Bill Text: FL S0184 | 2019 | Regular Session | Enrolled


Bill Title: Aging Programs

Spectrum: Bipartisan Bill

Status: (Passed) 2019-04-29 - Chapter No. 2019-11 [S0184 Detail]

Download: Florida-2019-S0184-Enrolled.html
       ENROLLED
       2019 Legislature                    CS for SB 184, 1st Engrossed
       
       
       
       
       
       
                                                              2019184er
    1  
    2         An act relating to aging programs; transferring the
    3         powers, duties, and functions of the Department of
    4         Elderly Affairs relating to hospices, assisted living
    5         facilities, adult family-care homes, and adult day
    6         care centers to the Agency for Health Care
    7         Administration; amending s. 20.41, F.S.; requiring the
    8         department to provide certain documents and
    9         information to the agency upon request; amending s.
   10         20.42, F.S.; establishing that the agency is the lead
   11         agency responsible for the regulation of hospices,
   12         assisted living facilities, adult day care centers,
   13         and adult family-care homes; amending ss. 400.605,
   14         400.60501, 400.6095, 400.610, 429.02, 429.17, 429.23,
   15         429.24, 429.255, 429.256, 429.27, 429.275, 429.31,
   16         429.34, 429.41, 429.42, 429.52, 429.54, 429.63,
   17         429.67, 429.71, 429.73, 429.75, 429.81, 429.929, and
   18         765.110, F.S.; conforming provisions to changes made
   19         by the act; providing an effective date.
   20          
   21  Be It Enacted by the Legislature of the State of Florida:
   22  
   23         Section 1. All powers, duties, functions, records,
   24  personnel, property, salary rate, budget authority, and
   25  administrative authority of the Department of Elderly Affairs
   26  relating to hospices, assisted living facilities, adult family
   27  care homes, and adult day care centers, and the administrative
   28  rules in chapters 58A-2, 58A-5, 58A-6, 58A-14, and 58T-1,
   29  Florida Administrative Code, are transferred by a type two
   30  transfer, as defined in s. 20.06(2), Florida Statutes, to the
   31  Agency for Health Care Administration.
   32         Section 2. Subsection (9) is added to section 20.41,
   33  Florida Statutes, to read:
   34         20.41 Department of Elderly Affairs.—There is created a
   35  Department of Elderly Affairs.
   36         (9) Upon request, the department shall provide the Agency
   37  for Health Care Administration with any documents and
   38  information needed for the agency’s regulation of hospices,
   39  assisted living facilities, adult family-care homes, and adult
   40  day care centers.
   41         Section 3. Subsection (3) of section 20.42, Florida
   42  Statutes, is amended to read:
   43         20.42 Agency for Health Care Administration.—
   44         (3) The department shall be the chief health policy and
   45  planning entity for the state. The department is responsible for
   46  health facility licensure, inspection, and regulatory
   47  enforcement; investigation of consumer complaints related to
   48  health care facilities and managed care plans; the
   49  implementation of the certificate of need program; the operation
   50  of the Florida Center for Health Information and Transparency;
   51  the administration of the Medicaid program; the administration
   52  of the contracts with the Florida Healthy Kids Corporation; the
   53  certification of health maintenance organizations and prepaid
   54  health clinics as set forth in part III of chapter 641; and any
   55  other duties prescribed by statute or agreement. The department
   56  is the lead agency responsible for the regulation of hospices,
   57  assisted living facilities, adult day care centers, and adult
   58  family-care homes.
   59         Section 4. Subsection (1) of section 400.605, Florida
   60  Statutes, is amended to read:
   61         400.605 Administration; forms; fees; rules; inspections;
   62  fines.—
   63         (1) The agency, in consultation with the department, may
   64  adopt rules to administer the requirements of part II of chapter
   65  408. The department, in consultation with the agency, shall by
   66  rule establish minimum standards and procedures for a hospice
   67  pursuant to this part. The rules must include:
   68         (a) The qualifications of professional and ancillary
   69  personnel to ensure the provision of appropriate and adequate
   70  hospice care.
   71         (b) Standards and procedures for the administrative
   72  management of a hospice.
   73         (c) Standards for hospice services that ensure the
   74  provision of quality patient care.
   75         (d) Components of a patient plan of care.
   76         (e) Procedures relating to the implementation of advanced
   77  directives and do-not-resuscitate orders.
   78         (f) Procedures for maintaining and ensuring confidentiality
   79  of patient records.
   80         (g) Standards for hospice care provided in freestanding
   81  inpatient facilities that are not otherwise licensed medical
   82  facilities and in residential care facilities such as nursing
   83  homes, assisted living facilities, adult family-care homes, and
   84  hospice residential units and facilities.
   85         (h) Components of a comprehensive emergency management
   86  plan, developed in consultation with the Department of Health,
   87  the Department of Elderly Affairs, and the Division of Emergency
   88  Management.
   89         (i) Standards and procedures relating to the establishment
   90  and activities of a quality assurance and utilization review
   91  committee.
   92         (j) Components and procedures relating to the collection of
   93  patient demographic data and other information on the provision
   94  of hospice care in this state.
   95         Section 5. Section 400.60501, Florida Statutes, is amended
   96  to read:
   97         400.60501 Outcome measures; adoption of federal quality
   98  measures; public reporting; annual report.—
   99         (1) No later than December 31, 2019, the department, in
  100  conjunction with the agency, shall adopt the national hospice
  101  outcome measures and survey data in 42 C.F.R. part 418 to
  102  determine the quality and effectiveness of hospice care for
  103  hospices licensed in the state.
  104         (2) The department, in conjunction with The agency, shall:
  105         (a) Make available to the public the national hospice
  106  outcome measures and survey data in a format that is
  107  comprehensible by a layperson and that allows a consumer to
  108  compare such measures of one or more hospices.
  109         (b) Develop an annual report that analyzes and evaluates
  110  the information collected under this act and any other data
  111  collection or reporting provisions of law.
  112         Section 6. Subsection (8) of section 400.6095, Florida
  113  Statutes, is amended to read:
  114         400.6095 Patient admission; assessment; plan of care;
  115  discharge; death.—
  116         (8) The hospice care team may withhold or withdraw
  117  cardiopulmonary resuscitation if presented with an order not to
  118  resuscitate executed pursuant to s. 401.45. The agency
  119  department shall adopt rules providing for the implementation of
  120  such orders. Hospice staff shall not be subject to criminal
  121  prosecution or civil liability, nor be considered to have
  122  engaged in negligent or unprofessional conduct, for withholding
  123  or withdrawing cardiopulmonary resuscitation pursuant to such an
  124  order and applicable rules. The absence of an order to
  125  resuscitate executed pursuant to s. 401.45 does not preclude a
  126  physician from withholding or withdrawing cardiopulmonary
  127  resuscitation as otherwise permitted by law.
  128         Section 7. Paragraph (b) of subsection (1) of section
  129  400.610, Florida Statutes, is amended to read:
  130         400.610 Administration and management of a hospice.—
  131         (1) A hospice shall have a clearly defined organized
  132  governing body, consisting of a minimum of seven persons who are
  133  representative of the general population of the community
  134  served. The governing body shall have autonomous authority and
  135  responsibility for the operation of the hospice and shall meet
  136  at least quarterly. The governing body shall:
  137         (b)1. Prepare and maintain a comprehensive emergency
  138  management plan that provides for continuing hospice services in
  139  the event of an emergency that is consistent with local special
  140  needs plans. The plan shall include provisions for ensuring
  141  continuing care to hospice patients who go to special needs
  142  shelters. The plan shall include the means by which the hospice
  143  provider will continue to provide staff to provide the same type
  144  and quantity of services to their patients who evacuate to
  145  special needs shelters which were being provided to those
  146  patients prior to evacuation. The plan is subject to review and
  147  approval by the county health department, except as provided in
  148  subparagraph 2. During its review, the county health department
  149  shall contact state and local health and medical stakeholders
  150  when necessary. The county health department shall complete its
  151  review to ensure that the plan complies with criteria in rules
  152  of the agency Department of Elderly Affairs within 90 days after
  153  receipt of the plan and shall either approve the plan or advise
  154  the hospice of necessary revisions. Hospice providers may
  155  establish links to local emergency operations centers to
  156  determine a mechanism by which to approach specific areas within
  157  a disaster area in order for the provider to reach its clients.
  158  A hospice shall demonstrate a good faith effort to comply with
  159  the requirements of this paragraph by documenting attempts of
  160  staff to follow procedures as outlined in the hospice’s
  161  comprehensive emergency management plan and to provide
  162  continuing care for those hospice clients who have been
  163  identified as needing alternative caregiver services in the
  164  event of an emergency.
  165         2. For any hospice that operates in more than one county,
  166  the Department of Health during its review shall contact state
  167  and local health and medical stakeholders when necessary. The
  168  Department of Health shall complete its review to ensure that
  169  the plan complies with criteria in rules of the agency
  170  Department of Elderly Affairs within 90 days after receipt of
  171  the plan and shall approve the plan or advise the hospice of
  172  necessary revisions. The Department of Health shall make every
  173  effort to avoid imposing differing requirements on a hospice
  174  that operates in more than one county as a result of differing
  175  or conflicting comprehensive plan requirements of the counties
  176  in which the hospice operates.
  177         Section 8. Subsections (13) and (17) of section 429.02,
  178  Florida Statutes, are amended to read:
  179         429.02 Definitions.—When used in this part, the term:
  180         (13) “Limited nursing services” means acts that may be
  181  performed by a person licensed under part I of chapter 464.
  182  Limited nursing services shall be for persons who meet the
  183  admission criteria established by the agency department for
  184  assisted living facilities but are and shall not be complex
  185  enough to require 24-hour nursing supervision and may include
  186  such services as the application and care of routine dressings,
  187  and care of casts, braces, and splints.
  188         (17) “Personal services” means direct physical assistance
  189  with or supervision of the activities of daily living, the self
  190  administration of medication, or other similar services that
  191  which the agency department may define by rule. The term may not
  192  be construed to mean the provision of medical, nursing, dental,
  193  or mental health services.
  194         Section 9. Subsection (6) of section 429.17, Florida
  195  Statutes, is amended to read:
  196         429.17 Expiration of license; renewal; conditional
  197  license.—
  198         (6) The agency department may by rule establish renewal
  199  procedures, identify forms, and specify documentation necessary
  200  to administer this section and. The agency, in consultation with
  201  the department, may adopt rules to administer the requirements
  202  of part II of chapter 408.
  203         Section 10. Subsection (10) of section 429.23, Florida
  204  Statutes, is amended to read:
  205         429.23 Internal risk management and quality assurance
  206  program; adverse incidents and reporting requirements.—
  207         (10) The agency Department of Elderly Affairs may adopt
  208  rules necessary to administer this section.
  209         Section 11. Subsection (8) of section 429.24, Florida
  210  Statutes, is amended to read:
  211         429.24 Contracts.—
  212         (8) The agency department may by rule clarify terms,
  213  establish procedures, clarify refund policies and contract
  214  provisions, and specify documentation as necessary to administer
  215  this section.
  216         Section 12. Subsections (4) and (5) of section 429.255,
  217  Florida Statutes, are amended to read:
  218         429.255 Use of personnel; emergency care.—
  219         (4) Facility staff may withhold or withdraw cardiopulmonary
  220  resuscitation or the use of an automated external defibrillator
  221  if presented with an order not to resuscitate executed pursuant
  222  to s. 401.45. The agency department shall adopt rules providing
  223  for the implementation of such orders. Facility staff and
  224  facilities may shall not be subject to criminal prosecution or
  225  civil liability, nor be considered to have engaged in negligent
  226  or unprofessional conduct, for withholding or withdrawing
  227  cardiopulmonary resuscitation or use of an automated external
  228  defibrillator pursuant to such an order and rules adopted by the
  229  agency department. The absence of an order to resuscitate
  230  executed pursuant to s. 401.45 does not preclude a physician
  231  from withholding or withdrawing cardiopulmonary resuscitation or
  232  use of an automated external defibrillator as otherwise
  233  permitted by law.
  234         (5) The agency Department of Elderly Affairs may adopt
  235  rules to implement the provisions of this section relating to
  236  use of an automated external defibrillator.
  237         Section 13. Subsection (6) of section 429.256, Florida
  238  Statutes, is amended to read:
  239         429.256 Assistance with self-administration of medication.—
  240         (6) The agency department may by rule establish facility
  241  procedures and interpret terms as necessary to implement this
  242  section.
  243         Section 14. Subsection (8) of section 429.27, Florida
  244  Statutes, is amended to read:
  245         429.27 Property and personal affairs of residents.—
  246         (8) The agency department may by rule clarify terms and
  247  specify procedures and documentation necessary to administer the
  248  provisions of this section relating to the proper management of
  249  residents’ funds and personal property and the execution of
  250  surety bonds.
  251         Section 15. Subsection (4) of section 429.275, Florida
  252  Statutes, is amended to read:
  253         429.275 Business practice; personnel records; liability
  254  insurance.—The assisted living facility shall be administered on
  255  a sound financial basis that is consistent with good business
  256  practices.
  257         (4) The agency department may by rule clarify terms,
  258  establish requirements for financial records, accounting
  259  procedures, personnel procedures, insurance coverage, and
  260  reporting procedures, and specify documentation as necessary to
  261  implement the requirements of this section.
  262         Section 16. Subsection (2) of section 429.31, Florida
  263  Statutes, is amended to read:
  264         429.31 Closing of facility; notice; penalty.—
  265         (2) Immediately upon the notice by the agency of the
  266  voluntary or involuntary termination of such operation, the
  267  agency shall monitor the transfer of residents to other
  268  facilities and ensure that residents’ rights are being
  269  protected. The agency department, in consultation with the
  270  Department of Children and Families, shall specify procedures
  271  for ensuring that all residents who receive services are
  272  appropriately relocated.
  273         Section 17. Subsection (1) of section 429.34, Florida
  274  Statutes, is amended to read:
  275         429.34 Right of entry and inspection.—
  276         (1) In addition to the requirements of s. 408.811, a duly
  277  designated officer or employee of the agency department, of the
  278  Department of Children and Families, of the Medicaid Fraud
  279  Control Unit of the Office of the Attorney General, or of the
  280  state or local fire marshal, or a representative of the State
  281  Long-Term Care Ombudsman Program or a member of the state or
  282  local long-term care ombudsman council has the right to enter
  283  unannounced upon and into the premises of any facility licensed
  284  under this part in order to determine the state of compliance
  285  with this part, part II of chapter 408, and applicable rules.
  286  Data collected by the State Long-Term Care Ombudsman Program,
  287  local long-term care ombudsman councils, or the state or local
  288  advocacy councils may be used by the agency in investigations
  289  involving violations of regulatory standards. A person specified
  290  in this section who knows or has reasonable cause to suspect
  291  that a vulnerable adult has been or is being abused, neglected,
  292  or exploited shall immediately report such knowledge or
  293  suspicion to the central abuse hotline pursuant to chapter 415.
  294         Section 18. Section 429.41, Florida Statutes, is amended to
  295  read:
  296         429.41 Rules establishing standards.—
  297         (1) It is the intent of the Legislature that rules
  298  published and enforced pursuant to this section shall include
  299  criteria by which a reasonable and consistent quality of
  300  resident care and quality of life may be ensured and the results
  301  of such resident care may be demonstrated. Such rules shall also
  302  ensure a safe and sanitary environment that is residential and
  303  noninstitutional in design or nature. It is further intended
  304  that reasonable efforts be made to accommodate the needs and
  305  preferences of residents to enhance the quality of life in a
  306  facility. Uniform firesafety standards for assisted living
  307  facilities shall be established by the State Fire Marshal
  308  pursuant to s. 633.206. The agency, in consultation with the
  309  department, may adopt rules to administer the requirements of
  310  part II of chapter 408. In order to provide safe and sanitary
  311  facilities and the highest quality of resident care
  312  accommodating the needs and preferences of residents, the agency
  313  department, in consultation with the agency, the Department of
  314  Children and Families, and the Department of Health, shall adopt
  315  rules, policies, and procedures to administer this part, which
  316  must include reasonable and fair minimum standards in relation
  317  to:
  318         (a) The requirements for and maintenance of facilities, not
  319  in conflict with chapter 553, relating to plumbing, heating,
  320  cooling, lighting, ventilation, living space, and other housing
  321  conditions, which will ensure the health, safety, and comfort of
  322  residents suitable to the size of the structure.
  323         1. Firesafety evacuation capability determination.—An
  324  evacuation capability evaluation for initial licensure shall be
  325  conducted within 6 months after the date of licensure.
  326         2. Firesafety requirements.—
  327         a. The National Fire Protection Association, Life Safety
  328  Code, NFPA 101 and 101A, current editions, shall be used in
  329  determining the uniform firesafety code adopted by the State
  330  Fire Marshal for assisted living facilities, pursuant to s.
  331  633.206.
  332         b. A local government or a utility may charge fees only in
  333  an amount not to exceed the actual expenses incurred by the
  334  local government or the utility relating to the installation and
  335  maintenance of an automatic fire sprinkler system in a licensed
  336  assisted living facility structure.
  337         c. All licensed facilities must have an annual fire
  338  inspection conducted by the local fire marshal or authority
  339  having jurisdiction.
  340         d. An assisted living facility that is issued a building
  341  permit or certificate of occupancy before July 1, 2016, may at
  342  its option and after notifying the authority having
  343  jurisdiction, remain under the provisions of the 1994 and 1995
  344  editions of the National Fire Protection Association, Life
  345  Safety Code, NFPA 101, and NFPA 101A. The facility opting to
  346  remain under such provisions may make repairs, modernizations,
  347  renovations, or additions to, or rehabilitate, the facility in
  348  compliance with NFPA 101, 1994 edition, and may utilize the
  349  alternative approaches to life safety in compliance with NFPA
  350  101A, 1995 edition. However, a facility for which a building
  351  permit or certificate of occupancy is issued before July 1,
  352  2016, that undergoes Level III building alteration or
  353  rehabilitation, as defined in the Florida Building Code, or
  354  seeks to utilize features not authorized under the 1994 or 1995
  355  editions of the Life Safety Code must thereafter comply with all
  356  aspects of the uniform firesafety standards established under s.
  357  633.206, and the Florida Fire Prevention Code, in effect for
  358  assisted living facilities as adopted by the State Fire Marshal.
  359         3. Resident elopement requirements.—Facilities are required
  360  to conduct a minimum of two resident elopement prevention and
  361  response drills per year. All administrators and direct care
  362  staff must participate in the drills, which shall include a
  363  review of procedures to address resident elopement. Facilities
  364  must document the implementation of the drills and ensure that
  365  the drills are conducted in a manner consistent with the
  366  facility’s resident elopement policies and procedures.
  367         (b) The preparation and annual update of a comprehensive
  368  emergency management plan. Such standards must be included in
  369  the rules adopted by the agency department after consultation
  370  with the Division of Emergency Management. At a minimum, the
  371  rules must provide for plan components that address emergency
  372  evacuation transportation; adequate sheltering arrangements;
  373  postdisaster activities, including provision of emergency power,
  374  food, and water; postdisaster transportation; supplies;
  375  staffing; emergency equipment; individual identification of
  376  residents and transfer of records; communication with families;
  377  and responses to family inquiries. The comprehensive emergency
  378  management plan is subject to review and approval by the local
  379  emergency management agency. During its review, the local
  380  emergency management agency shall ensure that the following
  381  agencies, at a minimum, are given the opportunity to review the
  382  plan: the Department of Elderly Affairs, the Department of
  383  Health, the Agency for Health Care Administration, and the
  384  Division of Emergency Management. Also, appropriate volunteer
  385  organizations must be given the opportunity to review the plan.
  386  The local emergency management agency shall complete its review
  387  within 60 days and either approve the plan or advise the
  388  facility of necessary revisions.
  389         (c) The number, training, and qualifications of all
  390  personnel having responsibility for the care of residents. The
  391  rules must require adequate staff to provide for the safety of
  392  all residents. Facilities licensed for 17 or more residents are
  393  required to maintain an alert staff for 24 hours per day.
  394         (d) All sanitary conditions within the facility and its
  395  surroundings which will ensure the health and comfort of
  396  residents. The rules must clearly delineate the responsibilities
  397  of the agency’s licensure and survey staff, the county health
  398  departments, and the local authority having jurisdiction over
  399  firesafety and ensure that inspections are not duplicative. The
  400  agency may collect fees for food service inspections conducted
  401  by the county health departments and transfer such fees to the
  402  Department of Health.
  403         (e) License application and license renewal, transfer of
  404  ownership, proper management of resident funds and personal
  405  property, surety bonds, resident contracts, refund policies,
  406  financial ability to operate, and facility and staff records.
  407         (f) Inspections, complaint investigations, moratoriums,
  408  classification of deficiencies, levying and enforcement of
  409  penalties, and use of income from fees and fines.
  410         (g) The enforcement of the resident bill of rights
  411  specified in s. 429.28.
  412         (h) The care and maintenance of residents, which must
  413  include, but is not limited to:
  414         1. The supervision of residents;
  415         2. The provision of personal services;
  416         3. The provision of, or arrangement for, social and leisure
  417  activities;
  418         4. The arrangement for appointments and transportation to
  419  appropriate medical, dental, nursing, or mental health services,
  420  as needed by residents;
  421         5. The management of medication;
  422         6. The nutritional needs of residents;
  423         7. Resident records; and
  424         8. Internal risk management and quality assurance.
  425         (i) Facilities holding a limited nursing, extended
  426  congregate care, or limited mental health license.
  427         (j) The establishment of specific criteria to define
  428  appropriateness of resident admission and continued residency in
  429  a facility holding a standard, limited nursing, extended
  430  congregate care, and limited mental health license.
  431         (k) The use of physical or chemical restraints. The use of
  432  physical restraints is limited to half-bed rails as prescribed
  433  and documented by the resident’s physician with the consent of
  434  the resident or, if applicable, the resident’s representative or
  435  designee or the resident’s surrogate, guardian, or attorney in
  436  fact. The use of chemical restraints is limited to prescribed
  437  dosages of medications authorized by the resident’s physician
  438  and must be consistent with the resident’s diagnosis. Residents
  439  who are receiving medications that can serve as chemical
  440  restraints must be evaluated by their physician at least
  441  annually to assess:
  442         1. The continued need for the medication.
  443         2. The level of the medication in the resident’s blood.
  444         3. The need for adjustments in the prescription.
  445         (l) The establishment of specific policies and procedures
  446  on resident elopement. Facilities shall conduct a minimum of two
  447  resident elopement drills each year. All administrators and
  448  direct care staff shall participate in the drills. Facilities
  449  shall document the drills.
  450         (2) In adopting any rules pursuant to this part, the
  451  department, in conjunction with the agency, shall make distinct
  452  standards for facilities based upon facility size; the types of
  453  care provided; the physical and mental capabilities and needs of
  454  residents; the type, frequency, and amount of services and care
  455  offered; and the staffing characteristics of the facility. Rules
  456  developed pursuant to this section may not restrict the use of
  457  shared staffing and shared programming in facilities that are
  458  part of retirement communities that provide multiple levels of
  459  care and otherwise meet the requirements of law and rule. If a
  460  continuing care facility licensed under chapter 651 or a
  461  retirement community offering multiple levels of care licenses a
  462  building or part of a building designated for independent living
  463  for assisted living, staffing requirements established in rule
  464  apply only to residents who receive personal, limited nursing,
  465  or extended congregate care services under this part. Such
  466  facilities shall retain a log listing the names and unit number
  467  for residents receiving these services. The log must be
  468  available to surveyors upon request. Except for uniform
  469  firesafety standards, the agency department shall adopt by rule
  470  separate and distinct standards for facilities with 16 or fewer
  471  beds and for facilities with 17 or more beds. The standards for
  472  facilities with 16 or fewer beds must be appropriate for a
  473  noninstitutional residential environment; however, the structure
  474  may not be more than two stories in height and all persons who
  475  cannot exit the facility unassisted in an emergency must reside
  476  on the first floor. The department, in conjunction with the
  477  agency, may make other distinctions among types of facilities as
  478  necessary to enforce this part. Where appropriate, the agency
  479  shall offer alternate solutions for complying with established
  480  standards, based on distinctions made by the department and the
  481  agency relative to the physical characteristics of facilities
  482  and the types of care offered.
  483         (3) The department shall submit a copy of proposed rules to
  484  the Speaker of the House of Representatives, the President of
  485  the Senate, and appropriate committees of substance for review
  486  and comment prior to the promulgation thereof. Rules adopted
  487  promulgated by the agency department shall encourage the
  488  development of homelike facilities that which promote the
  489  dignity, individuality, personal strengths, and decisionmaking
  490  ability of residents.
  491         (4) The agency, in consultation with the department, may
  492  waive rules adopted under promulgated pursuant to this part in
  493  order to demonstrate and evaluate innovative or cost-effective
  494  congregate care alternatives that which enable individuals to
  495  age in place. Such waivers may be granted only in instances
  496  where there is reasonable assurance that the health, safety, or
  497  welfare of residents will not be endangered. To apply for a
  498  waiver, the licensee shall submit to the agency a written
  499  description of the concept to be demonstrated, including goals,
  500  objectives, and anticipated benefits; the number and types of
  501  residents who will be affected, if applicable; a brief
  502  description of how the demonstration will be evaluated; and any
  503  other information deemed appropriate by the agency. Any facility
  504  granted a waiver shall submit a report of findings to the agency
  505  and the department within 12 months. At such time, the agency
  506  may renew or revoke the waiver or pursue any regulatory or
  507  statutory changes necessary to allow other facilities to adopt
  508  the same practices. The agency department may by rule clarify
  509  terms and establish waiver application procedures, criteria for
  510  reviewing waiver proposals, and procedures for reporting
  511  findings, as necessary to implement this subsection.
  512         (5) The agency may use an abbreviated biennial standard
  513  licensure inspection that consists of a review of key quality
  514  of-care standards in lieu of a full inspection in a facility
  515  that has a good record of past performance. However, a full
  516  inspection must be conducted in a facility that has a history of
  517  class I or class II violations, uncorrected class III
  518  violations, confirmed ombudsman council complaints, or confirmed
  519  licensure complaints, within the previous licensure period
  520  immediately preceding the inspection or if a potentially serious
  521  problem is identified during the abbreviated inspection. The
  522  agency, in consultation with the department, shall develop the
  523  key quality-of-care standards with input from the State Long
  524  Term Care Ombudsman Council and representatives of provider
  525  groups for incorporation into its rules.
  526         Section 19. Subsection (4) of section 429.42, Florida
  527  Statutes, is amended to read:
  528         429.42 Pharmacy and dietary services.—
  529         (4) The agency department may by rule establish procedures
  530  and specify documentation as necessary to implement this
  531  section.
  532         Section 20. Subsections (2), (3), (4), and (6) through (12)
  533  of section 429.52, Florida Statutes, are amended to read:
  534         429.52 Staff training and educational programs; core
  535  educational requirement.—
  536         (2) Administrators and other assisted living facility staff
  537  must meet minimum training and education requirements
  538  established by the agency Department of Elderly Affairs by rule.
  539  This training and education is intended to assist facilities to
  540  appropriately respond to the needs of residents, to maintain
  541  resident care and facility standards, and to meet licensure
  542  requirements.
  543         (3) The agency, in conjunction with providers, department
  544  shall develop establish a competency test and a minimum required
  545  score to indicate successful completion of the training and
  546  educational requirements. The competency test must be developed
  547  by the department in conjunction with the agency and providers.
  548  The required training and education must cover at least the
  549  following topics:
  550         (a) State law and rules relating to assisted living
  551  facilities.
  552         (b) Resident rights and identifying and reporting abuse,
  553  neglect, and exploitation.
  554         (c) Special needs of elderly persons, persons with mental
  555  illness, and persons with developmental disabilities and how to
  556  meet those needs.
  557         (d) Nutrition and food service, including acceptable
  558  sanitation practices for preparing, storing, and serving food.
  559         (e) Medication management, recordkeeping, and proper
  560  techniques for assisting residents with self-administered
  561  medication.
  562         (f) Firesafety requirements, including fire evacuation
  563  drill procedures and other emergency procedures.
  564         (g) Care of persons with Alzheimer’s disease and related
  565  disorders.
  566         (4) A new facility administrator must complete the required
  567  training and education, including the competency test, within 90
  568  days after date of employment as an administrator. Failure to do
  569  so is a violation of this part and subjects the violator to an
  570  administrative fine as prescribed in s. 429.19. Administrators
  571  licensed in accordance with part II of chapter 468 are exempt
  572  from this requirement. Other licensed professionals may be
  573  exempted, as determined by the agency department by rule.
  574         (6) Staff involved with the management of medications and
  575  assisting with the self-administration of medications under s.
  576  429.256 must complete a minimum of 6 additional hours of
  577  training provided by a registered nurse, a licensed pharmacist,
  578  or agency department staff. The agency department shall
  579  establish by rule the minimum requirements of this additional
  580  training.
  581         (7) Other facility staff shall participate in training
  582  relevant to their job duties as specified by rule of the agency
  583  department.
  584         (8) If the department or the agency determines that there
  585  are problems in a facility which that could be reduced through
  586  specific staff training or education beyond that already
  587  required under this section, the department or the agency may
  588  require, and provide, or cause to be provided, the training or
  589  education of any personal care staff in the facility.
  590         (9) The agency department shall adopt rules related to
  591  these training requirements, the competency test, necessary
  592  procedures, and competency test fees and shall adopt or contract
  593  with another entity to develop a curriculum, which shall be used
  594  as the minimum core training requirements. The agency department
  595  shall consult with representatives of stakeholder associations
  596  and agencies in the development of the curriculum.
  597         (10) The training required by this section other than the
  598  preservice orientation must be conducted by persons registered
  599  with the agency department as having the requisite experience
  600  and credentials to conduct the training. A person seeking to
  601  register as a trainer must provide the agency department with
  602  proof of completion of the minimum core training education
  603  requirements, successful passage of the competency test
  604  established under this section, and proof of compliance with the
  605  continuing education requirement in subsection (5).
  606         (11) A person seeking to register as a trainer must also:
  607         (a) Provide proof of completion of a 4-year degree from an
  608  accredited college or university and must have worked in a
  609  management position in an assisted living facility for 3 years
  610  after being core certified;
  611         (b) Have worked in a management position in an assisted
  612  living facility for 5 years after being core certified and have
  613  1 year of teaching experience as an educator or staff trainer
  614  for persons who work in assisted living facilities or other
  615  long-term care settings;
  616         (c) Have been previously employed as a core trainer for the
  617  agency or department; or
  618         (d) Meet other qualification criteria as defined in rule,
  619  which the agency department is authorized to adopt.
  620         (12) The agency department shall adopt rules to establish
  621  trainer registration requirements.
  622         Section 21. Section 429.54, Florida Statutes, is amended to
  623  read:
  624         429.54 Collection of information; local subsidy.—
  625         (1) To enable the agency department to collect the
  626  information requested by the Legislature regarding the actual
  627  cost of providing room, board, and personal care in facilities,
  628  the agency department is authorized to conduct field visits and
  629  audits of facilities as may be necessary. The owners of randomly
  630  sampled facilities shall submit such reports, audits, and
  631  accountings of cost as the agency department may require by
  632  rule; provided that such reports, audits, and accountings shall
  633  be the minimum necessary to implement the provisions of this
  634  section. Any facility selected to participate in the study shall
  635  cooperate with the agency department by providing cost of
  636  operation information to interviewers.
  637         (2) Local governments or organizations may contribute to
  638  the cost of care of local facility residents by further
  639  subsidizing the rate of state-authorized payment to such
  640  facilities. Implementation of local subsidy requires agency
  641  shall require departmental approval and may shall not result in
  642  reductions in the state supplement.
  643         Section 22. Subsections (4) and (5) of section 429.63,
  644  Florida Statutes, are amended to read:
  645         429.63 Legislative intent; purpose.—
  646         (4) The Legislature further finds and declares that
  647  licensure under this part is a public trust and a privilege, and
  648  not an entitlement. This principle must guide the finder of fact
  649  or trier of law at any administrative proceeding or circuit
  650  court action initiated by the agency department to enforce this
  651  part.
  652         (5) Rules of the agency department relating to adult
  653  family-care homes shall be as minimal and flexible as possible
  654  to ensure the protection of residents while minimizing the
  655  obstacles that could inhibit the establishment of adult family
  656  care homes.
  657         Section 23. Subsections (9), (10), and (11) of section
  658  429.67, Florida Statutes, are amended to read:
  659         429.67 Licensure.—
  660         (9) In addition to the license categories available in s.
  661  408.808, the agency may issue a conditional license to a
  662  provider for the purpose of bringing the adult family-care home
  663  into compliance with licensure requirements. A conditional
  664  license must be limited to a specific period, not exceeding 6
  665  months. The agency department shall, by rule, establish criteria
  666  for issuing conditional licenses.
  667         (10) The agency department may adopt rules to establish
  668  procedures, identify forms, specify documentation, and clarify
  669  terms, as necessary, to administer this section.
  670         (11) The agency may adopt rules to administer the
  671  requirements of part II of chapter 408.
  672         Section 24. Subsection (6) of section 429.71, Florida
  673  Statutes, is amended to read:
  674         429.71 Classification of deficiencies; administrative
  675  fines.—
  676         (6) The agency shall establish department shall set forth,
  677  by rule, notice requirements and procedures for correction of
  678  deficiencies.
  679         Section 25. Section 429.73, Florida Statutes, is amended to
  680  read:
  681         429.73 Rules and standards relating to adult family-care
  682  homes.—
  683         (1) The agency, in consultation with the department, may
  684  adopt rules to administer the requirements of part II of chapter
  685  408. The department, in consultation with the Department of
  686  Health and, the Department of Children and Families, and the
  687  agency shall, by rule, establish by rule minimum standards to
  688  ensure the health, safety, and well-being of each resident in
  689  the adult family-care home pursuant to this part. The rules must
  690  address:
  691         (a) Requirements for the physical site of the facility and
  692  facility maintenance.
  693         (b) Services that must be provided to all residents of an
  694  adult family-care home and standards for such services, which
  695  must include, but need not be limited to:
  696         1. Room and board.
  697         2. Assistance necessary to perform the activities of daily
  698  living.
  699         3. Assistance necessary to administer medication.
  700         4. Supervision of residents.
  701         5. Health monitoring.
  702         6. Social and leisure activities.
  703         (c) Standards and procedures for license application and
  704  annual license renewal, advertising, proper management of each
  705  resident’s funds and personal property and personal affairs,
  706  financial ability to operate, medication management,
  707  inspections, complaint investigations, and facility, staff, and
  708  resident records.
  709         (d) Qualifications, training, standards, and
  710  responsibilities for providers and staff.
  711         (e) Compliance with chapter 419, relating to community
  712  residential homes.
  713         (f) Criteria and procedures for determining the
  714  appropriateness of a resident’s placement and continued
  715  residency in an adult family-care home. A resident who requires
  716  24-hour nursing supervision may not be retained in an adult
  717  family-care home unless such resident is an enrolled hospice
  718  patient and the resident’s continued residency is mutually
  719  agreeable to the resident and the provider.
  720         (g) Procedures for providing notice and assuring the least
  721  possible disruption of residents’ lives when residents are
  722  relocated, an adult family-care home is closed, or the ownership
  723  of an adult family-care home is transferred.
  724         (h) Procedures to protect the residents’ rights as provided
  725  in s. 429.85.
  726         (i) Procedures to promote the growth of adult family-care
  727  homes as a component of a long-term care system.
  728         (j) Procedures to promote the goal of aging in place for
  729  residents of adult family-care homes.
  730         (2) The agency department shall by rule provide by rule
  731  minimum standards and procedures for emergencies. Pursuant to s.
  732  633.206, the State Fire Marshal, in consultation with the
  733  department and the agency, shall adopt uniform firesafety
  734  standards for adult family-care homes.
  735         (3) The agency department shall adopt rules providing for
  736  the implementation of orders not to resuscitate. The provider
  737  may withhold or withdraw cardiopulmonary resuscitation if
  738  presented with an order not to resuscitate executed pursuant to
  739  s. 401.45. The provider shall not be subject to criminal
  740  prosecution or civil liability, nor be considered to have
  741  engaged in negligent or unprofessional conduct, for withholding
  742  or withdrawing cardiopulmonary resuscitation pursuant to such an
  743  order and applicable rules.
  744         Section 26. Subsections (3), (4), and (5) of section
  745  429.75, Florida Statutes, are amended to read:
  746         429.75 Training and education programs.—
  747         (3) Providers must complete the training and education
  748  program within a reasonable time determined by the agency
  749  department. Failure to complete the training and education
  750  program within the time set by the agency department is a
  751  violation of this part and subjects the provider to revocation
  752  of the license.
  753         (4) If the Department of Children and Families or, the
  754  agency, or the department determines that there are problems in
  755  an adult family-care home which could be reduced through
  756  specific training or education beyond that required under this
  757  section, the agency may require the provider or staff to
  758  complete such training or education.
  759         (5) The agency department may adopt rules as necessary to
  760  administer this section.
  761         Section 27. Subsection (2) of section 429.81, Florida
  762  Statutes, is amended to read:
  763         429.81 Residency agreements.—
  764         (2) Each residency agreement must specify the personal care
  765  and accommodations to be provided by the adult family-care home,
  766  the rates or charges, a requirement of at least 30 days’ notice
  767  before a rate increase, and any other provisions required by
  768  rule of the agency department.
  769         Section 28. Section 429.929, Florida Statutes, is amended
  770  to read:
  771         429.929 Rules establishing standards.—
  772         (1) The agency, in consultation with the department, may
  773  adopt rules to administer the requirements of part II of chapter
  774  408. The Department of Elderly Affairs, in conjunction with the
  775  agency, shall adopt rules to implement the provisions of this
  776  part. The rules must include reasonable and fair standards. Any
  777  conflict between these standards and those that may be set forth
  778  in local, county, or municipal ordinances shall be resolved in
  779  favor of those having statewide effect. Such standards must
  780  relate to:
  781         (a) The maintenance of adult day care centers with respect
  782  to plumbing, heating, lighting, ventilation, and other building
  783  conditions, including adequate meeting space, to ensure the
  784  health, safety, and comfort of participants and protection from
  785  fire hazard. Such standards may not conflict with chapter 553
  786  and must be based upon the size of the structure and the number
  787  of participants.
  788         (b) The number and qualifications of all personnel employed
  789  by adult day care centers who have responsibilities for the care
  790  of participants.
  791         (c) All sanitary conditions within adult day care centers
  792  and their surroundings, including water supply, sewage disposal,
  793  food handling, and general hygiene, and maintenance of sanitary
  794  conditions, to ensure the health and comfort of participants.
  795         (d) Basic services provided by adult day care centers.
  796         (e) Supportive and optional services provided by adult day
  797  care centers.
  798         (f) Data and information relative to participants and
  799  programs of adult day care centers, including, but not limited
  800  to, the physical and mental capabilities and needs of the
  801  participants, the availability, frequency, and intensity of
  802  basic services and of supportive and optional services provided,
  803  the frequency of participation, the distances traveled by
  804  participants, the hours of operation, the number of referrals to
  805  other centers or elsewhere, and the incidence of illness.
  806         (g) Components of a comprehensive emergency management
  807  plan, developed in consultation with the Department of Health,
  808  the Agency for Health Care Administration, and the Division of
  809  Emergency Management.
  810         (2) Pursuant to this part, s. 408.811, and applicable
  811  rules, the agency may conduct an abbreviated biennial inspection
  812  of key quality-of-care standards, in lieu of a full inspection,
  813  of a center that has a record of good performance. However, the
  814  agency must conduct a full inspection of a center that has had
  815  one or more confirmed complaints within the licensure period
  816  immediately preceding the inspection or which has a serious
  817  problem identified during the abbreviated inspection. The agency
  818  shall develop the key quality-of-care standards, taking into
  819  consideration the comments and recommendations of the Department
  820  of Elderly Affairs and of provider groups. These standards shall
  821  be included in rules adopted by the agency Department of Elderly
  822  Affairs.
  823         Section 29. Subsection (4) of section 765.110, Florida
  824  Statutes, is amended to read:
  825         765.110 Health care facilities and providers; discipline.—
  826         (4) The Department of Elderly Affairs for hospices and, in
  827  consultation with the Department of Elderly Affairs, the
  828  Department of Health, in consultation with the Department of
  829  Elderly Affairs, for health care providers; the Agency for
  830  Health Care Administration for hospitals, hospices, nursing
  831  homes, home health agencies, and health maintenance
  832  organizations; and the Department of Children and Families for
  833  facilities subject to part I of chapter 394 shall adopt rules to
  834  implement this the provisions of the section.
  835         Section 30. This act shall take effect July 1, 2019.

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