absent from a facility for 24
  729  hours or more, the licensee may provide for the safekeeping of
  730  the client’s personal effects of a value in excess of $1,000.
  731         (5) Any funds or other property belonging to or due to a
  732  client or expendable for his or her account that is received by
  733  licensee shall be trust funds and shall be kept separate from
  734  the funds and property of the licensee and other clients or
  735  shall be specifically credited to such client. Such trust funds
  736  shall be used or otherwise expended only for the account of the
  737  client. At least once every month, unless upon order of a court
  738  of competent jurisdiction, the licensee shall furnish the client
  739  and the client’s representative a complete and verified
  740  statement of all funds and other property to which this
  741  subsection applies, detailing the amount and items received,
  742  together with their sources and disposition. In any event, the
  743  licensee shall furnish such statement annually and upon the
  744  discharge or transfer of a client. Any governmental agency or
  745  private charitable agency contributing funds or other property
  746  to the account of a client shall also be entitled to receive
  747  such statement monthly and upon the discharge or transfer of the
  748  client.
  749         (6)(a) In addition to any damages or civil penalties to
  750  which a person is subject, any person who:
  751         1. Intentionally withholds a client’s personal funds,
  752  personal property, or personal needs allowance, or who demands,
  753  beneficially receives, or contracts for payment of all or any
  754  part of a client’s personal property or personal needs allowance
  755  in satisfaction of the facility rate for supplies and services;
  756  or
  757         2. Borrows from or pledges any personal funds of a client,
  758  other than the amount agreed to by written contract under s.
  759  429.24,
  761  commits a misdemeanor of the first degree, punishable as
  762  provided in s. 775.082 or s. 775.083.
  763         (b) Any licensee, administrator, employee, or
  764  representative thereof who is granted power of attorney for any
  765  client of the facility and who misuses or misappropriates funds
  766  obtained through this power commits a felony of the third
  767  degree, punishable as provided in s. 775.082, s. 775.083, or s.
  768  775.084.
  769         (7) In the event of the death of a client, a licensee shall
  770  return all refunds, funds, and property held in trust to the
  771  client’s personal representative, if one has been appointed at
  772  the time the licensee disburses such funds, or, if not, to the
  773  client’s spouse or adult next of kin named in a beneficiary
  774  designation form provided by the licensee to the client. If the
  775  client has no spouse or adult next of kin or such person cannot
  776  be located, funds due the client shall be placed in an interest
  777  bearing account and all property held in trust by the licensee
  778  shall be safeguarded until such time as the funds and property
  779  are disbursed pursuant to the Florida Probate Code. Such funds
  780  shall be kept separate from the funds and property of the
  781  licensee and other clients of the facility. If the funds of the
  782  deceased client are not disbursed pursuant to the Florida
  783  Probate Code within 2 years after the client’s death, the funds
  784  shall be deposited in the Health Care Trust Fund administered by
  785  the agency.
  786         (8) The agency, by rule, may clarify terms and specify
  787  procedures and documentation necessary to administer the
  788  provisions of this section relating to the proper management of
  789  clients’ funds and personal property and the execution of surety
  790  bonds.
  791         Section 13. Section 400.9981, Florida Statutes, is created
  792  to read:
  793         400.9981 Rules establishing standards.—
  794         (1) It is the intent of the Legislature that rules
  795  published and enforced pursuant to this part and part II of
  796  chapter 408 include criteria to ensure reasonable and consistent
  797  quality of care and client safety. Rules should make reasonable
  798  efforts to accommodate the needs and preferences of clients to
  799  enhance the quality of life in transitional living facilities.
  800         (2) The agency may adopt and enforce rules to implement
  801  this part and part II of chapter 408, which shall include
  802  reasonable and fair criteria in relation to the following:
  803         (a) The location of transitional living facilities.
  804         (b) The number of qualifications of all personnel,
  805  including management, medical, nursing, and other professional
  806  personnel and nursing assistants and support personnel having
  807  responsibility for any part of the care given to clients. The
  808  licensee must have enough qualified professional staff available
  809  to carry out and monitor the various professional interventions
  810  in accordance with the stated goals and objectives of each
  811  comprehensive treatment plan.
  812         (c) Requirements for personnel procedures, reporting
  813  procedures, and documentation necessary to implement this part.
  814         (d) Services provided to clients of transitional living
  815  facilities.
  816         (e) The preparation and annual update of a comprehensive
  817  emergency management plan in consultation with the Division of
  818  Emergency Management. At a minimum, the rules must provide for
  819  plan components that address emergency evacuation
  820  transportation; adequate sheltering arrangements; postdisaster
  821  activities, including provision of emergency power, food, and
  822  water; postdisaster transportation; supplies; staffing;
  823  emergency equipment; individual identification of clients and
  824  transfer of records; communication with families; and responses
  825  to family inquiries.
  826         Section 14. Section 400.9982, Florida Statutes, is created
  827  to read:
  828         400.9982 Violations; penalties.—
  829         (1) Each violation of this part and rules adopted pursuant
  830  thereto shall be classified according to the nature of the
  831  violation and the gravity of its probable effect on facility
  832  clients. The agency shall indicate the classification on the
  833  written notice of the violation as follows:
  834         (a) Class “I” violations are defined in s. 408.813. The
  835  agency shall issue a citation regardless of correction and
  836  impose an administrative fine of $5,000 for an isolated
  837  violation, $7,500 for a patterned violation, and $10,000 for a
  838  widespread violation. Violations may be identified and a fine
  839  must be levied notwithstanding the correction of the deficiency
  840  giving rise to the violation.
  841         (b) Class “II” violations are defined in s. 408.813. The
  842  agency shall impose an administrative fine of $1,000 for an
  843  isolated violation, $2,500 for a patterned violation, and $5,000
  844  for a widespread violation. A fine must be levied
  845  notwithstanding the correction of the deficiency giving rise to
  846  the violation.
  847         (c) Class “III” violations are defined in s. 408.813. The
  848  agency shall impose an administrative fine of $500 for an
  849  isolated violation, $750 for a patterned violation, and $1,000
  850  for a widespread violation. If a deficiency giving rise to a
  851  class “III” violation is corrected within the time specified by
  852  the agency, a fine may not be imposed.
  853         (d) Class “IV” violations are defined in s. 408.813. The
  854  agency shall impose an administrative fine for a cited class IV
  855  violation in an amount not less than $100 and not exceeding $200
  856  for each violation. If a deficiency giving rise to a class “IV”
  857  violation is corrected within the time specified by the agency,
  858  a fine may not be imposed.
  859         Section 15. Section 400.9983, Florida Statutes, is created
  860  to read:
  861         400.9983 Receivership proceedings.—The agency may apply s.
  862  429.22 with regard to receivership proceedings for transitional
  863  living facilities.
  864         Section 16. Section 400.9984, Florida Statutes, is created
  865  to read:
  866         400.9984 Interagency communication.—The agency, the
  867  department, the Agency for Persons with Disabilities, and the
  868  Department of Children and Families shall develop electronic
  869  systems to ensure that relevant information pertaining to the
  870  regulation of transitional living facilities and clients is
  871  timely and effectively communicated among agencies in order to
  872  facilitate the protection of clients. Electronic sharing of
  873  information shall include, at a minimum, a brain and spinal cord
  874  injury registry and a client abuse registry.
  875         Section 17. Section 400.805, Florida Statutes, is repealed.
  876  Every transitional living facility licensed under s. 400.805 on
  877  or before July 1, 2013, shall be licensed under the provisions
  878  of this act.
  879         Section 18. Subsection (9) of section 381.745, Florida
  880  Statutes, is amended to read:
  881         381.745 Definitions; ss. 381.739-381.79.—As used in ss.
  882  381.739-381.79, the term:
  883         (9) “Transitional living facility,for the purpose of this
  884  part, means a state-approved facility, as defined and licensed
  885  under chapter 400 or chapter 429, or a facility approved by the
  886  brain and spinal cord injury program in accordance with this
  887  chapter.
  888         Section 19. Section 381.75, Florida Statutes, is amended to
  889  read:
  890         381.75 Duties and responsibilities of the department, of
  891  transitional living facilities, and of residents.—Consistent
  892  with the mandate of s. 381.7395, the department shall develop
  893  and administer a multilevel treatment program for individuals
  894  who sustain brain or spinal cord injuries and who are referred
  895  to the brain and spinal cord injury program.
  896         (1) Within 15 days after any report of an individual who
  897  has sustained a brain or spinal cord injury, the department
  898  shall notify the individual or the most immediate available
  899  family members of their right to assistance from the state, the
  900  services available, and the eligibility requirements.
  901         (2) The department shall refer individuals who have brain
  902  or spinal cord injuries to other state agencies to assure that
  903  rehabilitative services, if desired, are obtained by that
  904  individual.
  905         (3) The department, in consultation with emergency medical
  906  service, shall develop standards for an emergency medical
  907  evacuation system that will ensure that all individuals who
  908  sustain traumatic brain or spinal cord injuries are transported
  909  to a department-approved trauma center that meets the standards
  910  and criteria established by the emergency medical service and
  911  the acute-care standards of the brain and spinal cord injury
  912  program.
  913         (4) The department shall develop standards for designation
  914  of rehabilitation centers to provide rehabilitation services for
  915  individuals who have brain or spinal cord injuries.
  916         (5) The department shall determine the appropriate number
  917  of designated acute-care facilities, inpatient rehabilitation
  918  centers, and outpatient rehabilitation centers, needed based on
  919  incidence, volume of admissions, and other appropriate criteria.
  920         (6) The department shall develop standards for designation
  921  of transitional living facilities to provide transitional living
  922  services for individuals who participate in the brain and spinal
  923  cord injury program the opportunity to adjust to their
  924  disabilities and to develop physical and functional skills in a
  925  supported living environment.
  926         (a) The Agency for Health Care Administration, in
  927  consultation with the department, shall develop rules for the
  928  licensure of transitional living facilities for individuals who
  929  have brain or spinal cord injuries.
  930         (b) The goal of a transitional living program for
  931  individuals who have brain or spinal cord injuries is to assist
  932  each individual who has such a disability to achieve a higher
  933  level of independent functioning and to enable that person to
  934  reenter the community. The program shall be focused on preparing
  935  participants to return to community living.
  936         (c) A transitional living facility for an individual who
  937  has a brain or spinal cord injury shall provide to such
  938  individual, in a residential setting, a goal-oriented treatment
  939  program designed to improve the individual’s physical,
  940  cognitive, communicative, behavioral, psychological, and social
  941  functioning, as well as to provide necessary support and
  942  supervision. A transitional living facility shall offer at least
  943  the following therapies: physical, occupational, speech,
  944  neuropsychology, independent living skills training, behavior
  945  analysis for programs serving brain-injured individuals, health
  946  education, and recreation.
  947         (d) All residents shall use the transitional living
  948  facility as a temporary measure and not as a permanent home or
  949  domicile. The transitional living facility shall develop an
  950  initial treatment plan for each resident within 3 days after the
  951  resident’s admission. The transitional living facility shall
  952  develop a comprehensive plan of treatment and a discharge plan
  953  for each resident as soon as practical, but no later than 30
  954  days after the resident’s admission. Each comprehensive
  955  treatment plan and discharge plan must be reviewed and updated
  956  as necessary, but no less often than quarterly. This subsection
  957  does not require the discharge of an individual who continues to
  958  require any of the specialized services described in paragraph
  959  (c) or who is making measurable progress in accordance with that
  960  individual’s comprehensive treatment plan. The transitional
  961  living facility shall discharge any individual who has an
  962  appropriate discharge site and who has achieved the goals of his
  963  or her discharge plan or who is no longer making progress toward
  964  the goals established in the comprehensive treatment plan and
  965  the discharge plan. The discharge location must be the least
  966  restrictive environment in which an individual’s health, well
  967  being, and safety is preserved.
  968         (7) Recipients of services, under this section, from any of
  969  the facilities referred to in this section shall pay a fee based
  970  on ability to pay.
  971         Section 20. Subsection (4) of section 381.78, Florida
  972  Statutes, is amended to read:
  973         381.78 Advisory council on brain and spinal cord injuries.—
  974         (4) The council shall:
  975         (a) provide advice and expertise to the department in the
  976  preparation, implementation, and periodic review of the brain
  977  and spinal cord injury program.
  978         (b) Annually appoint a five-member committee composed of
  979  one individual who has a brain injury or has a family member
  980  with a brain injury, one individual who has a spinal cord injury
  981  or has a family member with a spinal cord injury, and three
  982  members who shall be chosen from among these representative
  983  groups: physicians, other allied health professionals,
  984  administrators of brain and spinal cord injury programs, and
  985  representatives from support groups with expertise in areas
  986  related to the rehabilitation of individuals who have brain or
  987  spinal cord injuries, except that one and only one member of the
  988  committee shall be an administrator of a transitional living
  989  facility. Membership on the council is not a prerequisite for
  990  membership on this committee.
  991         1. The committee shall perform onsite visits to those
  992  transitional living facilities identified by the Agency for
  993  Health Care Administration as being in possible violation of the
  994  statutes and rules regulating such facilities. The committee
  995  members have the same rights of entry and inspection granted
  996  under s. 400.805(4) to designated representatives of the agency.
  997         2. Factual findings of the committee resulting from an
  998  onsite investigation of a facility pursuant to subparagraph 1.
  999  shall be adopted by the agency in developing its administrative
 1000  response regarding enforcement of statutes and rules regulating
 1001  the operation of the facility.
 1002         3. Onsite investigations by the committee shall be funded
 1003  by the Health Care Trust Fund.
 1004         4. Travel expenses for committee members shall be
 1005  reimbursed in accordance with s. 112.061.
 1006         5. Members of the committee shall recuse themselves from
 1007  participating in any investigation that would create a conflict
 1008  of interest under state law, and the council shall replace the
 1009  member, either temporarily or permanently.
 1010         Section 21. Subsection (21) of section 408.802, Florida
 1011  Statutes, is amended to read:
 1012         408.802 Applicability.—The provisions of this part apply to
 1013  the provision of services that require licensure as defined in
 1014  this part and to the following entities licensed, registered, or
 1015  certified by the agency, as described in chapters 112, 383, 390,
 1016  394, 395, 400, 429, 440, 483, and 765:
 1017         (21) Transitional living facilities, as provided under part
 1018  XI V of chapter 400.
 1019         Section 22. Subsection (20) of section 408.820, Florida
 1020  Statutes, is amended to read:
 1021         408.820 Exemptions.—Except as prescribed in authorizing
 1022  statutes, the following exemptions shall apply to specified
 1023  requirements of this part:
 1024         (20) Transitional living facilities, as provided under part
 1025  XI V of chapter 400, are exempt from s. 408.810(10).
 1026         Section 23. Subsection (5) of section 400.93, Florida
 1027  Statutes, is amended to read:
 1028         400.93 Licensure required; exemptions; unlawful acts;
 1029  penalties.—
 1030         (5) The following are exempt from home medical equipment
 1031  provider licensure, unless they have a separate company,
 1032  corporation, or division that is in the business of providing
 1033  home medical equipment and services for sale or rent to
 1034  consumers at their regular or temporary place of residence
 1035  pursuant to the provisions of this part:
 1036         (a) Providers operated by the Department of Health or
 1037  Federal Government.
 1038         (b) Nursing homes licensed under part II.
 1039         (c) Assisted living facilities licensed under chapter 429,
 1040  when serving their residents.
 1041         (d) Home health agencies licensed under part III.
 1042         (e) Hospices licensed under part IV.
 1043         (f) Intermediate care facilities, homes for special
 1044  services, and transitional living facilities licensed under part
 1045  V.
 1046         (g) Transitional living facilities licensed under part XI.
 1047         (h)(g) Hospitals and ambulatory surgical centers licensed
 1048  under chapter 395.
 1049         (i)(h) Manufacturers and wholesale distributors when not
 1050  selling directly to consumers.
 1051         (j)(i) Licensed health care practitioners who utilize home
 1052  medical equipment in the course of their practice, but do not
 1053  sell or rent home medical equipment to their patients.
 1054         (k)(j) Pharmacies licensed under chapter 465.
 1055         Section 24. Paragraph (l) of subsection (4) of section
 1056  400.9905, Florida Statutes, is amended to read:
 1057         400.9905 Definitions.—
 1058         (4) “Clinic” means an entity where health care services are
 1059  provided to individuals and which tenders charges for
 1060  reimbursement for such services, including a mobile clinic and a
 1061  portable equipment provider. As used in this part, the term does
 1062  not include and the licensure requirements of this part do not
 1063  apply to:
 1064         (l) Orthotic, or prosthetic, pediatric cardiology, or
 1065  perinatology clinical facilities or anesthesia clinical
 1066  facilities that are not otherwise exempt under paragraph (a) or
 1067  paragraph (k) and that are a publicly traded corporation or that
 1068  are wholly owned, directly or indirectly, by a publicly traded
 1069  corporation. As used in this paragraph, a publicly traded
 1070  corporation is a corporation that issues securities traded on an
 1071  exchange registered with the United States Securities and
 1072  Exchange Commission as a national securities exchange.
 1074  Notwithstanding this subsection, an entity shall be deemed a
 1075  clinic and must be licensed under this part in order to receive
 1076  reimbursement under the Florida Motor Vehicle No-Fault Law, ss.
 1077  627.730-627.7405, unless exempted under s. 627.736(5)(h).
 1078         Section 25. This act shall take effect July 1, 2013.