Florida Senate - 2017                        COMMITTEE AMENDMENT
       Bill No. SB 474
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  03/27/2017           .                                

       The Committee on Health Policy (Grimsley) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 400.6005, Florida Statutes, is amended
    6  to read:
    7         400.6005 Legislative findings and intent.—The Legislature
    8  finds that a terminally ill patient individuals and their
    9  families, who is are no longer pursuing curative medical
   10  treatment and the patient’s family, should have the opportunity
   11  to select a support system that allows permits the patient to
   12  exercise maximum independence and dignity during the final days
   13  of life. The Legislature also finds that a seriously ill patient
   14  and the patient’s family should have the opportunity to select a
   15  support system that provides palliative care and supportive care
   16  and allows the patient to exercise maximum independence while
   17  receiving such care. The Legislature finds that hospice care
   18  provides a cost-effective and less intrusive form of medical
   19  care while meeting the social, psychological, and spiritual
   20  needs of terminally ill and seriously ill patients and their
   21  families. The intent of this part is to provide for the
   22  development, establishment, and enforcement of basic standards
   23  to ensure the safe and adequate care of persons receiving
   24  hospice services.
   25         Section 2. Section 400.601, Florida Statutes, is amended to
   26  read:
   27         400.601 Definitions.—As used in this part, the term:
   28         (1) “Agency” means the Agency for Health Care
   29  Administration.
   30         (2) “Department” means the Department of Elderly Affairs.
   31         (3) “Hospice” means a centrally administered corporation or
   32  a limited liability company that provides a continuum of
   33  palliative care and supportive care for a the terminally ill
   34  patient and his or her family.
   35         (4) “Hospice care team” means an interdisciplinary team of
   36  qualified professionals and volunteers who, in consultation with
   37  a the patient, the patient’s family, and the patient’s primary
   38  or attending physician, collectively assess, coordinate, and
   39  provide the appropriate palliative care and supportive care to
   40  hospice patients and their families.
   41         (5) “Hospice program” means a program offered by a hospice
   42  which provides a continuum of palliative care and supportive
   43  care for a patient and his or her family.
   44         (6)(5) “Hospice residential unit” means a homelike living
   45  facility, other than a facility licensed under other parts of
   46  this chapter, under chapter 395, or under chapter 429, which
   47  that is operated by a hospice for the benefit of its patients
   48  and is considered by a patient who lives there to be his or her
   49  primary residence.
   50         (7)(6) “Hospice services” means items and services
   51  furnished to a terminally ill patient and family by a hospice,
   52  or by others under arrangements with such a program, in a place
   53  of temporary or permanent residence used as the patient’s home
   54  for the purpose of maintaining the patient at home; or, if the
   55  patient needs short-term institutionalization, the services
   56  shall be furnished in cooperation with those contracted
   57  institutions or in the hospice inpatient facility.
   58         (8)(7) “Palliative care” means services or interventions
   59  furnished to a seriously ill patient and family which are not
   60  curative but are provided for the reduction or abatement of pain
   61  and human suffering.
   62         (9)(8) “Patient” means the terminally or seriously ill
   63  individual receiving hospice services from a hospice.
   64         (10)(9) “Plan of care” means a written assessment by the
   65  hospice of each patient’s and family’s needs and preferences,
   66  and the services to be provided by the hospice to meet those
   67  needs.
   68         (11) “Seriously ill” means that the person has a life
   69  threatening medical condition that may be irreversible and may
   70  continue indefinitely, and such condition may be managed through
   71  palliative care.
   72         (12)(10) “Terminally ill” means that the patient has a
   73  medical prognosis that his or her life expectancy is 1 year or
   74  less if the illness runs its normal course.
   75         Section 3. Section 400.60501, Florida Statutes, is amended
   76  to read:
   77         400.60501 Outcome measures; adoption of federal quality
   78  measures; public reporting national initiatives; annual report.—
   79         (1) No later than December 31, 2019 2007, the department of
   80  Elderly Affairs, in conjunction with the agency for Health Care
   81  Administration, shall develop adopt the national hospice outcome
   82  measures in 42 C.F.R. part 418 to determine the quality and
   83  effectiveness of hospice care for hospices licensed in the
   84  state. At a minimum, these outcome measures shall include a
   85  requirement that 50 percent of patients who report severe pain
   86  on a 0-to-10 scale must report a reduction to 5 or less by the
   87  end of the 4th day of care on the hospice program.
   88         (2) For hospices licensed in the state, The department of
   89  Elderly Affairs, in conjunction with the agency for Health Care
   90  Administration, shall:
   91         (a) Make available to the public the national hospice
   92  outcome measures in a format that is comprehensible by a
   93  layperson and that allows a consumer to compare such measures of
   94  one or more hospices. Consider and adopt national initiatives,
   95  such as those developed by the national hospice and Palliative
   96  Care Organization, to set benchmarks for measuring the quality
   97  of hospice care provided in the state.
   98         (b) Develop an annual report that analyzes and evaluates
   99  the information collected under this act and any other data
  100  collection or reporting provisions of law.
  101         Section 4. Section 400.609, Florida Statutes, is amended to
  102  read:
  103         400.609 Hospice services.—Each hospice shall provide a
  104  continuum of hospice services which affords afford the
  105  terminally ill patient and the family of the patient a range of
  106  service delivery which can be tailored to specific needs and
  107  preferences of the terminally ill patient and family at any
  108  point in time throughout the length of care for the terminally
  109  ill patient and during the bereavement period. These services
  110  must be available 24 hours a day, 7 days a week, and must
  111  include:
  112         (1) SERVICES.—
  113         (a) The hospice care team shall directly provide the
  114  following core services: nursing services, social work services,
  115  pastoral or counseling services, dietary counseling, and
  116  bereavement counseling services. Physician services may be
  117  provided by the hospice directly or through contract. A hospice
  118  may also use contracted staff if necessary to supplement hospice
  119  employees in order to meet the needs of patients during periods
  120  of peak patient loads or under extraordinary circumstances.
  121         (b) Each hospice must also provide or arrange for such
  122  additional services as are needed to meet the palliative and
  123  support needs of the patient and family. These services may
  124  include, but are not limited to, physical therapy, occupational
  125  therapy, speech therapy, massage therapy, home health aide
  126  services, infusion therapy, provision of medical supplies and
  127  durable medical equipment, day care, homemaker and chore
  128  services, and funeral services.
  129         (2) HOSPICE HOME CARE.—Hospice care and services provided
  130  in a private home shall be the primary form of care. The goal of
  131  hospice home care shall be to provide adequate training and
  132  support to encourage self-sufficiency and allow patients and
  133  families to maintain the patient comfortably at home for as long
  134  as possible. The services of the hospice home care program shall
  135  be of the highest quality and shall be provided by the hospice
  136  care team.
  137         (3) HOSPICE RESIDENTIAL CARE.—Hospice care and services, to
  138  the extent practicable and compatible with the needs and
  139  preferences of the patient, may be provided by the hospice care
  140  team to a patient living in an assisted living facility, adult
  141  family-care home, nursing home, hospice residential unit or
  142  facility, or other nondomestic place of permanent or temporary
  143  residence. A resident or patient living in an assisted living
  144  facility, adult family-care home, nursing home, or other
  145  facility subject to state licensing who has been admitted to a
  146  hospice program shall be considered a hospice patient, and the
  147  hospice program shall be responsible for coordinating and
  148  ensuring the delivery of hospice care and services to such
  149  person pursuant to the standards and requirements of this part
  150  and rules adopted under this part.
  151         (4) HOSPICE INPATIENT CARE.—The inpatient component of care
  152  is a short-term adjunct to hospice home care and hospice
  153  residential care and shall be used only for pain control,
  154  symptom management, or respite care. The total number of
  155  inpatient days for all hospice patients in any 12-month period
  156  may not exceed 20 percent of the total number of hospice days
  157  for all the hospice patients of the licensed hospice. Hospice
  158  inpatient care shall be under the direct administration of the
  159  hospice, whether the inpatient facility is a freestanding
  160  hospice facility or part of a facility licensed pursuant to
  161  chapter 395 or part II of this chapter. The facility or rooms
  162  within a facility used for the hospice inpatient component of
  163  care shall be arranged, administered, and managed in such a
  164  manner as to provide privacy, dignity, comfort, warmth, and
  165  safety for the terminally ill patient and the family. Every
  166  possible accommodation must be made to create as homelike an
  167  atmosphere as practicable. To facilitate overnight family
  168  visitation within the facility, rooms must be limited to no more
  169  than double occupancy; and, whenever possible, both occupants
  170  must be hospice patients. There must be a continuum of care and
  171  a continuity of caregivers between the hospice home program and
  172  the inpatient aspect of care to the extent practicable and
  173  compatible with the preferences of the patient and his or her
  174  family. Fees charged for hospice inpatient care, whether
  175  provided directly by the hospice or through contract, must be
  176  made available upon request to the Agency for Health Care
  177  Administration. The hours for daily operation and the location
  178  of the place where the services are provided must be determined,
  179  to the extent practicable, by the accessibility of such services
  180  to the patients and families served by the hospice.
  181         (5) BEREAVEMENT COUNSELING.—The hospice bereavement program
  182  must be a comprehensive program, under professional supervision,
  183  that provides a continuum of formal and informal supportive
  184  services to the family for a minimum of 1 year after the
  185  patient’s death. This subsection does not constitute an
  186  additional exemption from chapter 490 or chapter 491.
  187         Section 5. Section 400.6093, Florida Statutes, is created
  188  to read:
  189         400.6093 Community palliative care services.—A hospice may
  190  provide palliative care to a seriously ill patient and his or
  191  her family members. Such palliative care may be provided to
  192  manage the side effects of treatment for a progressive disease
  193  or medical or surgical condition. Such care may also be provided
  194  directly by the hospice or by other providers under contract
  195  with the hospice. This section does not preclude the provision
  196  of palliative care to seriously ill patients or their family
  197  members by any other health care provider or health care
  198  facility otherwise authorized to provide such care. This section
  199  does not mandate or prescribe additional Medicaid coverage.
  200         Section 6. Subsections (1) and (2) of section 400.6095,
  201  Florida Statutes, are amended to read:
  202         400.6095 Patient admission; assessment; plan of care;
  203  discharge; death.—
  204         (1) Each hospice shall make its services available to all
  205  terminally ill patients persons and their families without
  206  regard to age, gender, national origin, sexual orientation,
  207  disability, diagnosis, cost of therapy, ability to pay, or life
  208  circumstances. A hospice may shall not impose any value or
  209  belief system on its patients or their families and shall
  210  respect the values and belief systems of its patients and their
  211  families.
  212         (2) Admission of a terminally ill patient to a hospice
  213  program shall be made upon a diagnosis and prognosis of terminal
  214  illness by a physician licensed pursuant to chapter 458 or
  215  chapter 459 and must shall be dependent on the expressed request
  216  and informed consent of the patient.
  217         Section 7. Section 400.6096, Florida Statutes, is created
  218  to read:
  219         400.6096 Disposal of prescribed controlled substances
  220  following the death of a patient in the home.—
  221         (1) A hospice physician, nurse, or social worker is
  222  authorized to assist in the disposal of a controlled substance
  223  prescribed to a patient at the time of the patient’s death
  224  pursuant to the disposal regulations in 21 C.F.R. s. 1317.
  225         (2) A hospice that assists in the disposal of a prescribed
  226  controlled substance found in the patient’s home at the time of
  227  the patient’s death must establish a written policy, procedure,
  228  or system for acceptable disposal methods.
  229         (3) A hospice physician, nurse, or social worker, upon the
  230  patient’s death and with the permission of a family member or a
  231  caregiver of the patient, may assist in the disposal of an
  232  unused controlled substance prescribed to the patient, pursuant
  233  to the written policy, procedure, or system established under
  234  subsection (2).
  235         (4) The prescribed controlled substance disposal procedure
  236  must be carried out in the patient’s home. Hospice staff and
  237  volunteers are not authorized to remove a prescribed controlled
  238  substance from the patient’s home.
  239         Section 8. Section 400.611, Florida Statutes, is amended to
  240  read:
  241         400.611 Interdisciplinary records of care; confidentiality;
  242  release of records.—
  243         (1) A hospice shall maintain an up-to-date,
  244  interdisciplinary record of care being given and patient and
  245  family status shall be kept. Records shall contain pertinent
  246  past and current medical, nursing, social, and other therapeutic
  247  information and such other information that is necessary for the
  248  safe and adequate care of the patient. Notations regarding all
  249  aspects of care for the patient and family shall be made in the
  250  record. When services are terminated, the record shall show the
  251  date and reason for termination.
  252         (2) Patient records shall be retained for a period of 5 6
  253  years after termination of hospice services, unless otherwise
  254  provided by law. In the case of a patient who is a minor, the 5
  255  6-year period shall begin on the date the patient reaches or
  256  would have reached the age of majority.
  257         (3) The interdisciplinary record of patient records of care
  258  and billing records are confidential.
  259         (4) A hospice may not release a patient’s interdisciplinary
  260  record or any portion thereof, unless the person requesting the
  261  information provides to the hospice:
  262         (a) A patient authorization executed by the patient; or
  263  legal guardian has given express written informed consent;
  264         (b) If the patient is incapacitated, a patient
  265  authorization executed before the patient’s death by the
  266  patient’s then acting legal guardian, health care surrogate,
  267  health care proxy, or agent under power of attorney;
  268         (c)A court order appointing the person as the
  269  administrator, curator, executor, or personal representative of
  270  the patient’s estate with authority to obtain the patient’s
  271  medical records;
  272         (d) If a judicial appointment has not been made pursuant to
  273  paragraph (c), a last will that is self-proved under s. 732.503
  274  and designates the person to act as the patient’s personal
  275  representative; or
  276         (e)An order by a court of competent jurisdiction to
  277  release the interdisciplinary record to the person has so
  278  ordered; or
  279         (c) A state or federal agency, acting under its statutory
  280  authority, requires submission of aggregate statistical data.
  281  Any information obtained from patient records by a state agency
  282  pursuant to its statutory authority is confidential and exempt
  283  from the provisions of s. 119.07(1).
  284         (5) For purposes of this section, the term “patient
  285  authorization” means an unrevoked written statement by the
  286  patient, or an oral statement made by the patient which has been
  287  reduced to writing in the patient’s interdisciplinary record of
  288  care, or, in the case of an incapacitated patient, by the
  289  patient’s then acting legal guardian, health care surrogate,
  290  agent under a power of attorney, or health care proxy giving the
  291  patient’s permission to release the interdisciplinary record to
  292  a person requesting the record.
  293         (6) A hospice must release requested aggregate patient
  294  statistical data to a state or federal agency acting under its
  295  statutory authority. Any information obtained from patient
  296  records by a state agency pursuant to its statutory authority is
  297  confidential and exempt from s. 119.07(1).
  298         Section 9. This act shall take effect July 1, 2017.
  300  ================= T I T L E  A M E N D M E N T ================
  301  And the title is amended as follows:
  302         Delete everything before the enacting clause
  303  and insert:
  304                        A bill to be entitled                      
  305         An act relating to hospice care; amending s. 400.6005,
  306         F.S.; revising legislative findings and intent;
  307         amending s. 400.601, F.S.; redefining the term
  308         “hospice”; defining the terms “hospice program” and
  309         “seriously ill”; amending s. 400.60501, F.S.;
  310         requiring the Department of Elderly Affairs, in
  311         conjunction with the Agency for Health Care
  312         Administration, to adopt national hospice outcome
  313         measures by a specified date and to make such measures
  314         available to the public; amending s. 400.609;
  315         clarifying provisions relating to hospice services;
  316         creating s. 400.6093, F.S.; authorizing hospices, or
  317         providers operating under contract with a hospice, to
  318         provide palliative care to seriously ill persons and
  319         their family members; providing construction; amending
  320         s. 400.6095, F.S.; making technical changes; creating
  321         s. 400.6096, F.S.; authorizing certain hospice
  322         personnel to assist in the disposal of certain
  323         prescribed controlled substances; requiring a hospice
  324         that chooses to assist in the disposal of certain
  325         prescribed controlled substances to establish
  326         policies, procedures, and systems for the disposal;
  327         authorizing a hospice physician, nurse, or social
  328         worker to assist in the disposals of certain
  329         prescribed controlled substances; providing
  330         requirements for such disposals; amending s. 400.611,
  331         F.S.; requiring a hospice to maintain an up-to-date
  332         interdisciplinary record of care; revising the patient
  333         records retention period; providing for the
  334         confidentiality of the interdisciplinary record of
  335         patient care; specifying to whom and under what
  336         conditions a hospice may release a patient’s
  337         interdisciplinary record of care; defining a term;
  338         requiring a hospice to release patient statistical
  339         data to certain agencies; specifying that information
  340         from patient records is confidential and exempt from
  341         certain provisions; providing an effective date.