Bill Text: FL S1254 | 2014 | Regular Session | Comm Sub
Bill Title: Health Care Services
Spectrum: Slight Partisan Bill (? 3-1)
Status: (Failed) 2014-04-30 - Laid on Table, companion bill(s) passed, see CS/CS/HB 1179 (Ch. 2014-142), HB 5201 (Ch. 2014-57) [S1254 Detail]
Download: Florida-2014-S1254-Comm_Sub.html
Florida Senate - 2014 CS for CS for CS for SB 1254 By the Committees on Appropriations; Rules; and Health Policy; and Senator Grimsley 576-04576-14 20141254c3 1 A bill to be entitled 2 An act relating to health care services; amending ss. 3 390.012, 400.021, 400.0712, 400.23, 400.487, 400.497, 4 400.506, 400.509, 400.6095, 400.914, 400.935, 400.962, 5 400.967, 400.980, 409.912, 429.255, 429.73, 440.102, 6 483.245, 765.541, and 765.544, F.S.; removing certain 7 rulemaking authority relating to the disposal of fetal 8 remains by abortion clinics, nursing home equipment 9 and furnishings, license applications for nursing home 10 facilities, evaluation of nursing home facilities, 11 home health agencies and cardiopulmonary 12 resuscitation, home health agency standards, nurse 13 registry emergency management plans, registration of 14 certain service providers, hospice and cardiopulmonary 15 resuscitation, standards for prescribed pediatric 16 extended care facilities, minimum standards relating 17 to home medical equipment providers, standards for 18 intermediate care facilities for the developmentally 19 disabled, rules and the classification of deficiencies 20 for intermediate care facilities for the 21 developmentally disabled, the registration of health 22 care service pools, participation in a Medicaid 23 provider lock-in program, assisted living facilities 24 and cardiopulmonary resuscitation, adult family-care 25 homes and cardiopulmonary resuscitation, guidelines 26 for drug-free workplace laboratories, penalties for 27 rebates, standards for organ procurement 28 organizations; administrative penalties for violations 29 of the organ and tissue donor education and 30 procurement program; amending s. 395.003, F.S.; 31 revising provisions relating to the provision of 32 cardiovascular services by a hospital; amending s. 33 400.471, F.S.; exempting a home health agency that is 34 not Medicare or Medicaid certified and does not 35 provide skilled nursing care from having to provide 36 documentation of accreditation; amending s. 400.474, 37 F.S.; revising the report requirements for home health 38 agencies; creating s. 400.9141, F.S.; limiting 39 services at PPEC centers; amending s. 400.934, F.S., 40 relating to home medical equipment providers; 41 requiring that the emergency management plan include 42 criteria relating to the maintenance of patient 43 equipment and supply lists; amending s. 409.972, F.S.; 44 exempting certain people from the requirement to 45 enroll in Medicaid managed care; providing an 46 effective date. 47 48 Be It Enacted by the Legislature of the State of Florida: 49 50 Section 1. Paragraph (d) of subsection (3) of section 51 390.012, Florida Statutes, is amended to read: 52 390.012 Powers of agency; rules; disposal of fetal 53 remains.— 54 (3) For clinics that perform or claim to perform abortions 55 after the first trimester of pregnancy, the agency shall adopt 56 rules pursuant to ss. 120.536(1) and 120.54 to implement the 57 provisions of this chapter, including the following: 58 (d) Rules relating to the medical screening and evaluation 59 of each abortion clinic patient. At a minimum, these rules must 60shallrequire: 61 1. A medical history including reported allergies to 62 medications, antiseptic solutions, or latex; past surgeries; and 63 an obstetric and gynecological history. 64 2. A physical examination, including a bimanual examination 65 estimating uterine size and palpation of the adnexa. 66 3. The appropriate laboratory tests, including: 67 a. Urine or blood tests for pregnancy performed before the 68 abortion procedure. 69 b. A test for anemia. 70 c. Rh typing, unless reliable written documentation of 71 blood type is available. 72 d. Other tests as indicated from the physical examination. 73 4. An ultrasound evaluation for all patients. The rules 74 mustshallrequire that if a person who is not a physician 75 performs an ultrasound examination, that person shall have 76 documented evidence that he or she has completed a course in the 77 operation of ultrasound equipment as prescribed in rule.The78rules shall require clinics to be in compliance with s.79390.0111.80 5. That the physician is responsible for estimating the 81 gestational age of the fetus based on the ultrasound examination 82 and obstetric standards in keeping with established standards of 83 care regarding the estimation of fetal age as defined in rule 84 and shall write the estimate in the patient’s medical history. 85 The physician shall keep original prints of each ultrasound 86 examination of a patient in the patient’s medical history file. 87 Section 2. Paragraph (a) of subsection (6) of section 88 395.003, Florida Statutes, is amended to read: 89 395.003 Licensure; denial, suspension, and revocation.— 90 (6)(a) A specialty hospital may not provide any service or 91 regularly serve any population group beyond those services or 92 groups specified in its license. Aspecialty-licensed children’s93 hospital that is authorized to provide pediatric cardiac 94 catheterization and pediatric open-heart surgery services may 95 provide cardiovascular service to adults who, as children, were 96 previously served by the hospital for congenital heart disease, 97 or tothosepatients who are referred only for a specialized 98 procedureonlyfor congenital heart disease by an adult 99 hospital, without obtaining additional licensure as a provider 100 of adult cardiovascular services. The agency may request 101 documentation as needed to support patient selection and 102 treatment. This subsection does not apply to a specialty 103 licensed children’s hospital that is already licensed to provide 104 adult cardiovascular services. 105 Section 3. Subsection (11) of section 400.021, Florida 106 Statutes, is amended to read: 107 400.021 Definitions.—When used in this part, unless the 108 context otherwise requires, the term: 109 (11) “Nursing home bed” means an accommodation thatwhich110 is ready for immediate occupancy, or is capable of being made 111 ready for occupancy within 48 hours, excluding the provision of 112 staffing,;and thatwhichconforms to minimum space 113 requirements, including the availability of appropriate 114 equipment and furnishings within the 48 hours, as specified by 115rule ofthe agency, for the provision of services specified in 116 this part to a single resident. 117 Section 4. Subsection (3) of section 400.0712, Florida 118 Statutes, is amended to read: 119 400.0712 Application for inactive license.— 120(3) The agency shall adopt rules pursuant to ss. 120.536(1)121and 120.54 necessary to implement this section.122 Section 5. Section 400.23, Florida Statutes, is amended to 123 read: 124 400.23 Rules; evaluation and deficiencies; licensure 125 status.— 126 (1) It is the intent of the Legislature that rules 127 published and enforced pursuant to this part and part II of 128 chapter 408shallinclude criteria by which a reasonable and 129 consistent quality of resident care may be ensured,andthe 130 results of such resident care can be demonstrated, andby which131 safe and sanitary nursing homes can be provided. It is further 132 intended that reasonable efforts be made to accommodate the 133 needs and preferences of residents to enhance the quality of 134 life in a nursing home. In addition, efforts shall be made to 135 minimize the amount of paperwork associated with the reporting 136 and documentation requirements of these rules. 137 (2) Pursuant to the intention of the Legislature, the 138 agency, in consultation with the Department of Health and the 139 Department of Elderly Affairs, mayshalladoptand enforcerules 140 to administerimplementthis part and part II of chapter 408. 141 The rules must specify, but are not limited to,which shall142includereasonable and fair criteria relatingin relationto: 143 (a) The location of the facility and housing conditions 144 that will ensure the health, safety, and comfort of residents, 145 including an adequate call system. In adoptingmakingsuch 146 rules, the agency shall be guided by criteria recommended by 147 nationally recognized reputable professional groups and 148 associations that havewithknowledge of such subject matters. 149 The agency shall update or revise thesuchcriteria as the need 150 arises. The agency may require alterations to a building if it 151 determines that an existing condition constitutes a distinct 152 hazard to life, health, or safety. In performinganyinspections 153 of facilities authorized by this part or part II of chapter 408, 154 the agency may enforce the special-occupancy provisions of the 155 Florida Building Code and the Florida Fire Prevention Code which 156 apply to nursing homes. A residentResidentsor his or her 157 representative musttheir representatives shallbe able to 158 request a change in the placement of the bed in his or hertheir159 room if,provided thatat admission, the resident isthey are160 presented with a room that meets requirements of the Florida 161 Building Code. The location of a bed may be changed if the 162 requested placement does not infringe on the resident’s roommate 163 or interfere with the resident’s care or safety as determined by 164 the care planning team in accordance with facility policies and 165 procedures. In addition, the bed placement may not be used as a 166 restraint. Each facility shall maintain a log of resident rooms 167 with beds that are not in strict compliance with the Florida 168 Building Code in order for such log to be used by surveyors and 169 nurse monitors during inspections and visits. A resident or a 170 resident’sresidentrepresentative who requests that a bed be 171 moved mustshallsign a statement indicating that he or she 172 understands that the room will not be in compliance with the 173 Florida Building Code, but that he or shetheywould prefer to 174 exercise thetheirright to self-determination. The statement 175 must be retained as part of the resident’s care plan. AAny176 facility that offers this option must submit a letter signed by 177 the nursing home administrator of record to the agency notifying 178 it of this practice along with a copy of the policies and 179 procedures of the facility. The agency is directed to provide 180 assistance to the Florida Building Commission in updating the 181 construction standards of the code relatingrelativeto nursing 182 homes. 183 (b) The number and qualifications of all personnel, 184 including management, medical, nursing, and other professional 185 personnel, and nursing assistants, orderlies, and support 186 personnel, having responsibility for any part of the care given 187 residents. 188 (c) All sanitary conditions within the facility and its 189 surroundings, including water supply, sewage disposal, food 190 handling, and general hygiene which will ensure the health and 191 comfort of residents. 192 (d) The equipment essential to the health and welfare of 193 the residents. 194 (e) A uniform accounting system. 195 (f) The care, treatment, and maintenance of residents and 196 measurement of the quality and adequacy thereof, based on rules 197 developed under this chapter and the Omnibus Budget 198 Reconciliation Act of 1987,(Pub. L. No. 100-203) (December 22,1991987), Title IV (Medicare, Medicaid, and Other Health-Related 200 Programs), Subtitle C (Nursing Home Reform), as amended. 201 (g) The preparation and annual update of a comprehensive 202 emergency management plan. The agency shall establishadopt203rules establishingminimum criteria for the plan after 204 consultation with the Division of Emergency Management. At a 205 minimum, therules must provide forplan components must provide 206that addressemergency evacuation transportation; adequate 207 sheltering arrangements; postdisaster activities, including 208 emergency power, food, and water; postdisaster transportation; 209 supplies; staffing; emergency equipment; individual 210 identification of residents and transfer of records; and 211 responding to family inquiries. The comprehensive emergency 212 management plan is subject to review and approval by the local 213 emergency management agency. During theitsreview, the local 214 emergency management agency shall ensure that the following 215 agencies, at a minimum, are given the opportunity to review the 216 plan: the Department of Elderly Affairs, the Department of 217 Health, the Agency for Health Care Administration, and the 218 Division of Emergency Management.Also,Appropriate volunteer 219 organizations must also be given the opportunity to review the 220 plan. The local emergency management agency shall complete its 221 review within 60 days andeitherapprove the plan or advise the 222 facility of necessary revisions. 223 (h) The availability, distribution, and posting of reports 224 and records pursuant to s. 400.191 and the Gold Seal Program 225 pursuant to s. 400.235. 226 (3)(a)1.The agency shall enforceadopt rules providing227 minimum staffing requirements for nursing home facilities. 228 1. These requirements must include, for each facility: 229 a. A combined minimum weekly average of certified nursing 230 assistant and licensed nursing staffingcombinedof 3.6 hours of 231 direct care per resident per day. As used in this sub 232 subparagraph, a week is defined as Sunday through Saturday. 233 b. A minimum certified nursing assistant staffing of 2.5 234 hours of direct care per resident per day. A facility may not 235 staff below one certified nursing assistant per 20 residents. 236 c. A minimum licensed nursing staffing of 1.0 hour of 237 direct care per resident per day. A facility may not staff below 238 one licensed nurse per 40 residents. 239 2. Nursing assistants employed under s. 400.211(2) may be 240 included in computing the staffing ratio for certified nursing 241 assistants if their job responsibilities include only nursing 242 assistant-related duties. 243 3. Each nursing home facility must document compliance with 244 staffing standardsasrequired under this paragraph and post 245 daily the names of staff on duty for the benefit of facility 246 residents and the public. 247 4. The agency shall recognize the use of licensed nurses 248 for compliance with the minimum staffing requirements for 249 certified nursing assistants if the nursing home facility 250 otherwise meets the minimum staffing requirements for licensed 251 nurses and the licensed nurses are performing the duties ofa252 certified nursing assistantsassistant. Unless otherwise 253 approved by the agency, licensed nurses counted toward the 254 minimum staffing requirements for certified nursing assistants 255 must exclusively perform the duties ofacertified nursing 256 assistantsassistantfor the entire shift and not also be 257 counted toward the minimum staffing requirements for licensed 258 nurses. If the agency approved a facility’s request to use a 259 licensed nurse to perform both licensed nursing and certified 260 nursing assistant duties, the facility must allocate the amount 261 of staff time specifically spent on certified nursing assistant 262 duties for the purpose of documenting compliance with minimum 263 staffing requirements for certified and licensed nursing staff. 264 The hours of a licensed nurse with dual job responsibilities may 265 not be counted twice. 266 (b) Nonnursing staff providing eating assistance to 267 residents doesshallnot count toward compliance with minimum 268 staffing standards. 269 (c) Licensed practical nurses licensed under chapter 464 270 who are providing nursing services in nursing home facilities 271 under this part may supervise the activities of other licensed 272 practical nurses, certified nursing assistants, and other 273 unlicensed personnel providing services in such facilities in 274 accordance with rules adopted by the Board of Nursing. 275 (4)Rules developed pursuant toThis section doesshallnot 276 restrict the use of shared staffing and shared programming in 277 facilities thatwhichare part of retirement communities that 278 provide multiple levels of care and otherwise meet the 279 requirement of law or rule. 280 (5)The agency, in collaboration with the Division of281Children’s Medical Services of the Department of Health, must282adopt rules for:283 (a) Minimum standards of care for persons under 21 years of 284 age who reside in nursing home facilities may be established by 285 the agency, in collaboration with the Division of Children’s 286 Medical Services of the Department of Health. A facility may be 287 exempted from these standards and the provisions of paragraph 288 (b) for specifiedspecificpersons between 18 and 21 years of 289 age,if the person’s physician agrees that minimum standards of 290 care based on age are not necessary. 291 (b) The followingMinimumstaffing requirements for persons 292 under 21 years of age who reside in nursing home facilities,293whichapply in lieu of the requirements contained in subsection 294 (3):.295 1. For persons under 21 years of age who require skilled 296 care: 297 a. A minimum combined average of 3.9 hours of direct care 298 per resident per day must be provided by licensed nurses, 299 respiratory therapists, respiratory care practitioners, and 300 certified nursing assistants. 301 b. A minimum licensed nursing staffing of 1.0 hour of 302 direct care per resident per daymust be provided. 303 c. Up toNo more than1.5 hours of certified nursing 304 assistant care per resident per day may be counted in 305 determining the minimum direct care hours required. 306 d. One registered nurse must be on duty on the site 24 307 hours per day on the unit where children reside. 308 2. For persons under 21 years of age who are medically 309 fragile: 310 a. A minimum combined average of 5.0 hours of direct care 311 per resident per day must be provided by licensed nurses, 312 respiratory therapists, respiratory care practitioners, and 313 certified nursing assistants. 314 b. A minimum licensed nursing staffing of 1.7 hours of 315 direct care per resident per day must be provided. 316 c. Up toNo more than1.5 hours of certified nursing 317 assistant care per resident per day may be counted in 318 determining the minimum direct care hours required. 319 d. One registered nurse must be on duty on the site 24 320 hours per day on atheunit where children reside. 321 (6) BeforePrior toconducting a survey of the facility, 322 the survey team shall obtain a copy of the local long-term care 323 ombudsman council report on the facility. Problems noted in the 324 report shall be incorporated into and followed up through the 325 agency’s inspection process. This procedure does not preclude 326 the local long-term care ombudsman council from requesting the 327 agency to conduct a followup visit to the facility. 328 (7) The agency shall, at least every 15 months, evaluate 329 all nursing home facilities and determinemake a determination330as tothe degree of compliance by each licensee with the 331 established rules adopted under this part as a basis for 332 assigning a licensure status to athatfacility. The agency 333 shall base its evaluation on the most recent inspection report, 334 taking into consideration findings from other official reports, 335 surveys, interviews, investigations, and inspections. In 336 addition to license categories authorized under part II of 337 chapter 408, the agency shall assign alicensure status of338 standard or conditional licensure status to each nursing home. 339 (a) A standard licensure status means that a facility has 340 no class I or class II deficiencies and has corrected all class 341 III deficiencies within the time established by the agency. 342 (b) A conditional licensure status means that a facility, 343 due to the presence of one or more class I or class II 344 deficiencies, or class III deficiencies not corrected within the 345 time established by the agency, is not in substantial compliance 346 at the time of the survey with criteria established under this 347 part or with rules adopted by the agency. If the facility has no 348 class I, class II, or class III deficiencies at the time of the 349 followup survey, a standard licensure status may be assigned. 350 (c) In evaluating the overall quality of care and services 351 and determining whether the facility will receive a conditional 352 or standard license, the agency shall consider the needs and 353 limitations of residents in the facility and the results of 354 interviews and surveys of a representative sampling of 355 residents, families of residents, ombudsman council members in 356 the planning and service area in which the facility is located, 357 guardians of residents, and staff of the nursing home facility. 358 (d) The current licensure status of each facility must be 359 indicated in bold print on the face of the license. A list of 360 the deficiencies of the facility shall be posted in a prominent 361 place that is in clear and unobstructed public view at or near 362 the place where residents are being admitted to that facility. 363 Licensees receiving a conditional licensure status for a 364 facility shall prepare, within 10 working days after receiving 365 notice of deficiencies, a plan for correction of all 366 deficiencies andshallsubmit the plan to the agency for 367 approval. 368 (e) The agency shalladopt rules that: 369 1. Establish uniform procedures for the evaluation of 370 facilities. 371 2. Provide criteria in the areas referenced in paragraph 372 (c). 373 3. Address other areas necessary for carrying out the 374 intent of this section. 375 (8) The agency shall ensureadopt rules pursuant to this376part and part II of chapter 408 to providethat, ifwhenthe 377 criteria established under subsection (2) are not met, such 378 deficiencies shall be classified according to the nature and the 379 scope of the deficiency. The scope shall be cited as isolated, 380 patterned, or widespread. An isolated deficiency is a deficiency 381 affecting one or a very limited number of residents, or 382 involving one or a very limited number of staff, or a situation 383 that occurred only occasionally or in a very limited number of 384 locations. A patterned deficiency is a deficiency in whichwhere385 more than a very limited number of residents are affected, or 386 more than a very limited number of staff are involved, or the 387 situation has occurred in several locations, or the same 388 resident or residents have been affected by repeated occurrences 389 of the same deficient practice but the effect of the deficient 390 practice is not found to be pervasive throughout the facility. A 391 widespread deficiency is a deficiency in which the problems 392 causing the deficiency are pervasive in the facility or 393 represent systemic failure that has affected or has the 394 potential to affect a large portion of the facility’s residents. 395 The agency shall indicate the classification on the face of the 396 notice of deficiencies as follows: 397 (a) A class I deficiency is a deficiency that the agency 398 determines presents a situation in which immediate corrective 399 action is necessary because the facility’s noncompliance has 400 caused, or is likely to cause, serious injury, harm, impairment, 401 or death to a resident receiving care in a facility. The 402 condition or practice constituting a class I violation must 403shallbe abated or eliminated immediately, unless a fixed period 404 of time, as determined by the agency, is required for 405 correction. A class I deficiency is subject to a civil penalty 406 of $10,000 for an isolated deficiency, $12,500 for a patterned 407 deficiency, and $15,000 for a widespread deficiency. The fine 408 amount isshall bedoubled for each deficiency if the facility 409 was previously cited for one or more class I or class II 410 deficiencies during the last licensure inspection or during an 411anyinspection or complaint investigation since the last 412 licensure inspection. A fine must be levied notwithstanding the 413 correction of the deficiency. 414 (b) A class II deficiency is a deficiency that the agency 415 determines has compromised atheresident’s ability to maintain 416 or reach his or her highest practicable physical, mental, and 417 psychosocial well-being, as defined by an accurate and 418 comprehensive resident assessment, plan of care, and provision 419 of services. A class II deficiency is subject to a civil penalty 420 of $2,500 for an isolated deficiency, $5,000 for a patterned 421 deficiency, and $7,500 for a widespread deficiency. The fine 422 amount isshall bedoubled for each deficiency if the facility 423 was previously cited for one or more class I or class II 424 deficiencies during the last licensure inspection or anany425 inspection or complaint investigation since the last licensure 426 inspection. A fine shall be levied notwithstanding the 427 correction of the deficiency. 428 (c) A class III deficiency is a deficiency that the agency 429 determines will result in no more than minimal physical, mental, 430 or psychosocial discomfort to atheresident or has the 431 potential to compromise atheresident’s ability to maintain or 432 reach his or her highest practical physical, mental, or 433 psychosocial well-being, as defined by an accurate and 434 comprehensive resident assessment, plan of care, and provision 435 of services. A class III deficiency is subject to a civil 436 penalty of $1,000 for an isolated deficiency, $2,000 for a 437 patterned deficiency, and $3,000 for a widespread deficiency. 438 The fine amount isshall bedoubled for each deficiency if the 439 facility was previously cited for one or more class I or class 440 II deficiencies during the last licensure inspection or anany441 inspection or complaint investigation since the last licensure 442 inspection. A citation for a class III deficiency must specify 443 the time within which the deficiency is required to be 444 corrected. If a class III deficiency is corrected within the 445 time specified, a civil penalty may not be imposed. 446 (d) A class IV deficiency is a deficiency that the agency 447 determines has the potential for causing no more than a minor 448 negative impact on atheresident. If the class IV deficiency is 449 isolated, no plan of correction is required. 450 (9) Civil penalties paid by aanylicensee under subsection 451 (8) shall be deposited in the Health Care Trust Fund and 452 expended as provided in s. 400.063. 453 (10) Agency records, reports, ranking systems, Internet 454 information, and publications must be promptly updated to 455 reflect the most current agency actions. 456 Section 6. Paragraph (h) of subsection (2) of section 457 400.471, Florida Statutes, is amended to read: 458 400.471 Application for license; fee.— 459 (2) In addition to the requirements of part II of chapter 460 408, the initial applicant must file with the application 461 satisfactory proof that the home health agency is in compliance 462 with this part and applicable rules, including: 463 (h) In the case of an application for initial licensure, 464 documentation of accreditation, or an application for 465 accreditation, from an accrediting organization that is 466 recognized by the agency as having standards comparable to those 467 required by this part and part II of chapter 408. 468 Notwithstanding s. 408.806, an applicant that has applied for 469 accreditation must provide proof of accreditation that is not 470 conditional or provisional within 120 days after the date of the 471 agency’s receipt of the application for licensure or the 472 application shall be withdrawn from further consideration. Such 473 accreditation must be maintained by the home health agency to 474 maintain licensure. The agency shall accept, in lieu of its own 475 periodic licensure survey, the submission of the survey of an 476 accrediting organization that is recognized by the agency if the 477 accreditation of the licensed home health agency is not 478 provisional and if the licensed home health agency authorizes 479 releases of, and the agency receives the report of, the 480 accrediting organization. A home health agency that is not 481 Medicare or Medicaid certified and does not provide skilled 482 nursing care is exempt from this paragraph. 483 Section 7. Subsection (7) of section 400.474, Florida 484 Statutes, is amended to read: 485 400.474 Administrative penalties.— 486 (7) A home health agency shall electronically submit to the 487 agency, within 15 days after the end of each calendar quarter,a 488writtenreport for each 6-month period ending March 31 and 489 September 30. 490 (a) Each report must includethat includesthe following 491 data as ittheyexisted on the last day of the reporting period 492quarter: 493 1.(a)The number of insulin-dependent diabetic patients who 494 receive insulin-injection services from the home health agency. 495 2.(b)The number of patients who receive both home health 496 services from the home health agency and hospice services. 497 3.(c)The number of patients who receive home health 498 services from the home health agency. 499 4.(d)The name and license number of each nurse whose 500 primary job responsibility is to provide home health services to 501 patients and who received remuneration from the home health 502 agency in excess of $50,000$25,000during the reporting period 503calendar quarter. 504 (b) If the home health agency fails to submit thewritten505quarterlyreport within 15 days after the end of the applicable 506 reporting periodeach calendar quarter, the agencyfor Health507Care Administrationshall impose a fine of $200 per day against 508 the home health agencyin the amount of $200 per dayuntil the 509 agencyfor Health Care Administrationreceives the report, 510 except that the total fine imposed pursuant to this subsection 511 may not exceed $5,000 per reporting periodquarter. A home 512 health agency is exempt from submission of the report and the 513 imposition of the fine if it is not a Medicaid or Medicare 514 provideror if it does not share a controlling interest with a515licensee, as defined in s. 408.803, which bills the Florida516Medicaid program or the Medicare program. 517 Section 8. Subsection (7) of section 400.487, Florida 518 Statutes, is amended to read: 519 400.487 Home health service agreements; physician’s, 520 physician assistant’s, and advanced registered nurse 521 practitioner’s treatment orders; patient assessment; 522 establishment and review of plan of care; provision of services; 523 orders not to resuscitate.— 524 (7) Home health agency personnel may withhold or withdraw 525 cardiopulmonary resuscitation if presented with an order not to 526 resuscitate executed pursuant to s. 401.45.The agency shall527adopt rules providing for the implementation of such orders.528 Home health personnel and agencies areshallnotbesubject to 529 criminal prosecution or civil liability and are not,nor be530 considered to have engaged in negligent or unprofessional 531 conduct,for withholding or withdrawing cardiopulmonary 532 resuscitation pursuant to such an order and rules adopted by the 533 agency. 534 Section 9. Section 400.497, Florida Statutes, is amended to 535 read: 536 400.497 Rules establishing minimum standards.—The agency 537 mayshalladopt, publish, and enforcerules to administer 538implementpart II of chapter 408 and this part, including the 539 provider’s duties and responsibilities under, as applicable,ss. 540 400.506 and 400.509. Rules shall specify, but are not limited 541 to,which must providereasonable and fair minimum standards 542 relating to: 543 (1) The home health aide competency test and home health 544 aide training. The agency shall create the home health aide 545 competency test and establish the curriculum and instructor 546 qualifications for home health aide training. Licensed home 547 health agencies may provide this training and shall furnish 548 documentation of such training to other licensed home health 549 agencies upon request. Successful passage of the competency test 550 by home health aides may be substituted for the training 551 required under this section and agencyanyruleadopted pursuant552thereto. 553 (2) Shared staffing.The agency shall allowShared staffing 554 is allowed if the home health agency is part of a retirement 555 community that provides multiple levels of care, is located on 556 one campus, is licensed under this chapter or chapter 429, and 557 otherwise meets the requirements of law and rule. 558 (3) The criteria for the frequency of onsite licensure 559 surveys. 560 (4) Licensure application and renewal. 561 (5) Oversight by the director of nursing, including. The562agency shall develop rules related to: 563 (a) Standards that address oversight responsibilities by 564 the director of nursing forofskilled nursing and personal care 565 services provided by the home health agency’s staff; 566 (b) Requirements for a director of nursing to provide to 567 the agency, upon request, a certified daily report of the home 568 health services provided by a specified direct employee or 569 contracted staff member on behalf of the home health agency. The 570 agency may request a certified daily report for up toonly for a571period not to exceed2 years beforeprior tothe date of the 572 request; and 573 (c) A quality assurance program for home health services 574 provided by the home health agency. 575 (6) Conditions for using a recent unannounced licensure 576 inspection for the inspection required underins. 408.806 577 related to a licensure application associated with a change in 578 ownership of a licensed home health agency. 579 (7) The requirements for onsite and electronic 580 accessibility of supervisory personnel of home health agencies. 581 (8) Information to be included in patients’ records. 582 (9) Geographic service areas. 583 (10) Preparation of a comprehensive emergency management 584 plan pursuant to s. 400.492. 585(a) The Agency for Health Care Administration shall adopt586rules establishing minimum criteria for the plan and plan587updates, with the concurrence of the Department of Health and in588consultation with the Division of Emergency Management.589 (a)(b)An emergency planThe rulesmustaddress the590requirements in s. 400.492. In addition, the rules shallprovide 591 for the maintenance of patient-specific medication lists that 592 can accompany patients who are transported from their homes. 593 (b)(c)The plan is subject to review and approval by the 594 county health department. During its review, the county health 595 department shall contact state and local health and medical 596 stakeholders when necessary. The county health department shall 597 complete its review to ensure that the plan is in accordance 598 with the requirements of lawcriteria in the Agency for Health599Care Administration ruleswithin 90 days after receipt of the 600 plan and shall approve the plan or advise the home health agency 601 of necessary revisions. If the home health agency fails to 602 submit a plan or fails to submit the requested information or 603 revisions to the county health department within 30 days after 604 written notification from the county health department, the 605 county health department shall notify the Agency for Health Care 606 Administration. The agency shall notify the home health agency 607 that its failure constitutes a deficiency, subject to a fine of 608 $5,000 per occurrence. If the plan is not submitted, information 609 is not provided, or revisions are not made as requested, the 610 agency may impose the fine. 611 (c)(d)For aanyhome health agency that operates in more 612 than one county, the Department of Health shall review the plan, 613 after consulting with state and local health and medical 614 stakeholders when necessary. The department shall complete its 615 review within 90 days after receipt of the plan and shall 616 approve the plan or advise the home health agency of necessary 617 revisions. The department shall make every effort to avoid 618 imposing differing requirements on a home health agency that 619 operates in more than one county as a result of differing or 620 conflicting comprehensive plan requirements of the counties in 621 which the home health agency operates. 622 (d)(e)The requirements in this subsection do not apply to: 623 1. A facility that is certified under chapter 651 and has a 624 licensed home health agency used exclusively by residents of the 625 facility; or 626 2. A retirement community that consists of both residential 627 units for independent living andeithera licensed nursing home 628 or an assisted living facility,and has a licensed home health 629 agency used exclusively bytheresidents of the retirement 630 community, if, providedthe comprehensive emergency management 631 plan for the facility or retirement community provides for 632 continuous care of all residents with special needs during an 633 emergency. 634 Section 10. Paragraph (f) of subsection (12) and subsection 635 (17) of section 400.506, Florida Statutes, are amended to read: 636 400.506 Licensure of nurse registries; requirements; 637 penalties.— 638 (12) Each nurse registry shall prepare and maintain a 639 comprehensive emergency management plan that is consistent with 640 the criteria in this subsection and with the local special needs 641 plan. The plan shall be updated annually. The plan shall include 642 the means by which the nurse registry will continue to provide 643 the same type and quantity of services to its patients who 644 evacuate to special needs shelters which were being provided to 645 those patients prior to evacuation. The plan shall specify how 646 the nurse registry shall facilitate the provision of continuous 647 care by persons referred for contract to persons who are 648 registered pursuant to s. 252.355 during an emergency that 649 interrupts the provision of care or services in private 650 residences. Nurse registries may establish links to local 651 emergency operations centers to determine a mechanism by which 652 to approach specific areas within a disaster area in order for a 653 provider to reach its clients. Nurse registries shall 654 demonstrate a good faith effort to comply with the requirements 655 of this subsection by documenting attempts of staff to follow 656 procedures outlined in the nurse registry’s comprehensive 657 emergency management plan which support a finding that the 658 provision of continuing care has been attempted for patients 659 identified as needing care by the nurse registry and registered 660 under s. 252.355 in the event of an emergency under this 661 subsection. 662(f) The Agency for Health Care Administration shall adopt663rules establishing minimum criteria for the comprehensive664emergency management plan and plan updates required by this665subsection, with the concurrence of the Department of Health and666in consultation with the Division of Emergency Management.667(17) The Agency for Health Care Administration shall adopt668rules to implement this section and part II of chapter 408.669 Section 11. Subsection (7) of section 400.509, Florida 670 Statutes, is amended to read: 671 400.509 Registration of particular service providers exempt 672 from licensure; certificate of registration; regulation of 673 registrants.— 674(7) The Agency for Health Care Administration shall adopt675rules to administer this section and part II of chapter 408.676 Section 12. Subsection (8) of section 400.6095, Florida 677 Statutes, is amended to read: 678 400.6095 Patient admission; assessment; plan of care; 679 discharge; death.— 680 (8) The hospice care team may withhold or withdraw 681 cardiopulmonary resuscitation if presented with an order not to 682 resuscitate executed pursuant to s. 401.45.The department shall683adopt rules providing for the implementation of such orders.684 Hospice staff areshallnotbesubject to criminal prosecution 685 or civil liability, norbeconsidered to have engaged in 686 negligent or unprofessional conduct, for withholding or 687 withdrawing cardiopulmonary resuscitation pursuant to such an 688 order and applicable rules. The absence of an order to 689 resuscitate executed pursuant to s. 401.45 does not preclude a 690 physician from withholding or withdrawing cardiopulmonary 691 resuscitation as otherwise permitted by law. 692 Section 13. Section 400.914, Florida Statutes, is amended 693 to read: 694 400.914 Rulemaking;Rules establishingstandards.— 695 (1) Pursuant to the intention of the Legislature to provide 696 safe and sanitary facilities and healthful programs, the agency 697 in conjunction with the Division of Children’s Medical Services 698 of the Department of Health mayshalladoptand publishrules to 699 administerimplement the provisions ofthis part and part II of 700 chapter 408, which shall include reasonable and fair standards. 701 Any conflict between these rulesstandardsand those established 702that may be set forthin local, county, or city ordinances shall 703 be resolved in favor of those having statewide effect. 704 (2) The rules must specify, but are not limited to, 705 reasonable and fair standards relatingSuch standards shall706relateto: 707 (a) The assurance that PPEC services are family centered 708 and provide individualized medical, developmental, and family 709 training services. 710 (b) The maintenance of PPEC centers, not in conflict with 711the provisions ofchapter 553 and based upon the size of the 712 structure and number of children, relating to plumbing, heating, 713 lighting, ventilation, and other building conditions, including 714 adequate space, which will ensure the health, safety, comfort, 715 and protection from fire of the children served. 716 (c) The application of the appropriate provisions of the 717 most recent edition of the “Life Safety Code” (NFPA-101)shall718be applied. 719 (d) The number and qualifications of all personnel who have 720 responsibility for the care of the children served. 721 (e) All sanitary conditions within the PPEC center and its 722 surroundings, including water supply, sewage disposal, food 723 handling, and general hygiene, and maintenance thereof, which 724 will ensure the health and comfort of children served. 725 (f) Programs and basic services promoting and maintaining 726 the health and development of the children served and meeting 727 the training needs of the children’s legal guardians. 728 (g) Supportive, contracted, other operational, and 729 transportation services. 730 (h) Maintenance of appropriate medical records, data, and 731 information relative to the children and programs. Such records 732 shall be maintained in the facility for inspection by the 733 agency. 734(2) The agency shall adopt rules to ensure that:735(a) No child attends a PPEC center for more than 12 hours736within a 24-hour period.737(b) No PPEC center provides services other than those738provided to medically or technologically dependent children.739 Section 14. Section 400.9141, Florida Statutes, is created 740 to read: 741 400.9141 Limitations.— 742 (1) A child may not attend a PPEC center for more than 12 743 hours within a 24-hour period. 744 (2) A PPEC center may provide services only to medically or 745 technologically dependent children. 746 Section 15. Paragraph (a) of subsection (20) of section 747 400.934, Florida Statutes, is amended to read: 748 400.934 Minimum standards.—As a requirement of licensure, 749 home medical equipment providers shall: 750 (20)(a) Prepare and maintain a comprehensive emergency 751 management plan that meets minimum criteria established by 752 agency rule, including criteria for the maintenance of patient 753 equipment and supply lists that accompany patients who are 754 transported from their homes. Such rules shall be formulated in 755 consultation with the Department of Health and the Division of 756 Emergency Managementunder s. 400.935. The plan shall be updated 757 annually and shall provide for continuing home medical equipment 758 services for life-supporting or life-sustaining equipment, as 759 defined in s. 400.925, during an emergency that interrupts home 760 medical equipment services in a patient’s home. The plan must 761shallinclude: 762 1. The means by which the home medical equipment provider 763 will continue to provide equipment to perform the same type and 764 quantity of services to its patients who evacuate to special 765 needs shelters which were being provided to those patients 766 beforeprior toevacuation. 767 2. The means by which the home medical equipment provider 768 establishes and maintains an effective response to emergencies 769 and disasters, including plans for: 770 a. Notification of staff when emergency response measures 771 are initiated. 772 b. Communication between staff members, county health 773 departments, and local emergency management agencies, which 774 includes provisions for a backup communications system. 775 c. Identification of resources necessary to continue 776 essential care or services or referrals to other organizations 777 subject to written agreement. 778 d. Contacting and prioritizing patients in need of 779 continued medical equipment services and supplies. 780 Section 16. Section 400.935, Florida Statutes, is amended 781 to read: 782 400.935 Rule authorityRules establishing minimum783standards.—The agency shall adopt, publish, and enforcerules as 784 necessary to implement this part and part II of chapter 408. The 785 rules must specify, but not be limited to,which must provide786 reasonable and fair minimum standards relating to: 787 (1) The qualifications and minimum training requirements of 788 all home medical equipment provider personnel. 789(2) Financial ability to operate.790 (2)(3)The administration of the home medical equipment 791 provider. 792(4) Procedures for maintaining patient records.793 (3)(5)Ensuring that the home medical equipment and 794 services provided by a home medical equipment provider are in 795 accordance with the plan of treatment established for each 796 patient, when provided as a part of a plan of treatment. 797 (4)(6)Contractual arrangements for the provision of home 798 medical equipment and services by providers not employed by the 799 home medical equipment provider providing for the consumer’s 800 needs. 801 (5)(7)Physical location and zoning requirements. 802 (6)(8)Home medical equipment requiring home medical 803 equipment services. 804(9) Preparation of the comprehensive emergency management805plan under s. 400.934 and the establishment of minimum criteria806for the plan, including the maintenance of patient equipment and807supply lists that can accompany patients who are transported808from their homes. Such rules shall be formulated in consultation809with the Department of Health and the Division of Emergency810Management.811 Section 17. Subsection (5) of section 400.962, Florida 812 Statutes, is amended to read: 813 400.962 License required; license application.— 814 (5) The applicant must agree to provide or arrange for 815 active treatment services by an interdisciplinary team in order 816 to maximize individual independence or prevent regression or 817 loss of functional status.Standards for active treatment shall818be adopted by the Agency for Health Care Administration by rule819pursuant to ss. 120.536(1) and 120.54.Active treatment services 820 shall be provided in accordance with the individual support plan 821 and shall be reimbursed as part of the per diem rate as paid 822 under the Medicaid program. 823 Section 18. Subsections (2) and (3) of section 400.967, 824 Florida Statutes, are amended to read: 825 400.967 Rules and classification of deficiencies.— 826 (2)Pursuant to the intention of the Legislature,The 827 agency, in consultation with the Agency for Persons with 828 Disabilities and the Department of Elderly Affairs, mayshall829 adopt and enforce rules as necessary to administer this part and 830 part II of chapter 408, whichshallincludereasonable and fair831 criteria governing: 832 (a) The location and construction of the facility; 833 including fire and life safety, plumbing, heating, cooling, 834 lighting, ventilation, and other housing conditions that ensure 835 the health, safety, and comfort of residents. The agency shall 836 establish standards for facilities and equipment to increase the 837 extent to which new facilities, and a new wing or floor added to 838 an existing facility after July 1, 2000, are structurally 839 capable of serving as shelters only for residents, staff, and 840 families of residents and staff, and equipped to be self 841 supporting during and immediately following disasters. The 842 agency shall update or revise the criteria as the need arises. 843AllFacilities must comply with thethoselifesafety code 844 requirements and building code standards applicable whenat the845time of approval oftheir construction plans are approved. The 846 agency may require alterations to a building if it determines 847 that an existing condition constitutes adistincthazard to 848 life, health, or safety. The agency may state theshall adopt849fair and reasonable rules setting forthconditions under which 850 existing facilities undergoing additions, alterations, 851 conversions, renovations, or repairs are required to comply with 852 the most recent updated or revised standards. 853 (b) The number and qualifications of all personnel, 854 including management, medical, nursing, and other personnel, 855 having responsibility for any part of the care given to 856 residents. 857 (c)AllSanitary conditions within the facility and its 858 surroundings, including water supply, sewage disposal, food 859 handling, and general hygiene, whichwillensure the health and 860 comfort of residents. 861 (d)TheEquipment essential to the health and welfare of 862 the residents. 863 (e) A uniform accounting system. 864 (f) The care, treatment, and maintenance of residents and 865 the assessmentmeasurementof the quality and adequacy thereof. 866 (g) The preparation and annual update of a comprehensive 867 emergency management plan. After consultation with the Division 868 of Emergency Management, the agency may establishshall adopt869rules establishingminimum criteria forthe plan after870consultation with the Division of Emergency Management. At a871minimum, the rules must provideforplan components that address 872 emergency evacuation transportation; adequate sheltering 873 arrangements; postdisaster activities, including emergency 874 power, food, and water; postdisaster transportation; supplies; 875 staffing; emergency equipment; individual identification of 876 residents and transfer of records; and responding to family 877 inquiries. The comprehensive emergency management plan is 878 subject to review and approval by the local emergency management 879 agency. During theitsreview, the local emergency management 880 agency shall ensure that the following agencies, at a minimum, 881 are given the opportunity to review the plan: the Department of 882 Elderly Affairs, the Agency for Persons with Disabilities, the 883 Agency for Health Care Administration, and the Division of 884 Emergency Management.Also,Appropriate volunteer organizations 885 must also be given the opportunity to review the plan. The local 886 emergency management agency shall complete its review within 60 887 days andeitherapprove the plan or advise the facility of 888 necessary revisions. 889 (h) The use of restraint and seclusion. Such criteriarules890 must be consistent with recognized best practices; prohibit 891 inherently dangerous restraint or seclusion procedures; 892 establish limitations on the use and duration of restraint and 893 seclusion; establish measures to ensure the safety of clients 894 and staff during an incident of restraint or seclusion; 895 establish procedures for staff to follow before, during, and 896 after incidents of restraint or seclusion, including 897 individualized plans for the use of restraints or seclusion in 898 emergency situations; establish professional qualifications of 899 and training for staff who may order or be engaged in the use of 900 restraint or seclusion; establish requirements for facility data 901 collection and reporting relating to the use of restraint and 902 seclusion; and establish procedures relating to the 903 documentation of the use of restraint or seclusion in the 904 client’s facility or program record. 905 (3) IfThe agency shall adopt rules to provide that, when906 the criteria established under this part and part II of chapter 907 408 are not met, such deficiencies shall be classified according 908 to the nature of the deficiency. The agency shall indicate the 909 classification on the face of the notice of deficiencies as 910 follows: 911 (a) Class I deficiencies are those which the agency 912 determines present an imminent danger totheresidents or guests 913 of the facility or a substantial probability that death or 914 serious physical harm willwouldresult therefrom. The condition 915 or practice constituting a class I violation must be abated or 916 eliminated immediately, unless the agency determines that a 917 fixed period of time, as determined by the agency,is required 918 for correction. A class I deficiency is subject to a civil 919 penalty in an amount of at leastnot less than$5,000 but not 920 more thanand not exceeding$10,000 for each deficiency. A fine 921 may be levied notwithstanding the correction of the deficiency. 922 (b) Class II deficiencies are those which the agency 923 determines have a direct or immediate relationship to the 924 health, safety, or security ofthefacility residents but do not 925 meet the criteria established for, other thanclass I 926 deficiencies. A class II deficiency is subject to a civil 927 penalty in an amount of at leastnot less than$1,000 and not 928 more thannot exceeding$5,000 for each deficiency. A citation 929 for a class II deficiency mustshallspecify the time within 930 which the deficiency must be corrected. If a class II deficiency 931 is corrected within the time specified, anocivil penalty may 932 notshallbe imposed, unless it is a repeated offense. 933 (c) Class III deficiencies are those which the agency 934 determines to have an indirect or potential relationship to the 935 health, safety, or security ofthefacility residents but do not 936 meet the criteria for, other thanclass I or class II 937 deficiencies. A class III deficiency is subject to a civil 938 penalty of at leastnot less than$500 and not more than 939exceeding$1,000 for each deficiency. A citation for a class III 940 deficiency mustshallspecify the time within which the 941 deficiency must be corrected. If a class III deficiency is 942 corrected within the time specified, anocivil penalty may not 943shallbe imposed, unless it is a repeated offense. 944 Section 19. Subsection (2) of section 400.980, Florida 945 Statutes, is amended to read: 946 400.980 Health care services pools.— 947 (2) The requirements of part II of chapter 408 apply to the 948 provision of services that require licensure or registration 949 pursuant to this part and part II of chapter 408 and to entities 950 registered by or applying for such registration from the agency 951 pursuant to this part. Registration or a license issued by the 952 agency is required for the operation of a health care services 953 pool in this state. In accordance with s. 408.805, an applicant 954 or licensee shall pay a fee for each license application 955 submitted using this part, part II of chapter 408, and 956 applicable rules. The agency shalladopt rules andprovide forms 957 required for such registration and shall impose a registration 958 fee in an amount sufficient to cover the cost of administering 959 this part and part II of chapter 408. In addition to the 960 requirements in part II of chapter 408, the registrant must 961 provide the agency with any change of information contained on 962 the original registration application within 14 days before 963prior tothe change. 964 Section 20. Subsection (43) of section 409.912, Florida 965 Statutes, is amended to read: 966 409.912 Cost-effective purchasing of health care.—The 967 agency shall purchase goods and services for Medicaid recipients 968 in the most cost-effective manner consistent with the delivery 969 of quality medical care. To ensure that medical services are 970 effectively utilized, the agency may, in any case, require a 971 confirmation or second physician’s opinion of the correct 972 diagnosis for purposes of authorizing future services under the 973 Medicaid program. This section does not restrict access to 974 emergency services or poststabilization care services as defined 975 in 42 C.F.R. part 438.114. Such confirmation or second opinion 976 shall be rendered in a manner approved by the agency. The agency 977 shall maximize the use of prepaid per capita and prepaid 978 aggregate fixed-sum basis services when appropriate and other 979 alternative service delivery and reimbursement methodologies, 980 including competitive bidding pursuant to s. 287.057, designed 981 to facilitate the cost-effective purchase of a case-managed 982 continuum of care. The agency shall also require providers to 983 minimize the exposure of recipients to the need for acute 984 inpatient, custodial, and other institutional care and the 985 inappropriate or unnecessary use of high-cost services. The 986 agency shall contract with a vendor to monitor and evaluate the 987 clinical practice patterns of providers in order to identify 988 trends that are outside the normal practice patterns of a 989 provider’s professional peers or the national guidelines of a 990 provider’s professional association. The vendor must be able to 991 provide information and counseling to a provider whose practice 992 patterns are outside the norms, in consultation with the agency, 993 to improve patient care and reduce inappropriate utilization. 994 The agency may mandate prior authorization, drug therapy 995 management, or disease management participation for certain 996 populations of Medicaid beneficiaries, certain drug classes, or 997 particular drugs to prevent fraud, abuse, overuse, and possible 998 dangerous drug interactions. The Pharmaceutical and Therapeutics 999 Committee shall make recommendations to the agency on drugs for 1000 which prior authorization is required. The agency shall inform 1001 the Pharmaceutical and Therapeutics Committee of its decisions 1002 regarding drugs subject to prior authorization. The agency is 1003 authorized to limit the entities it contracts with or enrolls as 1004 Medicaid providers by developing a provider network through 1005 provider credentialing. The agency may competitively bid single 1006 source-provider contracts if procurement of goods or services 1007 results in demonstrated cost savings to the state without 1008 limiting access to care. The agency may limit its network based 1009 on the assessment of beneficiary access to care, provider 1010 availability, provider quality standards, time and distance 1011 standards for access to care, the cultural competence of the 1012 provider network, demographic characteristics of Medicaid 1013 beneficiaries, practice and provider-to-beneficiary standards, 1014 appointment wait times, beneficiary use of services, provider 1015 turnover, provider profiling, provider licensure history, 1016 previous program integrity investigations and findings, peer 1017 review, provider Medicaid policy and billing compliance records, 1018 clinical and medical record audits, and other factors. Providers 1019 are not entitled to enrollment in the Medicaid provider network. 1020 The agency shall determine instances in which allowing Medicaid 1021 beneficiaries to purchase durable medical equipment and other 1022 goods is less expensive to the Medicaid program than long-term 1023 rental of the equipment or goods. The agency may establish rules 1024 to facilitate purchases in lieu of long-term rentals in order to 1025 protect against fraud and abuse in the Medicaid program as 1026 defined in s. 409.913. The agency may seek federal waivers 1027 necessary to administer these policies. 1028 (43) Subject to the availability of funds, the agency shall 1029 mandate a recipient’s participation in a provider lock-in 1030 program, when appropriate, if a recipient is found by the agency 1031 to have used Medicaid goods or services at a frequency or amount 1032 not medically necessary, limiting the receipt of goods or 1033 services to medically necessary providers after the 21-day 1034 appeal process has ended, for at leasta period of not less than1035 1 year. The lock-in programs mustshallinclude, but are not 1036 limited to, pharmacies, medical doctors, and infusion clinics. 1037 The limitation does not apply to emergency services and care 1038 provided to the recipient in a hospital emergency department. 1039 The agency shall seek any federal waivers necessary to implement 1040 this subsection.The agency shall adopt any rules necessary to1041comply with or administer this subsection.This subsection 1042 expires October 1, 2014. 1043 Section 21. Paragraph (e) of subsection (2) of section 1044 409.972, Florida Statutes, is amended to read: 1045 409.972 Mandatory and voluntary enrollment.— 1046 (2) The following Medicaid-eligible persons are exempt from 1047 mandatory managed care enrollment required by s. 409.965, and 1048 may voluntarily choose to participate in the managed medical 1049 assistance program: 1050 (e) Medicaid recipients enrolled in the home and community 1051 based services waiver pursuant to chapter 393,andMedicaid 1052 recipients waiting for waiver services, and Medicaid recipients 1053 under the age of 21 who are not receiving waiver services but 1054 are authorized by the Agency for Persons with Disabilities or 1055 the Department of Children and Families to reside in a group 1056 home facility licensed pursuant to chapter 393. 1057 Section 22. Subsection (4) of section 429.255, Florida 1058 Statutes, is amended to read: 1059 429.255 Use of personnel; emergency care.— 1060 (4) Facility staff may withhold or withdraw cardiopulmonary 1061 resuscitation or the use of an automated external defibrillator 1062 if presented with an order not to resuscitate executed pursuant 1063 to s. 401.45.The department shall adopt rules providing for the1064implementation of such orders.Facility staff and facilities are 1065shallnotbesubject to criminal prosecution or civil liability, 1066 norbeconsidered to have engaged in negligent or unprofessional 1067 conduct, for withholding or withdrawing cardiopulmonary 1068 resuscitation or use of an automated external defibrillator 1069 pursuant to such an order and rules adopted by the department. 1070 The absence of an order to resuscitate executed pursuant to s. 1071 401.45 does not preclude a physician from withholding or 1072 withdrawing cardiopulmonary resuscitation or use of an automated 1073 external defibrillator as otherwise permitted by law. 1074 Section 23. Subsection (3) of section 429.73, Florida 1075 Statutes, is amended to read: 1076 429.73 Rules and standards relating to adult family-care 1077 homes.— 1078 (3)The department shall adopt rules providing for the1079implementation of orders not to resuscitate.The provider may 1080 withhold or withdraw cardiopulmonary resuscitation if presented 1081 with an order not to resuscitate executed pursuant to s. 401.45. 1082 The provider isshallnotbesubject to criminal prosecution or 1083 civil liability, norbeconsidered to have engaged in negligent 1084 or unprofessional conduct, for withholding or withdrawing 1085 cardiopulmonary resuscitation pursuant to such an order and 1086 applicable rules. 1087 Section 24. Subsection (10) of section 440.102, Florida 1088 Statutes, is amended to read: 1089 440.102 Drug-free workplace program requirements.—The 1090 following provisions apply to a drug-free workplace program 1091 implemented pursuant to law or to rules adopted by the Agency 1092 for Health Care Administration: 1093 (10) RULES.—The Agency for Health Care Administration shall1094adopt rulesPursuant to s. 112.0455, part II of chapter 408, and 1095 using criteria established by the United States Department of 1096 Health and Human Services, the agency shall adopt rulesas1097general guidelinesformodelingdrug-free workplace 1098 laboratories, includingconcerning, but not limited to: 1099 (a) Standards for licensing drug-testing laboratories and 1100 suspension and revocation of such licenses. 1101 (b) Urine, hair, blood, and other body specimens and 1102 minimum specimen amounts that are appropriate for drug testing. 1103 (c) Methods of analysis and procedures to ensure reliable 1104 drug-testing results, including standards for initial tests and 1105 confirmation tests. 1106 (d) Minimum cutoff detection levels for each drug or 1107 metabolites of such drug for the purposes of determining a 1108 positive test result. 1109 (e) Chain-of-custody procedures to ensure proper 1110 identification, labeling, and handling of specimens tested. 1111 (f) Retention, storage, and transportation procedures to 1112 ensure reliable results on confirmation tests and retests. 1113 Section 25. Subsection (2) of section 483.245, Florida 1114 Statutes, is amended to read: 1115 483.245 Rebates prohibited; penalties.— 1116 (2) The agency may establish andshall adopt rules that1117 assess administrative penalties for acts prohibited by 1118 subsection (1). IfIn the case ofan entity is licensed by the 1119 agency, such penalties may include any disciplinary action 1120 available to the agency under the appropriate licensing laws. If 1121In the case ofan entity is not licensed by the agency, such 1122 penalties may include: 1123 (a) A fine not to exceed $1,000; 1124 (b) If applicable, a recommendation by the agency to the 1125 appropriate licensing board that disciplinary action be taken. 1126 Section 26. Subsections (1) and (2) of section 765.541, 1127 Florida Statutes, are amended to read: 1128 765.541 LicensureCertificationof procurement 1129 organizations; agency responsibilities.—The agency shall: 1130 (1) Establish a program for the licensurecertificationof 1131 organizations, corporations, or other entities engaged in the 1132 procurement of organs, tissues, and eyes within the state for 1133 transplantation. 1134 (2) Adopt rules as necessary to implementthat set forth1135appropriate standards and guidelines for the program in1136accordance withss. 765.541-765.546 and part II of chapter 408. 1137TheseStandards and guidelines for the program adopted by the 1138 agency must be substantially based on theexistinglaws of the 1139 Federal Government and this state, and theexistingstandards 1140 and guidelines of one or more nationally recognized 1141 accreditation organizations or federally regulated networks 1142 determined by the agency to possess reasonable expertise in 1143 organ procurement if such guidelines are consistent with the 1144 requirements of ss. 765.541-765.546.theUnited Network for1145Organ Sharing (UNOS), the American Association of Tissue Banks1146(AATB), the South-Eastern Organ Procurement Foundation (SEOPF),1147the North American Transplant Coordinators Organization (NATCO),1148and the Eye Bank Association of America (EBAA). In addition, the1149agency shall, before adopting these standards and guidelines,1150seek input from all procurement organizations based in this1151state.1152 Section 27. Subsection (2) of section 765.544, Florida 1153 Statutes, is amended to read: 1154 765.544 Fees; organ and tissue donor education and 1155 procurement.— 1156(2) The agency shall specify by rule the administrative1157penalties for the purpose of ensuring adherence to the standards1158of quality and practice required by this chapter, part II of1159chapter 408, and applicable rules of the agency for continued1160certification.1161 Section 28. This act shall take effect July 1, 2014.