Bill Text: FL S0760 | 2010 | Regular Session | Comm Sub

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Bill Title: Health Care [SPSC]

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2010-04-30 - Died in Committee on Policy & Steering Committee on Ways and Means, companion bill(s) passed, see CS/CS/SB 1412 (Ch. 2010-102) [S0760 Detail]

Download: Florida-2010-S0760-Comm_Sub.html

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Florida Senate - 2010                              CS for SB 760 
 
By the Committee on Health Regulation; and Senator Gaetz 
588-04383A-10                                          2010760c1 
1                        A bill to be entitled 
2         An act relating to health care; repealing s. 
3         112.0455(10)(e), F.S., relating to a prohibition 
4         against applying the Drug-Free Workplace Act 
5         retroactively; amending ss. 154.11, 395.3038, 400.925, 
6         400.9935, 408.05, 440.13, 627.645, 627.668, 627.669, 
7         627.736, 641.495, and 766.1015, F.S.; changing 
8         references to the Joint Commission on the 
9         Accreditation of Healthcare Organizations to the 
10         “Joint Commission”; amending s. 318.21, F.S.; 
11         requiring that a specified percentage of fines 
12         collected from certain civil penalties levied by 
13         county courts for traffic infractions be deposited 
14         into the Brain and Spinal Cord Injury Rehabilitation 
15         Trust Fund within the Department of Health for use for 
16         Medicaid recipients who have spinal cord injuries; 
17         amending s. 381.06014, F.S.; defining the term 
18         “volunteer donor”; requiring that certain blood 
19         establishments disclose specified information on the 
20         Internet; repealing s. 383.325, F.S., relating to 
21         records of licensed birth center facilities; amending 
22         s. 394.741 F.S.; changing references to the Council on 
23         Accreditation for Children and Family Services to the 
24         “Council on Accreditation”; amending s. 394.4787, 
25         F.S.; conforming a cross-reference; amending s. 
26         395.002, F.S.; redefining the term “accrediting 
27         organizations” as it relates to hospital licensure and 
28         regulation; deleting definitions of the terms “initial 
29         denial determination,” “private review agent,” 
30         “utilization review,” and “utilization review plan” as 
31         they relate to hospital licensure and regulation; 
32         amending s. 395.003, F.S.; deleting an obsolete 
33         provision; conforming a cross-reference; amending s. 
34         395.0193, F.S.; requiring the Division of Medical 
35         Quality Assurance within the Department of Health 
36         rather than the Agency for Health Care Administration 
37         to review certain peer review reports and disciplinary 
38         actions; amending s. 395.1023, F.S.; requiring a 
39         licensed facility to adopt a protocol to designate a 
40         physician to act as a liaison between the Department 
41         of Children and Family Services, rather than the 
42         Department of Health, and the licensed facility in 
43         cases involving suspected child abuse; amending s. 
44         395.1041, F.S., relating to emergency services; 
45         deleting obsolete provisions; repealing s. 395.1046, 
46         F.S., relating to the investigation of complaints 
47         regarding hospitals; amending s. 395.1055, F.S.; 
48         requiring the agency to adopt rules that ensure that 
49         licensed facility beds conform to certain standards as 
50         specified by the agency, the Florida Building Code, 
51         and the Florida Fire Prevention Code; amending s. 
52         395.10972, F.S.; changing a reference to the Florida 
53         Society of Healthcare Risk Management to the “Florida 
54         Society for Healthcare Risk Management and Patient 
55         Safety”; amending s. 395.2050, F.S.; providing that 
56         the federal Centers for Medicare and Medicaid 
57         Services, rather than the federal Health Care 
58         Financing Administration, designates organ procurement 
59         organizations; amending s. 395.3036, F.S.; correcting 
60         a cross-reference; repealing s. 395.3037, F.S.; 
61         deleting obsolete definitions; amending s. 395.602, 
62         F.S.; revising the definition of a “rural hospital” as 
63         it relates to hospital licensure and regulation; 
64         amending s. 400.021, F.S.; revising the definition of 
65         a “geriatric outpatient clinic” with regard to 
66         staffing; amending s. 400.0239, F.S.; deleting an 
67         obsolete provision; amending s. 400.0255, F.S.; 
68         correcting an obsolete cross-reference to 
69         administrative rules; amending s. 400.063, F.S.; 
70         removing an obsolete provision; amending s. 400.071, 
71         F.S.; revising the requirements for an application for 
72         a license to operate a nursing home facility; amending 
73         s. 400.0712, F.S.; deleting a provision related to the 
74         issuance of an inactive license to a nursing home; 
75         amending s. 400.111, F.S.; specifying that the 
76         required disclosure of a financial or ownership 
77         interest is contingent upon a request by the agency; 
78         amending s. 400.1183, F.S.; requiring nursing home 
79         facilities to maintain records of grievances for 
80         agency inspection; deleting a requirement that a 
81         facility report the number of grievances handled 
82         during the prior licensure period; amending s. 
83         400.141, F.S.; conforming a cross-reference; deleting 
84         the requirement that a facility submit to the agency 
85         information regarding a management company with which 
86         it has entered into an agreement; specifying a fine 
87         for a nursing facility’s failure to impose an 
88         admissions moratorium if it has failed to comply with 
89         state minimum-staffing requirements; deleting the 
90         requirement for a facility to report to the agency any 
91         filing of bankruptcy protection, divestiture, or 
92         corporate reorganization; amending s. 400.142, F.S.; 
93         removing obsolete provisions requiring the agency to 
94         adopt certain rules; repealing s. 400.147(10), F.S., 
95         relating to a requirement that a nursing home report 
96         any notice of a filing of a claim for a violation of a 
97         resident’s rights or a claim of negligence; repealing 
98         s. 400.148, F.S., relating to the Medicaid “Up-or-Out” 
99         Quality of Care Contract Management Program; amending 
100         s. 400.19, F.S.; authorizing the agency to verify the 
101         correction of certain violations without reinspection, 
102         even when they are related to resident rights or 
103         resident care, after an unannounced inspection of a 
104         nursing home; repealing s. 400.195, F.S., relating to 
105         reporting requirements; deleting obsolete provisions; 
106         amending s. 400.23, F.S.; changing a reference to the 
107         Division of Children’s Medical Services to the 
108         “Division of Children’s Medical Services Network”; 
109         deleting an obsolete provision; amending s. 400.275, 
110         F.S.; deleting a requirement that the agency ensure 
111         that a newly hired nursing home surveyor is assigned 
112         full time to a licensed nursing home to observe 
113         facility operations; amending ss. 400.484, 400.967, 
114         and 429.71, F.S.; redesignating class I, II, III, and 
115         IV deficiencies as class I, II, III, and IV 
116         “violations”; amending s. 400.606, F.S.; eliminating a 
117         requirement that the plan for the delivery of home, 
118         residential, and homelike inpatient hospice services 
119         for terminally ill patients and their families include 
120         projected annual operating costs; amending s. 400.607, 
121         F.S.; revising the grounds under which the agency may 
122         take administrative action against a hospice; amending 
123         s. 400.915, F.S.; correcting an obsolete cross 
124         reference to administrative rules; amending s. 
125         400.931, F.S.; deleting a provision allowing an 
126         applicant for a license to be a home medical equipment 
127         provider to submit a surety bond to the agency; 
128         amending s. 400.932, F.S.; revising the grounds under 
129         which the agency may take administrative action 
130         against a home medical equipment provider; amending s. 
131         400.933, F.S.; prohibiting a home medical equipment 
132         provider from providing a survey or inspection of an 
133         accrediting organization in lieu of periodic agency 
134         inspection if the provider’s licensure is conditional; 
135         amending s. 400.953, F.S.; deleting a requirement that 
136         the general manager of a home medical equipment 
137         provider annually sign an affidavit regarding the 
138         background screening of personnel; providing 
139         requirements for submission of the affidavit; amending 
140         s. 400.9905, F.S.; specifying that certain licensure 
141         requirements do not apply to certain orthotic, 
142         prosthetic, pediatric cardiology, or perinatology 
143         clinical facilities; redefining the term “portable 
144         service or equipment provider” as it relates to the 
145         Health Care Clinic Act; amending s. 400.991, F.S.; 
146         conforming a provision to changes made by the act; 
147         revising application requirements to show proof of 
148         financial ability to operate a health care clinic; 
149         amending s. 408.034, F.S.; prohibiting the agency from 
150         issuing a license to a health care facility that 
151         applies for a license to operate an intermediate care 
152         facility for developmentally disabled persons under 
153         certain circumstances; amending s. 408.036, F.S., 
154         relating to certificates of need; conforming a 
155         provision to changes made by the act; amending s. 
156         408.043, F.S.; requiring a freestanding facility or a 
157         part of the facility that is the inpatient hospice 
158         care component of a hospice to obtain a certificate of 
159         need, regardless of whether it is primarily engaged in 
160         providing inpatient care and related services; 
161         amending s. 408.061, F.S.; revising requirements for 
162         the reporting of certified data elements by health 
163         care facilities; amending s. 408.10, F.S.; authorizing 
164         the agency to provide staffing for a toll-free phone 
165         number for the purpose of handling consumer complaints 
166         regarding a health care facility; repealing s. 
167         408.802(11), F.S., relating to the applicability of 
168         the Health Care Licensing Procedures Act to private 
169         review agents; amending s. 408.804, F.S.; providing a 
170         criminal penalty for altering, defacing, or falsifying 
171         a license certificate of certain health care 
172         providers; providing civil penalties for displaying an 
173         altered, defaced, or falsified license certificate; 
174         amending s. 408.806, F.S.; requiring the agency to 
175         provide a courtesy notice to a licensee regarding the 
176         expiration of a licensee’s license; providing that 
177         failure of the agency to provide the courtesy notice 
178         or failure of the licensee to receive the notice does 
179         not excuse the licensee from timely renewing its 
180         license; providing that payment of the late fee is 
181         required for a later application; amending s. 408.810, 
182         F.S.; revising the requirements for obtaining and 
183         maintaining a license for certain health care 
184         providers and those who own a controlling interest in 
185         a health care provider; amending s. 408.813, F.S.; 
186         authorizing the agency to impose administrative fines 
187         for unclassified violations and identifying some of 
188         those violations; amending s. 408.815, F.S.; 
189         authorizing the agency to extend the expiration date 
190         of a license for the purpose of the safe and orderly 
191         discharge of clients; authorizing the agency to impose 
192         conditions on the extension; amending s. 409.906, 
193         F.S.; requiring the agency, in consultation with the 
194         Department of Elderly Affairs, to phase out the adult 
195         day health care waiver program; requiring adult day 
196         health care waiver providers, in consultation with 
197         resource centers for the aged, to assist in the 
198         transition of enrollees from the waiver program; 
199         repealing s. 409.221(4)(k), F.S., relating to the 
200         responsibility of the agency, the Department of 
201         Elderly Affairs, the Department of Health, the 
202         Department of Children and Family Services, and the 
203         Agency for Persons with Disabilities to review and 
204         assess the implementation of the consumer-directed 
205         care program and the agency’s responsibility to submit 
206         a report to the Legislature; repealing s. 
207         409.912(15)(e), (f), and (g), F.S., relating to a 
208         requirement that the Agency for Health Care 
209         Administration submit a report to the Legislature 
210         regarding the operation of the CARES program; amending 
211         s. 429.07, F.S.; deleting the requirement for an 
212         assisted living facility to obtain an additional 
213         license in order to provide limited nursing services; 
214         deleting the requirement for the Agency for Health 
215         Care Administration to conduct quarterly monitoring 
216         visits of facilities that hold a license to provide 
217         extended congregate care services; deleting the 
218         requirement for the Department of Elderly Affairs to 
219         report annually on the status of and recommendations 
220         related to extended congregate care; deleting the 
221         requirement for the Agency for Health Care 
222         Administration to conduct monitoring visits at least 
223         twice a year to facilities providing limited nursing 
224         services; increasing the licensure fees and the 
225         maximum fee required for a standard license; 
226         increasing the licensure fees for the extended 
227         congregate care license; eliminating the license fee 
228         for the limited nursing services license; transferring 
229         from another provision of law the requirement that a 
230         biennial survey of an assisted living facility include 
231         specific actions to determine whether the facility is 
232         adequately protecting residents’ rights; providing 
233         that an assisted living facility that has been cited 
234         for certain violations is subject to monitoring 
235         visits; requiring a registered nurse to participate in 
236         certain monitoring visits; amending s. 429.11, F.S.; 
237         deleting a provision authorizing issuance of a 
238         provisional license to operate as an assisted living 
239         facility; repealing s. 429.12(2), F.S., relating to 
240         the sale or transfer of ownership of an assisted 
241         living facility; amending s. 429.14, F.S.; authorizing 
242         the agency to provide to the Division of Hotels and 
243         Restaurants of the Department of Business and 
244         Professional Regulation, by electronic means or 
245         through the agency’s website, information regarding 
246         the denial, suspension, or revocation of a license; 
247         amending s. 429.17, F.S.; deleting provisions related 
248         to the limited nursing services license; revising the 
249         requirements for a conditional license to operate an 
250         assisted living facility; amending s. 429.19, F.S.; 
251         clarifying that a monitoring fee may be assessed in 
252         addition to an administrative fine; repealing s. 
253         429.23(5), F.S., relating to a requirement that each 
254         assisted living facility submit a report to the agency 
255         regarding liability claims filed against it; amending 
256         s. 429.255, F.S.; eliminating provisions authorizing 
257         the use of volunteers to provide certain health-care 
258         related services in assisted living facilities; 
259         authorizing assisted living facilities to provide 
260         limited nursing services; requiring an assisted living 
261         facility to be responsible for certain recordkeeping 
262         and staff to be trained to monitor residents receiving 
263         certain health-care-related services; repealing s. 
264         429.28(3), F.S., relating to a requirement for a 
265         biennial survey of an assisted living facility, to 
266         conform to changes made by the act; amending s. 
267         429.35, F.S.; authorizing the agency to provide to the 
268         local ombudsman council, electronically or through the 
269         agency’s website, information regarding the results of 
270         an inspection; amending s. 429.41, F.S., relating to 
271         rulemaking; conforming provisions to changes made by 
272         the act; amending s. 429.53, F.S.; requiring the 
273         agency, rather than the agency’s area offices of 
274         licensure and certification, to provide consultation 
275         to certain persons and licensees regarding assisted 
276         living facilities; redefining the term “consultation” 
277         as it relates to assisted living facilities; amending 
278         s. 429.54, F.S.; requiring licensed assisted living 
279         facilities to electronically report certain data 
280         semiannually to the Agency for Health Care 
281         Administration in accordance with rules adopted by the 
282         Department of Elderly Affairs; amending s. 429.65, 
283         F.S.; redefining the term “adult family-care home” as 
284         it relates to the Adult Family-Care Home Act; 
285         repealing s. 429.901(5), F.S.; relating to the 
286         definition of the term “multiple or repeated 
287         violations”; repealing s. 429.911(2)(a), F.S.; 
288         deleting a ground for agency action against an adult 
289         day care center; amending s. 429.915, F.S.; revising 
290         requirements for a conditional license to operate an 
291         adult day care center; amending s. 430.80, F.S.; 
292         conforming a cross-reference; amending s. 483.201, 
293         F.S.; providing for disciplinary action against 
294         clinical laboratories failing to disclose specified 
295         information on the Internet; providing a maximum 
296         annual administrative fine that may be imposed 
297         annually against certain clinical laboratories for 
298         failure to comply with such disclosure requirement; 
299         amending s. 483.294, F.S.; requiring the agency to 
300         biennially, rather than at least annually, inspect the 
301         premises and operations of multiphasic health testing 
302         centers; amending s. 499.003, F.S.; revising the 
303         definition of the term “health care entity” to clarify 
304         that a blood establishment may be a health care entity 
305         and engage in certain activities; amending s. 499.005, 
306         F.S.; clarifying provisions prohibiting the 
307         unauthorized wholesale distribution of a prescription 
308         drug that was purchased by a hospital or other health 
309         care entity, to conform to changes made by the act; 
310         amending s. 499.01, F.S.; exempting certain blood 
311         establishments from the requirements to be permitted 
312         as a prescription drug manufacturer and register 
313         products; requiring that certain blood establishments 
314         obtain a restricted prescription drug distributor 
315         permit under specified conditions; limiting the 
316         prescription drugs that a blood establishment may 
317         distribute under the restricted prescription drug 
318         distributor permit; authorizing the Department of 
319         Health to adopt rules; providing effective dates. 
320 
321  Be It Enacted by the Legislature of the State of Florida: 
322 
323         Section 1. Paragraph (e) of subsection (10) of section 
324  112.0455, Florida Statutes, is repealed. 
325         Section 2. Paragraph (n) of subsection (1) of section 
326  154.11, Florida Statutes, is amended to read: 
327         154.11 Powers of board of trustees.— 
328         (1) The board of trustees of each public health trust shall 
329  be deemed to exercise a public and essential governmental 
330  function of both the state and the county and in furtherance 
331  thereof it shall, subject to limitation by the governing body of 
332  the county in which such board is located, have all of the 
333  powers necessary or convenient to carry out the operation and 
334  governance of designated health care facilities, including, but 
335  without limiting the generality of, the foregoing: 
336         (n) To make original appointments of appoint originally the 
337  staff of physicians to practice in any designated facility owned 
338  or operated by the board and to approve the bylaws and rules to 
339  be adopted by the medical staff of any designated facility owned 
340  and operated by the board., Such governing regulations must to 
341  be in accordance with the standards of the Joint Commission and 
342  must on the Accreditation of Hospitals which provide, among 
343  other things, for the method of appointing additional staff 
344  members and for the removal of staff members. 
345         Section 3. Subsection (15) of section 318.21, Florida 
346  Statutes, is amended to read: 
347         318.21 Disposition of civil penalties by county courts.—All 
348  civil penalties received by a county court pursuant to the 
349  provisions of this chapter shall be distributed and paid monthly 
350  as follows: 
351         (15) Of the additional fine assessed under s. 318.18(3)(e) 
352  for a violation of s. 316.1893, 50 percent of the moneys 
353  received from the fines shall be remitted to the Department of 
354  Revenue and deposited into the Brain and Spinal Cord Injury 
355  Trust Fund within the Department of Health and shall be 
356  appropriated to the Department of Health Agency for Health Care 
357  Administration as general revenue to provide an enhanced 
358  Medicaid payment to nursing homes that serve adult Medicaid 
359  recipients with brain and spinal cord injuries that are 
360  medically complex and that are technologically and respiratory 
361  dependent. The remaining 50 percent of the moneys received from 
362  the enhanced fine imposed under s. 318.18(3)(e) shall be 
363  remitted to the Department of Revenue and deposited into the 
364  Department of Health Administrative Trust Fund to provide 
365  financial support to certified trauma centers in the counties 
366  where enhanced penalty zones are established to ensure the 
367  availability and accessibility of trauma services. Funds 
368  deposited into the Administrative Trust Fund under this 
369  subsection shall be allocated as follows: 
370         (a) Fifty percent shall be allocated equally among all 
371  Level I, Level II, and pediatric trauma centers in recognition 
372  of readiness costs for maintaining trauma services. 
373         (b) Fifty percent shall be allocated among Level I, Level 
374  II, and pediatric trauma centers based on each center’s relative 
375  volume of trauma cases as reported in the Department of Health 
376  Trauma Registry. 
377         Section 4. Section 381.06014, Florida Statutes, is amended 
378  to read: 
379         381.06014 Blood establishments.— 
380         (1) As used in this section, the term: 
381         (a) “Blood establishment” means any person, entity, or 
382  organization, operating within the state, which examines an 
383  individual for the purpose of blood donation or which collects, 
384  processes, stores, tests, or distributes blood or blood 
385  components collected from the human body for the purpose of 
386  transfusion, for any other medical purpose, or for the 
387  production of any biological product. 
388         (b) “Volunteer donor” means a person who does not receive 
389  remuneration, other than an incentive, for a blood donation 
390  intended for transfusion, and the product container of the 
391  donation from the person qualifies for labeling with the 
392  statement “volunteer donor” under 21 C.F.R. 606.121. 
393         (2) Any blood establishment operating in the state may not 
394  conduct any activity defined in subsection (1) unless that blood 
395  establishment is operated in a manner consistent with the 
396  provisions of Title 21 parts 211 and 600-640, Code of Federal 
397  Regulations. 
398         (3) Any blood establishment determined to be operating in 
399  the state in a manner not consistent with the provisions of 
400  Title 21 parts 211 and 600-640, Code of Federal Regulations, and 
401  in a manner that constitutes a danger to the health or well 
402  being of donors or recipients as evidenced by the federal Food 
403  and Drug Administration’s inspection reports and the revocation 
404  of the blood establishment’s license or registration shall be in 
405  violation of this chapter and shall immediately cease all 
406  operations in the state. 
407         (4) The operation of a blood establishment in a manner not 
408  consistent with the provisions of Title 21 parts 211 and 600 
409  640, Code of Federal Regulations, and in a manner that 
410  constitutes a danger to the health or well-being of blood donors 
411  or recipients as evidenced by the federal Food and Drug 
412  Administration’s inspection process is declared a nuisance and 
413  inimical to the public health, welfare, and safety. The Agency 
414  for Health Care Administration or any state attorney may bring 
415  an action for an injunction to restrain such operations or 
416  enjoin the future operation of the blood establishment. 
417         (5) A blood establishment that collects blood or blood 
418  components from volunteer donors must disclose on the Internet 
419  information to educate and inform donors and the public about 
420  the blood establishment’s activities. A hospital that collects 
421  blood or blood components from volunteer donors for its own use 
422  or for health care providers that are part of its business 
423  entity is exempt from the disclosure requirements in this 
424  subsection. The information required to be disclosed under this 
425  subsection may be cumulative for all blood establishments within 
426  a business entity. Disciplinary action against the blood 
427  establishment’s clinical laboratory license may be taken as 
428  provided in s. 483.201 for a blood establishment that is 
429  required to disclose but fails to disclose on its website all of 
430  the following information: 
431         (a) A description of the steps involved in collecting, 
432  processing, and distributing volunteer donations, presented in a 
433  manner appropriate for the donating public. 
434         (b) By March 1 of each year, the number of units of blood 
435  components, identified by component, which were: 
436         1. Produced by the blood establishment during the preceding 
437  calendar year; 
438         2. Obtained from other sources during the preceding 
439  calendar year; 
440         3. Distributed during the preceding year to health care 
441  providers located outside this state. However, if the blood 
442  establishment collects donations in a county outside this state, 
443  distributions to health care providers in that county shall be 
444  excluded. Such information shall be aggregated by health care 
445  providers located within the United States and its territories 
446  or outside the United States and its territories; and 
447         4. Distributed to entities that are not health care 
448  providers during the preceding year. Such information shall be 
449  aggregated by purchasers located within the United States and 
450  its territories or outside the United States and its 
451  territories; 
452 
453  For purposes of this paragraph, the components that must be 
454  reported include whole blood, red blood cells, leukoreduced red 
455  blood cells, fresh frozen plasma or the equivalent, recovered 
456  plasma, platelets, and cryoprecipitated antihemophilic factor. 
457         (c) The blood establishment’s conflict-of-interest policy, 
458  policy concerning related-party transactions, whistleblower 
459  policy, and policy for determining executive compensation. If a 
460  change to any of these documents occurs, the revised document 
461  must be available on the blood establishment’s website by the 
462  following March 1. 
463         (d)1. The most recent 3 years of the Return of Organization 
464  Exempt from Income Tax, Internal Revenue Service Form 990, if 
465  the business entity for the blood establishment is eligible to 
466  file such return. The Form 990 must be available on the blood 
467  establishment’s website within 30 calendar days after filing it 
468  with the Internal Revenue Service; or 
469         2. If the business entity for the blood establishment is 
470  not eligible to file the Form 990 return, a balance sheet, 
471  income statement, statement of changes in cash flow, and the 
472  expression of an opinion thereon by an independent certified 
473  public accountant who audited or reviewed such financial 
474  statements. Such documents must be available on the blood 
475  establishment’s website within 120 days after the end of the 
476  blood establishment’s fiscal year and must remain on the blood 
477  establishment’s website for at least 36 months. 
478         Section 5. Section 383.325, Florida Statutes, is repealed. 
479         Section 6. Subsection (2) of section 394.741, Florida 
480  Statutes, is amended to read: 
481         394.741 Accreditation requirements for providers of 
482  behavioral health care services.— 
483         (2) Notwithstanding any provision of law to the contrary, 
484  accreditation shall be accepted by the agency and department in 
485  lieu of the agency’s and department’s facility licensure onsite 
486  review requirements and shall be accepted as a substitute for 
487  the department’s administrative and program monitoring 
488  requirements, except as required by subsections (3) and (4), 
489  for: 
490         (a) Any organization from which the department purchases 
491  behavioral health care services that is accredited by the Joint 
492  Commission on Accreditation of Healthcare Organizations or the 
493  Council on Accreditation for Children and Family Services, or 
494  has those services that are being purchased by the department 
495  accredited by CARF—the Rehabilitation Accreditation Commission. 
496         (b) Any mental health facility licensed by the agency or 
497  any substance abuse component licensed by the department that is 
498  accredited by the Joint Commission on Accreditation of 
499  Healthcare Organizations, CARF—the Rehabilitation Accreditation 
500  Commission, or the Council on Accreditation of Children and 
501  Family Services. 
502         (c) Any network of providers from which the department or 
503  the agency purchases behavioral health care services accredited 
504  by the Joint Commission on Accreditation of Healthcare 
505  Organizations, CARF—the Rehabilitation Accreditation Commission, 
506  the Council on Accreditation of Children and Family Services, or 
507  the National Committee for Quality Assurance. A provider 
508  organization that, which is part of an accredited network, is 
509  afforded the same rights under this part. 
510         Section 7. Subsection (7) of section 394.4787, Florida 
511  Statutes, is amended to read: 
512         394.4787 Definitions; ss. 394.4786, 394.4787, 394.4788, and 
513  394.4789.—As used in this section and ss. 394.4786, 394.4788, 
514  and 394.4789: 
515         (7) “Specialty psychiatric hospital” means a hospital 
516  licensed by the agency pursuant to s. 395.002(26) s. 395.002(28) 
517  and part II of chapter 408 as a specialty psychiatric hospital. 
518         Section 8. Section 395.002, Florida Statutes, is amended to 
519  read: 
520         395.002 Definitions.—As used in this chapter the term: 
521         (1) “Accrediting organizations” means nationally recognized 
522  or approved accrediting organizations whose standards 
523  incorporate comparable licensure requirements as determined by 
524  the agency the Joint Commission on Accreditation of Healthcare 
525  Organizations, the American Osteopathic Association, the 
526  Commission on Accreditation of Rehabilitation Facilities, and 
527  the Accreditation Association for Ambulatory Health Care, Inc. 
528         (2) “Agency” means the Agency for Health Care 
529  Administration. 
530         (3) “Ambulatory surgical center” or “mobile surgical 
531  facility” means a facility that has as its the primary purpose 
532  the provision of which is to provide elective surgical care, in 
533  which the patient is admitted to and discharged from the such 
534  facility within the same working day and is not permitted to 
535  stay overnight, and which is not part of a hospital. However, a 
536  facility existing for the primary purpose of performing 
537  terminations of pregnancy, an office maintained by a physician 
538  for the practice of medicine, or an office maintained for the 
539  practice of dentistry shall not be construed to be an ambulatory 
540  surgical center, provided that any facility or office that which 
541  is certified or seeks certification as a Medicare ambulatory 
542  surgical center shall be licensed as an ambulatory surgical 
543  center pursuant to s. 395.003. Any structure or vehicle in which 
544  a physician maintains an office and practices surgery, and which 
545  can appear to the public to be a mobile office because the 
546  structure or vehicle operates at more than one address, shall be 
547  construed to be a mobile surgical facility. 
548         (4) “Biomedical waste” means any solid or liquid waste as 
549  defined in s. 381.0098(2)(a). 
550         (5) “Clinical privileges” means the privileges granted to a 
551  physician or other licensed health care practitioner to render 
552  patient care services in a hospital, but does not include the 
553  privilege of admitting patients. 
554         (6) “Department” means the Department of Health. 
555         (7) “Director” means any member of the official board of 
556  directors as reported in the organization’s annual corporate 
557  report to the Florida Department of State, or, if no such report 
558  is made, any member of the operating board of directors. The 
559  term excludes members of separate, restricted boards that serve 
560  only in an advisory capacity to the operating board. 
561         (8) “Emergency medical condition” means: 
562         (a) A medical condition manifesting itself by acute 
563  symptoms of sufficient severity, which may include severe pain, 
564  such that the absence of immediate medical attention could 
565  reasonably be expected to result in any of the following: 
566         1. Serious jeopardy to patient health, including a pregnant 
567  woman or fetus. 
568         2. Serious impairment to bodily functions. 
569         3. Serious dysfunction of any bodily organ or part. 
570         (b) With respect to a pregnant woman: 
571         1. That there is inadequate time to effect safe transfer to 
572  another hospital prior to delivery; 
573         2. That a transfer may pose a threat to the health and 
574  safety of the patient or fetus; or 
575         3. That there is evidence of the onset and persistence of 
576  uterine contractions or rupture of the membranes. 
577         (9) “Emergency services and care” means medical screening, 
578  examination, and evaluation by a physician, or, to the extent 
579  permitted by applicable law, by other appropriate personnel 
580  under the supervision of a physician, to determine if an 
581  emergency medical condition exists and, if it does, the care, 
582  treatment, or surgery by a physician necessary to relieve or 
583  eliminate the emergency medical condition, within the service 
584  capability of the facility. 
585         (10) “General hospital” means any facility that which meets 
586  the provisions of subsection (12) and which regularly makes its 
587  facilities and services available to the general population. 
588         (11) “Governmental unit” means the state or any county, 
589  municipality, or other political subdivision, or any department, 
590  division, board, or other agency of any of the foregoing. 
591         (12) “Hospital” means any establishment that: 
592         (a) Offers services more intensive than those required for 
593  room, board, personal services, and general nursing care, and 
594  offers facilities and beds for use beyond 24 hours by 
595  individuals requiring diagnosis, treatment, or care for illness, 
596  injury, deformity, infirmity, abnormality, disease, or 
597  pregnancy; and 
598         (b) Regularly makes available at least clinical laboratory 
599  services, diagnostic X-ray services, and treatment facilities 
600  for surgery or obstetrical care, or other definitive medical 
601  treatment of similar extent, except that a critical access 
602  hospital, as defined in s. 408.07, shall not be required to make 
603  available treatment facilities for surgery, obstetrical care, or 
604  similar services as long as it maintains its critical access 
605  hospital designation and shall be required to make such 
606  facilities available only if it ceases to be designated as a 
607  critical access hospital. 
608 
609  However, the provisions of this chapter does do not apply to any 
610  institution conducted by or for the adherents of any well 
611  recognized church or religious denomination that depends 
612  exclusively upon prayer or spiritual means to heal, care for, or 
613  treat any person. For purposes of local zoning matters, the term 
614  “hospital” includes a medical office building located on the 
615  same premises as a hospital facility, provided the land on which 
616  the medical office building is constructed is zoned for use as a 
617  hospital; provided the premises were zoned for hospital purposes 
618  on January 1, 1992. 
619         (13) “Hospital bed” means a hospital accommodation that 
620  which is ready for immediate occupancy, or is capable of being 
621  made ready for occupancy within 48 hours, excluding provision of 
622  staffing, and which conforms to minimum space, equipment, and 
623  furnishings standards as specified by rule of the agency for the 
624  provision of services specified in this section to a single 
625  patient. 
626         (14) “Initial denial determination” means a determination 
627  by a private review agent that the health care services 
628  furnished or proposed to be furnished to a patient are 
629  inappropriate, not medically necessary, or not reasonable. 
630         (14)(15) “Intensive residential treatment programs for 
631  children and adolescents” means a specialty hospital accredited 
632  by an accrediting organization as defined in subsection (1) 
633  which provides 24-hour care and which has the primary functions 
634  of diagnosis and treatment of patients under the age of 18 
635  having psychiatric disorders in order to restore such patients 
636  to an optimal level of functioning. 
637         (15)(16) “Licensed facility” means a hospital, ambulatory 
638  surgical center, or mobile surgical facility licensed in 
639  accordance with this chapter. 
640         (16)(17) “Lifesafety” means the control and prevention of 
641  fire and other life-threatening conditions on a premises for the 
642  purpose of preserving human life. 
643         (17)(18) “Managing employee” means the administrator or 
644  other similarly titled individual who is responsible for the 
645  daily operation of the facility. 
646         (18)(19) “Medical staff” means physicians licensed under 
647  chapter 458 or chapter 459 with privileges in a licensed 
648  facility, as well as other licensed health care practitioners 
649  with clinical privileges as approved by a licensed facility’s 
650  governing board. 
651         (19)(20) “Medically necessary transfer” means a transfer 
652  made necessary because the patient is in immediate need of 
653  treatment for an emergency medical condition for which the 
654  facility lacks service capability or is at service capacity. 
655         (20)(21) “Mobile surgical facility” is a mobile facility in 
656  which licensed health care professionals provide elective 
657  surgical care under contract with the Department of Corrections 
658  or a private correctional facility operating pursuant to chapter 
659  957 and in which inmate patients are admitted to and discharged 
660  from said facility within the same working day and are not 
661  permitted to stay overnight. However, mobile surgical facilities 
662  may only provide health care services to the inmate patients of 
663  the Department of Corrections, or inmate patients of a private 
664  correctional facility operating pursuant to chapter 957, and not 
665  to the general public. 
666         (21)(22) “Person” means any individual, partnership, 
667  corporation, association, or governmental unit. 
668         (22)(23) “Premises” means those buildings, beds, and 
669  equipment located at the address of the licensed facility and 
670  all other buildings, beds, and equipment for the provision of 
671  hospital, ambulatory surgical, or mobile surgical care located 
672  in such reasonable proximity to the address of the licensed 
673  facility as to appear to the public to be under the dominion and 
674  control of the licensee. For any licensee that is a teaching 
675  hospital as defined in s. 408.07(45), reasonable proximity 
676  includes any buildings, beds, services, programs, and equipment 
677  under the dominion and control of the licensee that are located 
678  at a site with a main address that is within 1 mile of the main 
679  address of the licensed facility; and all such buildings, beds, 
680  and equipment may, at the request of a licensee or applicant, be 
681  included on the facility license as a single premises. 
682         (24) “Private review agent” means any person or entity 
683  which performs utilization review services for third-party 
684  payors on a contractual basis for outpatient or inpatient 
685  services. However, the term shall not include full-time 
686  employees, personnel, or staff of health insurers, health 
687  maintenance organizations, or hospitals, or wholly owned 
688  subsidiaries thereof or affiliates under common ownership, when 
689  performing utilization review for their respective hospitals, 
690  health maintenance organizations, or insureds of the same 
691  insurance group. For this purpose, health insurers, health 
692  maintenance organizations, and hospitals, or wholly owned 
693  subsidiaries thereof or affiliates under common ownership, 
694  include such entities engaged as administrators of self 
695  insurance as defined in s. 624.031. 
696         (23)(25) “Service capability” means all services offered by 
697  the facility where identification of services offered is 
698  evidenced by the appearance of the service in a patient’s 
699  medical record or itemized bill. 
700         (24)(26) “At service capacity” means the temporary 
701  inability of a hospital to provide a service that which is 
702  within the service capability of the hospital, due to maximum 
703  use of the service at the time of the request for the service. 
704         (25)(27) “Specialty bed” means a bed, other than a general 
705  bed, designated on the face of the hospital license for a 
706  dedicated use. 
707         (26)(28) “Specialty hospital” means any facility that which 
708  meets the provisions of subsection (12), and which regularly 
709  makes available either: 
710         (a) The range of medical services offered by general 
711  hospitals, but restricted to a defined age or gender group of 
712  the population; 
713         (b) A restricted range of services appropriate to the 
714  diagnosis, care, and treatment of patients with specific 
715  categories of medical or psychiatric illnesses or disorders; or 
716         (c) Intensive residential treatment programs for children 
717  and adolescents as defined in subsection (15). 
718         (27)(29) “Stabilized” means, with respect to an emergency 
719  medical condition, that no material deterioration of the 
720  condition is likely, within reasonable medical probability, to 
721  result from the transfer of the patient from a hospital. 
722         (30) “Utilization review” means a system for reviewing the 
723  medical necessity or appropriateness in the allocation of health 
724  care resources of hospital services given or proposed to be 
725  given to a patient or group of patients. 
726         (31) “Utilization review plan” means a description of the 
727  policies and procedures governing utilization review activities 
728  performed by a private review agent. 
729         (28)(32) “Validation inspection” means an inspection of the 
730  premises of a licensed facility by the agency to assess whether 
731  a review by an accrediting organization has adequately evaluated 
732  the licensed facility according to minimum state standards. 
733         Section 9. Subsection (1) and paragraph (b) of subsection 
734  (2) of section 395.003, Florida Statutes, are amended to read: 
735         395.003 Licensure; denial, suspension, and revocation.— 
736         (1)(a) The requirements of part II of chapter 408 apply to 
737  the provision of services that require licensure pursuant to ss. 
738  395.001-395.1065 and part II of chapter 408 and to entities 
739  licensed by or applying for such licensure from the Agency for 
740  Health Care Administration pursuant to ss. 395.001-395.1065. A 
741  license issued by the agency is required in order to operate a 
742  hospital, ambulatory surgical center, or mobile surgical 
743  facility in this state. 
744         (b)1. It is unlawful for a person to use or advertise to 
745  the public, in any way or by any medium whatsoever, any facility 
746  as a “hospital,” “ambulatory surgical center,” or “mobile 
747  surgical facility” unless such facility has first secured a 
748  license under the provisions of this part. 
749         2. This part does not apply to veterinary hospitals or to 
750  commercial business establishments using the word “hospital,” 
751  “ambulatory surgical center,” or “mobile surgical facility” as a 
752  part of a trade name if no treatment of human beings is 
753  performed on the premises of such establishments. 
754         (c) Until July 1, 2006, additional emergency departments 
755  located off the premises of licensed hospitals may not be 
756  authorized by the agency. 
757         (2) 
758         (b) The agency shall, at the request of a licensee that is 
759  a teaching hospital as defined in s. 408.07(45), issue a single 
760  license to a licensee for facilities that have been previously 
761  licensed as separate premises, provided such separately licensed 
762  facilities, taken together, constitute the same premises as 
763  defined in s. 395.002(22) s. 395.002(23). Such license for the 
764  single premises shall include all of the beds, services, and 
765  programs that were previously included on the licenses for the 
766  separate premises. The granting of a single license under this 
767  paragraph shall not in any manner reduce the number of beds, 
768  services, or programs operated by the licensee. 
769         Section 10. Paragraph (e) of subsection (2) and subsection 
770  (4) of section 395.0193, Florida Statutes, are amended to read: 
771         395.0193 Licensed facilities; peer review; disciplinary 
772  powers; agency or partnership with physicians.— 
773         (2) Each licensed facility, as a condition of licensure, 
774  shall provide for peer review of physicians who deliver health 
775  care services at the facility. Each licensed facility shall 
776  develop written, binding procedures by which such peer review 
777  shall be conducted. Such procedures shall include: 
778         (e) Recording of agendas and minutes that which do not 
779  contain confidential material, for review by the Division of 
780  Medical Quality Assurance of the department Health Quality 
781  Assurance of the agency. 
782         (4) Pursuant to ss. 458.337 and 459.016, any disciplinary 
783  actions taken under subsection (3) shall be reported in writing 
784  to the Division of Medical Quality Assurance of the department 
785  Health Quality Assurance of the agency within 30 working days 
786  after its initial occurrence, regardless of the pendency of 
787  appeals to the governing board of the hospital. The notification 
788  shall identify the disciplined practitioner, the action taken, 
789  and the reason for such action. All final disciplinary actions 
790  taken under subsection (3), if different from those which were 
791  reported to the department agency within 30 days after the 
792  initial occurrence, shall be reported within 10 working days to 
793  the Division of Medical Quality Assurance of the department 
794  Health Quality Assurance of the agency in writing and shall 
795  specify the disciplinary action taken and the specific grounds 
796  therefor. The division shall review each report and determine 
797  whether it potentially involved conduct by the licensee that is 
798  subject to disciplinary action, in which case s. 456.073 shall 
799  apply. The reports are not subject to inspection under s. 
800  119.07(1) even if the division’s investigation results in a 
801  finding of probable cause. 
802         Section 11. Section 395.1023, Florida Statutes, is amended 
803  to read: 
804         395.1023 Child abuse and neglect cases; duties.—Each 
805  licensed facility shall adopt a protocol that, at a minimum, 
806  requires the facility to: 
807         (1) Incorporate a facility policy that every staff member 
808  has an affirmative duty to report, pursuant to chapter 39, any 
809  actual or suspected case of child abuse, abandonment, or 
810  neglect; and 
811         (2) In any case involving suspected child abuse, 
812  abandonment, or neglect, designate, at the request of the 
813  Department of Children and Family Services department, a staff 
814  physician to act as a liaison between the hospital and the 
815  Department of Children and Family Services office that which is 
816  investigating the suspected abuse, abandonment, or neglect, and 
817  the child protection team, as defined in s. 39.01, when the case 
818  is referred to such a team. 
819 
820  Each general hospital and appropriate specialty hospital shall 
821  comply with the provisions of this section and shall notify the 
822  agency and the Department of Children and Family Services 
823  department of its compliance by sending a copy of its policy to 
824  the agency and the Department of Children and Family Services 
825  department as required by rule. The failure by a general 
826  hospital or appropriate specialty hospital to comply shall be 
827  punished by a fine not exceeding $1,000, to be fixed, imposed, 
828  and collected by the agency. Each day in violation is considered 
829  a separate offense. 
830         Section 12. Subsection (2) and paragraph (d) of subsection 
831  (3) of section 395.1041, Florida Statutes, are amended to read: 
832         395.1041 Access to emergency services and care.— 
833         (2) INVENTORY OF HOSPITAL EMERGENCY SERVICES.—The agency 
834  shall establish and maintain an inventory of hospitals with 
835  emergency services. The inventory shall list all services within 
836  the service capability of the hospital, and such services shall 
837  appear on the face of the hospital license. Each hospital having 
838  emergency services shall notify the agency of its service 
839  capability in the manner and form prescribed by the agency. The 
840  agency shall use the inventory to assist emergency medical 
841  services providers and others in locating appropriate emergency 
842  medical care. The inventory shall also be made available to the 
843  general public. On or before August 1, 1992, the agency shall 
844  request that each hospital identify the services which are 
845  within its service capability. On or before November 1, 1992, 
846  the agency shall notify each hospital of the service capability 
847  to be included in the inventory. The hospital has 15 days from 
848  the date of receipt to respond to the notice. By December 1, 
849  1992, the agency shall publish a final inventory. Each hospital 
850  shall reaffirm its service capability when its license is 
851  renewed and shall notify the agency of the addition of a new 
852  service or the termination of a service prior to a change in its 
853  service capability. 
854         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 
855  FACILITY OR HEALTH CARE PERSONNEL.— 
856         (d)1. Every hospital shall ensure the provision of services 
857  within the service capability of the hospital, at all times, 
858  either directly or indirectly through an arrangement with 
859  another hospital, through an arrangement with one or more 
860  physicians, or as otherwise made through prior arrangements. A 
861  hospital may enter into an agreement with another hospital for 
862  purposes of meeting its service capability requirement, and 
863  appropriate compensation or other reasonable conditions may be 
864  negotiated for these backup services. 
865         2. If any arrangement requires the provision of emergency 
866  medical transportation, such arrangement must be made in 
867  consultation with the applicable provider and may not require 
868  the emergency medical service provider to provide transportation 
869  that is outside the routine service area of that provider or in 
870  a manner that impairs the ability of the emergency medical 
871  service provider to timely respond to prehospital emergency 
872  calls. 
873         3. A hospital shall not be required to ensure service 
874  capability at all times as required in subparagraph 1. if, prior 
875  to the receiving of any patient needing such service capability, 
876  such hospital has demonstrated to the agency that it lacks the 
877  ability to ensure such capability and it has exhausted all 
878  reasonable efforts to ensure such capability through backup 
879  arrangements. In reviewing a hospital’s demonstration of lack of 
880  ability to ensure service capability, the agency shall consider 
881  factors relevant to the particular case, including the 
882  following: 
883         a. Number and proximity of hospitals with the same service 
884  capability. 
885         b. Number, type, credentials, and privileges of 
886  specialists. 
887         c. Frequency of procedures. 
888         d. Size of hospital. 
889         4. The agency shall publish proposed rules implementing a 
890  reasonable exemption procedure by November 1, 1992. Subparagraph 
891  1. shall become effective upon the effective date of said rules 
892  or January 31, 1993, whichever is earlier. For a period not to 
893  exceed 1 year from the effective date of subparagraph 1., a 
894  hospital requesting an exemption shall be deemed to be exempt 
895  from offering the service until the agency initially acts to 
896  deny or grant the original request. The agency has 45 days from 
897  the date of receipt of the request to approve or deny the 
898  request. After the first year from the effective date of 
899  subparagraph 1., If the agency fails to initially act within the 
900  time period, the hospital is deemed to be exempt from offering 
901  the service until the agency initially acts to deny the request. 
902         Section 13. Section 395.1046, Florida Statutes, is 
903  repealed. 
904         Section 14. Paragraph (e) of subsection (1) of section 
905  395.1055, Florida Statutes, is amended to read: 
906         395.1055 Rules and enforcement.— 
907         (1) The agency shall adopt rules pursuant to ss. 120.536(1) 
908  and 120.54 to implement the provisions of this part, which shall 
909  include reasonable and fair minimum standards for ensuring that: 
910         (e) Licensed facility beds conform to minimum space, 
911  equipment, and furnishings standards as specified by the agency, 
912  the Florida Building Code, and the Florida Fire Prevention Code 
913  department. 
914         Section 15. Subsection (1) of section 395.10972, Florida 
915  Statutes, is amended to read: 
916         395.10972 Health Care Risk Manager Advisory Council.—The 
917  Secretary of Health Care Administration may appoint a seven 
918  member advisory council to advise the agency on matters 
919  pertaining to health care risk managers. The members of the 
920  council shall serve at the pleasure of the secretary. The 
921  council shall designate a chair. The council shall meet at the 
922  call of the secretary or at those times as may be required by 
923  rule of the agency. The members of the advisory council shall 
924  receive no compensation for their services, but shall be 
925  reimbursed for travel expenses as provided in s. 112.061. The 
926  council shall consist of individuals representing the following 
927  areas: 
928         (1) Two shall be active health care risk managers, 
929  including one risk manager who is recommended by and a member of 
930  the Florida Society for of Healthcare Risk Management and 
931  Patient Safety. 
932         Section 16. Subsection (3) of section 395.2050, Florida 
933  Statutes, is amended to read: 
934         395.2050 Routine inquiry for organ and tissue donation; 
935  certification for procurement activities; death records review.— 
936         (3) Each organ procurement organization designated by the 
937  federal Centers for Medicare and Medicaid Services Health Care 
938  Financing Administration and licensed by the state shall conduct 
939  an annual death records review in the organ procurement 
940  organization’s affiliated donor hospitals. The organ procurement 
941  organization shall enlist the services of every Florida licensed 
942  tissue bank and eye bank affiliated with or providing service to 
943  the donor hospital and operating in the same service area to 
944  participate in the death records review. 
945         Section 17. Subsection (2) of section 395.3036, Florida 
946  Statutes, is amended to read: 
947         395.3036 Confidentiality of records and meetings of 
948  corporations that lease public hospitals or other public health 
949  care facilities.—The records of a private corporation that 
950  leases a public hospital or other public health care facility 
951  are confidential and exempt from the provisions of s. 119.07(1) 
952  and s. 24(a), Art. I of the State Constitution, and the meetings 
953  of the governing board of a private corporation are exempt from 
954  s. 286.011 and s. 24(b), Art. I of the State Constitution when 
955  the public lessor complies with the public finance 
956  accountability provisions of s. 155.40(5) with respect to the 
957  transfer of any public funds to the private lessee and when the 
958  private lessee meets at least three of the five following 
959  criteria: 
960         (2) The public lessor and the private lessee do not 
961  commingle any of their funds in any account maintained by either 
962  of them, other than the payment of the rent and administrative 
963  fees or the transfer of funds pursuant to subsection (5)(2). 
964         Section 18. Section 395.3037, Florida Statutes, is 
965  repealed. 
966         Section 19. Subsections (1), (4), and (5) of section 
967  395.3038, Florida Statutes, are amended to read: 
968         395.3038 State-listed primary stroke centers and 
969  comprehensive stroke centers; notification of hospitals.— 
970         (1) The agency shall make available on its website and to 
971  the department a list of the name and address of each hospital 
972  that meets the criteria for a primary stroke center and the name 
973  and address of each hospital that meets the criteria for a 
974  comprehensive stroke center. The list of primary and 
975  comprehensive stroke centers shall include only those hospitals 
976  that attest in an affidavit submitted to the agency that the 
977  hospital meets the named criteria, or those hospitals that 
978  attest in an affidavit submitted to the agency that the hospital 
979  is certified as a primary or a comprehensive stroke center by 
980  the Joint Commission on Accreditation of Healthcare 
981  Organizations. 
982         (4) The agency shall adopt by rule criteria for a primary 
983  stroke center which are substantially similar to the 
984  certification standards for primary stroke centers of the Joint 
985  Commission on Accreditation of Healthcare Organizations. 
986         (5) The agency shall adopt by rule criteria for a 
987  comprehensive stroke center. However, if the Joint Commission on 
988  Accreditation of Healthcare Organizations establishes criteria 
989  for a comprehensive stroke center, the agency shall establish 
990  criteria for a comprehensive stroke center which are 
991  substantially similar to those criteria established by the Joint 
992  Commission on Accreditation of Healthcare Organizations. 
993         Section 20. Subsection (2) of section 395.602, Florida 
994  Statutes, is amended to read: 
995         395.602 Rural hospitals.— 
996         (2) DEFINITIONS.—As used in this part: 
997         (a) “Emergency care hospital” means a medical facility that 
998  which provides: 
999         1. Emergency medical treatment; and 
1000         2. Inpatient care to ill or injured persons prior to their 
1001  transportation to another hospital or provides inpatient medical 
1002  care to persons needing care for a period of up to 96 hours. The 
1003  96-hour limitation on inpatient care does not apply to respite, 
1004  skilled nursing, hospice, or other nonacute care patients. 
1005         (b) “Essential access community hospital” means any 
1006  facility that which: 
1007         1. Has at least 100 beds; 
1008         2. Is located more than 35 miles from any other essential 
1009  access community hospital, rural referral center, or urban 
1010  hospital meeting criteria for classification as a regional 
1011  referral center; 
1012         3. Is part of a network that includes rural primary care 
1013  hospitals; 
1014         4. Provides emergency and medical backup services to rural 
1015  primary care hospitals in its rural health network; 
1016         5. Extends staff privileges to rural primary care hospital 
1017  physicians in its network; and 
1018         6. Accepts patients transferred from rural primary care 
1019  hospitals in its network. 
1020         (c) “Inactive rural hospital bed” means a licensed acute 
1021  care hospital bed, as defined in s. 395.002(13), that is 
1022  inactive in that it cannot be occupied by acute care inpatients. 
1023         (d) “Rural area health education center” means an area 
1024  health education center (AHEC), as authorized by Pub. L. No. 94 
1025  484, which provides services in a county with a population 
1026  density of no greater than 100 persons per square mile. 
1027         (e) “Rural hospital” means an acute care hospital licensed 
1028  under this chapter which has, having 100 or fewer licensed beds 
1029  and an emergency room and, which is: 
1030         1. The sole provider within a county with a population 
1031  density of no greater than 100 persons per square mile; 
1032         2. An acute care hospital, in a county with a population 
1033  density of no greater than 100 persons per square mile, which is 
1034  at least 30 minutes of travel time, on normally traveled roads 
1035  under normal traffic conditions, from any other acute care 
1036  hospital within the same county; 
1037         3. A hospital supported by a tax district or subdistrict 
1038  whose boundaries encompass a population of 100 persons or fewer 
1039  per square mile; 
1040         4. A hospital in a constitutional charter county with a 
1041  population of over 1 million persons that has imposed a local 
1042  option health service tax pursuant to law and in an area that 
1043  was directly impacted by a catastrophic event on August 24, 
1044  1992, for which the Governor of Florida declared a state of 
1045  emergency pursuant to chapter 125, and has 120 beds or less that 
1046  serves an agricultural community with an emergency room 
1047  utilization of no less than 20,000 visits and a Medicaid 
1048  inpatient utilization rate greater than 15 percent; 
1049         4.5. A hospital with a service area that has a population 
1050  of 100 persons or fewer per square mile. As used in this 
1051  subparagraph, the term “service area” means the fewest number of 
1052  zip codes that account for 75 percent of the hospital’s 
1053  discharges for the most recent 5-year period, based on 
1054  information available from the hospital inpatient discharge 
1055  database in the Florida Center for Health Information and Policy 
1056  Analysis at the Agency for Health Care Administration; or 
1057         5.6. A hospital designated as a critical access hospital, 
1058  as defined in s. 408.07(15). 
1059 
1060  Population densities used in this paragraph must be based upon 
1061  the most recently completed United States census. A hospital 
1062  that received funds under s. 409.9116 for a quarter beginning no 
1063  later than July 1, 2002, is deemed to have been and shall 
1064  continue to be a rural hospital from that date through June 30, 
1065  2015, if the hospital continues to have 100 or fewer licensed 
1066  beds and an emergency room, or meets the criteria of 
1067  subparagraph 4. An acute care hospital that has not previously 
1068  been designated as a rural hospital and that meets the criteria 
1069  of this paragraph shall be granted such designation upon 
1070  application, including supporting documentation to the Agency 
1071  for Health Care Administration. 
1072         (f) “Rural primary care hospital” means any facility 
1073  meeting the criteria in paragraph (e) or s. 395.605 which 
1074  provides: 
1075         1. Twenty-four-hour emergency medical care; 
1076         2. Temporary inpatient care for periods of 72 hours or less 
1077  to patients requiring stabilization before discharge or transfer 
1078  to another hospital. The 72-hour limitation does not apply to 
1079  respite, skilled nursing, hospice, or other nonacute care 
1080  patients; and 
1081         3. Has no more than six licensed acute care inpatient beds. 
1082         (g) “Swing-bed” means a bed that which can be used 
1083  interchangeably as either a hospital, skilled nursing facility 
1084  (SNF), or intermediate care facility (ICF) bed pursuant to 42 
1085  C.F.R. parts 405, 435, 440, 442, and 447. 
1086         Section 21. Subsection (8) of section 400.021, Florida 
1087  Statutes, is amended to read: 
1088         400.021 Definitions.—When used in this part, unless the 
1089  context otherwise requires, the term: 
1090         (8) “Geriatric outpatient clinic” means a site for 
1091  providing outpatient health care to persons 60 years of age or 
1092  older, which is staffed by a registered nurse or a physician 
1093  assistant, a licensed practical nurse under the direct 
1094  supervision of a registered nurse, or an advanced registered 
1095  nurse practitioner. 
1096         Section 22. Paragraph (g) of subsection (2) of section 
1097  400.0239, Florida Statutes, is amended to read: 
1098         400.0239 Quality of Long-Term Care Facility Improvement 
1099  Trust Fund.— 
1100         (2) Expenditures from the trust fund shall be allowable for 
1101  direct support of the following: 
1102         (g) Other initiatives authorized by the Centers for 
1103  Medicare and Medicaid Services for the use of federal civil 
1104  monetary penalties, including projects recommended through the 
1105  Medicaid “Up-or-Out” Quality of Care Contract Management Program 
1106  pursuant to s. 400.148. 
1107         Section 23. Subsection (15) of section 400.0255, Florida 
1108  Statutes, is amended to read 
1109         400.0255 Resident transfer or discharge; requirements and 
1110  procedures; hearings.— 
1111         (15)(a) The department’s Office of Appeals Hearings shall 
1112  conduct hearings under this section. The office shall notify the 
1113  facility of a resident’s request for a hearing. 
1114         (b) The department shall, by rule, establish procedures to 
1115  be used for fair hearings requested by residents. These 
1116  procedures shall be equivalent to the procedures used for fair 
1117  hearings for other Medicaid cases appearing in s.� 409.285 and 
1118  applicable rules, chapter 10-2, part VI, Florida Administrative 
1119  Code. The burden of proof must be clear and convincing evidence. 
1120  A hearing decision must be rendered within 90 days after receipt 
1121  of the request for hearing. 
1122         (c) If the hearing decision is favorable to the resident 
1123  who has been transferred or discharged, the resident must be 
1124  readmitted to the facility’s first available bed. 
1125         (d) The decision of the hearing officer shall be final. Any 
1126  aggrieved party may appeal the decision to the district court of 
1127  appeal in the appellate district where the facility is located. 
1128  Review procedures shall be conducted in accordance with the 
1129  Florida Rules of Appellate Procedure. 
1130         Section 24. Subsection (2) of section 400.063, Florida 
1131  Statutes, is amended to read: 
1132         400.063 Resident protection.— 
1133         (2) The agency is authorized to establish for each 
1134  facility, subject to intervention by the agency, a separate bank 
1135  account for the deposit to the credit of the agency of any 
1136  moneys received from the Health Care Trust Fund or any other 
1137  moneys received for the maintenance and care of residents in the 
1138  facility, and the agency is authorized to disburse moneys from 
1139  such account to pay obligations incurred for the purposes of 
1140  this section. The agency is authorized to requisition moneys 
1141  from the Health Care Trust Fund in advance of an actual need for 
1142  cash on the basis of an estimate by the agency of moneys to be 
1143  spent under the authority of this section. Any bank account 
1144  established under this section need not be approved in advance 
1145  of its creation as required by s. 17.58, but shall be secured by 
1146  depository insurance equal to or greater than the balance of 
1147  such account or by the pledge of collateral security in 
1148  conformance with criteria established in s. 18.11. The agency 
1149  shall notify the Chief Financial Officer of any such account so 
1150  established and shall make a quarterly accounting to the Chief 
1151  Financial Officer for all moneys deposited in such account. 
1152         Section 25. Subsections (1) and (5) of section 400.071, 
1153  Florida Statutes, are amended to read: 
1154         400.071 Application for license.— 
1155         (1) In addition to the requirements of part II of chapter 
1156  408, the application for a license shall be under oath and must 
1157  contain the following: 
1158         (a) The location of the facility for which a license is 
1159  sought and an indication, as in the original application, that 
1160  such location conforms to the local zoning ordinances. 
1161         (b) A signed affidavit disclosing any financial or 
1162  ownership interest that a controlling interest as defined in 
1163  part II of chapter 408 has held in the last 5 years in any 
1164  entity licensed by this state or any other state to provide 
1165  health or residential care which has closed voluntarily or 
1166  involuntarily; has filed for bankruptcy; has had a receiver 
1167  appointed; has had a license denied, suspended, or revoked; or 
1168  has had an injunction issued against it which was initiated by a 
1169  regulatory agency. The affidavit must disclose the reason any 
1170  such entity was closed, whether voluntarily or involuntarily. 
1171         (c) The total number of beds and the total number of 
1172  Medicare and Medicaid certified beds. 
1173         (b)(d) Information relating to the applicant and employees 
1174  which the agency requires by rule. The applicant must 
1175  demonstrate that sufficient numbers of qualified staff, by 
1176  training or experience, will be employed to properly care for 
1177  the type and number of residents who will reside in the 
1178  facility. 
1179         (c)(e) Copies of any civil verdict or judgment involving 
1180  the applicant rendered within the 10 years preceding the 
1181  application, relating to medical negligence, violation of 
1182  residents’ rights, or wrongful death. As a condition of 
1183  licensure, the licensee agrees to provide to the agency copies 
1184  of any new verdict or judgment involving the applicant, relating 
1185  to such matters, within 30 days after filing with the clerk of 
1186  the court. The information required in this paragraph shall be 
1187  maintained in the facility’s licensure file and in an agency 
1188  database that which is available as a public record. 
1189         (5) As a condition of licensure, each facility must 
1190  establish and submit with its application a plan for quality 
1191  assurance and for conducting risk management. 
1192         Section 26. Section 400.0712, Florida Statutes, is amended 
1193  to read: 
1194         400.0712 Application for inactive license.— 
1195         (1) As specified in this section, the agency may issue an 
1196  inactive license to a nursing home facility for all or a portion 
1197  of its beds. Any request by a licensee that a nursing home or 
1198  portion of a nursing home become inactive must be submitted to 
1199  the agency in the approved format. The facility may not initiate 
1200  any suspension of services, notify residents, or initiate 
1201  inactivity before receiving approval from the agency; and a 
1202  licensee that violates this provision may not be issued an 
1203  inactive license. 
1204         (1)(2) In addition to the authority granted in part II of 
1205  chapter 408, the agency may issue an inactive license to a 
1206  nursing home that chooses to use an unoccupied contiguous 
1207  portion of the facility for an alternative use to meet the needs 
1208  of elderly persons through the use of less restrictive, less 
1209  institutional services. 
1210         (a) An inactive license issued under this subsection may be 
1211  granted for a period not to exceed the current licensure 
1212  expiration date but may be renewed by the agency at the time of 
1213  licensure renewal. 
1214         (b) A request to extend the inactive license must be 
1215  submitted to the agency in the approved format and approved by 
1216  the agency in writing. 
1217         (c) Nursing homes that receive an inactive license to 
1218  provide alternative services shall not receive preference for 
1219  participation in the Assisted Living for the Elderly Medicaid 
1220  waiver. 
1221         (2)(3) The agency shall adopt rules pursuant to ss. 
1222  120.536(1) and 120.54 necessary to administer implement this 
1223  section. 
1224         Section 27. Section 400.111, Florida Statutes, is amended 
1225  to read: 
1226         400.111 Disclosure of controlling interest.—In addition to 
1227  the requirements of part II of chapter 408, when requested by 
1228  the agency, the licensee shall submit a signed affidavit 
1229  disclosing any financial or ownership interest that a 
1230  controlling interest has held within the last 5 years in any 
1231  entity licensed by the state or any other state to provide 
1232  health or residential care if that which entity has closed 
1233  voluntarily or involuntarily; has filed for bankruptcy; has had 
1234  a receiver appointed; has had a license denied, suspended, or 
1235  revoked; or has had an injunction issued against it which was 
1236  initiated by a regulatory agency. The affidavit must disclose 
1237  the reason such entity was closed, whether voluntarily or 
1238  involuntarily. 
1239         Section 28. Section 400.1183, Florida Statutes, is amended 
1240  to read: 
1241         400.1183 Resident grievance procedures.— 
1242         (1) Every nursing home must have a grievance procedure 
1243  available to its residents and their families. The grievance 
1244  procedure must include: 
1245         (a) An explanation of how to pursue redress of a grievance. 
1246         (b) The names, job titles, and telephone numbers of the 
1247  employees responsible for implementing the facility’s grievance 
1248  procedure. The list must include the address and the toll-free 
1249  telephone numbers of the ombudsman and the agency. 
1250         (c) A simple description of the process through which a 
1251  resident may, at any time, contact the toll-free telephone 
1252  hotline of the ombudsman or the agency to report the unresolved 
1253  grievance. 
1254         (d) A procedure for providing assistance to residents who 
1255  cannot prepare a written grievance without help. 
1256         (2) Each facility shall maintain records of all grievances 
1257  for agency inspection and shall report to the agency at the time 
1258  of relicensure the total number of grievances handled during the 
1259  prior licensure period, a categorization of the cases underlying 
1260  the grievances, and the final disposition of the grievances. 
1261         (3) Each facility must respond to the grievance within a 
1262  reasonable time after its submission. 
1263         (4) The agency may investigate any grievance at any time. 
1264         Section 29. Section 400.141, Florida Statutes, is amended 
1265  to read: 
1266         400.141 Administration and management of nursing home 
1267  facilities.— 
1268         (1) Every licensed facility shall comply with all 
1269  applicable standards and rules of the agency and shall: 
1270         (a) Be under the administrative direction and charge of a 
1271  licensed administrator. 
1272         (b) Appoint a medical director licensed pursuant to chapter 
1273  458 or chapter 459. The agency may establish by rule more 
1274  specific criteria for the appointment of a medical director. 
1275         (c) Have available the regular, consultative, and emergency 
1276  services of physicians licensed by the state. 
1277         (d) Provide for resident use of a community pharmacy as 
1278  specified in s. 400.022(1)(q). Any other law to the contrary 
1279  notwithstanding, a registered pharmacist licensed in Florida, 
1280  that is under contract with a facility licensed under this 
1281  chapter or chapter 429, shall repackage a nursing facility 
1282  resident’s bulk prescription medication that which has been 
1283  packaged by another pharmacist licensed in any state in the 
1284  United States into a unit dose system compatible with the system 
1285  used by the nursing facility, if the pharmacist is requested to 
1286  offer such service. In order to be eligible for the repackaging, 
1287  a resident or the resident’s spouse must receive prescription 
1288  medication benefits provided through a former employer as part 
1289  of his or her retirement benefits, a qualified pension plan as 
1290  specified in s. 4972 of the Internal Revenue Code, a federal 
1291  retirement program as specified under 5 C.F.R. s. 831, or a 
1292  long-term care policy as defined in s. 627.9404(1). A pharmacist 
1293  who correctly repackages and relabels the medication and the 
1294  nursing facility that which correctly administers such 
1295  repackaged medication under this paragraph may not be held 
1296  liable in any civil or administrative action arising from the 
1297  repackaging. In order to be eligible for the repackaging, a 
1298  nursing facility resident for whom the medication is to be 
1299  repackaged shall sign an informed consent form provided by the 
1300  facility which includes an explanation of the repackaging 
1301  process and which notifies the resident of the immunities from 
1302  liability provided in this paragraph. A pharmacist who 
1303  repackages and relabels prescription medications, as authorized 
1304  under this paragraph, may charge a reasonable fee for costs 
1305  resulting from the implementation of this provision. 
1306         (e) Provide for the access of the facility residents to 
1307  dental and other health-related services, recreational services, 
1308  rehabilitative services, and social work services appropriate to 
1309  their needs and conditions and not directly furnished by the 
1310  licensee. When a geriatric outpatient nurse clinic is conducted 
1311  in accordance with rules adopted by the agency, outpatients 
1312  attending such clinic shall not be counted as part of the 
1313  general resident population of the nursing home facility, nor 
1314  shall the nursing staff of the geriatric outpatient clinic be 
1315  counted as part of the nursing staff of the facility, until the 
1316  outpatient clinic load exceeds 15 a day. 
1317         (f) Be allowed and encouraged by the agency to provide 
1318  other needed services under certain conditions. If the facility 
1319  has a standard licensure status, and has had no class I or class 
1320  II violations deficiencies during the past 2 years or has been 
1321  awarded a Gold Seal under the program established in s. 400.235, 
1322  it may be encouraged by the agency to provide services, 
1323  including, but not limited to, respite and adult day services 
1324  that, which enable individuals to move in and out of the 
1325  facility. A facility is not subject to any additional licensure 
1326  requirements for providing these services. Respite care may be 
1327  offered to persons in need of short-term or temporary nursing 
1328  home services. Respite care must be provided in accordance with 
1329  this part and rules adopted by the agency. However, the agency 
1330  shall, by rule, adopt modified requirements for resident 
1331  assessment, resident care plans, resident contracts, physician 
1332  orders, and other provisions, as appropriate, for short-term or 
1333  temporary nursing home services. The agency shall allow for 
1334  shared programming and staff in a facility that which meets 
1335  minimum standards and offers services pursuant to this 
1336  paragraph, but, if the facility is cited for deficiencies in 
1337  patient care, may require additional staff and programs 
1338  appropriate to the needs of service recipients. A person who 
1339  receives respite care may not be counted as a resident of the 
1340  facility for purposes of the facility’s licensed capacity unless 
1341  that person receives 24-hour respite care. A person receiving 
1342  either respite care for 24 hours or longer or adult day services 
1343  must be included when calculating minimum staffing for the 
1344  facility. Any costs and revenues generated by a nursing home 
1345  facility from nonresidential programs or services shall be 
1346  excluded from the calculations of Medicaid per diems for nursing 
1347  home institutional care reimbursement. 
1348         (g) If the facility has a standard license or is a Gold 
1349  Seal facility, exceeds the minimum required hours of licensed 
1350  nursing and certified nursing assistant direct care per resident 
1351  per day, and is part of a continuing care facility licensed 
1352  under chapter 651 or a retirement community that offers other 
1353  services pursuant to part III of this chapter or part I or part 
1354  III of chapter 429 on a single campus, be allowed to share 
1355  programming and staff. At the time of inspection and in the 
1356  semiannual report required pursuant to paragraph (o), a 
1357  continuing care facility or retirement community that uses this 
1358  option must demonstrate through staffing records that minimum 
1359  staffing requirements for the facility were met. Licensed nurses 
1360  and certified nursing assistants who work in the nursing home 
1361  facility may be used to provide services elsewhere on campus if 
1362  the facility exceeds the minimum number of direct care hours 
1363  required per resident per day and the total number of residents 
1364  receiving direct care services from a licensed nurse or a 
1365  certified nursing assistant does not cause the facility to 
1366  violate the staffing ratios required under s. 400.23(3)(a). 
1367  Compliance with the minimum staffing ratios shall be based on 
1368  total number of residents receiving direct care services, 
1369  regardless of where they reside on campus. If the facility 
1370  receives a conditional license, it may not share staff until the 
1371  conditional license status ends. This paragraph does not 
1372  restrict the agency’s authority under federal or state law to 
1373  require additional staff if a facility is cited for deficiencies 
1374  in care which are caused by an insufficient number of certified 
1375  nursing assistants or licensed nurses. The agency may adopt 
1376  rules for the documentation necessary to determine compliance 
1377  with this provision. 
1378         (h) Maintain the facility premises and equipment and 
1379  conduct its operations in a safe and sanitary manner. 
1380         (i) If the licensee furnishes food service, provide a 
1381  wholesome and nourishing diet sufficient to meet generally 
1382  accepted standards of proper nutrition for its residents and 
1383  provide such therapeutic diets as may be prescribed by attending 
1384  physicians. In making rules to implement this paragraph, the 
1385  agency shall be guided by standards recommended by nationally 
1386  recognized professional groups and associations with knowledge 
1387  of dietetics. 
1388         (j) Keep full records of resident admissions and 
1389  discharges; medical and general health status, including medical 
1390  records, personal and social history, and identity and address 
1391  of next of kin or other persons who may have responsibility for 
1392  the affairs of the residents; and individual resident care plans 
1393  including, but not limited to, prescribed services, service 
1394  frequency and duration, and service goals. The records shall be 
1395  open to inspection by the agency. 
1396         (k) Keep such fiscal records of its operations and 
1397  conditions as may be necessary to provide information pursuant 
1398  to this part. 
1399         (l) Furnish copies of personnel records for employees 
1400  affiliated with such facility, to any other facility licensed by 
1401  this state requesting this information pursuant to this part. 
1402  Such information contained in the records may include, but is 
1403  not limited to, disciplinary matters and any reason for 
1404  termination. Any facility releasing such records pursuant to 
1405  this part shall be considered to be acting in good faith and may 
1406  not be held liable for information contained in such records, 
1407  absent a showing that the facility maliciously falsified such 
1408  records. 
1409         (m) Publicly display a poster provided by the agency 
1410  containing the names, addresses, and telephone numbers for the 
1411  state’s abuse hotline, the State Long-Term Care Ombudsman, the 
1412  Agency for Health Care Administration consumer hotline, the 
1413  Advocacy Center for Persons with Disabilities, the Florida 
1414  Statewide Advocacy Council, and the Medicaid Fraud Control Unit, 
1415  with a clear description of the assistance to be expected from 
1416  each. 
1417         (n) Submit to the agency the information specified in s. 
1418  400.071(1)(b) for a management company within 30 days after the 
1419  effective date of the management agreement. 
1420         (n)(o)1. Submit semiannually to the agency, or more 
1421  frequently if requested by the agency, information regarding 
1422  facility staff-to-resident ratios, staff turnover, and staff 
1423  stability, including information regarding certified nursing 
1424  assistants, licensed nurses, the director of nursing, and the 
1425  facility administrator. For purposes of this reporting: 
1426         a. Staff-to-resident ratios must be reported in the 
1427  categories specified in s. 400.23(3)(a) and applicable rules. 
1428  The ratio must be reported as an average for the most recent 
1429  calendar quarter. 
1430         b. Staff turnover must be reported for the most recent 12 
1431  month period ending on the last workday of the most recent 
1432  calendar quarter prior to the date the information is submitted. 
1433  The turnover rate must be computed quarterly, with the annual 
1434  rate being the cumulative sum of the quarterly rates. The 
1435  turnover rate is the total number of terminations or separations 
1436  experienced during the quarter, excluding any employee 
1437  terminated during a probationary period of 3 months or less, 
1438  divided by the total number of staff employed at the end of the 
1439  period for which the rate is computed, and expressed as a 
1440  percentage. 
1441         c. The formula for determining staff stability is the total 
1442  number of employees who that have been employed for more than 12 
1443  months, divided by the total number of employees employed at the 
1444  end of the most recent calendar quarter, and expressed as a 
1445  percentage. 
1446         d. A nursing facility that has failed to comply with state 
1447  minimum-staffing requirements for 2 consecutive days is 
1448  prohibited from accepting new admissions until the facility has 
1449  achieved the minimum-staffing requirements for a period of 6 
1450  consecutive days. For the purposes of this sub-subparagraph, any 
1451  person who was a resident of the facility and was absent from 
1452  the facility for the purpose of receiving medical care at a 
1453  separate location or was on a leave of absence is not considered 
1454  a new admission. Failure to impose such an admissions moratorium 
1455  constitutes a class II violation, and the agency shall fine the 
1456  nursing facility $1,000 for such violation deficiency. 
1457         e. A nursing facility that which does not have a 
1458  conditional license may be cited for failure to comply with the 
1459  standards in s. 400.23(3)(a)1.a. only if it has failed to meet 
1460  those standards on 2 consecutive days or if it has failed to 
1461  meet at least 97 percent of those standards on any one day. 
1462         f. A facility that which has a conditional license must be 
1463  in compliance with the standards in s. 400.23(3)(a) at all 
1464  times. 
1465         2. This paragraph does not limit the agency’s ability to 
1466  impose a deficiency or take other actions if a facility does not 
1467  have enough staff to meet the residents’ needs. 
1468         (o)(p) Notify a licensed physician when a resident exhibits 
1469  signs of dementia or cognitive impairment or has a change of 
1470  condition in order to rule out the presence of an underlying 
1471  physiological condition that may be contributing to such 
1472  dementia or impairment. The notification must occur within 30 
1473  days after the acknowledgment of such signs by facility staff. 
1474  If an underlying condition is determined to exist, the facility 
1475  shall arrange, with the appropriate health care provider, the 
1476  necessary care and services to treat the condition. 
1477         (p)(q) If the facility implements a dining and hospitality 
1478  attendant program, ensure that the program is developed and 
1479  implemented under the supervision of the facility director of 
1480  nursing. A licensed nurse, licensed speech or occupational 
1481  therapist, or a registered dietitian must conduct training of 
1482  dining and hospitality attendants. A person employed by a 
1483  facility as a dining and hospitality attendant must perform 
1484  tasks under the direct supervision of a licensed nurse. 
1485         (r) Report to the agency any filing for bankruptcy 
1486  protection by the facility or its parent corporation, 
1487  divestiture or spin-off of its assets, or corporate 
1488  reorganization within 30 days after the completion of such 
1489  activity. 
1490         (q)(s) Maintain general and professional liability 
1491  insurance coverage that is in force at all times. In lieu of 
1492  general and professional liability insurance coverage, a state 
1493  designated teaching nursing home and its affiliated assisted 
1494  living facilities created under s. 430.80 may demonstrate proof 
1495  of financial responsibility as provided in s. 430.80(3)(h). 
1496         (r)(t) Maintain in the medical record for each resident a 
1497  daily chart of certified nursing assistant services provided to 
1498  the resident. The certified nursing assistant who is caring for 
1499  the resident must complete this record by the end of his or her 
1500  shift. This record must indicate assistance with activities of 
1501  daily living, assistance with eating, and assistance with 
1502  drinking, and must record each offering of nutrition and 
1503  hydration for those residents whose plan of care or assessment 
1504  indicates a risk for malnutrition or dehydration. 
1505         (s)(u) Before November 30 of each year, subject to the 
1506  availability of an adequate supply of the necessary vaccine, 
1507  provide for immunizations against influenza viruses to all its 
1508  consenting residents in accordance with the recommendations of 
1509  the United States Centers for Disease Control and Prevention, 
1510  subject to exemptions for medical contraindications and 
1511  religious or personal beliefs. Subject to these exemptions, any 
1512  consenting person who becomes a resident of the facility after 
1513  November 30 but before March 31 of the following year must be 
1514  immunized within 5 working days after becoming a resident. 
1515  Immunization shall not be provided to any resident who provides 
1516  documentation that he or she has been immunized as required by 
1517  this paragraph. This paragraph does not prohibit a resident from 
1518  receiving the immunization from his or her personal physician if 
1519  he or she so chooses. A resident who chooses to receive the 
1520  immunization from his or her personal physician shall provide 
1521  proof of immunization to the facility. The agency may adopt and 
1522  enforce any rules necessary to comply with or administer 
1523  implement this paragraph subsection. 
1524         (t)(v) Assess all residents for eligibility for 
1525  pneumococcal polysaccharide vaccination (PPV) and vaccinate 
1526  residents when indicated within 60 days after the effective date 
1527  of this act in accordance with the recommendations of the United 
1528  States Centers for Disease Control and Prevention, subject to 
1529  exemptions for medical contraindications and religious or 
1530  personal beliefs. Residents admitted after the effective date of 
1531  this act shall be assessed within 5 working days of admission 
1532  and, when indicated, vaccinated within 60 days in accordance 
1533  with the recommendations of the United States Centers for 
1534  Disease Control and Prevention, subject to exemptions for 
1535  medical contraindications and religious or personal beliefs. 
1536  Immunization shall not be provided to any resident who provides 
1537  documentation that he or she has been immunized as required by 
1538  this paragraph. This paragraph does not prohibit a resident from 
1539  receiving the immunization from his or her personal physician if 
1540  he or she so chooses. A resident who chooses to receive the 
1541  immunization from his or her personal physician shall provide 
1542  proof of immunization to the facility. The agency may adopt and 
1543  enforce any rules necessary to comply with or administer 
1544  implement this paragraph. 
1545         (u)(w) Annually encourage and promote to its employees the 
1546  benefits associated with immunizations against influenza viruses 
1547  in accordance with the recommendations of the United States 
1548  Centers for Disease Control and Prevention. The agency may adopt 
1549  and enforce any rules necessary to comply with or administer 
1550  implement this paragraph. 
1551         (2) Facilities that have been awarded a Gold Seal under the 
1552  program established in s. 400.235 may develop a plan to provide 
1553  certified nursing assistant training as prescribed by federal 
1554  regulations and state rules and may apply to the agency for 
1555  approval of their program. 
1556         Section 30. Subsection (3) of section 400.142, Florida 
1557  Statutes, is amended to read: 
1558         400.142 Emergency medication kits; orders not to 
1559  resuscitate.— 
1560         (3) Facility staff may withhold or withdraw cardiopulmonary 
1561  resuscitation if presented with an order not to resuscitate 
1562  executed pursuant to s. 401.45. The agency shall adopt rules 
1563  providing for the implementation of such orders. Facility staff 
1564  and facilities are shall not be subject to criminal prosecution 
1565  or civil liability, nor be considered to have engaged in 
1566  negligent or unprofessional conduct, for withholding or 
1567  withdrawing cardiopulmonary resuscitation pursuant to such an 
1568  order and rules adopted by the agency. The absence of an order 
1569  not to resuscitate executed pursuant to s. 401.45 does not 
1570  preclude a physician from withholding or withdrawing 
1571  cardiopulmonary resuscitation as otherwise permitted by law. 
1572         Section 31. Subsection (10) of section 400.147, Florida 
1573  Statutes, is repealed. 
1574         Section 32. Section 400.148, Florida Statutes, is repealed. 
1575         Section 33. Subsection (3) of section 400.19, Florida 
1576  Statutes, is amended to read: 
1577         400.19 Right of entry and inspection.— 
1578         (3) The agency shall every 15 months conduct at least one 
1579  unannounced inspection to determine compliance by the licensee 
1580  with statutes, and with rules adopted promulgated under the 
1581  provisions of those statutes, governing minimum standards of 
1582  construction, quality and adequacy of care, and rights of 
1583  residents. The survey shall be conducted every 6 months for the 
1584  next 2-year period if the facility has been cited for a class I 
1585  deficiency, has been cited for two or more class II violations 
1586  deficiencies arising from separate surveys or investigations 
1587  within a 60-day period, or has had three or more substantiated 
1588  complaints within a 6-month period, each resulting in at least 
1589  one class I or class II deficiency. In addition to any other 
1590  fees or fines in this part, the agency shall assess a fine for 
1591  each facility that is subject to the 6-month survey cycle. The 
1592  fine for the 2-year period shall be $6,000, one-half to be paid 
1593  at the completion of each survey. The agency may adjust this 
1594  fine by the change in the Consumer Price Index, based on the 12 
1595  months immediately preceding the increase, to cover the cost of 
1596  the additional surveys. The agency shall verify through 
1597  subsequent inspection that any deficiency identified during 
1598  inspection is corrected. However, the agency may verify the 
1599  correction of a class III or class IV violation deficiency 
1600  unrelated to resident rights or resident care without 
1601  reinspecting the facility if adequate written documentation has 
1602  been received from the facility, which provides assurance that 
1603  the deficiency has been corrected. The giving or causing to be 
1604  given of advance notice of such unannounced inspections by an 
1605  employee of the agency to any unauthorized person shall 
1606  constitute cause for suspension of not fewer than 5 working days 
1607  according to the provisions of chapter 110. 
1608         Section 34. Section 400.195, Florida Statutes, is repealed. 
1609         Section 35. Subsection (5) of section 400.23, Florida 
1610  Statutes, is amended to read: 
1611         400.23 Rules; evaluation and deficiencies; licensure 
1612  status.— 
1613         (5) The agency, in collaboration with the Division of 
1614  Children’s Medical Services Network of the Department of Health, 
1615  must, no later than December 31, 1993, adopt rules for minimum 
1616  standards of care for persons under 21 years of age who reside 
1617  in nursing home facilities. The rules must include a methodology 
1618  for reviewing a nursing home facility under ss. 408.031-408.045 
1619  which serves only persons under 21 years of age. A facility may 
1620  be exempt from these standards for specific persons between 18 
1621  and 21 years of age, if the person’s physician agrees that 
1622  minimum standards of care based on age are not necessary. 
1623         Section 36. Subsection (1) of section 400.275, Florida 
1624  Statutes, is amended to read: 
1625         400.275 Agency duties.— 
1626         (1) The agency shall ensure that each newly hired nursing 
1627  home surveyor, as a part of basic training, is assigned full 
1628  time to a licensed nursing home for at least 2 days within a 7 
1629  day period to observe facility operations outside of the survey 
1630  process before the surveyor begins survey responsibilities. Such 
1631  observations may not be the sole basis of a deficiency citation 
1632  against the facility. The agency may not assign an individual to 
1633  be a member of a survey team for purposes of a survey, 
1634  evaluation, or consultation visit at a nursing home facility in 
1635  which the surveyor was an employee within the preceding 5 years. 
1636         Section 37. Section 400.484, Florida Statutes, is amended 
1637  to read: 
1638         400.484 Right of inspection; violations deficiencies; 
1639  fines.— 
1640         (1) In addition to the requirements of s. 408.811, the 
1641  agency may make such inspections and investigations as are 
1642  necessary in order to determine the state of compliance with 
1643  this part, part II of chapter 408, and applicable rules. 
1644         (2) The agency shall impose fines for various classes of 
1645  violations deficiencies in accordance with the following 
1646  schedule: 
1647         (a) A class I violation is defined in s. 408.813. A class I 
1648  deficiency is any act, omission, or practice that results in a 
1649  patient’s death, disablement, or permanent injury, or places a 
1650  patient at imminent risk of death, disablement, or permanent 
1651  injury. Upon finding a class I violation deficiency, the agency 
1652  shall impose an administrative fine in the amount of $15,000 for 
1653  each occurrence and each day that the violation deficiency 
1654  exists. 
1655         (b) A class II violation is defined in s. 408.813. A class 
1656  II deficiency is any act, omission, or practice that has a 
1657  direct adverse effect on the health, safety, or security of a 
1658  patient. Upon finding a class II violation deficiency, the 
1659  agency shall impose an administrative fine in the amount of 
1660  $5,000 for each occurrence and each day that the violation 
1661  deficiency exists. 
1662         (c) A class III violation is defined in s. 408.813. A class 
1663  III deficiency is any act, omission, or practice that has an 
1664  indirect, adverse effect on the health, safety, or security of a 
1665  patient. Upon finding an uncorrected or repeated class III 
1666  violation deficiency, the agency shall impose an administrative 
1667  fine not to exceed $1,000 for each occurrence and each day that 
1668  the uncorrected or repeated violation deficiency exists. 
1669         (d) A class IV violation is defined in s. 408.813. A class 
1670  IV deficiency is any act, omission, or practice related to 
1671  required reports, forms, or documents which does not have the 
1672  potential of negatively affecting patients. These violations are 
1673  of a type that the agency determines do not threaten the health, 
1674  safety, or security of patients. Upon finding an uncorrected or 
1675  repeated class IV violation deficiency, the agency shall impose 
1676  an administrative fine not to exceed $500 for each occurrence 
1677  and each day that the uncorrected or repeated violation 
1678  deficiency exists. 
1679         (3) In addition to any other penalties imposed pursuant to 
1680  this section or part, the agency may assess costs related to an 
1681  investigation that results in a successful prosecution, 
1682  excluding costs associated with an attorney’s time. 
1683         Section 38. Subsections (1) and (4) of section 400.606, 
1684  Florida Statutes, are amended to read: 
1685         400.606 License; application; renewal; conditional license 
1686  or permit; certificate of need.— 
1687         (1) In addition to the requirements of part II of chapter 
1688  408, the initial application and change of ownership application 
1689  must be accompanied by a plan for the delivery of home, 
1690  residential, and homelike inpatient hospice services to 
1691  terminally ill persons and their families. Such plan must 
1692  contain, but need not be limited to: 
1693         (a) The estimated average number of terminally ill persons 
1694  to be served monthly. 
1695         (b) The geographic area in which hospice services will be 
1696  available. 
1697         (c) A listing of services that which are or will be 
1698  provided, either directly by the applicant or through 
1699  contractual arrangements with existing providers. 
1700         (d) Provisions for the implementation of hospice home care 
1701  within 3 months after licensure. 
1702         (e) Provisions for the implementation of hospice homelike 
1703  inpatient care within 12 months after licensure. 
1704         (f) The number and disciplines of professional staff to be 
1705  employed. 
1706         (g) The name and qualifications of any existing or 
1707  potential contractee. 
1708         (h) A plan for attracting and training volunteers. 
1709         (i) The projected annual operating cost of the hospice. 
1710 
1711  If the applicant is an existing licensed health care provider, 
1712  the application must be accompanied by a copy of the most recent 
1713  profit-loss statement and, if applicable, the most recent 
1714  licensure inspection report. 
1715         (4) A freestanding hospice facility that is primarily 
1716  engaged in providing inpatient and related services and that is 
1717  not otherwise licensed as a health care facility shall be 
1718  required to obtain a certificate of need. However, a 
1719  freestanding hospice facility with six or fewer beds shall not 
1720  be required to comply with institutional standards such as, but 
1721  not limited to, standards requiring sprinkler systems, emergency 
1722  electrical systems, or special lavatory devices. 
1723         Section 39. Subsection (2) of section 400.607, Florida 
1724  Statutes, is amended to read: 
1725         400.607 Denial, suspension, revocation of license; 
1726  emergency actions; imposition of administrative fine; grounds.— 
1727         (2) A violation of the provisions of this part, part II of 
1728  chapter 408, or applicable rules Any of the following actions by 
1729  a licensed hospice or any of its employees shall be grounds for 
1730  administrative action by the agency against a hospice.: 
1731         (a) A violation of the provisions of this part, part II of 
1732  chapter 408, or applicable rules. 
1733         (b) An intentional or negligent act materially affecting 
1734  the health or safety of a patient. 
1735         Section 40. Section 400.915, Florida Statutes, is amended 
1736  to read: 
1737         400.915 Construction and renovation; requirements.—The 
1738  requirements for the construction or renovation of a PPEC center 
1739  shall comply with: 
1740         (1) The provisions of chapter 553, which pertain to 
1741  building construction standards, including plumbing, electrical 
1742  code, glass, manufactured buildings, accessibility for the 
1743  physically disabled; 
1744         (2) The provisions of s. 633.022 and applicable rules 
1745  pertaining to physical minimum standards for nonresidential 
1746  child care physical facilities in rule 10M-12.003, Florida 
1747  Administrative Code, Child Care Standards; and 
1748         (3) The standards or rules adopted pursuant to this part 
1749  and part II of chapter 408. 
1750         Section 41. Subsection (1) of section 400.925, Florida 
1751  Statutes, is amended to read: 
1752         400.925 Definitions.—As used in this part, the term: 
1753         (1) “Accrediting organizations” means the Joint Commission 
1754  on Accreditation of Healthcare Organizations or other national 
1755  accreditation agencies whose standards for accreditation are 
1756  comparable to those required by this part for licensure. 
1757         Section 42. Section 400.931, Florida Statutes, is amended 
1758  to read: 
1759         400.931 Application for license; fee; provisional license; 
1760  temporary permit.— 
1761         (1) In addition to the requirements of part II of chapter 
1762  408, the applicant must file with the application satisfactory 
1763  proof that the home medical equipment provider is in compliance 
1764  with this part and applicable rules, including: 
1765         (a) A report, by category, of the equipment to be provided, 
1766  indicating those offered either directly by the applicant or 
1767  through contractual arrangements with existing providers. 
1768  Categories of equipment include: 
1769         1. Respiratory modalities. 
1770         2. Ambulation aids. 
1771         3. Mobility aids. 
1772         4. Sickroom setup. 
1773         5. Disposables. 
1774         (b) A report, by category, of the services to be provided, 
1775  indicating those offered either directly by the applicant or 
1776  through contractual arrangements with existing providers. 
1777  Categories of services include: 
1778         1. Intake. 
1779         2. Equipment selection. 
1780         3. Delivery. 
1781         4. Setup and installation. 
1782         5. Patient training. 
1783         6. Ongoing service and maintenance. 
1784         7. Retrieval. 
1785         (c) A listing of those with whom the applicant contracts, 
1786  both the providers the applicant uses to provide equipment or 
1787  services to its consumers and the providers for whom the 
1788  applicant provides services or equipment. 
1789         (2) As an alternative to submitting proof of financial 
1790  ability to operate as required in s. 408.810(8), the applicant 
1791  may submit a $50,000 surety bond to the agency. 
1792         (2)(3) As specified in part II of chapter 408, the home 
1793  medical equipment provider must also obtain and maintain 
1794  professional and commercial liability insurance. Proof of 
1795  liability insurance, as defined in s. 624.605, must be submitted 
1796  with the application. The agency shall set the required amounts 
1797  of liability insurance by rule, but the required amount must not 
1798  be less than $250,000 per claim. In the case of contracted 
1799  services, it is required that the contractor must have liability 
1800  insurance not less than $250,000 per claim. 
1801         (3)(4) When a change of the general manager of a home 
1802  medical equipment provider occurs, the licensee must notify the 
1803  agency of the change within 45 days. 
1804         (4)(5) In accordance with s. 408.805, an applicant or a 
1805  licensee shall pay a fee for each license application submitted 
1806  under this part, part II of chapter 408, and applicable rules. 
1807  The amount of the fee shall be established by rule and may not 
1808  exceed $300 per biennium. The agency shall set the fees in an 
1809  amount that is sufficient to cover its costs in carrying out its 
1810  responsibilities under this part. However, state, county, or 
1811  municipal governments applying for licenses under this part are 
1812  exempt from the payment of license fees. 
1813         (5)(6) An applicant for initial licensure, renewal, or 
1814  change of ownership shall also pay an inspection fee not to 
1815  exceed $400, which shall be paid by all applicants except those 
1816  not subject to licensure inspection by the agency as described 
1817  in s. 400.933. 
1818         Section 43. Subsection (2) of section 400.932, Florida 
1819  Statutes, is amended to read: 
1820         400.932 Administrative penalties.— 
1821         (2) A violation of this part, part II of chapter 408, or 
1822  applicable rules Any of the following actions by an employee of 
1823  a home medical equipment provider is are grounds for 
1824  administrative action or penalties by the agency.: 
1825         (a) Violation of this part, part II of chapter 408, or 
1826  applicable rules. 
1827         (b) An intentional, reckless, or negligent act that 
1828  materially affects the health or safety of a patient. 
1829         Section 44. Subsection (2) of section 400.933, Florida 
1830  Statutes, is amended to read: 
1831         400.933 Licensure inspections and investigations.— 
1832         (2) The agency shall accept, in lieu of its own periodic 
1833  inspections for licensure, submission of the following: 
1834         (a) The survey or inspection of an accrediting 
1835  organization, provided the accreditation of the licensed home 
1836  medical equipment provider is not conditional or provisional and 
1837  provided the licensed home medical equipment provider authorizes 
1838  release of, and the agency receives the report of, the 
1839  accrediting organization; or 
1840         (b) A copy of a valid medical oxygen retail establishment 
1841  permit issued by the Department of Health, pursuant to chapter 
1842  499. 
1843         Section 45. Subsection (2) of section 400.953, Florida 
1844  Statutes, is amended to read: 
1845         400.953 Background screening of home medical equipment 
1846  provider personnel.—The agency shall require employment 
1847  screening as provided in chapter 435, using the level 1 
1848  standards for screening set forth in that chapter, for home 
1849  medical equipment provider personnel. 
1850         (2) The general manager of each home medical equipment 
1851  provider must sign an affidavit annually, under penalty of 
1852  perjury, stating that all home medical equipment provider 
1853  personnel hired on or after July 1, 1999, who enter the home of 
1854  a patient in the capacity of their employment have been screened 
1855  and that its remaining personnel have worked for the home 
1856  medical equipment provider continuously since before July 1, 
1857  1999. This attestation must be submitted in accordance with s. 
1858  408.809(6). 
1859         Section 46. Section 400.967, Florida Statutes, is amended 
1860  to read: 
1861         400.967 Rules and classification of violations 
1862  deficiencies.— 
1863         (1) It is the intent of the Legislature that rules adopted 
1864  and enforced under this part and part II of chapter 408 include 
1865  criteria by which a reasonable and consistent quality of 
1866  resident care may be ensured, the results of such resident care 
1867  can be demonstrated, and safe and sanitary facilities can be 
1868  provided. 
1869         (2) Pursuant to the intention of the Legislature, the 
1870  agency, in consultation with the Agency for Persons with 
1871  Disabilities and the Department of Elderly Affairs, shall adopt 
1872  and enforce rules to administer this part and part II of chapter 
1873  408, which shall include reasonable and fair criteria governing: 
1874         (a) The location and construction of the facility; 
1875  including fire and life safety, plumbing, heating, cooling, 
1876  lighting, ventilation, and other housing conditions that will 
1877  ensure the health, safety, and comfort of residents. The agency 
1878  shall establish standards for facilities and equipment to 
1879  increase the extent to which new facilities and a new wing or 
1880  floor added to an existing facility after July 1, 2000, are 
1881  structurally capable of serving as shelters only for residents, 
1882  staff, and families of residents and staff, and equipped to be 
1883  self-supporting during and immediately following disasters. The 
1884  Agency for Health Care Administration shall work with facilities 
1885  licensed under this part and report to the Governor and the 
1886  Legislature by April 1, 2000, its recommendations for cost 
1887  effective renovation standards to be applied to existing 
1888  facilities. In making such rules, the agency shall be guided by 
1889  criteria recommended by nationally recognized, reputable 
1890  professional groups and associations having knowledge concerning 
1891  such subject matters. The agency shall update or revise such 
1892  criteria as the need arises. All facilities must comply with 
1893  those lifesafety code requirements and building code standards 
1894  applicable at the time of approval of their construction plans. 
1895  The agency may require alterations to a building if it 
1896  determines that an existing condition constitutes a distinct 
1897  hazard to life, health, or safety. The agency shall adopt fair 
1898  and reasonable rules setting forth conditions under which 
1899  existing facilities undergoing additions, alterations, 
1900  conversions, renovations, or repairs are required to comply with 
1901  the most recent updated or revised standards. 
1902         (b) The number and qualifications of all personnel, 
1903  including management, medical nursing, and other personnel, 
1904  having responsibility for any part of the care given to 
1905  residents. 
1906         (c) All sanitary conditions within the facility and its 
1907  surroundings, including water supply, sewage disposal, food 
1908  handling, and general hygiene, which will ensure the health and 
1909  comfort of residents. 
1910         (d) The equipment essential to the health and welfare of 
1911  the residents. 
1912         (e) A uniform accounting system. 
1913         (f) The care, treatment, and maintenance of residents and 
1914  measurement of the quality and adequacy thereof. 
1915         (g) The preparation and annual update of a comprehensive 
1916  emergency management plan. The agency shall adopt rules 
1917  establishing minimum criteria for the plan after consultation 
1918  with the Department of Community Affairs. At a minimum, the 
1919  rules must provide for plan components that address emergency 
1920  evacuation transportation; adequate sheltering arrangements; 
1921  postdisaster activities, including emergency power, food, and 
1922  water; postdisaster transportation; supplies; staffing; 
1923  emergency equipment; individual identification of residents and 
1924  transfer of records; and responding to family inquiries. The 
1925  comprehensive emergency management plan is subject to review and 
1926  approval by the local emergency management agency. During its 
1927  review, the local emergency management agency shall ensure that 
1928  the following agencies, at a minimum, are given the opportunity 
1929  to review the plan: the Department of Elderly Affairs, the 
1930  Agency for Persons with Disabilities, the Agency for Health Care 
1931  Administration, and the Department of Community Affairs. Also, 
1932  appropriate volunteer organizations must be given the 
1933  opportunity to review the plan. The local emergency management 
1934  agency shall complete its review within 60 days and either 
1935  approve the plan or advise the facility of necessary revisions. 
1936         (h) The use of restraint and seclusion. Such rules must be 
1937  consistent with recognized best practices; prohibit inherently 
1938  dangerous restraint or seclusion procedures; establish 
1939  limitations on the use and duration of restraint and seclusion; 
1940  establish measures to ensure the safety of clients and staff 
1941  during an incident of restraint or seclusion; establish 
1942  procedures for staff to follow before, during, and after 
1943  incidents of restraint or seclusion, including individualized 
1944  plans for the use of restraints or seclusion in emergency 
1945  situations; establish professional qualifications of and 
1946  training for staff who may order or be engaged in the use of 
1947  restraint or seclusion; establish requirements for facility data 
1948  collection and reporting relating to the use of restraint and 
1949  seclusion; and establish procedures relating to the 
1950  documentation of the use of restraint or seclusion in the 
1951  client’s facility or program record. 
1952         (3) The agency shall adopt rules to provide that, when the 
1953  criteria established under this part and part II of chapter 408 
1954  are not met, such violations deficiencies shall be classified 
1955  according to the nature of the violation deficiency. The agency 
1956  shall indicate the classification on the face of the notice of 
1957  violations deficiencies as follows: 
1958         (a) Class I violations deficiencies are defined in s. 
1959  408.813. those which the agency determines present an imminent 
1960  danger to the residents or guests of the facility or a 
1961  substantial probability that death or serious physical harm 
1962  would result therefrom. The condition or practice constituting a 
1963  class I violation must be abated or eliminated immediately, 
1964  unless a fixed period of time, as determined by the agency, is 
1965  required for correction. A class I violation deficiency is 
1966  subject to a civil penalty in an amount not less than $5,000 and 
1967  not exceeding $10,000 for each violation deficiency. A fine may 
1968  be levied notwithstanding the correction of the violation 
1969  deficiency. 
1970         (b) Class II violations deficiencies are defined in s. 
1971  408.813. those which the agency determines have a direct or 
1972  immediate relationship to the health, safety, or security of the 
1973  facility residents, other than class I deficiencies. A class II 
1974  violation deficiency is subject to a civil penalty in an amount 
1975  not less than $1,000 and not exceeding $5,000 for each 
1976  deficiency. A citation for a class II violation deficiency shall 
1977  specify the time within which the violation deficiency must be 
1978  corrected. If a class II violation deficiency is corrected 
1979  within the time specified, no civil penalty shall be imposed, 
1980  unless it is a repeated offense. 
1981         (c) Class III violations deficiencies are defined in s. 
1982  408.813. those which the agency determines to have an indirect 
1983  or potential relationship to the health, safety, or security of 
1984  the facility residents, other than class I or class II 
1985  deficiencies. A class III violation deficiency is subject to a 
1986  civil penalty of not less than $500 and not exceeding $1,000 for 
1987  each violation deficiency. A citation for a class III violation 
1988  deficiency shall specify the time within which the violation 
1989  deficiency must be corrected. If a class III violation 
1990  deficiency is corrected within the time specified, no civil 
1991  penalty shall be imposed, unless it is a repeated offense. 
1992         (d) Class IV violations are defined in s. 408.813. 
1993         (4) The agency shall approve or disapprove the plans and 
1994  specifications within 60 days after receipt of the final plans 
1995  and specifications. The agency may be granted one 15-day 
1996  extension for the review period, if the secretary of the agency 
1997  so approves. If the agency fails to act within the specified 
1998  time, it is deemed to have approved the plans and 
1999  specifications. When the agency disapproves plans and 
2000  specifications, it must set forth in writing the reasons for 
2001  disapproval. Conferences and consultations may be provided as 
2002  necessary. 
2003         (5) The agency may charge an initial fee of $2,000 for 
2004  review of plans and construction on all projects, no part of 
2005  which is refundable. The agency may also collect a fee, not to 
2006  exceed 1 percent of the estimated construction cost or the 
2007  actual cost of review, whichever is less, for the portion of the 
2008  review that which encompasses initial review through the initial 
2009  revised construction document review. The agency may collect its 
2010  actual costs on all subsequent portions of the review and 
2011  construction inspections. Initial fee payment must accompany the 
2012  initial submission of plans and specifications. Any subsequent 
2013  payment that is due is payable upon receipt of the invoice from 
2014  the agency. Notwithstanding any other provision of law, all 
2015  money received by the agency under this section shall be deemed 
2016  to be trust funds, to be held and applied solely for the 
2017  operations required under this section. 
2018         Section 47. Subsections (4) and (7) of section 400.9905, 
2019  Florida Statutes, are amended to read: 
2020         400.9905 Definitions.— 
2021         (4) “Clinic” means an entity where at which health care 
2022  services are provided to individuals and which tenders charges 
2023  for reimbursement for such services, including a mobile clinic 
2024  and a portable service or equipment provider. For purposes of 
2025  this part, the term does not include and the licensure 
2026  requirements of this part do not apply to: 
2027         (a) Entities licensed or registered by the state under 
2028  chapter 395; or entities licensed or registered by the state and 
2029  providing only health care services within the scope of services 
2030  authorized under their respective licenses granted under ss. 
2031  383.30-383.335, chapter 390, chapter 394, chapter 397, this 
2032  chapter except part X, chapter 429, chapter 463, chapter 465, 
2033  chapter 466, chapter 478, part I of chapter 483, chapter 484, or 
2034  chapter 651; end-stage renal disease providers authorized under 
2035  42 C.F.R. part 405, subpart U; or providers certified under 42 
2036  C.F.R. part 485, subpart B or subpart H; or any entity that 
2037  provides neonatal or pediatric hospital-based health care 
2038  services or other health care services by licensed practitioners 
2039  solely within a hospital licensed under chapter 395. 
2040         (b) Entities that own, directly or indirectly, entities 
2041  licensed or registered by the state pursuant to chapter 395; or 
2042  entities that own, directly or indirectly, entities licensed or 
2043  registered by the state and providing only health care services 
2044  within the scope of services authorized pursuant to their 
2045  respective licenses granted under ss. 383.30-383.335, chapter 
2046  390, chapter 394, chapter 397, this chapter except part X, 
2047  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478, 
2048  part I of chapter 483, chapter 484, chapter 651; end-stage renal 
2049  disease providers authorized under 42 C.F.R. part 405, subpart 
2050  U; or providers certified under 42 C.F.R. part 485, subpart B or 
2051  subpart H; or any entity that provides neonatal or pediatric 
2052  hospital-based health care services by licensed practitioners 
2053  solely within a hospital licensed under chapter 395. 
2054         (c) Entities that are owned, directly or indirectly, by an 
2055  entity licensed or registered by the state pursuant to chapter 
2056  395; or entities that are owned, directly or indirectly, by an 
2057  entity licensed or registered by the state and providing only 
2058  health care services within the scope of services authorized 
2059  pursuant to their respective licenses granted under ss. 383.30 
2060  383.335, chapter 390, chapter 394, chapter 397, this chapter 
2061  except part X, chapter 429, chapter 463, chapter 465, chapter 
2062  466, chapter 478, part I of chapter 483, chapter 484, or chapter 
2063  651; end-stage renal disease providers authorized under 42 
2064  C.F.R. part 405, subpart U; or providers certified under 42 
2065  C.F.R. part 485, subpart B or subpart H; or any entity that 
2066  provides neonatal or pediatric hospital-based health care 
2067  services by licensed practitioners solely within a hospital 
2068  under chapter 395. 
2069         (d) Entities that are under common ownership, directly or 
2070  indirectly, with an entity licensed or registered by the state 
2071  pursuant to chapter 395; or entities that are under common 
2072  ownership, directly or indirectly, with an entity licensed or 
2073  registered by the state and providing only health care services 
2074  within the scope of services authorized pursuant to their 
2075  respective licenses granted under ss. 383.30-383.335, chapter 
2076  390, chapter 394, chapter 397, this chapter except part X, 
2077  chapter 429, chapter 463, chapter 465, chapter 466, chapter 478, 
2078  part I of chapter 483, chapter 484, or chapter 651; end-stage 
2079  renal disease providers authorized under 42 C.F.R. part 405, 
2080  subpart U; or providers certified under 42 C.F.R. part 485, 
2081  subpart B or subpart H; or any entity that provides neonatal or 
2082  pediatric hospital-based health care services by licensed 
2083  practitioners solely within a hospital licensed under chapter 
2084  395. 
2085         (e) An entity that is exempt from federal taxation under 26 
2086  U.S.C. s. 501(c)(3) or (4), an employee stock ownership plan 
2087  under 26 U.S.C. s. 409 that has a board of trustees not less 
2088  than two-thirds of which are Florida-licensed health care 
2089  practitioners and provides only physical therapy services under 
2090  physician orders, any community college or university clinic, 
2091  and any entity owned or operated by the federal or state 
2092  government, including agencies, subdivisions, or municipalities 
2093  thereof. 
2094         (f) A sole proprietorship, group practice, partnership, or 
2095  corporation that provides health care services by physicians 
2096  covered by s. 627.419, that is directly supervised by one or 
2097  more of such physicians, and that is wholly owned by one or more 
2098  of those physicians or by a physician and the spouse, parent, 
2099  child, or sibling of that physician. 
2100         (g) A sole proprietorship, group practice, partnership, or 
2101  corporation that provides health care services by licensed 
2102  health care practitioners under chapter 457, chapter 458, 
2103  chapter 459, chapter 460, chapter 461, chapter 462, chapter 463, 
2104  chapter 466, chapter 467, chapter 480, chapter 484, chapter 486, 
2105  chapter 490, chapter 491, or part I, part III, part X, part 
2106  XIII, or part XIV of chapter 468, or s. 464.012, which are 
2107  wholly owned by one or more licensed health care practitioners, 
2108  or the licensed health care practitioners set forth in this 
2109  paragraph and the spouse, parent, child, or sibling of a 
2110  licensed health care practitioner, so long as one of the owners 
2111  who is a licensed health care practitioner is supervising the 
2112  business activities and is legally responsible for the entity’s 
2113  compliance with all federal and state laws. However, a health 
2114  care practitioner may not supervise services beyond the scope of 
2115  the practitioner’s license, except that, for the purposes of 
2116  this part, a clinic owned by a licensee in s. 456.053(3)(b) that 
2117  provides only services authorized pursuant to s. 456.053(3)(b) 
2118  may be supervised by a licensee specified in s. 456.053(3)(b). 
2119         (h) Clinical facilities affiliated with an accredited 
2120  medical school at which training is provided for medical 
2121  students, residents, or fellows. 
2122         (i) Entities that provide only oncology or radiation 
2123  therapy services by physicians licensed under chapter 458 or 
2124  chapter 459 or entities that provide oncology or radiation 
2125  therapy services by physicians licensed under chapter 458 or 
2126  chapter 459 which are owned by a corporation whose shares are 
2127  publicly traded on a recognized stock exchange. 
2128         (j) Clinical facilities affiliated with a college of 
2129  chiropractic accredited by the Council on Chiropractic Education 
2130  at which training is provided for chiropractic students. 
2131         (k) Entities that provide licensed practitioners to staff 
2132  emergency departments or to deliver anesthesia services in 
2133  facilities licensed under chapter 395 and that derive at least 
2134  90 percent of their gross annual revenues from the provision of 
2135  such services. Entities claiming an exemption from licensure 
2136  under this paragraph must provide documentation demonstrating 
2137  compliance. 
2138         (l) Orthotic, or prosthetic, pediatric cardiology, or 
2139  perinatology clinical facilities that are a publicly traded 
2140  corporation or that are wholly owned, directly or indirectly, by 
2141  a publicly traded corporation. As used in this paragraph, a 
2142  publicly traded corporation is a corporation that issues 
2143  securities traded on an exchange registered with the United 
2144  States Securities and Exchange Commission as a national 
2145  securities exchange. 
2146         (7) “Portable service or equipment provider” means an 
2147  entity that contracts with or employs persons to provide 
2148  portable health care services or equipment to multiple locations 
2149  which performing treatment or diagnostic testing of individuals, 
2150  that bills third-party payors for those services, and which that 
2151  otherwise meets the definition of a clinic in subsection (4). 
2152         Section 48. Subsections (1) and (4) of section 400.991, 
2153  Florida Statutes, are amended to read: 
2154         400.991 License requirements; background screenings; 
2155  prohibitions.— 
2156         (1)(a) The requirements of part II of chapter 408 apply to 
2157  the provision of services that require licensure pursuant to 
2158  this part and part II of chapter 408 and to entities licensed by 
2159  or applying for such licensure from the agency pursuant to this 
2160  part. A license issued by the agency is required in order to 
2161  operate a clinic in this state. Each clinic location shall be 
2162  licensed separately regardless of whether the clinic is operated 
2163  under the same business name or management as another clinic. 
2164         (b) Each mobile clinic must obtain a separate health care 
2165  clinic license and must provide to the agency, at least 
2166  quarterly, its projected street location to enable the agency to 
2167  locate and inspect such clinic. A portable service or equipment 
2168  provider must obtain a health care clinic license for a single 
2169  administrative office and is not required to submit quarterly 
2170  projected street locations. 
2171         (4) In addition to the requirements of part II of chapter 
2172  408, the applicant must file with the application satisfactory 
2173  proof that the clinic is in compliance with this part and 
2174  applicable rules, including: 
2175         (a) A listing of services to be provided either directly by 
2176  the applicant or through contractual arrangements with existing 
2177  providers; 
2178         (b) The number and discipline of each professional staff 
2179  member to be employed; and 
2180         (c) Proof of financial ability to operate as required under 
2181  ss. 408.8065 and s. 408.810(8). As an alternative to submitting 
2182  proof of financial ability to operate as required under s. 
2183  408.810(8), the applicant may file a surety bond of at least 
2184  $500,000 which guarantees that the clinic will act in full 
2185  conformity with all legal requirements for operating a clinic, 
2186  payable to the agency. The agency may adopt rules to specify 
2187  related requirements for such surety bond. 
2188         Section 49. Paragraph (g) of subsection (1) and paragraph 
2189  (a) of subsection (7) of section 400.9935, Florida Statutes, are 
2190  amended to read: 
2191         400.9935 Clinic responsibilities.— 
2192         (1) Each clinic shall appoint a medical director or clinic 
2193  director who shall agree in writing to accept legal 
2194  responsibility for the following activities on behalf of the 
2195  clinic. The medical director or the clinic director shall: 
2196         (g) Conduct systematic reviews of clinic billings to ensure 
2197  that the billings are not fraudulent or unlawful. Upon discovery 
2198  of an unlawful charge, the medical director or clinic director 
2199  shall take immediate corrective action. If the clinic performs 
2200  only the technical component of magnetic resonance imaging, 
2201  static radiographs, computed tomography, or positron emission 
2202  tomography, and provides the professional interpretation of such 
2203  services, in a fixed facility that is accredited by the Joint 
2204  Commission on Accreditation of Healthcare Organizations or the 
2205  Accreditation Association for Ambulatory Health Care, and the 
2206  American College of Radiology; and if, in the preceding quarter, 
2207  the percentage of scans performed by that clinic which was 
2208  billed to all personal injury protection insurance carriers was 
2209  less than 15 percent, the chief financial officer of the clinic 
2210  may, in a written acknowledgment provided to the agency, assume 
2211  the responsibility for the conduct of the systematic reviews of 
2212  clinic billings to ensure that the billings are not fraudulent 
2213  or unlawful. 
2214         (7)(a) Each clinic engaged in magnetic resonance imaging 
2215  services must be accredited by the Joint Commission on 
2216  Accreditation of Healthcare Organizations, the American College 
2217  of Radiology, or the Accreditation Association for Ambulatory 
2218  Health Care, within 1 year after licensure. A clinic that is 
2219  accredited by the American College of Radiology or is within the 
2220  original 1-year period after licensure and replaces its core 
2221  magnetic resonance imaging equipment shall be given 1 year after 
2222  the date on which the equipment is replaced to attain 
2223  accreditation. However, a clinic may request a single, 6-month 
2224  extension if it provides evidence to the agency establishing 
2225  that, for good cause shown, such clinic cannot be accredited 
2226  within 1 year after licensure, and that such accreditation will 
2227  be completed within the 6-month extension. After obtaining 
2228  accreditation as required by this subsection, each such clinic 
2229  must maintain accreditation as a condition of renewal of its 
2230  license. A clinic that files a change of ownership application 
2231  must comply with the original accreditation timeframe 
2232  requirements of the transferor. The agency shall deny a change 
2233  of ownership application if the clinic is not in compliance with 
2234  the accreditation requirements. When a clinic adds, replaces, or 
2235  modifies magnetic resonance imaging equipment and the 
2236  accreditation agency requires new accreditation, the clinic must 
2237  be accredited within 1 year after the date of the addition, 
2238  replacement, or modification but may request a single, 6-month 
2239  extension if the clinic provides evidence of good cause to the 
2240  agency. 
2241         Section 50. Subsection (2) of section 408.034, Florida 
2242  Statutes, is amended to read: 
2243         408.034 Duties and responsibilities of agency; rules.— 
2244         (2) In the exercise of its authority to issue licenses to 
2245  health care facilities and health service providers, as provided 
2246  under chapters 393 and 395 and parts II, and IV, and VIII of 
2247  chapter 400, the agency may not issue a license to any health 
2248  care facility or health service provider that fails to receive a 
2249  certificate of need or an exemption for the licensed facility or 
2250  service. 
2251         Section 51. Paragraph (d) of subsection (1) of section 
2252  408.036, Florida Statutes, is amended to read: 
2253         408.036 Projects subject to review; exemptions.— 
2254         (1) APPLICABILITY.—Unless exempt under subsection (3), all 
2255  health-care-related projects, as described in paragraphs (a) 
2256  (g), are subject to review and must file an application for a 
2257  certificate of need with the agency. The agency is exclusively 
2258  responsible for determining whether a health-care-related 
2259  project is subject to review under ss. 408.031-408.045. 
2260         (d) The establishment of a hospice or hospice inpatient 
2261  facility, except as provided in s. 408.043. 
2262         Section 52. Subsection (2) of section 408.043, Florida 
2263  Statutes, is amended to read: 
2264         408.043 Special provisions.— 
2265         (2) HOSPICES.—When an application is made for a certificate 
2266  of need to establish or to expand a hospice, the need for such 
2267  hospice shall be determined on the basis of the need for and 
2268  availability of hospice services in the community. The formula 
2269  on which the certificate of need is based shall discourage 
2270  regional monopolies and promote competition. The inpatient 
2271  hospice care component of a hospice that which is a freestanding 
2272  facility, or a part of a facility, which is primarily engaged in 
2273  providing inpatient care and related services and is not 
2274  licensed as a health care facility shall also be required to 
2275  obtain a certificate of need. Provision of hospice care by any 
2276  current provider of health care is a significant change in 
2277  service and therefore requires a certificate of need for such 
2278  services. 
2279         Section 53. Paragraph (k) of subsection (3) of section 
2280  408.05, Florida Statutes, is amended to read: 
2281         408.05 Florida Center for Health Information and Policy 
2282  Analysis.— 
2283         (3) COMPREHENSIVE HEALTH INFORMATION SYSTEM.—In order to 
2284  produce comparable and uniform health information and statistics 
2285  for the development of policy recommendations, the agency shall 
2286  perform the following functions: 
2287         (k) Develop, in conjunction with the State Consumer Health 
2288  Information and Policy Advisory Council, and implement a long 
2289  range plan for making available health care quality measures and 
2290  financial data that will allow consumers to compare health care 
2291  services. The health care quality measures and financial data 
2292  the agency must make available shall include, but is not limited 
2293  to, pharmaceuticals, physicians, health care facilities, and 
2294  health plans and managed care entities. The agency shall submit 
2295  the initial plan to the Governor, the President of the Senate, 
2296  and the Speaker of the House of Representatives by January 1, 
2297  2006, and shall update the plan and report on the status of its 
2298  implementation annually thereafter. The agency shall also make 
2299  the plan and status report available to the public on its 
2300  Internet website. As part of the plan, the agency shall identify 
2301  the process and timeframes for implementation, any barriers to 
2302  implementation, and recommendations of changes in the law that 
2303  may be enacted by the Legislature to eliminate the barriers. As 
2304  preliminary elements of the plan, the agency shall: 
2305         1. Make available patient-safety indicators, inpatient 
2306  quality indicators, and performance outcome and patient charge 
2307  data collected from health care facilities pursuant to s. 
2308  408.061(1)(a) and (2). The terms “patient-safety indicators” and 
2309  “inpatient quality indicators” shall be as defined by the 
2310  Centers for Medicare and Medicaid Services, the National Quality 
2311  Forum, the Joint Commission on Accreditation of Healthcare 
2312  Organizations, the Agency for Healthcare Research and Quality, 
2313  the Centers for Disease Control and Prevention, or a similar 
2314  national entity that establishes standards to measure the 
2315  performance of health care providers, or by other states. The 
2316  agency shall determine which conditions, procedures, health care 
2317  quality measures, and patient charge data to disclose based upon 
2318  input from the council. When determining which conditions and 
2319  procedures are to be disclosed, the council and the agency shall 
2320  consider variation in costs, variation in outcomes, and 
2321  magnitude of variations and other relevant information. When 
2322  determining which health care quality measures to disclose, the 
2323  agency: 
2324         a. Shall consider such factors as volume of cases; average 
2325  patient charges; average length of stay; complication rates; 
2326  mortality rates; and infection rates, among others, which shall 
2327  be adjusted for case mix and severity, if applicable. 
2328         b. May consider such additional measures that are adopted 
2329  by the Centers for Medicare and Medicaid Studies, National 
2330  Quality Forum, the Joint Commission on Accreditation of 
2331  Healthcare Organizations, the Agency for Healthcare Research and 
2332  Quality, Centers for Disease Control and Prevention, or a 
2333  similar national entity that establishes standards to measure 
2334  the performance of health care providers, or by other states. 
2335 
2336  When determining which patient charge data to disclose, the 
2337  agency shall include such measures as the average of 
2338  undiscounted charges on frequently performed procedures and 
2339  preventive diagnostic procedures, the range of procedure charges 
2340  from highest to lowest, average net revenue per adjusted patient 
2341  day, average cost per adjusted patient day, and average cost per 
2342  admission, among others. 
2343         2. Make available performance measures, benefit design, and 
2344  premium cost data from health plans licensed pursuant to chapter 
2345  627 or chapter 641. The agency shall determine which health care 
2346  quality measures and member and subscriber cost data to 
2347  disclose, based upon input from the council. When determining 
2348  which data to disclose, the agency shall consider information 
2349  that may be required by either individual or group purchasers to 
2350  assess the value of the product, which may include membership 
2351  satisfaction, quality of care, current enrollment or membership, 
2352  coverage areas, accreditation status, premium costs, plan costs, 
2353  premium increases, range of benefits, copayments and 
2354  deductibles, accuracy and speed of claims payment, credentials 
2355  of physicians, number of providers, names of network providers, 
2356  and hospitals in the network. Health plans shall make available 
2357  to the agency any such data or information that is not currently 
2358  reported to the agency or the office. 
2359         3. Determine the method and format for public disclosure of 
2360  data reported pursuant to this paragraph. The agency shall make 
2361  its determination based upon input from the State Consumer 
2362  Health Information and Policy Advisory Council. At a minimum, 
2363  the data shall be made available on the agency’s Internet 
2364  website in a manner that allows consumers to conduct an 
2365  interactive search that allows them to view and compare the 
2366  information for specific providers. The website must include 
2367  such additional information as is determined necessary to ensure 
2368  that the website enhances informed decisionmaking among 
2369  consumers and health care purchasers, which shall include, at a 
2370  minimum, appropriate guidance on how to use the data and an 
2371  explanation of why the data may vary from provider to provider. 
2372  The data specified in subparagraph 1. shall be released no later 
2373  than January 1, 2006, for the reporting of infection rates, and 
2374  no later than October 1, 2005, for mortality rates and 
2375  complication rates. The data specified in subparagraph 2. shall 
2376  be released no later than October 1, 2006. 
2377         4. Publish on its website undiscounted charges for no fewer 
2378  than 150 of the most commonly performed adult and pediatric 
2379  procedures, including outpatient, inpatient, diagnostic, and 
2380  preventative procedures. 
2381         Section 54. Paragraph (a) of subsection (1) of section 
2382  408.061, Florida Statutes, is amended to read: 
2383         408.061 Data collection; uniform systems of financial 
2384  reporting; information relating to physician charges; 
2385  confidential information; immunity.— 
2386         (1) The agency shall require the submission by health care 
2387  facilities, health care providers, and health insurers of data 
2388  necessary to carry out the agency’s duties. Specifications for 
2389  data to be collected under this section shall be developed by 
2390  the agency with the assistance of technical advisory panels 
2391  including representatives of affected entities, consumers, 
2392  purchasers, and such other interested parties as may be 
2393  determined by the agency. 
2394         (a) Data submitted by health care facilities, including the 
2395  facilities as defined in chapter 395, shall include, but are not 
2396  limited to: case-mix data, patient admission and discharge data, 
2397  hospital emergency department data that which shall include the 
2398  number of patients treated in the emergency department of a 
2399  licensed hospital reported by patient acuity level, data on 
2400  hospital-acquired infections as specified by rule, data on 
2401  complications as specified by rule, data on readmissions as 
2402  specified by rule, with patient and provider-specific 
2403  identifiers included, actual charge data by diagnostic groups, 
2404  financial data, accounting data, operating expenses, expenses 
2405  incurred for rendering services to patients who cannot or do not 
2406  pay, interest charges, depreciation expenses based on the 
2407  expected useful life of the property and equipment involved, and 
2408  demographic data. The agency shall adopt nationally recognized 
2409  risk adjustment methodologies or software consistent with the 
2410  standards of the Agency for Healthcare Research and Quality and 
2411  as selected by the agency for all data submitted as required by 
2412  this section. Data may be obtained from documents such as, but 
2413  not limited to: leases, contracts, debt instruments, itemized 
2414  patient bills, medical record abstracts, and related diagnostic 
2415  information. Reported data elements shall be reported 
2416  electronically and in accordance with rule 59E-7.012, Florida 
2417  Administrative Code. Data submitted shall be certified by the 
2418  chief executive officer or an appropriate and duly authorized 
2419  representative or employee of the licensed facility that the 
2420  information submitted is true and accurate. 
2421         Section 55. Subsection (1) of section 408.10, Florida 
2422  Statutes, is amended to read: 
2423         408.10 Consumer complaints.—The agency shall: 
2424         (1) Publish and make available to the public a toll-free 
2425  telephone number for the purpose of handling consumer complaints 
2426  and shall serve as a liaison between consumer entities and other 
2427  private entities and governmental entities for the disposition 
2428  of problems identified by consumers of health care. The agency 
2429  may provide staffing for this toll-free number through agency 
2430  staff or other arrangements. 
2431         Section 56. Subsection (11) of section 408.802, Florida 
2432  Statutes, is repealed. 
2433         Section 57. Effective October 1, 2010, subsection (3) is 
2434  added to section 408.804, Florida Statutes, to read: 
2435         408.804 License required; display.— 
2436         (3) A person who knowingly alters, defaces, or falsifies 
2437  any license certificate issued by the agency, or causes or 
2438  procures another person to commit such an offense, commits a 
2439  misdemeanor of the second degree, punishable as provided in s. 
2440  775.082 or s. 775.083. Any licensee or provider who displays an 
2441  altered, defaced, or falsified license certificate is subject to 
2442  the penalties set forth in s. 408.815 and an administrative fine 
2443  of $1,000 for each day of illegal display. 
2444         Section 58. Paragraph (d) of subsection (2) of section 
2445  408.806, Florida Statutes, is amended to read: 
2446         408.806 License application process.— 
2447         (2) 
2448         (d) The agency shall notify the licensee by mail or 
2449  electronically at least 90 days before the expiration of a 
2450  license that a renewal license is necessary to continue 
2451  operation. The failure of the licensee to timely submit a 
2452  renewal application and license application fee with the agency 
2453  shall result in a $50 per day late fee charged to the licensee 
2454  by the agency; however, the aggregate amount of the late fee may 
2455  not exceed 50 percent of the licensure fee or $500, whichever is 
2456  less. The agency shall provide a courtesy notice to the licensee 
2457  by United States mail, electronically, or by any other manner at 
2458  its address of record at least 90 days before the expiration of 
2459  a license informing the licensee of the expiration of the 
2460  license. Any failure of the agency to provide the courtesy 
2461  notice or any failure of the licensee to receive the courtesy 
2462  notice does not excuse the licensee from the legal obligation to 
2463  timely file the renewal application and license application fee 
2464  with the agency and does not mitigate the late fee. Payment of 
2465  the late fee is required in order for any late application to be 
2466  complete, and failure to pay the late fee is an omission from 
2467  the application. If an application is received after the 
2468  required filing date and exhibits a hand-canceled postmark 
2469  obtained from a United States post office dated on or before the 
2470  required filing date, no fine will be levied. 
2471         Section 59. Subsections (6) and (9) of section 408.810, 
2472  Florida Statutes, are amended to read: 
2473         408.810 Minimum licensure requirements.—In addition to the 
2474  licensure requirements specified in this part, authorizing 
2475  statutes, and applicable rules, each applicant and licensee must 
2476  comply with the requirements of this section in order to obtain 
2477  and maintain a license. 
2478         (6)(a) An applicant must provide the agency with proof of 
2479  the applicant’s legal right to occupy the property before a 
2480  license may be issued. Proof may include, but need not be 
2481  limited to, copies of warranty deeds, lease or rental 
2482  agreements, contracts for deeds, quitclaim deeds, or other such 
2483  documentation. 
2484         (b) If the property is encumbered by a mortgage or is 
2485  leased, an applicant must provide the agency with proof that the 
2486  mortgagor or landlord has received written notice of the 
2487  applicant’s intent, as mortgagee or tenant, to provide services 
2488  that require licensure and with instructions that the agency 
2489  must be served by certified mail with copies of any actions 
2490  initiated by the mortgagor or landlord against the applicant. 
2491         (9) A controlling interest may not withhold from the agency 
2492  any evidence of financial instability, including, but not 
2493  limited to, checks returned due to insufficient funds, 
2494  delinquent accounts, nonpayment of withholding taxes, unpaid 
2495  utility expenses, nonpayment for essential services, or adverse 
2496  court action concerning the financial viability of the provider 
2497  or any other provider licensed under this part which that is 
2498  under the control of the controlling interest. A controlling 
2499  interest shall notify the agency within 10 days after a court 
2500  action, including, but not limited to, the initiation of 
2501  bankruptcy proceedings, foreclosure, or eviction proceedings in 
2502  which the controlling interest is a petitioner or defendant. Any 
2503  person who violates this subsection commits a misdemeanor of the 
2504  second degree, punishable as provided in s. 775.082 or s. 
2505  775.083. Each day of continuing violation is a separate offense. 
2506         Section 60. Paragraph (e) is added to subsection (2) of 
2507  section 408.813, Florida Statutes, to read: 
2508         408.813 Administrative fines; violations.—As a penalty for 
2509  any violation of this part, authorizing statutes, or applicable 
2510  rules, the agency may impose an administrative fine. 
2511         (2) Violations of this part, authorizing statutes, or 
2512  applicable rules shall be classified according to the nature of 
2513  the violation and the gravity of its probable effect on clients. 
2514  The scope of a violation may be cited as an isolated, patterned, 
2515  or widespread deficiency. An isolated deficiency is a deficiency 
2516  affecting one or a very limited number of clients, or involving 
2517  one or a very limited number of staff, or a situation that 
2518  occurred only occasionally or in a very limited number of 
2519  locations. A patterned deficiency is a deficiency in which more 
2520  than a very limited number of clients are affected, or more than 
2521  a very limited number of staff are involved, or the situation 
2522  has occurred in several locations, or the same client or clients 
2523  have been affected by repeated occurrences of the same deficient 
2524  practice but the effect of the deficient practice is not found 
2525  to be pervasive throughout the provider. A widespread deficiency 
2526  is a deficiency in which the problems causing the deficiency are 
2527  pervasive in the provider or represent systemic failure that has 
2528  affected or has the potential to affect a large portion of the 
2529  provider’s clients. This subsection does not affect the 
2530  legislative determination of the amount of a fine imposed under 
2531  authorizing statutes. Violations shall be classified on the 
2532  written notice as follows: 
2533         (e) The agency may impose an administrative fine for 
2534  violations that do not qualify as class I, class II, class III, 
2535  or class IV violations. The amount of the fine may not exceed 
2536  $500 for each violation. Unclassified violations may include: 
2537         1. Violating any term or condition of a license. 
2538         2. Violating any provision of this part, authorizing 
2539  statutes, or applicable rules. 
2540         3. Exceeding licensed capacity without authorization. 
2541         4. Providing services beyond the scope of the license. 
2542         5. Violating a moratorium. 
2543         Section 61. Subsection (5) is added to section 408.815, 
2544  Florida Statutes, to read: 
2545         408.815 License or application denial; revocation.— 
2546         (5) In order to ensure the health, safety, and welfare of 
2547  clients when a license has been denied or revoked or is set to 
2548  terminate, the agency may extend the license expiration date for 
2549  up to 60 days after denial, revocation, or termination for the 
2550  sole purpose of allowing the safe and orderly discharge of 
2551  clients. The agency may impose conditions on the extension, 
2552  including, but not limited to, prohibiting or limiting 
2553  admissions, expediting discharge planning, submitting required 
2554  status reports, and mandatory monitoring by the agency or third 
2555  parties. The agency may terminate the extension or modify the 
2556  conditions at any time at its discretion. Upon the discharge of 
2557  the final client, the extension shall immediately terminate and 
2558  the provider shall cease operation and promptly surrender its 
2559  license certificate to the agency. During the extension, the 
2560  provider must continue to meet all other requirements of this 
2561  part, authorizing statutes, and applicable rules. This authority 
2562  is in addition to any other authority granted to the agency 
2563  under chapter 120, this part, and the authorizing statutes, but 
2564  does not create any right or entitlement to an extension of a 
2565  license expiration date. 
2566         Section 62. Paragraph (d) is added to subsection (13) of 
2567  section 409.906, Florida Statutes, to read: 
2568         409.906 Optional Medicaid services.—Subject to specific 
2569  appropriations, the agency may make payments for services which 
2570  are optional to the state under Title XIX of the Social Security 
2571  Act and are furnished by Medicaid providers to recipients who 
2572  are determined to be eligible on the dates on which the services 
2573  were provided. Any optional service that is provided shall be 
2574  provided only when medically necessary and in accordance with 
2575  state and federal law. Optional services rendered by providers 
2576  in mobile units to Medicaid recipients may be restricted or 
2577  prohibited by the agency. Nothing in this section shall be 
2578  construed to prevent or limit the agency from adjusting fees, 
2579  reimbursement rates, lengths of stay, number of visits, or 
2580  number of services, or making any other adjustments necessary to 
2581  comply with the availability of moneys and any limitations or 
2582  directions provided for in the General Appropriations Act or 
2583  chapter 216. If necessary to safeguard the state’s systems of 
2584  providing services to elderly and disabled persons and subject 
2585  to the notice and review provisions of s. 216.177, the Governor 
2586  may direct the Agency for Health Care Administration to amend 
2587  the Medicaid state plan to delete the optional Medicaid service 
2588  known as “Intermediate Care Facilities for the Developmentally 
2589  Disabled.” Optional services may include: 
2590         (13) HOME AND COMMUNITY-BASED SERVICES.— 
2591         (d) The agency, in consultation with the Department of 
2592  Elderly Affairs, shall phase out the adult day health care 
2593  waiver program and transfer existing waiver enrollees to other 
2594  appropriate home and community-based service programs. Effective 
2595  July 1, 2010, the adult day health care waiver program shall 
2596  cease to enroll new members. Existing enrollees in the adult day 
2597  health care program shall receive counseling regarding available 
2598  options and shall be offered an alternative home and community 
2599  based services program based on eligibility and personal choice. 
2600  Each enrollee in the waiver program shall continue to receive 
2601  home and community-based services without interruption in the 
2602  enrollee’s program of choice. The providers of the adult day 
2603  health care waiver program, in consultation with resource 
2604  centers for the aged, shall assist in the transition of 
2605  enrollees and cease provision of adult day health care waiver 
2606  services by December 31, 2010. The agency may seek federal 
2607  waiver approval to administer this change. 
2608         Section 63. Paragraph (k) of subsection (4) of section 
2609  409.221, Florida Statutes, is repealed. 
2610         Section 64. Paragraphs (e), (f), and (g) of subsection (15) 
2611  of section 409.912, Florida Statutes, are repealed. 
2612         Section 65. Section 429.07, Florida Statutes, is amended to 
2613  read: 
2614         429.07 License required; fee; and inspections.— 
2615         (1) The requirements of part II of chapter 408 apply to the 
2616  provision of services that require licensure pursuant to this 
2617  part and part II of chapter 408 and to entities licensed by or 
2618  applying for such licensure from the agency pursuant to this 
2619  part. A license issued by the agency is required in order to 
2620  operate an assisted living facility in this state. 
2621         (2) Separate licenses shall be required for facilities 
2622  maintained in separate premises, even though operated under the 
2623  same management. A separate license shall not be required for 
2624  separate buildings on the same grounds. 
2625         (3) In addition to the requirements of s. 408.806, each 
2626  license granted by the agency must state the type of care for 
2627  which the license is granted. Licenses shall be issued for one 
2628  or more of the following categories of care: standard, extended 
2629  congregate care, limited nursing services, or limited mental 
2630  health. 
2631         (a) A standard license shall be issued to a facility that 
2632  provides facilities providing one or more of the personal 
2633  services identified in s. 429.02. Such licensee facilities may 
2634  also employ or contract with a person licensed under part I of 
2635  chapter 464 to administer medications and perform other tasks as 
2636  specified in s. 429.255. 
2637         (b) An extended congregate care license shall be issued to 
2638  a licensee that provides facilities providing, directly or 
2639  through contract, services beyond those authorized in paragraph 
2640  (a), including acts performed pursuant to part I of chapter 464 
2641  by persons licensed thereunder, and supportive services defined 
2642  by rule to persons who otherwise would be disqualified from 
2643  continued residence in a facility licensed under this part. 
2644         1. In order for extended congregate care services to be 
2645  provided in a facility licensed under this part, the agency must 
2646  first determine that all requirements established in law and 
2647  rule are met and must specifically designate, on the facility’s 
2648  license, that such services may be provided and whether the 
2649  designation applies to all or part of a facility. Such 
2650  designation may be made at the time of initial licensure or 
2651  relicensure, or upon request in writing by a licensee under this 
2652  part and part II of chapter 408. Notification of approval or 
2653  denial of such request shall be made in accordance with part II 
2654  of chapter 408. An existing licensee facilities qualifying to 
2655  provide extended congregate care services must have maintained a 
2656  standard license and may not have been subject to administrative 
2657  sanctions during the previous 2 years, or since initial 
2658  licensure if the facility has been licensed for less than 2 
2659  years, for any of the following reasons: 
2660         a. A class I or class II violation; 
2661         b. Three or more repeat or recurring class III violations 
2662  of identical or similar resident care standards as specified in 
2663  rule from which a pattern of noncompliance is found by the 
2664  agency; 
2665         c. Three or more class III violations that were not 
2666  corrected in accordance with the corrective action plan approved 
2667  by the agency; 
2668         d. Violation of resident care standards resulting in a 
2669  requirement to employ the services of a consultant pharmacist or 
2670  consultant dietitian; 
2671         e. Denial, suspension, or revocation of a license for 
2672  another facility under this part in which the applicant for an 
2673  extended congregate care license has at least 25 percent 
2674  ownership interest; or 
2675         f. Imposition of a moratorium pursuant to this part or part 
2676  II of chapter 408 or initiation of injunctive proceedings. 
2677         2. A licensee Facilities that is are licensed to provide 
2678  extended congregate care services shall maintain a written 
2679  progress report for on each person who receives such services, 
2680  and the which report must describe describes the type, amount, 
2681  duration, scope, and outcome of services that are rendered and 
2682  the general status of the resident’s health. A registered nurse, 
2683  or appropriate designee, representing the agency shall visit 
2684  such facilities at least quarterly to monitor residents who are 
2685  receiving extended congregate care services and to determine if 
2686  the facility is in compliance with this part, part II of chapter 
2687  408, and rules that relate to extended congregate care. One of 
2688  these visits may be in conjunction with the regular survey. The 
2689  monitoring visits may be provided through contractual 
2690  arrangements with appropriate community agencies. A registered 
2691  nurse shall serve as part of the team that inspects such 
2692  facility. The agency may waive one of the required yearly 
2693  monitoring visits for a facility that has been licensed for at 
2694  least 24 months to provide extended congregate care services, 
2695  if, during the inspection, the registered nurse determines that 
2696  extended congregate care services are being provided 
2697  appropriately, and if the facility has no class I or class II 
2698  violations and no uncorrected class III violations. Before such 
2699  decision is made, the agency shall consult with the long-term 
2700  care ombudsman council for the area in which the facility is 
2701  located to determine if any complaints have been made and 
2702  substantiated about the quality of services or care. The agency 
2703  may not waive one of the required yearly monitoring visits if 
2704  complaints have been made and substantiated. 
2705         3. Licensees Facilities that are licensed to provide 
2706  extended congregate care services shall: 
2707         a. Demonstrate the capability to meet unanticipated 
2708  resident service needs. 
2709         b. Offer a physical environment that promotes a homelike 
2710  setting, provides for resident privacy, promotes resident 
2711  independence, and allows sufficient congregate space as defined 
2712  by rule. 
2713         c. Have sufficient staff available, taking into account the 
2714  physical plant and firesafety features of the building, to 
2715  assist with the evacuation of residents in an emergency, as 
2716  necessary. 
2717         d. Adopt and follow policies and procedures that maximize 
2718  resident independence, dignity, choice, and decisionmaking to 
2719  permit residents to age in place to the extent possible, so that 
2720  moves due to changes in functional status are minimized or 
2721  avoided. 
2722         e. Allow residents or, if applicable, a resident’s 
2723  representative, designee, surrogate, guardian, or attorney in 
2724  fact to make a variety of personal choices, participate in 
2725  developing service plans, and share responsibility in 
2726  decisionmaking. 
2727         f. Implement the concept of managed risk. 
2728         g. Provide, either directly or through contract, the 
2729  services of a person licensed pursuant to part I of chapter 464. 
2730         h. In addition to the training mandated in s. 429.52, 
2731  provide specialized training as defined by rule for facility 
2732  staff. 
2733         4. Licensees Facilities licensed to provide extended 
2734  congregate care services are exempt from the criteria for 
2735  continued residency as set forth in rules adopted under s. 
2736  429.41. Licensees Facilities so licensed shall adopt their own 
2737  requirements within guidelines for continued residency set forth 
2738  by rule. However, such licensees facilities may not serve 
2739  residents who require 24-hour nursing supervision. Licensees 
2740  Facilities licensed to provide extended congregate care services 
2741  shall provide each resident with a written copy of facility 
2742  policies governing admission and retention. 
2743         5. The primary purpose of extended congregate care services 
2744  is to allow residents, as they become more impaired, the option 
2745  of remaining in a familiar setting from which they would 
2746  otherwise be disqualified for continued residency. A licensee 
2747  facility licensed to provide extended congregate care services 
2748  may also admit an individual who exceeds the admission criteria 
2749  for a facility with a standard license, if the individual is 
2750  determined appropriate for admission to the extended congregate 
2751  care facility. 
2752         6. Before admission of an individual to a facility licensed 
2753  to provide extended congregate care services, the individual 
2754  must undergo a medical examination as provided in s. 429.26(4) 
2755  and the facility must develop a preliminary service plan for the 
2756  individual. 
2757         7. When a licensee facility can no longer provide or 
2758  arrange for services in accordance with the resident’s service 
2759  plan and needs and the licensee facility’s policy, the licensee 
2760  facility shall make arrangements for relocating the person in 
2761  accordance with s. 429.28(1)(k). 
2762         8. Failure to provide extended congregate care services may 
2763  result in denial of extended congregate care license renewal. 
2764         9. No later than January 1 of each year, the department, in 
2765  consultation with the agency, shall prepare and submit to the 
2766  Governor, the President of the Senate, the Speaker of the House 
2767  of Representatives, and the chairs of appropriate legislative 
2768  committees, a report on the status of, and recommendations 
2769  related to, extended congregate care services. The status report 
2770  must include, but need not be limited to, the following 
2771  information: 
2772         a. A description of the facilities licensed to provide such 
2773  services, including total number of beds licensed under this 
2774  part. 
2775         b. The number and characteristics of residents receiving 
2776  such services. 
2777         c. The types of services rendered that could not be 
2778  provided through a standard license. 
2779         d. An analysis of deficiencies cited during licensure 
2780  inspections. 
2781         e. The number of residents who required extended congregate 
2782  care services at admission and the source of admission. 
2783         f. Recommendations for statutory or regulatory changes. 
2784         g. The availability of extended congregate care to state 
2785  clients residing in facilities licensed under this part and in 
2786  need of additional services, and recommendations for 
2787  appropriations to subsidize extended congregate care services 
2788  for such persons. 
2789         h. Such other information as the department considers 
2790  appropriate. 
2791         (c) A limited nursing services license shall be issued to a 
2792  facility that provides services beyond those authorized in 
2793  paragraph (a) and as specified in this paragraph. 
2794         1. In order for limited nursing services to be provided in 
2795  a facility licensed under this part, the agency must first 
2796  determine that all requirements established in law and rule are 
2797  met and must specifically designate, on the facility’s license, 
2798  that such services may be provided. Such designation may be made 
2799  at the time of initial licensure or relicensure, or upon request 
2800  in writing by a licensee under this part and part II of chapter 
2801  408. Notification of approval or denial of such request shall be 
2802  made in accordance with part II of chapter 408. Existing 
2803  facilities qualifying to provide limited nursing services shall 
2804  have maintained a standard license and may not have been subject 
2805  to administrative sanctions that affect the health, safety, and 
2806  welfare of residents for the previous 2 years or since initial 
2807  licensure if the facility has been licensed for less than 2 
2808  years. 
2809         2. Facilities that are licensed to provide limited nursing 
2810  services shall maintain a written progress report on each person 
2811  who receives such nursing services, which report describes the 
2812  type, amount, duration, scope, and outcome of services that are 
2813  rendered and the general status of the resident’s health. A 
2814  registered nurse representing the agency shall visit such 
2815  facilities at least twice a year to monitor residents who are 
2816  receiving limited nursing services and to determine if the 
2817  facility is in compliance with applicable provisions of this 
2818  part, part II of chapter 408, and related rules. The monitoring 
2819  visits may be provided through contractual arrangements with 
2820  appropriate community agencies. A registered nurse shall also 
2821  serve as part of the team that inspects such facility. 
2822         3. A person who receives limited nursing services under 
2823  this part must meet the admission criteria established by the 
2824  agency for assisted living facilities. When a resident no longer 
2825  meets the admission criteria for a facility licensed under this 
2826  part, arrangements for relocating the person shall be made in 
2827  accordance with s. 429.28(1)(k), unless the facility is licensed 
2828  to provide extended congregate care services. 
2829         (4) In accordance with s. 408.805, an applicant or licensee 
2830  shall pay a fee for each license application submitted under 
2831  this part, part II of chapter 408, and applicable rules. The 
2832  amount of the fee shall be established by rule. 
2833         (a) The biennial license fee required of a facility is $356 
2834  $300 per license, with an additional fee of $67.50 $50 per 
2835  resident based on the total licensed resident capacity of the 
2836  facility, except that no additional fee will be assessed for 
2837  beds designated for recipients of optional state supplementation 
2838  payments provided for in s. 409.212. The total fee may not 
2839  exceed $18,500 $10,000. 
2840         (b) In addition to the total fee assessed under paragraph 
2841  (a), the agency shall require facilities that are licensed to 
2842  provide extended congregate care services under this part to pay 
2843  an additional fee per licensed facility. The amount of the 
2844  biennial fee shall be $501 $400 per license, with an additional 
2845  fee of $10 per resident based on the total licensed resident 
2846  capacity of the facility. 
2847         (c) In addition to the total fee assessed under paragraph 
2848  (a), the agency shall require facilities that are licensed to 
2849  provide limited nursing services under this part to pay an 
2850  additional fee per licensed facility. The amount of the biennial 
2851  fee shall be $250 per license, with an additional fee of $10 per 
2852  resident based on the total licensed resident capacity of the 
2853  facility. 
2854         (5) Counties or municipalities applying for licenses under 
2855  this part are exempt from the payment of license fees. 
2856         (6) In order to determine whether the licensee is 
2857  adequately protecting residents’ rights as provided in s. 
2858  429.28, the biennial survey must include private, informal 
2859  conversations with a sample of the residents and consultation 
2860  with the ombudsman council in the planning and service area in 
2861  which the facility is located to discuss residents’ experiences 
2862  within the facility. 
2863         (7) An assisted living facility that has been cited within 
2864  the previous 24-month period for a class I violation or a class 
2865  II violation, regardless of the status of any enforcement or 
2866  disciplinary action, is subject to periodic unannounced 
2867  monitoring to determine if the facility is in compliance with 
2868  this part, part II of chapter 408, and applicable rules. 
2869  Monitoring may occur through a desk review or onsite. If a cited 
2870  violation relates to providing or failing to provide nursing 
2871  care, a registered nurse must participate in at least two onsite 
2872  monitoring visits within a 12-month period. 
2873         Section 66. Section 429.11, Florida Statutes, is amended to 
2874  read: 
2875         429.11 Initial application for license; provisional 
2876  license.— 
2877         (1) Each applicant for licensure must comply with all 
2878  provisions of part II of chapter 408 and must: 
2879         (a) Identify all other homes or facilities, including the 
2880  addresses and the license or licenses under which they operate, 
2881  if applicable, which are currently operated by the applicant or 
2882  administrator and which provide housing, meals, and personal 
2883  services to residents. 
2884         (b) Provide the location of the facility for which a 
2885  license is sought and documentation, signed by the appropriate 
2886  local government official, which states that the applicant has 
2887  met local zoning requirements. 
2888         (c) Provide the name, address, date of birth, social 
2889  security number, education, and experience of the administrator, 
2890  if different from the applicant. 
2891         (2) The applicant shall provide proof of liability 
2892  insurance as defined in s. 624.605. 
2893         (3) If the applicant is a community residential home, the 
2894  applicant must provide proof that it has met the requirements 
2895  specified in chapter 419. 
2896         (4) The applicant must furnish proof that the facility has 
2897  received a satisfactory firesafety inspection. The local 
2898  authority having jurisdiction or the State Fire Marshal must 
2899  conduct the inspection within 30 days after written request by 
2900  the applicant. 
2901         (5) The applicant must furnish documentation of a 
2902  satisfactory sanitation inspection of the facility by the county 
2903  health department. 
2904         (6) In addition to the license categories available in s. 
2905  408.808, a provisional license may be issued to an applicant 
2906  making initial application for licensure or making application 
2907  for a change of ownership. A provisional license shall be 
2908  limited in duration to a specific period of time not to exceed 6 
2909  months, as determined by the agency. 
2910         (6)(7) A county or municipality may not issue an 
2911  occupational license that is being obtained for the purpose of 
2912  operating a facility regulated under this part without first 
2913  ascertaining that the applicant has been licensed to operate 
2914  such facility at the specified location or locations by the 
2915  agency. The agency shall furnish to local agencies responsible 
2916  for issuing occupational licenses sufficient instruction for 
2917  making such determinations. 
2918         Section 67. Subsection (2) of section 429.12, Florida 
2919  Statutes, is repealed. 
2920         Section 68. Subsections (5) and (6) of section 429.14, 
2921  Florida Statutes, are amended to read: 
2922         429.14 Administrative penalties.— 
2923         (5) An action taken by the agency to suspend, deny, or 
2924  revoke a facility’s license under this part or part II of 
2925  chapter 408, in which the agency claims that the facility owner 
2926  or an employee of the facility has threatened the health, 
2927  safety, or welfare of a resident of the facility shall be heard 
2928  by the Division of Administrative Hearings of the Department of 
2929  Management Services within 120 days after receipt of the 
2930  facility’s request for a hearing, unless that time limitation is 
2931  waived by both parties. The administrative law judge must render 
2932  a decision within 30 days after receipt of a proposed 
2933  recommended order. 
2934         (6) The agency shall provide to the Division of Hotels and 
2935  Restaurants of the Department of Business and Professional 
2936  Regulation, on a monthly basis, a list of those assisted living 
2937  facilities that have had their licenses denied, suspended, or 
2938  revoked or that are involved in an appellate proceeding pursuant 
2939  to s. 120.60 related to the denial, suspension, or revocation of 
2940  a license. This information may be provided electronically or 
2941  through the agency’s Internet website. 
2942         Section 69. Subsections (1), (4), and (5) of section 
2943  429.17, Florida Statutes, are amended to read: 
2944         429.17 Expiration of license; renewal; conditional 
2945  license.— 
2946         (1) Limited nursing, Extended congregate care, and limited 
2947  mental health licenses shall expire at the same time as the 
2948  facility’s standard license, regardless of when issued. 
2949         (4) In addition to the license categories available in s. 
2950  408.808, a conditional license may be issued to an applicant for 
2951  license renewal if the applicant fails to meet all standards and 
2952  requirements for licensure. A conditional license issued under 
2953  this subsection shall be limited in duration to a specific 
2954  period of time not to exceed 6 months, as determined by the 
2955  agency, and shall be accompanied by an agency-approved plan of 
2956  correction. 
2957         (5) When an extended congregate care or limited nursing 
2958  license is requested during a facility’s biennial license 
2959  period, the fee shall be prorated in order to permit the 
2960  additional license to expire at the end of the biennial license 
2961  period. The fee shall be calculated as of the date the 
2962  additional license application is received by the agency. 
2963         Section 70. Subsection (7) of section 429.19, Florida 
2964  Statutes, is amended to read: 
2965         429.19 Violations; imposition of administrative fines; 
2966  grounds.— 
2967         (7) In addition to any administrative fines imposed, the 
2968  agency may assess a survey or monitoring fee, equal to the 
2969  lesser of one half of the facility’s biennial license and bed 
2970  fee or $500, to cover the cost of conducting initial complaint 
2971  investigations that result in the finding of a violation that 
2972  was the subject of the complaint or monitoring visits conducted 
2973  under s. 429.28(3)(c) to verify the correction of the 
2974  violations, or to monitor the health, safety, or security of 
2975  residents under s. 429.07(7). 
2976         Section 71. Subsection (5) of section 429.23, Florida 
2977  Statutes, is repealed. 
2978         Section 72. Section 429.255, Florida Statutes, is amended 
2979  to read: 
2980         429.255 Use of personnel; emergency care.— 
2981         (1)(a) Persons under contract to the facility or, facility 
2982  staff, or volunteers, who are licensed according to part I of 
2983  chapter 464, or those persons exempt under s. 464.022(1), and 
2984  others as defined by rule, may administer medications to 
2985  residents, take residents’ vital signs, manage individual weekly 
2986  pill organizers for residents who self-administer medication, 
2987  give prepackaged enemas ordered by a physician, observe 
2988  residents, document observations on the appropriate resident’s 
2989  record, report observations to the resident’s physician, and 
2990  contract or allow residents or a resident’s representative, 
2991  designee, surrogate, guardian, or attorney in fact to contract 
2992  with a third party, provided residents meet the criteria for 
2993  appropriate placement as defined in s. 429.26. Persons under 
2994  contract to the facility or facility staff who are licensed 
2995  according to part I of chapter 464 may provide limited nursing 
2996  services. Nursing assistants certified pursuant to part II of 
2997  chapter 464 may take residents’ vital signs as directed by a 
2998  licensed nurse or physician. The licensee is responsible for 
2999  maintaining documentation of services provided under this 
3000  paragraph as required by rule and ensuring that staff are 
3001  adequately trained to monitor residents receiving these 
3002  services. 
3003         (b) All staff in facilities licensed under this part shall 
3004  exercise their professional responsibility to observe residents, 
3005  to document observations on the appropriate resident’s record, 
3006  and to report the observations to the resident’s physician. 
3007  However, the owner or administrator of the facility shall be 
3008  responsible for determining that the resident receiving services 
3009  is appropriate for residence in the facility. 
3010         (c) In an emergency situation, licensed personnel may carry 
3011  out their professional duties pursuant to part I of chapter 464 
3012  until emergency medical personnel assume responsibility for 
3013  care. 
3014         (2) In facilities licensed to provide extended congregate 
3015  care, persons under contract to the facility or, facility staff, 
3016  or volunteers, who are licensed according to part I of chapter 
3017  464, or those persons exempt under s. 464.022(1), or those 
3018  persons certified as nursing assistants pursuant to part II of 
3019  chapter 464, may also perform all duties within the scope of 
3020  their license or certification, as approved by the facility 
3021  administrator and pursuant to this part. 
3022         (3) Facility staff may withhold or withdraw cardiopulmonary 
3023  resuscitation if presented with an order not to resuscitate 
3024  executed pursuant to s. 401.45. The department shall adopt rules 
3025  providing for the implementation of such orders. Facility staff 
3026  and facilities shall not be subject to criminal prosecution or 
3027  civil liability, nor be considered to have engaged in negligent 
3028  or unprofessional conduct, for withholding or withdrawing 
3029  cardiopulmonary resuscitation pursuant to such an order and 
3030  rules adopted by the department. The absence of an order to 
3031  resuscitate executed pursuant to s. 401.45 does not preclude a 
3032  physician from withholding or withdrawing cardiopulmonary 
3033  resuscitation as otherwise permitted by law. 
3034         Section 73. Subsection (3) of section 429.28, Florida 
3035  Statutes, is repealed. 
3036         Section 74. Subsection (2) of section 429.35, Florida 
3037  Statutes, is amended to read: 
3038         429.35 Maintenance of records; reports.— 
3039         (2) Within 60 days after the date of the biennial 
3040  inspection visit required under s. 408.811 or within 30 days 
3041  after the date of any interim visit, the agency shall forward 
3042  the results of the inspection to the local ombudsman council in 
3043  whose planning and service area, as defined in part II of 
3044  chapter 400, the facility is located; to at least one public 
3045  library or, in the absence of a public library, the county seat 
3046  in the county in which the inspected assisted living facility is 
3047  located; and, when appropriate, to the district Adult Services 
3048  and Mental Health Program Offices. This information may be 
3049  provided electronically or through the agency’s Internet site. 
3050         Section 75. Paragraphs (i) and (j) of subsection (1) of 
3051  section 429.41, Florida Statutes, are amended to read: 
3052         429.41 Rules establishing standards.— 
3053         (1) It is the intent of the Legislature that rules 
3054  published and enforced pursuant to this section shall include 
3055  criteria by which a reasonable and consistent quality of 
3056  resident care and quality of life may be ensured and the results 
3057  of such resident care may be demonstrated. Such rules shall also 
3058  ensure a safe and sanitary environment that is residential and 
3059  noninstitutional in design or nature. It is further intended 
3060  that reasonable efforts be made to accommodate the needs and 
3061  preferences of residents to enhance the quality of life in a 
3062  facility. The agency, in consultation with the department, may 
3063  adopt rules to administer the requirements of part II of chapter 
3064  408. In order to provide safe and sanitary facilities and the 
3065  highest quality of resident care accommodating the needs and 
3066  preferences of residents, the department, in consultation with 
3067  the agency, the Department of Children and Family Services, and 
3068  the Department of Health, shall adopt rules, policies, and 
3069  procedures to administer this part, which must include 
3070  reasonable and fair minimum standards in relation to: 
3071         (i) Facilities holding an a limited nursing, extended 
3072  congregate care, or limited mental health license. 
3073         (j) The establishment of specific criteria to define 
3074  appropriateness of resident admission and continued residency in 
3075  a facility holding a standard, limited nursing, extended 
3076  congregate care, and limited mental health license. 
3077         Section 76. Section 429.53, Florida Statutes, is amended to 
3078  read: 
3079         429.53 Consultation by the agency.— 
3080         (1) The area offices of licensure and certification of the 
3081  agency shall provide consultation to the following upon request: 
3082         (a) A licensee of a facility. 
3083         (b) A person interested in obtaining a license to operate a 
3084  facility under this part. 
3085         (2) As used in this section, “consultation” includes: 
3086         (a) An explanation of the requirements of this part and 
3087  rules adopted pursuant thereto; 
3088         (b) An explanation of the license application and renewal 
3089  procedures; and 
3090         (c) The provision of a checklist of general local and state 
3091  approvals required prior to constructing or developing a 
3092  facility and a listing of the types of agencies responsible for 
3093  such approvals; 
3094         (d) An explanation of benefits and financial assistance 
3095  available to a recipient of supplemental security income 
3096  residing in a facility; 
3097         (c)(e) Any other information which the agency deems 
3098  necessary to promote compliance with the requirements of this 
3099  part; and 
3100         (f) A preconstruction review of a facility to ensure 
3101  compliance with agency rules and this part. 
3102         (3) The agency may charge a fee commensurate with the cost 
3103  of providing consultation under this section. 
3104         Section 77. Section 429.54, Florida Statutes, is amended to 
3105  read: 
3106         429.54 Collection of information; local subsidy.— 
3107         (1) Facilities that are licensed under this part must 
3108  report electronically to the agency semiannually, or more 
3109  frequently as determined by rule, data related to the facility, 
3110  including, but not limited to: the total number of residents, 
3111  the number of residents who are receiving limited mental health 
3112  services, the number of residents who are receiving extended 
3113  congregate care services, the number of residents who are 
3114  receiving limited nursing services, funding sources of the 
3115  residents, and professional staffing employed by or under 
3116  contract with the licensee to provide resident services. The 
3117  department, in consultation with the agency, shall adopt rules 
3118  to administer this subsection. 
3119         (2)(1) To enable the department to collect the information 
3120  requested by the Legislature regarding the actual cost of 
3121  providing room, board, and personal care in facilities, the 
3122  department is authorized to conduct field visits and audits of 
3123  facilities as may be necessary. The owners of randomly sampled 
3124  facilities shall submit such reports, audits, and accountings of 
3125  cost as the department may require by rule; provided that such 
3126  reports, audits, and accountings shall be the minimum necessary 
3127  to implement the provisions of this section. Any facility 
3128  selected to participate in the study shall cooperate with the 
3129  department by providing cost of operation information to 
3130  interviewers. 
3131         (3)(2) Local governments or organizations may contribute to 
3132  the cost of care of local facility residents by further 
3133  subsidizing the rate of state-authorized payment to such 
3134  facilities. Implementation of local subsidy shall require 
3135  departmental approval and shall not result in reductions in the 
3136  state supplement. 
3137         Section 78. Subsections (2) and (11) of section 429.65, 
3138  Florida Statutes, are amended to read: 
3139         429.65 Definitions.—As used in this part, the term: 
3140         (2) “Adult family-care home” means a full-time, family-type 
3141  living arrangement, in a private home, under which up to two 
3142  individuals a person who reside in the home and own or rent owns 
3143  or rents the home provide provides room, board, and personal 
3144  care, on a 24-hour basis, for no more than five disabled adults 
3145  or frail elders who are not relatives. The following family-type 
3146  living arrangements are not required to be licensed as an adult 
3147  family-care home: 
3148         (a) An arrangement whereby the person who resides in the 
3149  home and owns or rents the home provides room, board, and 
3150  personal services for not more than two adults who do not 
3151  receive optional state supplementation under s. 409.212. The 
3152  person who provides the housing, meals, and personal care must 
3153  own or rent the home and reside therein. 
3154         (b) An arrangement whereby the person who owns or rents the 
3155  home provides room, board, and personal services only to his or 
3156  her relatives. 
3157         (c) An establishment that is licensed as an assisted living 
3158  facility under this chapter. 
3159         (11) “Provider” means up to two individuals a person who 
3160  are is licensed to operate an adult family-care home. 
3161         Section 79. Section 429.71, Florida Statutes, is amended to 
3162  read: 
3163         429.71 Classification of violations deficiencies; 
3164  administrative fines.— 
3165         (1) In addition to the requirements of part II of chapter 
3166  408 and in addition to any other liability or penalty provided 
3167  by law, the agency may impose an administrative fine on a 
3168  provider according to the following classification: 
3169         (a) Class I violations are defined in s. 408.813. those 
3170  conditions or practices related to the operation and maintenance 
3171  of an adult family-care home or to the care of residents which 
3172  the agency determines present an imminent danger to the 
3173  residents or guests of the facility or a substantial probability 
3174  that death or serious physical or emotional harm would result 
3175  therefrom. The condition or practice that constitutes a class I 
3176  violation must be abated or eliminated within 24 hours, unless a 
3177  fixed period, as determined by the agency, is required for 
3178  correction. A class I violation deficiency is subject to an 
3179  administrative fine in an amount not less than $500 and not 
3180  exceeding $1,000 for each violation. A fine may be levied 
3181  notwithstanding the correction of the violation deficiency. 
3182         (b) Class II violations are defined in s. 408.813. those 
3183  conditions or practices related to the operation and maintenance 
3184  of an adult family-care home or to the care of residents which 
3185  the agency determines directly threaten the physical or 
3186  emotional health, safety, or security of the residents, other 
3187  than class I violations. A class II violation is subject to an 
3188  administrative fine in an amount not less than $250 and not 
3189  exceeding $500 for each violation. A citation for a class II 
3190  violation must specify the time within which the violation is 
3191  required to be corrected. If a class II violation is corrected 
3192  within the time specified, no civil penalty shall be imposed, 
3193  unless it is a repeated offense. 
3194         (c) Class III violations are defined in s. 408.813. those 
3195  conditions or practices related to the operation and maintenance 
3196  of an adult family-care home or to the care of residents which 
3197  the agency determines indirectly or potentially threaten the 
3198  physical or emotional health, safety, or security of residents, 
3199  other than class I or class II violations. A class III violation 
3200  is subject to an administrative fine in an amount not less than 
3201  $100 and not exceeding $250 for each violation. A citation for a 
3202  class III violation shall specify the time within which the 
3203  violation is required to be corrected. If a class III violation 
3204  is corrected within the time specified, no civil penalty shall 
3205  be imposed, unless it is a repeated offense. 
3206         (d) Class IV violations are defined in s. 408.813. those 
3207  conditions or occurrences related to the operation and 
3208  maintenance of an adult family-care home, or related to the 
3209  required reports, forms, or documents, which do not have the 
3210  potential of negatively affecting the residents. A provider that 
3211  does not correct A class IV violation within the time limit 
3212  specified by the agency is subject to an administrative fine in 
3213  an amount not less than $50 and not exceeding $100 for each 
3214  violation. Any class IV violation that is corrected during the 
3215  time the agency survey is conducted will be identified as an 
3216  agency finding and not as a violation. 
3217         (2) The agency may impose an administrative fine for 
3218  violations that which do not qualify as class I, class II, class 
3219  III, or class IV violations. The amount of the fine may shall 
3220  not exceed $250 for each violation or $2,000 in the aggregate. 
3221  Unclassified violations may include: 
3222         (a) Violating any term or condition of a license. 
3223         (b) Violating any provision of this part, part II of 
3224  chapter 408, or applicable rules. 
3225         (c) Failure to follow the criteria and procedures provided 
3226  under part I of chapter 394 relating to the transportation, 
3227  voluntary admission, and involuntary examination of adult 
3228  family-care home residents. 
3229         (d) Exceeding licensed capacity. 
3230         (e) Providing services beyond the scope of the license. 
3231         (f) Violating a moratorium. 
3232         (3) Each day during which a violation occurs constitutes a 
3233  separate offense. 
3234         (4) In determining whether a penalty is to be imposed, and 
3235  in fixing the amount of any penalty to be imposed, the agency 
3236  must consider: 
3237         (a) The gravity of the violation. 
3238         (b) Actions taken by the provider to correct a violation. 
3239         (c) Any previous violation by the provider. 
3240         (d) The financial benefit to the provider of committing or 
3241  continuing the violation. 
3242         (5) As an alternative to or in conjunction with an 
3243  administrative action against a provider, the agency may request 
3244  a plan of corrective action that demonstrates a good faith 
3245  effort to remedy each violation by a specific date, subject to 
3246  the approval of the agency. 
3247         (5)(6) The department shall set forth, by rule, notice 
3248  requirements and procedures for correction of deficiencies. 
3249         Section 80. Subsection (5) of section 429.901, Florida 
3250  Statutes, is repealed. 
3251         Section 81. Paragraph (a) of subsection (2) of section 
3252  429.911, Florida Statutes is repealed. 
3253         Section 82. Section 429.915, Florida Statutes, is amended 
3254  to read: 
3255         429.915 Conditional license.—In addition to the license 
3256  categories available in part II of chapter 408, the agency may 
3257  issue a conditional license to an applicant for license renewal 
3258  or change of ownership if the applicant fails to meet all 
3259  standards and requirements for licensure. A conditional license 
3260  issued under this subsection must be limited to a specific 
3261  period not exceeding 6 months, as determined by the agency, and 
3262  must be accompanied by an approved plan of correction. 
3263         Section 83. Subsection (3) of section 430.80, Florida 
3264  Statutes, is amended to read: 
3265         430.80 Implementation of a teaching nursing home pilot 
3266  project.— 
3267         (3) To be designated as a teaching nursing home, a nursing 
3268  home licensee must, at a minimum: 
3269         (a) Provide a comprehensive program of integrated senior 
3270  services that include institutional services and community-based 
3271  services; 
3272         (b) Participate in a nationally recognized accreditation 
3273  program and hold a valid accreditation, such as the 
3274  accreditation awarded by the Joint Commission on Accreditation 
3275  of Healthcare Organizations; 
3276         (c) Have been in business in this state for a minimum of 10 
3277  consecutive years; 
3278         (d) Demonstrate an active program in multidisciplinary 
3279  education and research that relates to gerontology; 
3280         (e) Have a formalized contractual relationship with at 
3281  least one accredited health profession education program located 
3282  in this state; 
3283         (f) Have a formalized contractual relationship with an 
3284  accredited hospital that is designated by law as a teaching 
3285  hospital; and 
3286         (g) Have senior staff members who hold formal faculty 
3287  appointments at universities, which must include at least one 
3288  accredited health profession education program. 
3289         (h) Maintain insurance coverage pursuant to s. 
3290  400.141(1)(q) s. 400.141(1)(s) or proof of financial 
3291  responsibility in a minimum amount of $750,000. Such proof of 
3292  financial responsibility may include: 
3293         1. Maintaining an escrow account consisting of cash or 
3294  assets eligible for deposit in accordance with s. 625.52; or 
3295         2. Obtaining and maintaining pursuant to chapter 675 an 
3296  unexpired, irrevocable, nontransferable and nonassignable letter 
3297  of credit issued by any bank or savings association organized 
3298  and existing under the laws of this state or any bank or savings 
3299  association organized under the laws of the United States which 
3300  that has its principal place of business in this state or which 
3301  has a branch office that which is authorized to receive deposits 
3302  in this state. The letter of credit shall be used to satisfy the 
3303  obligation of the facility to the claimant upon presentment of a 
3304  final judgment indicating liability and awarding damages to be 
3305  paid by the facility or upon presentment of a settlement 
3306  agreement signed by all parties to the agreement when such final 
3307  judgment or settlement is a result of a liability claim against 
3308  the facility. 
3309         Section 84. Paragraph (a) of subsection (2) of section 
3310  440.13, Florida Statutes, is amended to read: 
3311         440.13 Medical services and supplies; penalty for 
3312  violations; limitations.— 
3313         (2) MEDICAL TREATMENT; DUTY OF EMPLOYER TO FURNISH.— 
3314         (a) Subject to the limitations specified elsewhere in this 
3315  chapter, the employer shall furnish to the employee such 
3316  medically necessary remedial treatment, care, and attendance for 
3317  such period as the nature of the injury or the process of 
3318  recovery may require, which is in accordance with established 
3319  practice parameters and protocols of treatment as provided for 
3320  in this chapter, including medicines, medical supplies, durable 
3321  medical equipment, orthoses, prostheses, and other medically 
3322  necessary apparatus. Remedial treatment, care, and attendance, 
3323  including work-hardening programs or pain-management programs 
3324  accredited by the Commission on Accreditation of Rehabilitation 
3325  Facilities or Joint Commission on the Accreditation of Health 
3326  Organizations or pain-management programs affiliated with 
3327  medical schools, shall be considered as covered treatment only 
3328  when such care is given based on a referral by a physician as 
3329  defined in this chapter. Medically necessary treatment, care, 
3330  and attendance does not include chiropractic services in excess 
3331  of 24 treatments or rendered 12 weeks beyond the date of the 
3332  initial chiropractic treatment, whichever comes first, unless 
3333  the carrier authorizes additional treatment or the employee is 
3334  catastrophically injured. 
3335 
3336  Failure of the carrier to timely comply with this subsection 
3337  shall be a violation of this chapter and the carrier shall be 
3338  subject to penalties as provided for in s. 440.525. 
3339         Section 85. Subsection (11) is added to section 483.201, 
3340  Florida Statutes, to read: 
3341         483.201 Grounds for disciplinary action against clinical 
3342  laboratories.—In addition to the requirements of part II of 
3343  chapter 408, the following acts constitute grounds for which a 
3344  disciplinary action specified in s. 483.221 may be taken against 
3345  a clinical laboratory: 
3346         (11) A blood establishment that collects blood or blood 
3347  components from volunteer donors failing to disclose information 
3348  concerning its activities as required by s. 381.06014. Each day 
3349  of violation constitutes a separate violation and each separate 
3350  violation is subject to a separate fine. If multiple licensed 
3351  establishments operated by a single business entity fail to meet 
3352  such disclosure requirements, the agency may assess fines 
3353  against only one of the business entity’s clinical laboratory 
3354  licenses. The total administrative fine may not exceed $10,000 
3355  for each annual reporting period. 
3356         Section 86. Section 483.294, Florida Statutes, is amended 
3357  to read: 
3358         483.294 Inspection of centers.—In accordance with s. 
3359  408.811, the agency shall biennially, at least once annually, 
3360  inspect the premises and operations of all centers subject to 
3361  licensure under this part. 
3362         Section 87. Subsection (23) of section 499.003, Florida 
3363  Statutes, is amended to read 
3364         499.003 Definitions of terms used in this part.—As used in 
3365  this part, the term: 
3366         (23) “Health care entity” means a closed pharmacy or any 
3367  person, organization, or business entity that provides 
3368  diagnostic, medical, surgical, or dental treatment or care, or 
3369  chronic or rehabilitative care, but does not include any 
3370  wholesale distributor or retail pharmacy licensed under state 
3371  law to deal in prescription drugs. However, a blood 
3372  establishment may be a health care entity and engage in the 
3373  wholesale distribution of prescription drugs under s. 
3374  499.01(2)(g)1.c. 
3375         Section 88. Subsection (21) of section 499.005, Florida 
3376  Statutes, is amended to read: 
3377         499.005 Prohibited acts.—It is unlawful for a person to 
3378  perform or cause the performance of any of the following acts in 
3379  this state: 
3380         (21) The wholesale distribution of any prescription drug 
3381  that was: 
3382         (a) Purchased by a public or private hospital or other 
3383  health care entity, except as authorized in s. 499.01(2)(g)1.c.; 
3384  or 
3385         (b) Donated or supplied at a reduced price to a charitable 
3386  organization. 
3387         Section 89. Paragraphs (a) and (g) of subsection (2) of 
3388  section 499.01, Florida Statutes, are amended to read: 
3389         499.01 Permits.— 
3390         (2) The following permits are established: 
3391         (a) Prescription drug manufacturer permit.—A prescription 
3392  drug manufacturer permit is required for any person that is a 
3393  manufacturer of a prescription drug and that manufactures or 
3394  distributes such prescription drugs in this state. 
3395         1. A person that operates an establishment permitted as a 
3396  prescription drug manufacturer may engage in wholesale 
3397  distribution of prescription drugs manufactured at that 
3398  establishment and must comply with all of the provisions of this 
3399  part, except s. 499.01212, and the rules adopted under this 
3400  part, except s. 499.01212, that apply to a wholesale 
3401  distributor. 
3402         2. A prescription drug manufacturer must comply with all 
3403  appropriate state and federal good manufacturing practices. 
3404         3. A blood establishment as defined in s. 381.06014, 
3405  operating in a manner consistent with the provisions of Title 21 
3406  C.F.R. Parts 211 and 600-640, and manufacturing only the 
3407  prescription drugs described in s. 499.003(53)(d) is not 
3408  required to be permitted as a prescription drug manufacturer 
3409  under this paragraph or register products under s. 499.015. 
3410         (g) Restricted prescription drug distributor permit.— 
3411         1. A restricted prescription drug distributor permit is 
3412  required for: 
3413         a. Any person that engages in the distribution of a 
3414  prescription drug, which distribution is not considered 
3415  “wholesale distribution” under s. 499.003(53)(a). 
3416         b.1. Any A person who engages in the receipt or 
3417  distribution of a prescription drug in this state for the 
3418  purpose of processing its return or its destruction must obtain 
3419  a permit as a restricted prescription drug distributor if such 
3420  person is not the person initiating the return, the prescription 
3421  drug wholesale supplier of the person initiating the return, or 
3422  the manufacturer of the drug. 
3423         c. A blood establishment located in this state which 
3424  collects blood and blood components only from volunteer donors 
3425  as defined in s. 381.06014 or pursuant to an authorized 
3426  practitioner’s order for medical treatment or therapy and 
3427  engages in the wholesale distribution of a prescription drug not 
3428  described in s. 499.003(53)(d) to a health care entity. The 
3429  health care entity receiving a prescription drug distributed 
3430  under this sub-subparagraph must be licensed as a closed 
3431  pharmacy or provide health care services at that establishment. 
3432  The blood establishment must operate in accordance with s. 
3433  381.06014 and may distribute only: 
3434         (I) Prescription drugs indicated for a bleeding or clotting 
3435  disorder or anemia; 
3436         (II) Blood-collection containers approved under s. 505 of 
3437  the federal act; 
3438         (III) Drugs that are blood derivatives, or a recombinant or 
3439  synthetic form of a blood derivative; or 
3440         (IV) Prescription drugs identified in rules adopted by the 
3441  department which are essential to services performed or provided 
3442  by blood establishments and authorized for distribution by blood 
3443  establishments under federal law, 
3444 
3445  as long as all of the health care services provided by the blood 
3446  establishment are related to its activities as a registered 
3447  blood establishment or the health care services consist of 
3448  collecting, processing, storing, or administering human 
3449  hematopoietic stem cells or progenitor cells or performing 
3450  diagnostic testing of specimens if such specimens are tested 
3451  together with specimens undergoing routine donor testing. 
3452         2. Storage, handling, and recordkeeping of these 
3453  distributions by a person permitted as a restricted prescription 
3454  drug distributor must comply with the requirements for wholesale 
3455  distributors under s. 499.0121, but not those set forth in s. 
3456  499.01212 if the distribution occurs pursuant to sub 
3457  subparagraph 1.a. or sub-subparagraph 1.b. 
3458         3. A person who applies for a permit as a restricted 
3459  prescription drug distributor, or for the renewal of such a 
3460  permit, must provide to the department the information required 
3461  under s. 499.012. 
3462         4. The department may adopt rules regarding the 
3463  distribution of prescription drugs by hospitals, health care 
3464  entities, charitable organizations, or other persons not 
3465  involved in wholesale distribution, and blood establishments, 
3466  which rules are necessary for the protection of the public 
3467  health, safety, and welfare. The department may adopt rules 
3468  related to the transportation, storage, and recordkeeping of 
3469  prescription drugs which are essential to services performed or 
3470  provided by a blood establishment, including requirements for 
3471  the use of prescription drugs in mobile blood-collection 
3472  vehicles. 
3473         Section 90. Subsection (1) of section 627.645, Florida 
3474  Statutes, is amended to read: 
3475         627.645 Denial of health insurance claims restricted.— 
3476         (1) A No claim for payment under a health insurance policy 
3477  or self-insured program of health benefits for treatment, care, 
3478  or services in a licensed hospital that which is accredited by 
3479  the Joint Commission on the Accreditation of Hospitals, the 
3480  American Osteopathic Association, or the Commission on the 
3481  Accreditation of Rehabilitative Facilities may not shall be 
3482  denied because the such hospital lacks major surgical facilities 
3483  and is primarily of a rehabilitative nature, if such 
3484  rehabilitation is specifically for treatment of physical 
3485  disability. 
3486         Section 91. Paragraph (c) of subsection (2) of section 
3487  627.668, Florida Statutes, is amended to read: 
3488         627.668 Optional coverage for mental and nervous disorders 
3489  required; exception.— 
3490         (2) Under group policies or contracts, inpatient hospital 
3491  benefits, partial hospitalization benefits, and outpatient 
3492  benefits consisting of durational limits, dollar amounts, 
3493  deductibles, and coinsurance factors shall not be less favorable 
3494  than for physical illness generally, except that: 
3495         (c) Partial hospitalization benefits shall be provided 
3496  under the direction of a licensed physician. For purposes of 
3497  this part, the term “partial hospitalization services” is 
3498  defined as those services offered by a program accredited by the 
3499  Joint Commission on Accreditation of Hospitals (JCAH) or in 
3500  compliance with equivalent standards. Alcohol rehabilitation 
3501  programs accredited by the Joint Commission on Accreditation of 
3502  Hospitals or approved by the state and licensed drug abuse 
3503  rehabilitation programs shall also be qualified providers under 
3504  this section. In any benefit year, if partial hospitalization 
3505  services or a combination of inpatient and partial 
3506  hospitalization are utilized, the total benefits paid for all 
3507  such services shall not exceed the cost of 30 days of inpatient 
3508  hospitalization for psychiatric services, including physician 
3509  fees, which prevail in the community in which the partial 
3510  hospitalization services are rendered. If partial 
3511  hospitalization services benefits are provided beyond the limits 
3512  set forth in this paragraph, the durational limits, dollar 
3513  amounts, and coinsurance factors thereof need not be the same as 
3514  those applicable to physical illness generally. 
3515         Section 92. Subsection (3) of section 627.669, Florida 
3516  Statutes, is amended to read: 
3517         627.669 Optional coverage required for substance abuse 
3518  impaired persons; exception.— 
3519         (3) The benefits provided under this section shall be 
3520  applicable only if treatment is provided by, or under the 
3521  supervision of, or is prescribed by, a licensed physician or 
3522  licensed psychologist and if services are provided in a program 
3523  accredited by the Joint Commission on Accreditation of Hospitals 
3524  or approved by the state. 
3525         Section 93. Subsection (1) of section 627.736, Florida 
3526  Statutes, is amended to read: 
3527         627.736 Required personal injury protection benefits; 
3528  exclusions; priority; claims.— 
3529         (1) REQUIRED BENEFITS.—Every insurance policy complying 
3530  with the security requirements of s. 627.733 shall provide 
3531  personal injury protection to the named insured, relatives 
3532  residing in the same household, persons operating the insured 
3533  motor vehicle, passengers in such motor vehicle, and other 
3534  persons struck by such motor vehicle and suffering bodily injury 
3535  while not an occupant of a self-propelled vehicle, subject to 
3536  the provisions of subsection (2) and paragraph (4)(e), to a 
3537  limit of $10,000 for loss sustained by any such person as a 
3538  result of bodily injury, sickness, disease, or death arising out 
3539  of the ownership, maintenance, or use of a motor vehicle as 
3540  follows: 
3541         (a) Medical benefits.—Eighty percent of all reasonable 
3542  expenses for medically necessary medical, surgical, X-ray, 
3543  dental, and rehabilitative services, including prosthetic 
3544  devices, and medically necessary ambulance, hospital, and 
3545  nursing services. However, the medical benefits shall provide 
3546  reimbursement only for such services and care that are lawfully 
3547  provided, supervised, ordered, or prescribed by a physician 
3548  licensed under chapter 458 or chapter 459, a dentist licensed 
3549  under chapter 466, or a chiropractic physician licensed under 
3550  chapter 460 or that are provided by any of the following persons 
3551  or entities: 
3552         1. A hospital or ambulatory surgical center licensed under 
3553  chapter 395. 
3554         2. A person or entity licensed under ss. 401.2101-401.45 
3555  which that provides emergency transportation and treatment. 
3556         3. An entity wholly owned by one or more physicians 
3557  licensed under chapter 458 or chapter 459, chiropractic 
3558  physicians licensed under chapter 460, or dentists licensed 
3559  under chapter 466 or by such practitioner or practitioners and 
3560  the spouse, parent, child, or sibling of that practitioner or 
3561  those practitioners. 
3562         4. An entity wholly owned, directly or indirectly, by a 
3563  hospital or hospitals. 
3564         5. A health care clinic licensed under ss. 400.990-400.995 
3565  which that is: 
3566         a. Accredited by the Joint Commission on Accreditation of 
3567  Healthcare Organizations, the American Osteopathic Association, 
3568  the Commission on Accreditation of Rehabilitation Facilities, or 
3569  the Accreditation Association for Ambulatory Health Care, Inc.; 
3570  or 
3571         b. A health care clinic that: 
3572         (I) Has a medical director licensed under chapter 458, 
3573  chapter 459, or chapter 460; 
3574         (II) Has been continuously licensed for more than 3 years 
3575  or is a publicly traded corporation that issues securities 
3576  traded on an exchange registered with the United States 
3577  Securities and Exchange Commission as a national securities 
3578  exchange; and 
3579         (III) Provides at least four of the following medical 
3580  specialties: 
3581         (A) General medicine. 
3582         (B) Radiography. 
3583         (C) Orthopedic medicine. 
3584         (D) Physical medicine. 
3585         (E) Physical therapy. 
3586         (F) Physical rehabilitation. 
3587         (G) Prescribing or dispensing outpatient prescription 
3588  medication. 
3589         (H) Laboratory services. 
3590 
3591  The Financial Services Commission shall adopt by rule the form 
3592  that must be used by an insurer and a health care provider 
3593  specified in subparagraph 3., subparagraph 4., or subparagraph 
3594  5. to document that the health care provider meets the criteria 
3595  of this paragraph. This, which rule must include a requirement 
3596  for a sworn statement or affidavit. 
3597         (b) Disability benefits.—Sixty percent of any loss of gross 
3598  income and loss of earning capacity per individual from 
3599  inability to work proximately caused by the injury sustained by 
3600  the injured person, plus all expenses reasonably incurred in 
3601  obtaining from others ordinary and necessary services in lieu of 
3602  those that, but for the injury, the injured person would have 
3603  performed without income for the benefit of his or her 
3604  household. All disability benefits payable under this provision 
3605  shall be paid not less than every 2 weeks. 
3606         (c) Death benefits.—Death benefits equal to the lesser of 
3607  $5,000 or the remainder of unused personal injury protection 
3608  benefits per individual. The insurer may pay such benefits to 
3609  the executor or administrator of the deceased, to any of the 
3610  deceased’s relatives by blood or legal adoption or connection by 
3611  marriage, or to any person appearing to the insurer to be 
3612  equitably entitled thereto. 
3613 
3614  Only insurers writing motor vehicle liability insurance in this 
3615  state may provide the required benefits of this section, and no 
3616  such insurer shall require the purchase of any other motor 
3617  vehicle coverage other than the purchase of property damage 
3618  liability coverage as required by s. 627.7275 as a condition for 
3619  providing such required benefits. Insurers may not require that 
3620  property damage liability insurance in an amount greater than 
3621  $10,000 be purchased in conjunction with personal injury 
3622  protection. Such insurers shall make benefits and required 
3623  property damage liability insurance coverage available through 
3624  normal marketing channels. Any insurer writing motor vehicle 
3625  liability insurance in this state who fails to comply with such 
3626  availability requirement as a general business practice shall be 
3627  deemed to have violated part IX of chapter 626, and such 
3628  violation shall constitute an unfair method of competition or an 
3629  unfair or deceptive act or practice involving the business of 
3630  insurance; and any such insurer committing such violation shall 
3631  be subject to the penalties afforded in such part, as well as 
3632  those which may be afforded elsewhere in the insurance code. 
3633         Section 94. Subsection (12) of section 641.495, Florida 
3634  Statutes, is amended to read: 
3635         641.495 Requirements for issuance and maintenance of 
3636  certificate.— 
3637         (12) The provisions of part I of chapter 395 do not apply 
3638  to a health maintenance organization that, on or before January 
3639  1, 1991, provides not more than 10 outpatient holding beds for 
3640  short-term and hospice-type patients in an ambulatory care 
3641  facility for its members, provided that such health maintenance 
3642  organization maintains current accreditation by the Joint 
3643  Commission on Accreditation of Health Care Organizations, the 
3644  Accreditation Association for Ambulatory Health Care, or the 
3645  National Committee for Quality Assurance. 
3646         Section 95. Subsection (2) of section 766.1015, Florida 
3647  Statutes, is amended to read: 
3648         766.1015 Civil immunity for members of or consultants to 
3649  certain boards, committees, or other entities.— 
3650         (2) Such committee, board, group, commission, or other 
3651  entity must be established in accordance with state law or in 
3652  accordance with requirements of the Joint Commission on 
3653  Accreditation of Healthcare Organizations, established and duly 
3654  constituted by one or more public or licensed private hospitals 
3655  or behavioral health agencies, or established by a governmental 
3656  agency. To be protected by this section, the act, decision, 
3657  omission, or utterance may not be made or done in bad faith or 
3658  with malicious intent. 
3659         Section 96. Except as otherwise expressly provided in this 
3660  act, this act shall take effect July 1, 2010.