Florida Senate - 2022 COMMITTEE AMENDMENT
Bill No. CS for SB 804
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LEGISLATIVE ACTION
Senate . House
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The Committee on Rules (Gibson) recommended the following:
1 Senate Amendment
2
3 Delete lines 119 - 313
4 and insert:
5 b. A minimum certified nursing assistant staffing of 2.5
6 hours of direct care by a certified nursing assistant per
7 resident per day. A facility may not staff below a ratio of one
8 certified nursing assistant per 20 residents.
9 c. A minimum licensed nursing staffing of 1.0 hour of
10 direct care by a licensed nurse per resident per day. A facility
11 may not staff below a ratio of one licensed nurse per 40
12 residents.
13 2. Nursing assistants employed under s. 400.211(2) may be
14 included in computing the hours of direct care provided by
15 certified nursing assistants and may be included in computing
16 the staffing ratio for certified nursing assistants if their job
17 responsibilities include only nursing-assistant-related duties.
18 3. Each nursing home facility must document compliance with
19 staffing standards as required under this paragraph and post
20 daily the names of licensed nurses and certified nursing
21 assistants staff on duty for the benefit of facility residents
22 and the public. Facilities must maintain the records documenting
23 compliance with minimum staffing standards for a period of 5
24 years and must report staffing in accordance with 42 C.F.R. s.
25 483.70(q).
26 4. The agency must shall recognize the use of licensed
27 nurses for compliance with minimum staffing requirements for
28 certified nursing assistants if the nursing home facility
29 otherwise meets the minimum staffing requirements for licensed
30 nurses and the licensed nurses are performing the duties of a
31 certified nursing assistant. Unless otherwise approved by the
32 agency, licensed nurses counted toward the minimum staffing
33 requirements for certified nursing assistants must exclusively
34 perform the duties of a certified nursing assistant for the
35 entire shift and not also be counted toward the minimum staffing
36 requirements for licensed nurses. If the agency approved a
37 facility’s request to use a licensed nurse to perform both
38 licensed nursing and certified nursing assistant duties, the
39 facility must allocate the amount of staff time specifically
40 spent on certified nursing assistant duties for the purpose of
41 documenting compliance with minimum staffing requirements for
42 certified and licensed nursing staff. The hours of a licensed
43 nurse with dual job responsibilities may not be counted twice.
44 5. The nurse staffing requirements imposed in this
45 paragraph are minimum nurse staffing requirements for nursing
46 home facilities. Evidence that a facility complied with the
47 minimum direct care staffing requirements under subparagraph 1.
48 is not admissible as evidence of compliance with the nursing
49 services requirements under 42 C.F.R. s. 483.35 or 42 C.F.R. s.
50 483.70.
51 (c)(b) Paid feeding assistants and direct care staff, other
52 than certified nursing assistants, who have successfully
53 completed the feeding assistant training program under s.
54 400.141(1)(v) and who provide nonnursing staff providing eating
55 assistance to residents shall not count toward compliance with
56 overall direct care minimum staffing hours but not the hours of
57 direct care required for certified nursing assistants or
58 licensed nurses standards.
59 (d)(c) Licensed practical nurses licensed under chapter 464
60 who provide are providing nursing services in nursing home
61 facilities under this part may supervise the activities of other
62 licensed practical nurses, certified nursing assistants, and
63 other unlicensed personnel providing services in such facilities
64 in accordance with rules adopted by the Board of Nursing.
65 (e) The agency may adopt rules to implement this
66 subsection.
67 Section 3. Present subsection (2) of section 400.0234,
68 Florida Statutes, is redesignated as subsection (3), and a new
69 subsection (2) is added to that section, to read:
70 400.0234 Availability of facility records for investigation
71 of resident’s rights violations and defenses; penalty.—
72 (2) Forms filed with the agency pursuant to s. 408.061(5)
73 and (6) are not confidential or exempt from the provisions of s.
74 119.07(1) and s. 24(a), Art. I of the State Constitution and may
75 be discoverable and admissible in a civil action under this part
76 or an administrative action under this part or part II of
77 chapter 408.
78 Section 4. Subsection (4) of section 400.024, Florida
79 Statutes, is amended to read:
80 400.024 Failure to satisfy a judgment or settlement
81 agreement.—
82 (4) If, After the agency is placed on notice pursuant to
83 subsection (2), the following applies and:
84 (a) If the license is subject to renewal, the agency may
85 deny the license renewal unless compliance with this section is
86 achieved.; and
87 (b) If a change of ownership application for the facility
88 at issue is filed submitted by the licensee, by a person or
89 entity identified as having a controlling interest in the
90 licensee, or by a related party, the unsatisfied or undischarged
91 adverse final judgment under subsection (1) becomes the
92 responsibility and liability of the transferee, and the agency
93 shall deny the change of ownership application unless compliance
94 with this section is achieved.
95 (c) If a change of ownership application for the facility
96 at issue is filed by the licensee, by a person or entity
97 identified as having a controlling interest in the licensee, or
98 by a related party, then:
99 1. The licensee or transferor must provide written notice
100 of the filing of the application to each pending claimant or the
101 claimant’s attorney of record, if applicable, within 14 days
102 after the date the application is filed with the agency.
103 2. The written notice must be provided by certified mail,
104 return receipt requested, or other method that provides
105 verification of receipt.
106 3. A claimant has 30 days after the date of receipt of the
107 written notice to object to the application if the claimant has
108 reason to believe that the approval of the application would
109 facilitate a fraudulent transfer or allow the transferor to
110 avoid financial responsibility for the claimant’s pending claim.
111 4. The agency must consider any objection brought pursuant
112 to this subsection in its decision to approve or deny an
113 application for change of ownership under this part and part II
114 of chapter 408.
115 5. If a claim is pending in arbitration at the time that
116 the application for change of ownership is filed, the claimant
117 may file a petition to enjoin the transfer in circuit court.
118 6. As used in this paragraph, “claimant” means a resident
119 or the resident’s family or personal representative who has
120 notified the licensee or facility of a potential claim by notice
121 of intent letter or who has initiated an action, claim, or
122 arbitration proceeding against the licensee or facility.
123 Section 5. Paragraphs (g), (n), and (r) of subsection (1)
124 of section 400.141, Florida Statutes, are amended to read:
125 400.141 Administration and management of nursing home
126 facilities.—
127 (1) Every licensed facility shall comply with all
128 applicable standards and rules of the agency and shall:
129 (g) If the facility has a standard license, exceeds the
130 minimum required hours of direct care provided by licensed
131 nurses nursing and certified nursing assistants assistant direct
132 care per resident per day, and is part of a continuing care
133 facility licensed under chapter 651 or is a retirement community
134 that offers other services pursuant to part III of this chapter
135 or part I or part III of chapter 429 on a single campus, be
136 allowed to share programming and staff. At the time of
137 inspection, a continuing care facility or retirement community
138 that uses this option must demonstrate through staffing records
139 that minimum staffing requirements for the facility were met.
140 Licensed nurses and certified nursing assistants who work in the
141 facility may be used to provide services elsewhere on campus if
142 the facility exceeds the minimum number of direct care hours
143 required per resident per day and the total number of residents
144 receiving direct care services from a licensed nurse or a
145 certified nursing assistant does not cause the facility to
146 violate the staffing ratios required under s. 400.23(3)(b) s.
147 400.23(3)(a). Compliance with the minimum staffing ratios must
148 be based on the total number of residents receiving direct care
149 services, regardless of where they reside on campus. If the
150 facility receives a conditional license, it may not share staff
151 until the conditional license status ends. This paragraph does
152 not restrict the agency’s authority under federal or state law
153 to require additional staff if a facility is cited for
154 deficiencies in care which are caused by an insufficient number
155 of certified nursing assistants or licensed nurses. The agency
156 may adopt rules for the documentation necessary to determine
157 compliance with this provision.
158 (n) Comply with state minimum-staffing requirements:
159 1. The agency shall impose a moratorium on new admissions
160 for a facility that has failed for 48 consecutive hours to
161 comply with the minimum hours of direct care required to be
162 provided by a licensed nurse or certified nursing assistant. The
163 moratorium must be imposed until the facility is able to
164 document compliance with the minimum direct care hours required
165 per resident per day for licensed nurses and certified nursing
166 assistants state minimum-staffing requirements for 2 consecutive
167 days is prohibited from accepting new admissions until the
168 facility has achieved the minimum-staffing requirements for 6
169 consecutive days. For the purposes of this subparagraph, any
170 person who was a resident of the facility and was absent from
171 the facility for the purpose of receiving medical care at a
172 separate location or was on a leave of absence is not considered
173 a new admission. Failure by the facility to impose such an
174 admissions moratorium is subject to a $1,000 fine.
175 2. A facility that has a standard does not have a
176 conditional license may be cited for failure to comply with the
177 standards in s. 400.23(3)(b)1.b. and c. s. 400.23(3)(a)1.b. and
178 c. only if it has failed to meet those standards on 2
179 consecutive days or if it has failed to meet at least 97 percent
180 of those standards on any one day.
181 3. A facility that has a conditional license must be in
182 compliance with the standards in s. 400.23(3)(b) s. 400.23(3)(a)
183 at all times.
184 (r) Maintain in the medical record for each resident a
185 daily chart of direct care certified nursing assistant services
186 provided to the resident. The direct care staff certified
187 nursing assistant who is caring for the resident must complete
188 this record by the end of his or her shift. This record must
189 indicate assistance with activities of daily living, assistance
190 with eating, and assistance with drinking, and must record each
191 offering of nutrition and hydration for those residents whose
192 plan of care or assessment indicates a risk for malnutrition or
193 dehydration.
194 Section 6. Nursing Home Sustainability Task Force.—There is
195 created the Nursing Home Sustainability Task Force. The task
196 force shall review, analyze, and make recommendations specific
197 to the sustainability of the state’s model of providing quality
198 nursing home care. The task force shall consist of
199 representatives of nursing home providers, nurses, certified
200 nursing assistants, and aging advocates and other interested