Bill Text: FL S1254 | 2014 | Regular Session | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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
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 SB 1254 By the Committee on Health Policy; and Senator Grimsley 588-03230-14 20141254c1 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; creating s. 400.9141; limiting 31 services at PPEC centers; amending s. 400.934, 32 relating to home medical equipment providers; 33 requiring that the emergency management plan include 34 criteria relating to the maintenance of patient 35 equipment and supply lists; amending s. 409.962, F.S.; 36 redefining the term “provider service network”; 37 amending s. 409.972; exempting certain people from the 38 requirement to enroll in Medicaid managed care; 39 amending s. 409.974, F.S.; providing for contracting 40 with eligible plans; revising provisions relating to 41 negotiation with a provider service network; providing 42 requirements for termination of a contract with a 43 provider service network; providing an effective date. 44 45 Be It Enacted by the Legislature of the State of Florida: 46 47 Section 1. Paragraph (d) of subsection (3) of section 48 390.012, Florida Statutes, is amended to read: 49 390.012 Powers of agency; rules; disposal of fetal 50 remains.— 51 (3) For clinics that perform or claim to perform abortions 52 after the first trimester of pregnancy, the agency shall adopt 53 rules pursuant to ss. 120.536(1) and 120.54 to implement the 54 provisions of this chapter, including the following: 55 (d) Rules relating to the medical screening and evaluation 56 of each abortion clinic patient. At a minimum, these rules must 57shallrequire: 58 1. A medical history including reported allergies to 59 medications, antiseptic solutions, or latex; past surgeries; and 60 an obstetric and gynecological history. 61 2. A physical examination, including a bimanual examination 62 estimating uterine size and palpation of the adnexa. 63 3. The appropriate laboratory tests, including: 64 a. Urine or blood tests for pregnancy performed before the 65 abortion procedure. 66 b. A test for anemia. 67 c. Rh typing, unless reliable written documentation of 68 blood type is available. 69 d. Other tests as indicated from the physical examination. 70 4. An ultrasound evaluation for all patients. The rules 71 mustshallrequire that if a person who is not a physician 72 performs an ultrasound examination, that person shall have 73 documented evidence that he or she has completed a course in the 74 operation of ultrasound equipment as prescribed in rule.The75rules shall require clinics to be in compliance with s.76390.0111.77 5. That the physician is responsible for estimating the 78 gestational age of the fetus based on the ultrasound examination 79 and obstetric standards in keeping with established standards of 80 care regarding the estimation of fetal age as defined in rule 81 and shall write the estimate in the patient’s medical history. 82 The physician shall keep original prints of each ultrasound 83 examination of a patient in the patient’s medical history file. 84 Section 2. Subsection (11) of section 400.021, Florida 85 Statutes, is amended to read: 86 400.021 Definitions.—When used in this part, unless the 87 context otherwise requires, the term: 88 (11) “Nursing home bed” means an accommodation thatwhich89 is ready for immediate occupancy, or is capable of being made 90 ready for occupancy within 48 hours, excluding the provision of 91 staffing,;and thatwhichconforms to minimum space 92 requirements, including the availability of appropriate 93 equipment and furnishings within the 48 hours, as specified by 94rule ofthe agency, for the provision of services specified in 95 this part to a single resident. 96 Section 3. Subsection (3) of section 400.0712, Florida 97 Statutes, is amended to read: 98 400.0712 Application for inactive license.— 99(3) The agency shall adopt rules pursuant to ss. 120.536(1)100and 120.54 necessary to implement this section.101 Section 4. Section 400.23, Florida Statutes, is amended to 102 read: 103 400.23 Rules; evaluation and deficiencies; licensure 104 status.— 105 (1) It is the intent of the Legislature that rules 106 published and enforced pursuant to this part and part II of 107 chapter 408shallinclude criteria by which a reasonable and 108 consistent quality of resident care may be ensured,andthe 109 results of such resident care can be demonstrated, andby which110 safe and sanitary nursing homes can be provided. It is further 111 intended that reasonable efforts be made to accommodate the 112 needs and preferences of residents to enhance the quality of 113 life in a nursing home. In addition, efforts shall be made to 114 minimize the amount of paperwork associated with the reporting 115 and documentation requirements of these rules. 116 (2) Pursuant to the intention of the Legislature, the 117 agency, in consultation with the Department of Health and the 118 Department of Elderly Affairs, mayshalladoptand enforcerules 119 to administerimplementthis part and part II of chapter 408. 120 The rules must specify, but are not limited to,which shall121includereasonable and fair criteria relatingin relationto: 122 (a) The location of the facility and housing conditions 123 that will ensure the health, safety, and comfort of residents, 124 including an adequate call system. In adoptingmakingsuch 125 rules, the agency shall be guided by criteria recommended by 126 nationally recognized reputable professional groups and 127 associations that havewithknowledge of such subject matters. 128 The agency shall update or revise thesuchcriteria as the need 129 arises. The agency may require alterations to a building if it 130 determines that an existing condition constitutes a distinct 131 hazard to life, health, or safety. In performinganyinspections 132 of facilities authorized by this part or part II of chapter 408, 133 the agency may enforce the special-occupancy provisions of the 134 Florida Building Code and the Florida Fire Prevention Code which 135 apply to nursing homes. A residentResidentsor his or her 136 representative musttheir representatives shallbe able to 137 request a change in the placement of the bed in his or hertheir138 room if,provided thatat admission, the resident isthey are139 presented with a room that meets requirements of the Florida 140 Building Code. The location of a bed may be changed if the 141 requested placement does not infringe on the resident’s roommate 142 or interfere with the resident’s care or safety as determined by 143 the care planning team in accordance with facility policies and 144 procedures. In addition, the bed placement may not be used as a 145 restraint. Each facility shall maintain a log of resident rooms 146 with beds that are not in strict compliance with the Florida 147 Building Code in order for such log to be used by surveyors and 148 nurse monitors during inspections and visits. A resident or a 149 resident’sresidentrepresentative who requests that a bed be 150 moved mustshallsign a statement indicating that he or she 151 understands that the room will not be in compliance with the 152 Florida Building Code, but that he or shetheywould prefer to 153 exercise thetheirright to self-determination. The statement 154 must be retained as part of the resident’s care plan. AAny155 facility that offers this option must submit a letter signed by 156 the nursing home administrator of record to the agency notifying 157 it of this practice along with a copy of the policies and 158 procedures of the facility. The agency is directed to provide 159 assistance to the Florida Building Commission in updating the 160 construction standards of the code relatingrelativeto nursing 161 homes. 162 (b) The number and qualifications of all personnel, 163 including management, medical, nursing, and other professional 164 personnel, and nursing assistants, orderlies, and support 165 personnel, having responsibility for any part of the care given 166 residents. 167 (c) All sanitary conditions within the facility and its 168 surroundings, including water supply, sewage disposal, food 169 handling, and general hygiene which will ensure the health and 170 comfort of residents. 171 (d) The equipment essential to the health and welfare of 172 the residents. 173 (e) A uniform accounting system. 174 (f) The care, treatment, and maintenance of residents and 175 measurement of the quality and adequacy thereof, based on rules 176 developed under this chapter and the Omnibus Budget 177 Reconciliation Act of 1987,(Pub. L. No. 100-203) (December 22,1781987), Title IV (Medicare, Medicaid, and Other Health-Related 179 Programs), Subtitle C (Nursing Home Reform), as amended. 180 (g) The preparation and annual update of a comprehensive 181 emergency management plan. The agency shall establishadopt182rules establishingminimum criteria for the plan after 183 consultation with the Division of Emergency Management. At a 184 minimum, therules must provide forplan components must provide 185that addressemergency evacuation transportation; adequate 186 sheltering arrangements; postdisaster activities, including 187 emergency power, food, and water; postdisaster transportation; 188 supplies; staffing; emergency equipment; individual 189 identification of residents and transfer of records; and 190 responding to family inquiries. The comprehensive emergency 191 management plan is subject to review and approval by the local 192 emergency management agency. During theitsreview, the local 193 emergency management agency shall ensure that the following 194 agencies, at a minimum, are given the opportunity to review the 195 plan: the Department of Elderly Affairs, the Department of 196 Health, the Agency for Health Care Administration, and the 197 Division of Emergency Management.Also,Appropriate volunteer 198 organizations must also be given the opportunity to review the 199 plan. The local emergency management agency shall complete its 200 review within 60 days andeitherapprove the plan or advise the 201 facility of necessary revisions. 202 (h) The availability, distribution, and posting of reports 203 and records pursuant to s. 400.191 and the Gold Seal Program 204 pursuant to s. 400.235. 205 (3)(a)1.The agency shall enforceadopt rules providing206 minimum staffing requirements for nursing home facilities. 207 1. These requirements must include, for each facility: 208 a. A combined minimum weekly average of certified nursing 209 assistant and licensed nursing staffingcombinedof 3.6 hours of 210 direct care per resident per day. As used in this sub 211 subparagraph, a week is defined as Sunday through Saturday. 212 b. A minimum certified nursing assistant staffing of 2.5 213 hours of direct care per resident per day. A facility may not 214 staff below one certified nursing assistant per 20 residents. 215 c. A minimum licensed nursing staffing of 1.0 hour of 216 direct care per resident per day. A facility may not staff below 217 one licensed nurse per 40 residents. 218 2. Nursing assistants employed under s. 400.211(2) may be 219 included in computing the staffing ratio for certified nursing 220 assistants if their job responsibilities include only nursing 221 assistant-related duties. 222 3. Each nursing home facility must document compliance with 223 staffing standardsasrequired under this paragraph and post 224 daily the names of staff on duty for the benefit of facility 225 residents and the public. 226 4. The agency shall recognize the use of licensed nurses 227 for compliance with the minimum staffing requirements for 228 certified nursing assistants if the nursing home facility 229 otherwise meets the minimum staffing requirements for licensed 230 nurses and the licensed nurses are performing the duties ofa231 certified nursing assistantsassistant. Unless otherwise 232 approved by the agency, licensed nurses counted toward the 233 minimum staffing requirements for certified nursing assistants 234 must exclusively perform the duties ofacertified nursing 235 assistantsassistantfor the entire shift and not also be 236 counted toward the minimum staffing requirements for licensed 237 nurses. If the agency approved a facility’s request to use a 238 licensed nurse to perform both licensed nursing and certified 239 nursing assistant duties, the facility must allocate the amount 240 of staff time specifically spent on certified nursing assistant 241 duties for the purpose of documenting compliance with minimum 242 staffing requirements for certified and licensed nursing staff. 243 The hours of a licensed nurse with dual job responsibilities may 244 not be counted twice. 245 (b) Nonnursing staff providing eating assistance to 246 residents doesshallnot count toward compliance with minimum 247 staffing standards. 248 (c) Licensed practical nurses licensed under chapter 464 249 who are providing nursing services in nursing home facilities 250 under this part may supervise the activities of other licensed 251 practical nurses, certified nursing assistants, and other 252 unlicensed personnel providing services in such facilities in 253 accordance with rules adopted by the Board of Nursing. 254 (4)Rules developed pursuant toThis section doesshallnot 255 restrict the use of shared staffing and shared programming in 256 facilities thatwhichare part of retirement communities that 257 provide multiple levels of care and otherwise meet the 258 requirement of law or rule. 259 (5)The agency, in collaboration with the Division of260Children’s Medical Services of the Department of Health, must261adopt rules for:262 (a) Minimum standards of care for persons under 21 years of 263 age who reside in nursing home facilities may be established by 264 the agency, in collaboration with the Division of Children’s 265 Medical Services of the Department of Health. A facility may be 266 exempted from these standards and the provisions of paragraph 267 (b) for specifiedspecificpersons between 18 and 21 years of 268 age,if the person’s physician agrees that minimum standards of 269 care based on age are not necessary. 270 (b) The followingMinimumstaffing requirements for persons 271 under 21 years of age who reside in nursing home facilities,272whichapply in lieu of the requirements contained in subsection 273 (3):.274 1. For persons under 21 years of age who require skilled 275 care: 276 a. A minimum combined average of 3.9 hours of direct care 277 per resident per day must be provided by licensed nurses, 278 respiratory therapists, respiratory care practitioners, and 279 certified nursing assistants. 280 b. A minimum licensed nursing staffing of 1.0 hour of 281 direct care per resident per daymust be provided. 282 c. Up toNo more than1.5 hours of certified nursing 283 assistant care per resident per day may be counted in 284 determining the minimum direct care hours required. 285 d. One registered nurse must be on duty on the site 24 286 hours per day on the unit where children reside. 287 2. For persons under 21 years of age who are medically 288 fragile: 289 a. A minimum combined average of 5.0 hours of direct care 290 per resident per day must be provided by licensed nurses, 291 respiratory therapists, respiratory care practitioners, and 292 certified nursing assistants. 293 b. A minimum licensed nursing staffing of 1.7 hours of 294 direct care per resident per day must be provided. 295 c. Up toNo more than1.5 hours of certified nursing 296 assistant care per resident per day may be counted in 297 determining the minimum direct care hours required. 298 d. One registered nurse must be on duty on the site 24 299 hours per day on atheunit where children reside. 300 (6) BeforePrior toconducting a survey of the facility, 301 the survey team shall obtain a copy of the local long-term care 302 ombudsman council report on the facility. Problems noted in the 303 report shall be incorporated into and followed up through the 304 agency’s inspection process. This procedure does not preclude 305 the local long-term care ombudsman council from requesting the 306 agency to conduct a followup visit to the facility. 307 (7) The agency shall, at least every 15 months, evaluate 308 all nursing home facilities and determinemake a determination309as tothe degree of compliance by each licensee with the 310 established rules adopted under this part as a basis for 311 assigning a licensure status to athatfacility. The agency 312 shall base its evaluation on the most recent inspection report, 313 taking into consideration findings from other official reports, 314 surveys, interviews, investigations, and inspections. In 315 addition to license categories authorized under part II of 316 chapter 408, the agency shall assign alicensure status of317 standard or conditional licensure status to each nursing home. 318 (a) A standard licensure status means that a facility has 319 no class I or class II deficiencies and has corrected all class 320 III deficiencies within the time established by the agency. 321 (b) A conditional licensure status means that a facility, 322 due to the presence of one or more class I or class II 323 deficiencies, or class III deficiencies not corrected within the 324 time established by the agency, is not in substantial compliance 325 at the time of the survey with criteria established under this 326 part or with rules adopted by the agency. If the facility has no 327 class I, class II, or class III deficiencies at the time of the 328 followup survey, a standard licensure status may be assigned. 329 (c) In evaluating the overall quality of care and services 330 and determining whether the facility will receive a conditional 331 or standard license, the agency shall consider the needs and 332 limitations of residents in the facility and the results of 333 interviews and surveys of a representative sampling of 334 residents, families of residents, ombudsman council members in 335 the planning and service area in which the facility is located, 336 guardians of residents, and staff of the nursing home facility. 337 (d) The current licensure status of each facility must be 338 indicated in bold print on the face of the license. A list of 339 the deficiencies of the facility shall be posted in a prominent 340 place that is in clear and unobstructed public view at or near 341 the place where residents are being admitted to that facility. 342 Licensees receiving a conditional licensure status for a 343 facility shall prepare, within 10 working days after receiving 344 notice of deficiencies, a plan for correction of all 345 deficiencies andshallsubmit the plan to the agency for 346 approval. 347 (e) The agency shalladopt rules that: 348 1. Establish uniform procedures for the evaluation of 349 facilities. 350 2. Provide criteria in the areas referenced in paragraph 351 (c). 352 3. Address other areas necessary for carrying out the 353 intent of this section. 354 (8) The agency shall ensureadopt rules pursuant to this355part and part II of chapter 408 to providethat, ifwhenthe 356 criteria established under subsection (2) are not met, such 357 deficiencies shall be classified according to the nature and the 358 scope of the deficiency. The scope shall be cited as isolated, 359 patterned, or widespread. An isolated deficiency is a deficiency 360 affecting one or a very limited number of residents, or 361 involving one or a very limited number of staff, or a situation 362 that occurred only occasionally or in a very limited number of 363 locations. A patterned deficiency is a deficiency in whichwhere364 more than a very limited number of residents are affected, or 365 more than a very limited number of staff are involved, or the 366 situation has occurred in several locations, or the same 367 resident or residents have been affected by repeated occurrences 368 of the same deficient practice but the effect of the deficient 369 practice is not found to be pervasive throughout the facility. A 370 widespread deficiency is a deficiency in which the problems 371 causing the deficiency are pervasive in the facility or 372 represent systemic failure that has affected or has the 373 potential to affect a large portion of the facility’s residents. 374 The agency shall indicate the classification on the face of the 375 notice of deficiencies as follows: 376 (a) A class I deficiency is a deficiency that the agency 377 determines presents a situation in which immediate corrective 378 action is necessary because the facility’s noncompliance has 379 caused, or is likely to cause, serious injury, harm, impairment, 380 or death to a resident receiving care in a facility. The 381 condition or practice constituting a class I violation must 382shallbe abated or eliminated immediately, unless a fixed period 383 of time, as determined by the agency, is required for 384 correction. A class I deficiency is subject to a civil penalty 385 of $10,000 for an isolated deficiency, $12,500 for a patterned 386 deficiency, and $15,000 for a widespread deficiency. The fine 387 amount isshall bedoubled for each deficiency if the facility 388 was previously cited for one or more class I or class II 389 deficiencies during the last licensure inspection or during an 390anyinspection or complaint investigation since the last 391 licensure inspection. A fine must be levied notwithstanding the 392 correction of the deficiency. 393 (b) A class II deficiency is a deficiency that the agency 394 determines has compromised atheresident’s ability to maintain 395 or reach his or her highest practicable physical, mental, and 396 psychosocial well-being, as defined by an accurate and 397 comprehensive resident assessment, plan of care, and provision 398 of services. A class II deficiency is subject to a civil penalty 399 of $2,500 for an isolated deficiency, $5,000 for a patterned 400 deficiency, and $7,500 for a widespread deficiency. The fine 401 amount isshall bedoubled for each deficiency if the facility 402 was previously cited for one or more class I or class II 403 deficiencies during the last licensure inspection or anany404 inspection or complaint investigation since the last licensure 405 inspection. A fine shall be levied notwithstanding the 406 correction of the deficiency. 407 (c) A class III deficiency is a deficiency that the agency 408 determines will result in no more than minimal physical, mental, 409 or psychosocial discomfort to atheresident or has the 410 potential to compromise atheresident’s ability to maintain or 411 reach his or her highest practical physical, mental, or 412 psychosocial well-being, as defined by an accurate and 413 comprehensive resident assessment, plan of care, and provision 414 of services. A class III deficiency is subject to a civil 415 penalty of $1,000 for an isolated deficiency, $2,000 for a 416 patterned deficiency, and $3,000 for a widespread deficiency. 417 The fine amount isshall bedoubled for each deficiency if the 418 facility was previously cited for one or more class I or class 419 II deficiencies during the last licensure inspection or anany420 inspection or complaint investigation since the last licensure 421 inspection. A citation for a class III deficiency must specify 422 the time within which the deficiency is required to be 423 corrected. If a class III deficiency is corrected within the 424 time specified, a civil penalty may not be imposed. 425 (d) A class IV deficiency is a deficiency that the agency 426 determines has the potential for causing no more than a minor 427 negative impact on atheresident. If the class IV deficiency is 428 isolated, no plan of correction is required. 429 (9) Civil penalties paid by aanylicensee under subsection 430 (8) shall be deposited in the Health Care Trust Fund and 431 expended as provided in s. 400.063. 432 (10) Agency records, reports, ranking systems, Internet 433 information, and publications must be promptly updated to 434 reflect the most current agency actions. 435 Section 5. Subsection (7) of section 400.487, Florida 436 Statutes, is amended to read: 437 400.487 Home health service agreements; physician’s, 438 physician assistant’s, and advanced registered nurse 439 practitioner’s treatment orders; patient assessment; 440 establishment and review of plan of care; provision of services; 441 orders not to resuscitate.— 442 (7) Home health agency personnel may withhold or withdraw 443 cardiopulmonary resuscitation if presented with an order not to 444 resuscitate executed pursuant to s. 401.45.The agency shall445adopt rules providing for the implementation of such orders.446 Home health personnel and agencies areshallnotbesubject to 447 criminal prosecution or civil liability and are not,nor be448 considered to have engaged in negligent or unprofessional 449 conduct,for withholding or withdrawing cardiopulmonary 450 resuscitation pursuant to suchanorderand rules adopted by the451agency. 452 Section 6. Section 400.497, Florida Statutes, is amended to 453 read: 454 400.497 Rules establishing minimum standards.—The agency 455 mayshalladopt, publish, and enforcerules to administer 456implementpart II of chapter 408 and this part, including the 457 provider’s duties and responsibilities under, as applicable,ss. 458 400.506 and 400.509. Rules shall specify, but are not limited 459 to,which must providereasonable and fair minimum standards 460 relating to: 461 (1) The home health aide competency test and home health 462 aide training. The agency shall create the home health aide 463 competency test and establish the curriculum and instructor 464 qualifications for home health aide training. Licensed home 465 health agencies may provide this training and shall furnish 466 documentation of such training to other licensed home health 467 agencies upon request. Successful passage of the competency test 468 by home health aides may be substituted for the training 469 required under this section and agencyanyruleadopted pursuant470thereto. 471 (2) Shared staffing.The agency shall allowShared staffing 472 is allowed if the home health agency is part of a retirement 473 community that provides multiple levels of care, is located on 474 one campus, is licensed under this chapter or chapter 429, and 475 otherwise meets the requirements of law and rule. 476 (3) The criteria for the frequency of onsite licensure 477 surveys. 478 (4) Licensure application and renewal. 479 (5) Oversight by the director of nursing, including. The480agency shall develop rules related to: 481 (a) Standards that address oversight responsibilities by 482 the director of nursing forofskilled nursing and personal care 483 services provided by the home health agency’s staff; 484 (b) Requirements for a director of nursing to provide to 485 the agency, upon request, a certified daily report of the home 486 health services provided by a specified direct employee or 487 contracted staff member on behalf of the home health agency. The 488 agency may request a certified daily report for up toonly for a489period not to exceed2 years beforeprior tothe date of the 490 request; and 491 (c) A quality assurance program for home health services 492 provided by the home health agency. 493 (6) Conditions for using a recent unannounced licensure 494 inspection for the inspection required underins. 408.806 495 related to a licensure application associated with a change in 496 ownership of a licensed home health agency. 497 (7) The requirements for onsite and electronic 498 accessibility of supervisory personnel of home health agencies. 499 (8) Information to be included in patients’ records. 500 (9) Geographic service areas. 501 (10) Preparation of a comprehensive emergency management 502 plan pursuant to s. 400.492. 503(a) The Agency for Health Care Administration shall adopt504rules establishing minimum criteria for the plan and plan505updates, with the concurrence of the Department of Health and in506consultation with the Division of Emergency Management.507 (a)(b)An emergency planThe rulesmustaddress the508requirements in s. 400.492. In addition, the rules shallprovide 509 for the maintenance of patient-specific medication lists that 510 can accompany patients who are transported from their homes. 511 (b)(c)The plan is subject to review and approval by the 512 county health department. During its review, the county health 513 department shall contact state and local health and medical 514 stakeholders when necessary. The county health department shall 515 complete its review to ensure that the plan is in accordance 516 with the requirements of lawcriteria in the Agency for Health517Care Administration ruleswithin 90 days after receipt of the 518 plan and shall approve the plan or advise the home health agency 519 of necessary revisions. If the home health agency fails to 520 submit a plan or fails to submit the requested information or 521 revisions to the county health department within 30 days after 522 written notification from the county health department, the 523 county health department shall notify the Agency for Health Care 524 Administration. The agency shall notify the home health agency 525 that its failure constitutes a deficiency, subject to a fine of 526 $5,000 per occurrence. If the plan is not submitted, information 527 is not provided, or revisions are not made as requested, the 528 agency may impose the fine. 529 (c)(d)For aanyhome health agency that operates in more 530 than one county, the Department of Health shall review the plan, 531 after consulting with state and local health and medical 532 stakeholders when necessary. The department shall complete its 533 review within 90 days after receipt of the plan and shall 534 approve the plan or advise the home health agency of necessary 535 revisions. The department shall make every effort to avoid 536 imposing differing requirements on a home health agency that 537 operates in more than one county as a result of differing or 538 conflicting comprehensive plan requirements of the counties in 539 which the home health agency operates. 540 (d)(e)The requirements in this subsection do not apply to: 541 1. A facility that is certified under chapter 651 and has a 542 licensed home health agency used exclusively by residents of the 543 facility; or 544 2. A retirement community that consists of both residential 545 units for independent living andeithera licensed nursing home 546 or an assisted living facility,and has a licensed home health 547 agency used exclusively bytheresidents of the retirement 548 community, if, providedthe comprehensive emergency management 549 plan for the facility or retirement community provides for 550 continuous care of all residents with special needs during an 551 emergency. 552 Section 7. Paragraph (f) of subsection (12) and subsection 553 (17) of section 400.506, Florida Statutes, are amended to read: 554 400.506 Licensure of nurse registries; requirements; 555 penalties.— 556 (12) Each nurse registry shall prepare and maintain a 557 comprehensive emergency management plan that is consistent with 558 the criteria in this subsection and with the local special needs 559 plan. The plan shall be updated annually. The plan shall include 560 the means by which the nurse registry will continue to provide 561 the same type and quantity of services to its patients who 562 evacuate to special needs shelters which were being provided to 563 those patients prior to evacuation. The plan shall specify how 564 the nurse registry shall facilitate the provision of continuous 565 care by persons referred for contract to persons who are 566 registered pursuant to s. 252.355 during an emergency that 567 interrupts the provision of care or services in private 568 residences. Nurse registries may establish links to local 569 emergency operations centers to determine a mechanism by which 570 to approach specific areas within a disaster area in order for a 571 provider to reach its clients. Nurse registries shall 572 demonstrate a good faith effort to comply with the requirements 573 of this subsection by documenting attempts of staff to follow 574 procedures outlined in the nurse registry’s comprehensive 575 emergency management plan which support a finding that the 576 provision of continuing care has been attempted for patients 577 identified as needing care by the nurse registry and registered 578 under s. 252.355 in the event of an emergency under this 579 subsection. 580(f) The Agency for Health Care Administration shall adopt581rules establishing minimum criteria for the comprehensive582emergency management plan and plan updates required by this583subsection, with the concurrence of the Department of Health and584in consultation with the Division of Emergency Management.585(17) The Agency for Health Care Administration shall adopt586rules to implement this section and part II of chapter 408.587 Section 8. Subsection (7) of section 400.509, Florida 588 Statutes, is amended to read: 589 400.509 Registration of particular service providers exempt 590 from licensure; certificate of registration; regulation of 591 registrants.— 592(7) The Agency for Health Care Administration shall adopt593rules to administer this section and part II of chapter 408.594 Section 9. Subsection (8) of section 400.6095, Florida 595 Statutes, is amended to read: 596 400.6095 Patient admission; assessment; plan of care; 597 discharge; death.— 598 (8) The hospice care team may withhold or withdraw 599 cardiopulmonary resuscitation if presented with an order not to 600 resuscitate executed pursuant to s. 401.45.The department shall601adopt rules providing for the implementation of such orders.602 Hospice staff areshallnotbesubject to criminal prosecution 603 or civil liability, norbeconsidered to have engaged in 604 negligent or unprofessional conduct, for withholding or 605 withdrawing cardiopulmonary resuscitation pursuant to such an 606 order and applicable rules. The absence of an order to 607 resuscitate executed pursuant to s. 401.45 does not preclude a 608 physician from withholding or withdrawing cardiopulmonary 609 resuscitation as otherwise permitted by law. 610 Section 10. Section 400.914, Florida Statutes, is amended 611 to read: 612 400.914 Rulemaking;Rules establishingstandards.— 613 (1) Pursuant to the intention of the Legislature to provide 614 safe and sanitary facilities and healthful programs, the agency 615 in conjunction with the Division of Children’s Medical Services 616 of the Department of Health mayshalladoptand publishrules to 617 administerimplement the provisions ofthis part and part II of 618 chapter 408, which shall include reasonable and fair standards. 619 Any conflict between these rulesstandardsand those established 620that may be set forthin local, county, or city ordinances shall 621 be resolved in favor of those having statewide effect. 622 (2) The rules must specify, but are not limited to, 623 reasonable and fair standards relatingSuch standards shall624relateto: 625 (a) The assurance that PPEC services are family centered 626 and provide individualized medical, developmental, and family 627 training services. 628 (b) The maintenance of PPEC centers, not in conflict with 629the provisions ofchapter 553 and based upon the size of the 630 structure and number of children, relating to plumbing, heating, 631 lighting, ventilation, and other building conditions, including 632 adequate space, which will ensure the health, safety, comfort, 633 and protection from fire of the children served. 634 (c) The application of the appropriate provisions of the 635 most recent edition of the “Life Safety Code” (NFPA-101)shall636be applied. 637 (d) The number and qualifications of all personnel who have 638 responsibility for the care of the children served. 639 (e) All sanitary conditions within the PPEC center and its 640 surroundings, including water supply, sewage disposal, food 641 handling, and general hygiene, and maintenance thereof, which 642 will ensure the health and comfort of children served. 643 (f) Programs and basic services promoting and maintaining 644 the health and development of the children served and meeting 645 the training needs of the children’s legal guardians. 646 (g) Supportive, contracted, other operational, and 647 transportation services. 648 (h) Maintenance of appropriate medical records, data, and 649 information relative to the children and programs. Such records 650 shall be maintained in the facility for inspection by the 651 agency. 652(2) The agency shall adopt rules to ensure that:653(a) No child attends a PPEC center for more than 12 hours654within a 24-hour period.655(b) No PPEC center provides services other than those656provided to medically or technologically dependent children.657 Section 11. Section 400.9141, Florida Statutes, is created 658 to read: 659 400.9141 Limitations.— 660 (1) A child may not attend a PPEC center for more than 12 661 hours within a 24-hour period. 662 (2) A PPEC center may provide services only to medically or 663 technologically dependent children. 664 Section 12. Paragraph (a) of subsection (20) of section 665 400.934, Florida Statutes, is amended to read: 666 400.934 Minimum standards.—As a requirement of licensure, 667 home medical equipment providers shall: 668 (20)(a) Prepare and maintain a comprehensive emergency 669 management plan that meets minimum criteria established by 670 agency rule, including criteria for the maintenance of patient 671 equipment and supply lists that accompany patients who are 672 transported from their homes. Such rules shall be formulated in 673 consultation with the Department of Health and the Division of 674 Emergency Managementunder s. 400.935. The plan shall be updated 675 annually and shall provide for continuing home medical equipment 676 services for life-supporting or life-sustaining equipment, as 677 defined in s. 400.925, during an emergency that interrupts home 678 medical equipment services in a patient’s home. The plan must 679shallinclude: 680 1. The means by which the home medical equipment provider 681 will continue to provide equipment to perform the same type and 682 quantity of services to its patients who evacuate to special 683 needs shelters which were being provided to those patients 684 beforeprior toevacuation. 685 2. The means by which the home medical equipment provider 686 establishes and maintains an effective response to emergencies 687 and disasters, including plans for: 688 a. Notification of staff when emergency response measures 689 are initiated. 690 b. Communication between staff members, county health 691 departments, and local emergency management agencies, which 692 includes provisions for a backup communications system. 693 c. Identification of resources necessary to continue 694 essential care or services or referrals to other organizations 695 subject to written agreement. 696 d. Contacting and prioritizing patients in need of 697 continued medical equipment services and supplies. 698 Section 13. Section 400.935, Florida Statutes, is amended 699 to read: 700 400.935 Rule authorityRules establishing minimum701standards.—The agency shall adopt, publish, and enforcerules as 702 necessary to implement this part and part II of chapter 408. The 703 rules must specify, but not be limited to,which must provide704 reasonable and fair minimum standards relating to: 705 (1) The qualifications and minimum training requirements of 706 all home medical equipment provider personnel. 707(2) Financial ability to operate.708 (2)(3)The administration of the home medical equipment 709 provider. 710(4) Procedures for maintaining patient records.711 (3)(5)Ensuring that the home medical equipment and 712 services provided by a home medical equipment provider are in 713 accordance with the plan of treatment established for each 714 patient, when provided as a part of a plan of treatment. 715 (4)(6)Contractual arrangements for the provision of home 716 medical equipment and services by providers not employed by the 717 home medical equipment provider providing for the consumer’s 718 needs. 719 (5)(7)Physical location and zoning requirements. 720 (6)(8)Home medical equipment requiring home medical 721 equipment services. 722(9) Preparation of the comprehensive emergency management723plan under s. 400.934 and the establishment of minimum criteria724for the plan, including the maintenance of patient equipment and725supply lists that can accompany patients who are transported726from their homes. Such rules shall be formulated in consultation727with the Department of Health and the Division of Emergency728Management.729 Section 14. Subsection (5) of section 400.962, Florida 730 Statutes, is amended to read: 731 400.962 License required; license application.— 732 (5) The applicant must agree to provide or arrange for 733 active treatment services by an interdisciplinary team in order 734 to maximize individual independence or prevent regression or 735 loss of functional status.Standards for active treatment shall736be adopted by the Agency for Health Care Administration by rule737pursuant to ss. 120.536(1) and 120.54.Active treatment services 738 shall be provided in accordance with the individual support plan 739 and shall be reimbursed as part of the per diem rate as paid 740 under the Medicaid program. 741 Section 15. Subsections (2) and (3) of section 400.967, 742 Florida Statutes, are amended to read: 743 400.967 Rules and classification of deficiencies.— 744 (2)Pursuant to the intention of the Legislature,The 745 agency, in consultation with the Agency for Persons with 746 Disabilities and the Department of Elderly Affairs, mayshall747 adopt and enforce rules as necessary to administer this part and 748 part II of chapter 408, whichshallincludereasonable and fair749 criteria governing: 750 (a) The location and construction of the facility; 751 including fire and life safety, plumbing, heating, cooling, 752 lighting, ventilation, and other housing conditions that ensure 753 the health, safety, and comfort of residents. The agency shall 754 establish standards for facilities and equipment to increase the 755 extent to which new facilities, and a new wing or floor added to 756 an existing facility after July 1, 2000, are structurally 757 capable of serving as shelters only for residents, staff, and 758 families of residents and staff, and equipped to be self 759 supporting during and immediately following disasters. The 760 agency shall update or revise the criteria as the need arises. 761AllFacilities must comply with thethoselifesafety code 762 requirements and building code standards applicable whenat the763time of approval oftheir construction plans are approved. The 764 agency may require alterations to a building if it determines 765 that an existing condition constitutes adistincthazard to 766 life, health, or safety. The agency may state theshall adopt767fair and reasonable rules setting forthconditions under which 768 existing facilities undergoing additions, alterations, 769 conversions, renovations, or repairs are required to comply with 770 the most recent updated or revised standards. 771 (b) The number and qualifications of all personnel, 772 including management, medical, nursing, and other personnel, 773 having responsibility for any part of the care given to 774 residents. 775 (c)AllSanitary conditions within the facility and its 776 surroundings, including water supply, sewage disposal, food 777 handling, and general hygiene, whichwillensure the health and 778 comfort of residents. 779 (d)TheEquipment essential to the health and welfare of 780 the residents. 781 (e) A uniform accounting system. 782 (f) The care, treatment, and maintenance of residents and 783 the assessmentmeasurementof the quality and adequacy thereof. 784 (g) The preparation and annual update of a comprehensive 785 emergency management plan. After consultation with the Division 786 of Emergency Management, the agency may establishshall adopt787rules establishingminimum criteria forthe plan after788consultation with the Division of Emergency Management. At a789minimum, the rules must provideforplan components that address 790 emergency evacuation transportation; adequate sheltering 791 arrangements; postdisaster activities, including emergency 792 power, food, and water; postdisaster transportation; supplies; 793 staffing; emergency equipment; individual identification of 794 residents and transfer of records; and responding to family 795 inquiries. The comprehensive emergency management plan is 796 subject to review and approval by the local emergency management 797 agency. During theitsreview, the local emergency management 798 agency shall ensure that the following agencies, at a minimum, 799 are given the opportunity to review the plan: the Department of 800 Elderly Affairs, the Agency for Persons with Disabilities, the 801 Agency for Health Care Administration, and the Division of 802 Emergency Management.Also,Appropriate volunteer organizations 803 must also be given the opportunity to review the plan. The local 804 emergency management agency shall complete its review within 60 805 days andeitherapprove the plan or advise the facility of 806 necessary revisions. 807 (h) The use of restraint and seclusion. Such criteriarules808 must be consistent with recognized best practices; prohibit 809 inherently dangerous restraint or seclusion procedures; 810 establish limitations on the use and duration of restraint and 811 seclusion; establish measures to ensure the safety of clients 812 and staff during an incident of restraint or seclusion; 813 establish procedures for staff to follow before, during, and 814 after incidents of restraint or seclusion, including 815 individualized plans for the use of restraints or seclusion in 816 emergency situations; establish professional qualifications of 817 and training for staff who may order or be engaged in the use of 818 restraint or seclusion; establish requirements for facility data 819 collection and reporting relating to the use of restraint and 820 seclusion; and establish procedures relating to the 821 documentation of the use of restraint or seclusion in the 822 client’s facility or program record. 823 (3) IfThe agency shall adopt rules to provide that, when824 the criteria established under this part and part II of chapter 825 408 are not met, such deficiencies shall be classified according 826 to the nature of the deficiency. The agency shall indicate the 827 classification on the face of the notice of deficiencies as 828 follows: 829 (a) Class I deficiencies are those which the agency 830 determines present an imminent danger totheresidents or guests 831 of the facility or a substantial probability that death or 832 serious physical harm willwouldresult therefrom. The condition 833 or practice constituting a class I violation must be abated or 834 eliminated immediately, unless the agency determines that a 835 fixed period of time, as determined by the agency,is required 836 for correction. A class I deficiency is subject to a civil 837 penalty in an amount of at leastnot less than$5,000 but not 838 more thanand not exceeding$10,000 for each deficiency. A fine 839 may be levied notwithstanding the correction of the deficiency. 840 (b) Class II deficiencies are those which the agency 841 determines have a direct or immediate relationship to the 842 health, safety, or security ofthefacility residents but do not 843 meet the criteria established for, other thanclass I 844 deficiencies. A class II deficiency is subject to a civil 845 penalty in an amount of at leastnot less than$1,000 and not 846 more thannot exceeding$5,000 for each deficiency. A citation 847 for a class II deficiency mustshallspecify the time within 848 which the deficiency must be corrected. If a class II deficiency 849 is corrected within the time specified, anocivil penalty may 850 notshallbe imposed, unless it is a repeated offense. 851 (c) Class III deficiencies are those which the agency 852 determines to have an indirect or potential relationship to the 853 health, safety, or security ofthefacility residents but do not 854 meet the criteria for, other thanclass I or class II 855 deficiencies. A class III deficiency is subject to a civil 856 penalty of at leastnot less than$500 and not more than 857exceeding$1,000 for each deficiency. A citation for a class III 858 deficiency mustshallspecify the time within which the 859 deficiency must be corrected. If a class III deficiency is 860 corrected within the time specified, anocivil penalty may not 861shallbe imposed, unless it is a repeated offense. 862 Section 16. Subsection (2) of section 400.980, Florida 863 Statutes, is amended to read: 864 400.980 Health care services pools.— 865 (2) The requirements of part II of chapter 408 apply to the 866 provision of services that require licensure or registration 867 pursuant to this part and part II of chapter 408 and to entities 868 registered by or applying for such registration from the agency 869 pursuant to this part. Registration or a license issued by the 870 agency is required for the operation of a health care services 871 pool in this state. In accordance with s. 408.805, an applicant 872 or licensee shall pay a fee for each license application 873 submitted using this part, part II of chapter 408, and 874 applicable rules. The agency shalladopt rules andprovide forms 875 required for such registration and shall impose a registration 876 fee in an amount sufficient to cover the cost of administering 877 this part and part II of chapter 408. In addition to the 878 requirements in part II of chapter 408, the registrant must 879 provide the agency with any change of information contained on 880 the original registration application within 14 days before 881prior tothe change. 882 Section 17. Subsection (43) of section 409.912, Florida 883 Statutes, is amended to read: 884 409.912 Cost-effective purchasing of health care.—The 885 agency shall purchase goods and services for Medicaid recipients 886 in the most cost-effective manner consistent with the delivery 887 of quality medical care. To ensure that medical services are 888 effectively utilized, the agency may, in any case, require a 889 confirmation or second physician’s opinion of the correct 890 diagnosis for purposes of authorizing future services under the 891 Medicaid program. This section does not restrict access to 892 emergency services or poststabilization care services as defined 893 in 42 C.F.R. part 438.114. Such confirmation or second opinion 894 shall be rendered in a manner approved by the agency. The agency 895 shall maximize the use of prepaid per capita and prepaid 896 aggregate fixed-sum basis services when appropriate and other 897 alternative service delivery and reimbursement methodologies, 898 including competitive bidding pursuant to s. 287.057, designed 899 to facilitate the cost-effective purchase of a case-managed 900 continuum of care. The agency shall also require providers to 901 minimize the exposure of recipients to the need for acute 902 inpatient, custodial, and other institutional care and the 903 inappropriate or unnecessary use of high-cost services. The 904 agency shall contract with a vendor to monitor and evaluate the 905 clinical practice patterns of providers in order to identify 906 trends that are outside the normal practice patterns of a 907 provider’s professional peers or the national guidelines of a 908 provider’s professional association. The vendor must be able to 909 provide information and counseling to a provider whose practice 910 patterns are outside the norms, in consultation with the agency, 911 to improve patient care and reduce inappropriate utilization. 912 The agency may mandate prior authorization, drug therapy 913 management, or disease management participation for certain 914 populations of Medicaid beneficiaries, certain drug classes, or 915 particular drugs to prevent fraud, abuse, overuse, and possible 916 dangerous drug interactions. The Pharmaceutical and Therapeutics 917 Committee shall make recommendations to the agency on drugs for 918 which prior authorization is required. The agency shall inform 919 the Pharmaceutical and Therapeutics Committee of its decisions 920 regarding drugs subject to prior authorization. The agency is 921 authorized to limit the entities it contracts with or enrolls as 922 Medicaid providers by developing a provider network through 923 provider credentialing. The agency may competitively bid single 924 source-provider contracts if procurement of goods or services 925 results in demonstrated cost savings to the state without 926 limiting access to care. The agency may limit its network based 927 on the assessment of beneficiary access to care, provider 928 availability, provider quality standards, time and distance 929 standards for access to care, the cultural competence of the 930 provider network, demographic characteristics of Medicaid 931 beneficiaries, practice and provider-to-beneficiary standards, 932 appointment wait times, beneficiary use of services, provider 933 turnover, provider profiling, provider licensure history, 934 previous program integrity investigations and findings, peer 935 review, provider Medicaid policy and billing compliance records, 936 clinical and medical record audits, and other factors. Providers 937 are not entitled to enrollment in the Medicaid provider network. 938 The agency shall determine instances in which allowing Medicaid 939 beneficiaries to purchase durable medical equipment and other 940 goods is less expensive to the Medicaid program than long-term 941 rental of the equipment or goods. The agency may establish rules 942 to facilitate purchases in lieu of long-term rentals in order to 943 protect against fraud and abuse in the Medicaid program as 944 defined in s. 409.913. The agency may seek federal waivers 945 necessary to administer these policies. 946 (43) Subject to the availability of funds, the agency shall 947 mandate a recipient’s participation in a provider lock-in 948 program, when appropriate, if a recipient is found by the agency 949 to have used Medicaid goods or services at a frequency or amount 950 not medically necessary, limiting the receipt of goods or 951 services to medically necessary providers after the 21-day 952 appeal process has ended, for at leasta period of not less than953 1 year. The lock-in programs mustshallinclude, but are not 954 limited to, pharmacies, medical doctors, and infusion clinics. 955 The limitation does not apply to emergency services and care 956 provided to the recipient in a hospital emergency department. 957 The agency shall seek any federal waivers necessary to implement 958 this subsection.The agency shall adopt any rules necessary to959comply with or administer this subsection.This subsection 960 expires October 1, 2014. 961 Section 18. Subsection (13) of section 409.962, Florida 962 Statutes, is amended to read: 963 409.962 Definitions.—As used in this part, except as 964 otherwise specifically provided, the term: 965 (13) “Provider service network” means an entity qualified 966 pursuant to s. 409.912(4)(d) of which a controlling interest is 967 owned by a health care provider, or group ofaffiliated968 providers affiliated for the purpose of providing health care, 969 or a public agency or entity that delivers health services. 970 Health care providers include Florida-licensed health care 971 practitionersprofessionalsor licensed health care facilities, 972 federally qualified health care centers, and home health care 973 agencies. 974 Section 19. Paragraph (e) of subsection (2) of section 975 409.972, Florida Statutes, is amended to read: 976 409.972 Mandatory and voluntary enrollment.— 977 (2) The following Medicaid-eligible persons are exempt from 978 mandatory managed care enrollment required by s. 409.965, and 979 may voluntarily choose to participate in the managed medical 980 assistance program: 981 (e) Medicaid recipients enrolled in the home and community 982 based services waiver pursuant to chapter 393,andMedicaid 983 recipients waiting for waiver services, and Medicaid recipients 984 under the age of 21 who are not receiving waiver services but 985 are authorized by the Agency for Persons with Disabilities or 986 the Department of Children and Families to reside in a group 987 home facility licensed pursuant to chapter 393. 988 Section 20. Subsection (1) of section 409.974, Florida 989 Statutes, is amended to read: 990 409.974 Eligible plans.— 991 (1) ELIGIBLE PLAN SELECTION.—The agency shall select and 992 contract with eligible plans through the procurement process 993 described in s. 409.966. The agency shall notice invitations to 994 negotiate byno later thanJanuary 1, 2013. 995 (a) The agency shall procure and contract with two plans 996 for Region 1. At least one plan shall be a provider service 997 network if any provider service networks submit a responsive 998 bid. 999 (b) The agency shall procure and contract with two plans 1000 for Region 2. At least one plan shall be a provider service 1001 network if any provider service networks submit a responsive 1002 bid. 1003 (c) The agency shall procure and contract with at least 1004 three plans and up to five plans for Region 3. At least one plan 1005 must be a provider service network if any provider service 1006 networks submit a responsive bid. 1007 (d) The agency shall procure and contract with at least 1008 three plans and up to five plans for Region 4. At least one plan 1009 must be a provider service network if any provider service 1010 networks submit a responsive bid. 1011 (e) The agency shall procure and contract with at least two 1012 plans and up to four plans for Region 5. At least one plan must 1013 be a provider service network if any provider service networks 1014 submit a responsive bid. 1015 (f) The agency shall procure and contract with at least 1016 four plans and up to seven plans for Region 6. At least one plan 1017 must be a provider service network if any provider service 1018 networks submit a responsive bid. 1019 (g) The agency shall procure and contract with at least 1020 three plans and up to six plans for Region 7. At least one plan 1021 must be a provider service network if any provider service 1022 networks submit a responsive bid. 1023 (h) The agency shall procure and contract with at least two 1024 plans and up to four plans for Region 8. At least one plan must 1025 be a provider service network if any provider service networks 1026 submit a responsive bid. 1027 (i) The agency shall procure and contract with at least two 1028 plans and up to four plans for Region 9. At least one plan must 1029 be a provider service network if any provider service networks 1030 submit a responsive bid. 1031 (j) The agency shall procure and contract with at least two 1032 plans and up to four plans for Region 10. At least one plan must 1033 be a provider service network if any provider service networks 1034 submit a responsive bid. 1035 (k) The agency shall procure and contract with at least 1036 five plans and up to 10 plans for Region 11. At least one plan 1037 must be a provider service network if any provider service 1038 networks submit a responsive bid. 1039 1040 If no provider service network submits a responsive bid, the 1041 agency shall procure up tono more thanone less than the 1042 maximum number of eligible plans permitted in that region and,.1043 within the next 12 months after the initial invitation to 1044 negotiate, shall issue an invitation to negotiate in orderthe1045agency shall attemptto procure and contract with a provider 1046 service network. In a region in which the agency has contracted 1047 with only one provider service network and changes in the 1048 ownership or business structure of the network result in the 1049 network no longer meeting the definition of a provider service 1050 network under s. 409.962, the agency must, within the next 12 1051 months, terminate the contract, provideshallnotice of another 1052 invitation to negotiate, and procure and contractonlywith a 1053 provider service network in that regionnetworks in those1054regions where no provider service network has been selected. 1055 Section 21. Subsection (4) of section 429.255, Florida 1056 Statutes, is amended to read: 1057 429.255 Use of personnel; emergency care.— 1058 (4) Facility staff may withhold or withdraw cardiopulmonary 1059 resuscitation or the use of an automated external defibrillator 1060 if presented with an order not to resuscitate executed pursuant 1061 to s. 401.45.The department shall adopt rules providing for the1062implementation of such orders.Facility staff and facilities are 1063shallnotbesubject to criminal prosecution or civil liability, 1064 norbeconsidered to have engaged in negligent or unprofessional 1065 conduct, for withholding or withdrawing cardiopulmonary 1066 resuscitation or use of an automated external defibrillator 1067 pursuant to such an orderand rules adopted by the department. 1068 The absence of an order to resuscitate executed pursuant to s. 1069 401.45 does not preclude a physician from withholding or 1070 withdrawing cardiopulmonary resuscitation or use of an automated 1071 external defibrillator as otherwise permitted by law. 1072 Section 22. Subsection (3) of section 429.73, Florida 1073 Statutes, is amended to read: 1074 429.73 Rules and standards relating to adult family-care 1075 homes.— 1076 (3)The department shall adopt rules providing for the1077implementation of orders not to resuscitate.The provider may 1078 withhold or withdraw cardiopulmonary resuscitation if presented 1079 with an order not to resuscitate executed pursuant to s. 401.45. 1080 The provider isshallnotbesubject to criminal prosecution or 1081 civil liability, norbeconsidered to have engaged in negligent 1082 or unprofessional conduct, for withholding or withdrawing 1083 cardiopulmonary resuscitation pursuant to such an orderand1084applicable rules. 1085 Section 23. Subsection (10) of section 440.102, Florida 1086 Statutes, is amended to read: 1087 440.102 Drug-free workplace program requirements.—The 1088 following provisions apply to a drug-free workplace program 1089 implemented pursuant to law or to rules adopted by the Agency 1090 for Health Care Administration: 1091 (10) RULES.—The Agency for Health Care Administration shall1092adopt rulesPursuant to s. 112.0455, part II of chapter 408, and 1093 using criteria established by the United States Department of 1094 Health and Human Services, the agency shall adopt rulesas1095general guidelinesformodelingdrug-free workplace 1096 laboratories, includingconcerning, but not limited to: 1097 (a) Standards for licensing drug-testing laboratories and 1098 suspension and revocation of such licenses. 1099 (b) Urine, hair, blood, and other body specimens and 1100 minimum specimen amounts that are appropriate for drug testing. 1101 (c) Methods of analysis and procedures to ensure reliable 1102 drug-testing results, including standards for initial tests and 1103 confirmation tests. 1104 (d) Minimum cutoff detection levels for each drug or 1105 metabolites of such drug for the purposes of determining a 1106 positive test result. 1107 (e) Chain-of-custody procedures to ensure proper 1108 identification, labeling, and handling of specimens tested. 1109 (f) Retention, storage, and transportation procedures to 1110 ensure reliable results on confirmation tests and retests. 1111 Section 24. Subsection (2) of section 483.245, Florida 1112 Statutes, is amended to read: 1113 483.245 Rebates prohibited; penalties.— 1114 (2) The agency may establish andshall adopt rules that1115 assess administrative penalties for acts prohibited by 1116 subsection (1). IfIn the case ofan entity is licensed by the 1117 agency, such penalties may include any disciplinary action 1118 available to the agency under the appropriate licensing laws. If 1119In the case ofan entity is not licensed by the agency, such 1120 penalties may include: 1121 (a) A fine not to exceed $1,000; 1122 (b) If applicable, a recommendation by the agency to the 1123 appropriate licensing board that disciplinary action be taken. 1124 Section 25. Subsection (2) of section 765.541, Florida 1125 Statutes, is amended to read: 1126 765.541 LicensureCertificationof procurement 1127 organizations; agency responsibilities.—The agency shall: 1128 (1) Establish a program for the licensurecertificationof 1129 organizations, corporations, or other entities engaged in the 1130 procurement of organs, tissues, and eyes within the state for 1131 transplantation. 1132 (2) Adopt rules as necessary to implementthat set forth1133appropriate standards and guidelines for the program in1134accordance withss. 765.541-765.546 and part II of chapter 408. 1135TheseStandards and guidelines for the program adopted by the 1136 agency must be substantially based on theexistinglaws of the 1137 Federal Government and this state, and theexistingstandards 1138 and guidelines of the Organ Procurement and Transplantation 1139 Network (OPTN), the Association of Organ Procurement 1140 Organizations (AOPO)United Network for Organ Sharing (UNOS), the1141American Association of Tissue Banks (AATB), the South-Eastern1142Organ Procurement Foundation (SEOPF), the North American1143Transplant Coordinators Organization (NATCO), and the Eye Bank 1144 Association of America (EBAA).In addition, the agency shall,1145before adopting these standards and guidelines, seek input from1146all procurement organizations based in this state.1147 Section 26. Subsection (2) of section 765.544, Florida 1148 Statutes, is amended to read: 1149 765.544 Fees; organ and tissue donor education and 1150 procurement.— 1151(2) The agency shall specify by rule the administrative1152penalties for the purpose of ensuring adherence to the standards1153of quality and practice required by this chapter, part II of1154chapter 408, and applicable rules of the agency for continued1155certification.1156 Section 27. This act shall take effect July 1, 2014.