Bill Text: FL S1458 | 2011 | Regular Session | Comm Sub


Bill Title: Assisted Care Communities

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2011-05-07 - Indefinitely postponed and withdrawn from consideration [S1458 Detail]

Download: Florida-2011-S1458-Comm_Sub.html
       Florida Senate - 2011                             CS for SB 1458
       
       
       
       By the Committee on Health Regulation; and Senator Garcia
       
       
       
       
       588-03820A-11                                         20111458c1
    1                        A bill to be entitled                      
    2         An act relating to assisted care communities; amending
    3         s. 400.141, F.S.; deleting adult care communities from
    4         the standards and rules of the Agency for Health Care
    5         Administration which apply to registered pharmacists
    6         under contract with a nursing home and related health
    7         care facilities; amending s. 408.820, F.S.; providing
    8         that assisted living facilities are exempt from
    9         certain provisions authorizing the agency to impose
   10         administrative fines for violations of laws and
   11         applicable rules; amending s. 409.912, F.S.; requiring
   12         the agency to provide for the establishment of a
   13         demonstration project for a psychiatric facility in
   14         Miami-Dade County; amending s. 429.01, F.S.; revising
   15         legislative intent and the purposes of the Assisted
   16         Living Facilities Act; amending s. 429.02, F.S.;
   17         providing, revising, and deleting definitions;
   18         amending s. 429.04, F.S.; deleting provisions
   19         exempting a home health agency from licensure as an
   20         assisted living facility under certain circumstances;
   21         amending s. 429.07, F.S.; deleting limited nursing
   22         services as a category of care in which the agency may
   23         issue a license; revising the criteria and
   24         requirements for categories of care in which the
   25         agency may issue a license; revising the licensing
   26         fees; requiring the agency to conduct a survey to
   27         determine whether a facility must be monitored;
   28         providing that certain cited assisted living
   29         facilities are subject to unannounced monitoring
   30         activities; providing for a registered nurse to
   31         participate in monitoring visits within a certain time
   32         following a class I or class II violation involving
   33         nursing care; amending s. 429.08, F.S.; requiring
   34         emergency medical technicians or paramedics to report
   35         the operations of an unlicensed assisted living
   36         facility; amending s. 429.11, F.S.; requiring the
   37         Agency for Health Care Administration to develop an
   38         abbreviated form for submission of proof of financial
   39         ability to operate an assisted living facility;
   40         amending s. 429.12, F.S.; deleting the provision that
   41         requires a transferor of an assisted living facility
   42         to advise the transferee that a plan of correction
   43         must be submitted by the transferee and approved by
   44         the agency within a specified period; amending s.
   45         429.14, F.S.; deleting a provision that authorizes the
   46         agency to impose an administrative penalty due to the
   47         actions of a facility’s employee; revising the actions
   48         for which the agency may impose an administrative
   49         penalty; conforming a provision to changes made by the
   50         act; deleting the provision that authorizes the agency
   51         to revoke or deny the license of an assisted living
   52         facility that has certain class I violations; deleting
   53         a provisions that requires the agency to provide to
   54         the Division of Hotels and Restaurants of the
   55         Department of Business and Professional Regulation a
   56         monthly list of assisted living facilities that have
   57         had their licenses denied, suspended, or revoked;
   58         amending s. 429.17, F.S.; conforming provisions to
   59         changes made by the act; revising requirements for a
   60         conditional license; amending s. 429.178, F.S.;
   61         providing safety requirements for facilities serving
   62         persons with Alzheimer’s disease or other related
   63         disorders; deleting a provision relating to a
   64         facility’s responsibility for the payment of certain
   65         training and education programs; amending s. 429.19,
   66         F.S.; revising procedures for the Agency for Health
   67         Care Administration regarding the imposition of fines
   68         for violations of ch. 429, F.S., related to adult care
   69         communities; specifying the conditions or occurrences
   70         that constitute a class I, class II, class III, or
   71         class IV violation; amending s. 429.195, F.S.;
   72         prohibiting the licensee of an assisted living
   73         facility from contracting or promising to pay or
   74         receive any commission, bonus, kickback, or rebate or
   75         from engaging in any split-fee arrangement with any
   76         health care provider or health care facility;
   77         providing certain exceptions; amending s. 429.20,
   78         F.S.; prohibiting the solicitation of contributions of
   79         any kind in a threatening, coercive, or unduly
   80         forceful manner by or on behalf of an assisted living
   81         facility; deleting provisions specifying that the
   82         solicitation or receipt of contributions is grounds
   83         for denial, suspension, or revocation of a license for
   84         an assisted living facility; amending s. 429.23, F.S.;
   85         revising reporting requirements with respect to
   86         adverse incidents; amending s. 429.255, F.S.;
   87         permitting certain licensed persons to provide limited
   88         nursing services; deleting the provision that allows
   89         volunteers to perform duties within the scope of their
   90         license or certification in facilities that are
   91         licensed to provide extended congregate care; amending
   92         s. 429.256, F.S.; authorizing a facility to require
   93         certain dispensing systems for residents’
   94         prescriptions; revising criteria for assistance with
   95         self-administration of medication; amending s. 429.26,
   96         F.S.; removing a requirement that a facility notify a
   97         licensed physician when a resident exhibits certain
   98         signs of dementia, cognitive impairment, or change of
   99         condition; amending s. 429.27, F.S.; revising
  100         provisions relating to the property and personal
  101         effects of residents of a facility; requiring a
  102         facility’s licensee, owner, administrator, staff, or
  103         representative to execute a surety bond for each
  104         resident for whom power of attorney has been granted
  105         to the licensee, owner, administrator, or staff;
  106         deleting the provision that requires a governmental
  107         agency or private charitable agency to receive a
  108         statement of all funds and other property of a
  109         resident; deleting a provision that prohibits an
  110         administrator of a facility from levying an additional
  111         charge to the individual or the account for any
  112         supplies or services that the facility has agreed by
  113         contract to provide; repealing s. 429.275(4), F.S.,
  114         relating to rulemaking authority of the Department of
  115         Elderly Affairs over financial records, personnel
  116         procedures, accounting procedures, reporting
  117         procedures, and insurance coverage for residents of
  118         assisted living facilities; amending s. 429.28, F.S.,
  119         relating to the resident bill of rights; revising the
  120         number of days’ notice for relocation or termination
  121         of residency at a facility; removing responsibilities
  122         of the agency for conducting compliance surveys and
  123         complaint investigations; revising the actions of a
  124         person for which a staff member or employee of a
  125         facility is prohibited from taking retaliatory action
  126         upon; prohibiting the administrator of a facility from
  127         terminating the residency of an individual under
  128         certain circumstances; amending s. 429.41, F.S.;
  129         revising rulemaking authority regarding resident care
  130         and maintenance of facilities; requiring the State
  131         Fire Marshal, in cooperation with the agency, to
  132         establish and enforce firesafety standards; deleting
  133         the requirement for a facility to conduct a minimum
  134         number of resident elopement drills; requiring the
  135         agency to use an abbreviated biennial standard
  136         licensure inspection; requiring the agency, in
  137         consultation with the Department of Health, to
  138         develop, maintain, and update the key quality-of-care
  139         standards with input from the State Long-Term Care
  140         Ombudsman Council and representatives of associations
  141         and organizations representing assisted living
  142         facilities; amending s. 429.42, F.S.; removing a
  143         provision that required a corrective plan for
  144         deficiencies related to assistance with the self
  145         administration of medication or the administration of
  146         medication; deleting a requirement that the agency
  147         employ a certain number of pharmacists among its
  148         personnel who inspect assisted living facilities;
  149         amending s. 429.445, F.S.; removing a requirement that
  150         an assisted living facility submit certain information
  151         to the agency before commencing construction to expand
  152         the facility; amending s. 429.47, F.S.; authorizing an
  153         owner of an assisted living facility to advertise to
  154         the public while the facility is under construction or
  155         is seeking licensure; deleting a provision that
  156         prohibits a freestanding facility from advertising or
  157         implying that any part of it is a nursing home;
  158         amending s. 429.49, F.S.; conforming terminology to
  159         changes made by the act; amending s. 429.52, F.S.;
  160         revising training and education requirements for
  161         certain administrators, facility staff, and other
  162         licensed professionals; requiring training providers
  163         certified by the department to meet continuing
  164         education requirements and standards; providing
  165         conditions for the sanctioning of training providers
  166         and trainees; amending s. 429.53, F.S.; removing
  167         provisions relating to preconstruction approvals and
  168         reviews and agency consultations; repealing s. 429.54,
  169         F.S., relating to the collection of information
  170         regarding the actual cost of providing services in
  171         assisted living facilities and local subsidies;
  172         amending s. 429.71, F.S.; clarifying terminology;
  173         removing a provision authorizing the agency to request
  174         a plan to remedy violations by adult family-care
  175         homes; conforming terminology to changes made by the
  176         act; amending s. 429.81, F.S.; specifying that
  177         residency agreements require a resident to provide 30
  178         days’ written notice of intent to terminate his or her
  179         residency; creating s. 430.081, F.S.; authorizing the
  180         Department of Elderly Affairs to sanction training
  181         providers and trainees for infractions involving any
  182         required training; providing training infractions;
  183         providing sanctions; amending s. 817.505, F.S.;
  184         providing that payments by an assisted living facility
  185         are not considered patient brokering under certain
  186         circumstances; providing that licensure fees adjusted
  187         by consumer price index increases prior to the
  188         effective date of the act are not intended to be reset
  189         by the act and may continue to accrue as authorized by
  190         law; providing an effective date.
  191  
  192  Be It Enacted by the Legislature of the State of Florida:
  193  
  194         Section 1. Paragraph (d) of subsection (1) of section
  195  400.141, Florida Statutes, is amended to read:
  196         400.141 Administration and management of nursing home
  197  facilities.—
  198         (1) Every licensed facility shall comply with all
  199  applicable standards and rules of the agency and shall:
  200         (d) Provide for resident use of a community pharmacy as
  201  specified in s. 400.022(1)(q). Any other law to the contrary
  202  notwithstanding, a registered pharmacist licensed in Florida,
  203  that is under contract with a facility licensed under this
  204  chapter or chapter 429, shall repackage a nursing facility
  205  resident’s bulk prescription medication which has been packaged
  206  by another pharmacist licensed in any state in the United States
  207  into a unit dose system compatible with the system used by the
  208  nursing facility, if the pharmacist is requested to offer such
  209  service. In order to be eligible for the repackaging, a resident
  210  or the resident’s spouse must receive prescription medication
  211  benefits provided through a former employer as part of his or
  212  her retirement benefits, a qualified pension plan as specified
  213  in s. 4972 of the Internal Revenue Code, a federal retirement
  214  program as specified under 5 C.F.R. s. 831, or a long-term care
  215  policy as defined in s. 627.9404(1). A pharmacist who correctly
  216  repackages and relabels the medication and the nursing facility
  217  which correctly administers such repackaged medication under
  218  this paragraph may not be held liable in any civil or
  219  administrative action arising from the repackaging. In order to
  220  be eligible for the repackaging, a nursing facility resident for
  221  whom the medication is to be repackaged shall sign an informed
  222  consent form provided by the facility which includes an
  223  explanation of the repackaging process and which notifies the
  224  resident of the immunities from liability provided in this
  225  paragraph. A pharmacist who repackages and relabels prescription
  226  medications, as authorized under this paragraph, may charge a
  227  reasonable fee for costs resulting from the administration
  228  implementation of this provision.
  229         Section 2. Subsection (13) of section 408.820, Florida
  230  Statutes, is amended to read:
  231         408.820 Exemptions.—Except as prescribed in authorizing
  232  statutes, the following exemptions shall apply to specified
  233  requirements of this part:
  234         (13) Assisted living facilities, as provided under part I
  235  of chapter 429, are exempt from ss. s. 408.810(10) and
  236  408.813(2).
  237         Section 3. Subsection (41) of section 409.912, Florida
  238  Statutes, is amended to read:
  239         409.912 Cost-effective purchasing of health care.—The
  240  agency shall purchase goods and services for Medicaid recipients
  241  in the most cost-effective manner consistent with the delivery
  242  of quality medical care. To ensure that medical services are
  243  effectively utilized, the agency may, in any case, require a
  244  confirmation or second physician’s opinion of the correct
  245  diagnosis for purposes of authorizing future services under the
  246  Medicaid program. This section does not restrict access to
  247  emergency services or poststabilization care services as defined
  248  in 42 C.F.R. part 438.114. Such confirmation or second opinion
  249  shall be rendered in a manner approved by the agency. The agency
  250  shall maximize the use of prepaid per capita and prepaid
  251  aggregate fixed-sum basis services when appropriate and other
  252  alternative service delivery and reimbursement methodologies,
  253  including competitive bidding pursuant to s. 287.057, designed
  254  to facilitate the cost-effective purchase of a case-managed
  255  continuum of care. The agency shall also require providers to
  256  minimize the exposure of recipients to the need for acute
  257  inpatient, custodial, and other institutional care and the
  258  inappropriate or unnecessary use of high-cost services. The
  259  agency shall contract with a vendor to monitor and evaluate the
  260  clinical practice patterns of providers in order to identify
  261  trends that are outside the normal practice patterns of a
  262  provider’s professional peers or the national guidelines of a
  263  provider’s professional association. The vendor must be able to
  264  provide information and counseling to a provider whose practice
  265  patterns are outside the norms, in consultation with the agency,
  266  to improve patient care and reduce inappropriate utilization.
  267  The agency may mandate prior authorization, drug therapy
  268  management, or disease management participation for certain
  269  populations of Medicaid beneficiaries, certain drug classes, or
  270  particular drugs to prevent fraud, abuse, overuse, and possible
  271  dangerous drug interactions. The Pharmaceutical and Therapeutics
  272  Committee shall make recommendations to the agency on drugs for
  273  which prior authorization is required. The agency shall inform
  274  the Pharmaceutical and Therapeutics Committee of its decisions
  275  regarding drugs subject to prior authorization. The agency is
  276  authorized to limit the entities it contracts with or enrolls as
  277  Medicaid providers by developing a provider network through
  278  provider credentialing. The agency may competitively bid single
  279  source-provider contracts if procurement of goods or services
  280  results in demonstrated cost savings to the state without
  281  limiting access to care. The agency may limit its network based
  282  on the assessment of beneficiary access to care, provider
  283  availability, provider quality standards, time and distance
  284  standards for access to care, the cultural competence of the
  285  provider network, demographic characteristics of Medicaid
  286  beneficiaries, practice and provider-to-beneficiary standards,
  287  appointment wait times, beneficiary use of services, provider
  288  turnover, provider profiling, provider licensure history,
  289  previous program integrity investigations and findings, peer
  290  review, provider Medicaid policy and billing compliance records,
  291  clinical and medical record audits, and other factors. Providers
  292  shall not be entitled to enrollment in the Medicaid provider
  293  network. The agency shall determine instances in which allowing
  294  Medicaid beneficiaries to purchase durable medical equipment and
  295  other goods is less expensive to the Medicaid program than long
  296  term rental of the equipment or goods. The agency may establish
  297  rules to facilitate purchases in lieu of long-term rentals in
  298  order to protect against fraud and abuse in the Medicaid program
  299  as defined in s. 409.913. The agency may seek federal waivers
  300  necessary to administer these policies.
  301         (41) The agency shall establish provide for the development
  302  of a demonstration project by establishment in Miami-Dade County
  303  of a long-term-care facility and a psychiatric facility licensed
  304  pursuant to chapter 395 to improve access to health care for a
  305  predominantly minority, medically underserved, and medically
  306  complex population and to evaluate alternatives to nursing home
  307  care and general acute care for such population. Such project is
  308  to be located in a health care condominium and collocated
  309  colocated with licensed facilities providing a continuum of
  310  care. These projects are The establishment of this project is
  311  not subject to the provisions of s. 408.036 or s. 408.039.
  312         Section 4. Subsection (2) of section 429.01, Florida
  313  Statutes, is amended to read:
  314         429.01 Short title; purpose.—
  315         (2) The purpose of this act is to:
  316         (a) Promote the availability of appropriate services for
  317  elderly persons and adults with disabilities in the least
  318  restrictive and most homelike environment;, to
  319         (b) Encourage the development of facilities that promote
  320  the dignity, individuality, privacy, and decisionmaking ability
  321  of such persons;, to
  322         (c) Provide for the health, safety, and welfare of
  323  residents of assisted living facilities in the state;, to
  324         (d) Promote continued improvement of such facilities;, to
  325  encourage the development of innovative and affordable
  326  facilities particularly for persons with low to moderate
  327  incomes;, to
  328         (e) Ensure that all agencies of the state cooperate in the
  329  protection of such residents;, and to
  330         (f) Ensure that needed economic, social, mental health,
  331  health, and leisure services are made available to residents of
  332  such facilities through the efforts of the Agency for Health
  333  Care Administration, the Department of Elderly Affairs, the
  334  Department of Children and Family Services, the Department of
  335  Health, assisted living facilities, and other community
  336  agencies.
  337  
  338  To the maximum extent possible, appropriate community-based
  339  programs must be available to state-supported residents to
  340  augment the services provided in assisted living facilities. The
  341  Legislature recognizes that assisted living facilities are an
  342  important part of the continuum of long-term care in the state
  343  as community-based social models that have a health component
  344  and not as medical or nursing facilities. In support of the goal
  345  of aging in place, the Legislature further recognizes that
  346  assisted living facilities should be operated and regulated as
  347  residential environments with supportive services and not as
  348  medical or nursing facilities and, as such, should not be
  349  subject to the same regulations as medical or nursing facilities
  350  but instead be regulated in a less restrictive manner that is
  351  appropriate for a residential, nonmedical setting. The services
  352  available in these facilities, either directly or through
  353  contract or agreement, are intended to help residents remain as
  354  independent as possible. Regulations governing these facilities
  355  must be sufficiently flexible to allow facilities to adopt
  356  policies that enable residents to age in place when resources
  357  are available to meet their needs and accommodate their
  358  preferences.
  359         Section 5. Section 429.02, Florida Statutes, is amended to
  360  read:
  361         429.02 Definitions.—When used in this part, the term:
  362         (1) “Activities of daily living” means functions and tasks
  363  for self-care, including ambulation, bathing, dressing, eating,
  364  grooming, and toileting, and other similar tasks.
  365         (2) “Administrator” means an individual at least 21 years
  366  of age who is responsible for the operation and maintenance of
  367  an assisted living facility; for promoting the resident’s
  368  dignity, autonomy, independence, and privacy in the least
  369  restrictive and most homelike setting consistent with the
  370  resident’s preferences and physical and mental statuses; and for
  371  ensuring the appropriateness of continued placement of a
  372  resident, in consultation with the resident, resident’s
  373  representative or designee, if applicable, and the resident’s
  374  physician.
  375         (3) “Agency” means the Agency for Health Care
  376  Administration.
  377         (4) “Aging in place” or “age in place” means the process of
  378  providing increased or adjusted services to a person to
  379  compensate for the physical or mental decline that may occur
  380  with the aging process, in order to maximize the person’s
  381  dignity and independence and permit them to remain in a
  382  familiar, noninstitutional, residential environment for as long
  383  as possible, as determined by the individual, his or her
  384  physician, and the administrator. Such services may be provided
  385  by facility staff, volunteers, family, or friends, or through
  386  contractual arrangements with a third party.
  387         (5)“Arbitration” means a process whereby a neutral third
  388  person or panel, called an arbitrator or arbitration panel,
  389  considers the facts and arguments presented by the parties and
  390  renders a decision that may be biding or nonbinding as provided
  391  for in chapter 44.
  392         (6)(5) “Assisted living facility” means any residential
  393  setting that provides, directly or indirectly by means of
  394  contracts or arrangements, for a period exceeding 24 hours,
  395  building or buildings, section or distinct part of a building,
  396  private home, boarding home, home for the aged, or other
  397  residential facility, whether operated for profit or not, which
  398  undertakes through its ownership or management to provide
  399  housing, meals, and one or more personal services that meet the
  400  resident’s changing needs and preferences for a period exceeding
  401  24 hours to one or more adults who are not relatives of the
  402  owner or administrator. As used in this subsection, the term
  403  “residential setting” includes, but is not limited to, a
  404  building or buildings, section or distinct part of a building,
  405  private home, or other residence.
  406         (7)(6) “Chemical restraint” means a pharmacologic drug that
  407  physically limits, restricts, or deprives an individual of
  408  movement or mobility, and is used for discipline or convenience
  409  and not required for the treatment of medical symptoms.
  410         (8)(7) “Community living support plan” means a written
  411  document prepared by a mental health resident and the resident’s
  412  mental health case manager, in consultation with the
  413  administrator or the administrator’s designee, of an assisted
  414  living facility with a limited mental health license or the
  415  administrator’s designee. A copy must be provided to the
  416  administrator. The plan must include information about the
  417  supports, services, and special needs of the resident which
  418  enable the resident to live in the assisted living facility and
  419  a method by which facility staff can recognize and respond to
  420  the signs and symptoms particular to that resident which
  421  indicate the need for professional services.
  422         (9)(8) “Cooperative agreement” means a written statement of
  423  understanding between a mental health care provider and the
  424  administrator of the assisted living facility with a limited
  425  mental health license in which a mental health resident is
  426  living. The agreement must specify directions for accessing
  427  emergency and after-hours care for the mental health resident. A
  428  single cooperative agreement may service all mental health
  429  residents who are clients of the same mental health care
  430  provider.
  431         (10)(9) “Department” means the Department of Elderly
  432  Affairs.
  433         (11)(10) “Emergency” means a situation, physical condition,
  434  or method of operation which presents imminent danger of death
  435  or serious physical or mental harm to facility residents.
  436         (12)(11) “Extended congregate care” means acts beyond those
  437  authorized in subsection (19) (16) that may be performed
  438  pursuant to part I of chapter 464 by persons licensed thereunder
  439  while carrying out their professional duties, and other
  440  supportive services which may be specified by rule. The purpose
  441  of such services is to enable residents to age in place in a
  442  residential environment despite mental or physical limitations
  443  that might otherwise disqualify them from residency in a
  444  facility licensed under this part.
  445         (13)(12) “Guardian” means a person to whom the law has
  446  entrusted the custody and control of the person or property, or
  447  both, of a person who has been legally adjudged incapacitated.
  448         (14) “Licensed facility” means an assisted living facility
  449  for which a licensee has been issued a license pursuant to this
  450  part and part II of chapter 408.
  451         (15)(13) “Limited nursing services” means acts that may be
  452  performed pursuant to part I of chapter 464 by persons licensed
  453  thereunder while carrying out their professional duties but
  454  limited to those acts which the department specifies by rule.
  455  Acts which may be specified by rule as allowable limited nursing
  456  services shall be for persons who meet the admission criteria
  457  established by the department for assisted living facilities and
  458  shall not be complex enough to require 24-hour nursing
  459  supervision and may include such services as the application and
  460  care of routine dressings, and care of casts, braces, and
  461  splints.
  462         (16)(14) “Managed risk” means the process by which the
  463  facility staff discuss the service plan and the needs of the
  464  resident with the resident and, if applicable, the resident’s
  465  representative or designee or the resident’s surrogate,
  466  guardian, or attorney in fact, in such a way that the
  467  consequences of a decision, including any inherent risk, are
  468  explained to all parties and reviewed periodically in
  469  conjunction with the service plan, taking into account changes
  470  in the resident’s status and the ability of the facility to
  471  respond accordingly.
  472         (17)(15) “Mental health resident” means an individual who
  473  receives social security disability income due to a mental
  474  disorder as determined by the Social Security Administration or
  475  receives supplemental security income due to a mental disorder
  476  as determined by the Social Security Administration and receives
  477  optional state supplementation.
  478         (18)“Person” means any individual, partnership,
  479  corporation, association, or governmental unit.
  480         (19)(16) “Personal services” means direct physical
  481  assistance with or supervision of the activities of daily living
  482  and the self-administration of medication and other similar
  483  services which the department may define by rule. “Personal
  484  services” shall not be construed to mean the provision of
  485  medical, nursing, dental, or mental health services.
  486         (20)(17) “Physical restraint” means a device which
  487  physically limits, restricts, or deprives an individual of
  488  movement or mobility, including, but not limited to, a half-bed
  489  rail, a full-bed rail, a geriatric chair, and a posey restraint.
  490  The term “physical restraint” shall also include any device
  491  which was not specifically manufactured as a restraint but which
  492  has been altered, arranged, or otherwise used for this purpose.
  493  The term shall not include bandage material used for the purpose
  494  of binding a wound or injury.
  495         (21)(18) “Relative” means an individual who is the father,
  496  mother, stepfather, stepmother, son, daughter, brother, sister,
  497  grandmother, grandfather, great-grandmother, great-grandfather,
  498  grandson, granddaughter, uncle, aunt, first cousin, nephew,
  499  niece, husband, wife, father-in-law, mother-in-law, son-in-law,
  500  daughter-in-law, brother-in-law, sister-in-law, stepson,
  501  stepdaughter, stepbrother, stepsister, half brother, or half
  502  sister of an owner or administrator.
  503         (22)(19) “Resident” means a person 18 years of age or
  504  older, residing in and receiving care from an assisted living a
  505  facility.
  506         (23)(20) “Resident’s representative or designee” means a
  507  person other than the owner, or an agent or employee of the
  508  assisted living facility, designated in writing by the resident,
  509  if legally competent, to receive notice of changes in the
  510  contract executed pursuant to s. 429.24; to receive notice of
  511  and to participate in meetings between the resident and the
  512  facility owner, administrator, or staff concerning the rights of
  513  the resident; to assist the resident in contacting the ombudsman
  514  council if the resident has a complaint against the facility; or
  515  to bring legal action on behalf of the resident pursuant to s.
  516  429.29.
  517         (24)(21) “Service plan” means a written plan, developed and
  518  agreed upon by the resident and, if applicable, the resident’s
  519  representative or designee or the resident’s surrogate,
  520  guardian, or attorney in fact, if any, and the administrator or
  521  the administrator’s designee representing the facility, which
  522  addresses the unique physical and psychosocial needs, abilities,
  523  and personal preferences of each resident receiving extended
  524  congregate care services. The plan shall include a brief written
  525  description, in easily understood language, of what services
  526  shall be provided, who shall provide the services, when the
  527  services shall be rendered, and the purposes and benefits of the
  528  services.
  529         (25)(22) “Shared responsibility” means exploring the
  530  options available to a resident within a facility and the risks
  531  involved with each option when making decisions pertaining to
  532  the resident’s abilities, preferences, and service needs,
  533  thereby enabling the resident and, if applicable, the resident’s
  534  representative or designee, or the resident’s surrogate,
  535  guardian, or attorney in fact, and the facility to develop a
  536  service plan which best meets the resident’s needs and seeks to
  537  improve the resident’s quality of life.
  538         (26)(23) “Supervision” means reminding residents to engage
  539  in activities of daily living and the self-administration of
  540  medication, and, when necessary, observing or providing verbal
  541  cuing to residents while they perform these activities. The term
  542  “supervision” does not include one-on-one observation.
  543         (27)(24) “Supplemental security income,” Title XVI of the
  544  Social Security Act, means a program through which the Federal
  545  Government guarantees a minimum monthly income to every person
  546  who is age 65 or older, or disabled, or blind and meets the
  547  income and asset requirements.
  548         (28)(25) “Supportive services” means services designed to
  549  encourage and assist residents aged persons or adults with
  550  disabilities to remain in the least restrictive living
  551  environment and to maintain their independence as long as
  552  possible.
  553         (29)(26) “Twenty-four-hour nursing supervision” means
  554  services that are ordered by a physician for a resident whose
  555  condition requires the supervision of a physician and continued
  556  monitoring of vital signs and physical status. Such services
  557  shall be: medically complex enough to require constant
  558  supervision, assessment, planning, or intervention by a nurse;
  559  required to be performed by or under the direct supervision of
  560  licensed nursing personnel or other professional personnel for
  561  safe and effective performance; required on a daily basis; and
  562  consistent with the nature and severity of the resident’s
  563  condition or the disease state or stage.
  564         Section 6. Paragraphs (g) and (h) of subsection (2) of
  565  section 429.04, Florida Statutes, are amended to read:
  566         429.04 Facilities to be licensed; exemptions.—
  567         (2) The following are exempt from licensure under this
  568  part:
  569         (g) Any facility certified under chapter 651, or a
  570  retirement community, may provide services authorized under this
  571  part or part III of chapter 400 to its residents who live in
  572  single-family homes, duplexes, quadruplexes, or apartments
  573  located on the campus without obtaining a license to operate an
  574  assisted living facility if residential units within such
  575  buildings are used by residents who do not require staff
  576  supervision for that portion of the day when personal services
  577  are not being delivered and the owner obtains a home health
  578  license to provide such services. However, any building or
  579  distinct part of a building on the campus that is designated for
  580  persons who receive personal services and require supervision
  581  beyond that which is available while such services are being
  582  rendered must be licensed in accordance with this part. If a
  583  facility provides personal services to residents who do not
  584  otherwise require supervision and the owner is not licensed as a
  585  home health agency, the buildings or distinct parts of buildings
  586  where such services are rendered must be licensed under this
  587  part. A resident of a facility that obtains a home health
  588  license may contract with a home health agency of his or her
  589  choice, provided that the home health agency provides liability
  590  insurance and workers’ compensation coverage for its employees.
  591  Facilities covered by this exemption may establish policies that
  592  give residents the option of contracting for services and care
  593  beyond that which is provided by the facility to enable them to
  594  age in place. For purposes of this section, a retirement
  595  community consists of a facility licensed under this part or a
  596  facility licensed under part II of chapter 400, and apartments
  597  designed for independent living located on the same campus.
  598         (h) Any residential unit for independent living which is
  599  located within a facility certified under chapter 651, or any
  600  residential unit for independent living which is collocated
  601  colocated with a nursing home licensed under part II of chapter
  602  400 or collocated colocated with a facility licensed under this
  603  part in which services are provided through an outpatient clinic
  604  or a nursing home on an outpatient basis.
  605         Section 7. Subsections (3) and (4) of section 429.07,
  606  Florida Statutes, are amended, and subsections (6) and (7) are
  607  added to that section, to read:
  608         429.07 License required; fee.—
  609         (3) In addition to the requirements of s. 408.806, each
  610  license granted by the agency must state the type of care for
  611  which the license is granted. Licenses shall be issued for one
  612  or more of the following categories of care: standard, extended
  613  congregate care, limited nursing services, or limited mental
  614  health.
  615         (a) A standard license shall be issued to a licensee for a
  616  facility facilities providing one or more of the personal
  617  services identified in s. 429.02. Such facilities may also
  618  employ or contract with a person licensed under part I of
  619  chapter 464 to administer medications and perform other tasks as
  620  specified in s. 429.255.
  621         (b) An extended congregate care license shall be issued to
  622  a licensee for a facility facilities providing, directly or
  623  through contract, services beyond those authorized in paragraph
  624  (a), including services performed by persons licensed under part
  625  I of chapter 464 and supportive services, as defined by rule, to
  626  persons who would otherwise be disqualified from continued
  627  residence in a facility licensed under this part.
  628         1. In order for extended congregate care services to be
  629  provided, the agency must first determine that all requirements
  630  established in law and rule are met and must specifically
  631  designate, on the facility’s license, that such services may be
  632  provided and whether the designation applies to all or part of
  633  the facility. Such designation may be made at the time of
  634  initial licensure or relicensure, or upon request in writing by
  635  a licensee under this part and part II of chapter 408. The
  636  notification of approval or the denial of the request shall be
  637  made in accordance with part II of chapter 408. Existing
  638  facilities qualifying to provide extended congregate care
  639  services must have maintained a standard license and may not
  640  have been subject to administrative sanctions during the
  641  previous 2 years, or since initial licensure if the facility has
  642  been licensed for less than 2 years, for any of the following
  643  reasons:
  644         a. A class I or class II violation;
  645         b. Three or more repeat or recurring class III violations
  646  of identical or similar resident care standards from which a
  647  pattern of noncompliance is found by the agency;
  648         c. Three or more class III violations that were not
  649  corrected in accordance with the corrective action plan approved
  650  by the agency;
  651         b.d. Violation of resident care standards which results in
  652  requiring the facility to employ the services of a consultant
  653  pharmacist or consultant dietitian; or
  654         e. Denial, suspension, or revocation of a license for
  655  another facility licensed under this part in which the applicant
  656  for an extended congregate care license has at least 25 percent
  657  ownership interest; or
  658         c.f. Imposition of a moratorium pursuant to this part or
  659  part II of chapter 408 or initiation of injunctive proceedings.
  660         2. A licensee facility that is licensed to provide extended
  661  congregate care services shall maintain a written progress
  662  report for on each person who receives services, and the report
  663  must describe which describes the type, amount, duration, scope,
  664  and outcome of services that are rendered and the general status
  665  of the resident’s health. A registered nurse, or appropriate
  666  designee, representing the agency shall visit the facility at
  667  least quarterly to monitor residents who are receiving extended
  668  congregate care services and to determine if the facility is in
  669  compliance with this part, part II of chapter 408, and relevant
  670  rules. One of the visits may be in conjunction with the regular
  671  survey. The monitoring visits may be provided through
  672  contractual arrangements with appropriate community agencies. A
  673  registered nurse shall serve as part of the team that inspects
  674  the facility. The agency may waive one of the required yearly
  675  monitoring visits for a facility that has been licensed for at
  676  least 24 months to provide extended congregate care services,
  677  if, during the inspection, the registered nurse determines that
  678  extended congregate care services are being provided
  679  appropriately, and if the facility has no class I or class II
  680  violations and no uncorrected class III violations. The agency
  681  must first consult with the long-term care ombudsman council for
  682  the area in which the facility is located to determine if any
  683  complaints have been made and substantiated about the quality of
  684  services or care. The agency may not waive one of the required
  685  yearly monitoring visits if complaints have been made and
  686  substantiated.
  687         3. A licensee facility that is licensed to provide extended
  688  congregate care services shall must:
  689         a. Demonstrate the capability to meet unanticipated
  690  resident service needs.
  691         b. Offer a physical environment that promotes a homelike
  692  setting, provides for resident privacy, promotes resident
  693  independence, and allows sufficient congregate space as defined
  694  by rule.
  695         c. Have sufficient staff available, taking into account the
  696  physical plant and firesafety features of the residential
  697  setting building, to assist with the evacuation of residents in
  698  an emergency.
  699         d. Adopt and follow policies and procedures that maximize
  700  resident independence, dignity, choice, and decisionmaking to
  701  permit residents to age in place, so that moves due to changes
  702  in functional status are minimized or avoided.
  703         e. Allow residents or, if applicable, a resident’s
  704  representative, designee, surrogate, guardian, or attorney in
  705  fact to make a variety of personal choices, participate in
  706  developing service plans, and share responsibility in
  707  decisionmaking.
  708         f. Implement the concept of managed risk.
  709         g. Provide, directly or through contract, the services of a
  710  person licensed under part I of chapter 464.
  711         h. In addition to the training mandated in s. 429.52,
  712  provide specialized training as defined by rule for facility
  713  staff.
  714         4. A facility that is licensed to provide extended
  715  congregate care services is exempt from the criteria for
  716  continued residency set forth in rules adopted under s. 429.41.
  717  A licensed facility must adopt its own requirements within
  718  guidelines for continued residency set forth by rule. However,
  719  the facility may not serve residents who require 24-hour nursing
  720  supervision. A licensed facility that provides extended
  721  congregate care services must also provide each resident with a
  722  written copy of facility policies governing admission and
  723  retention.
  724         5. The primary purpose of extended congregate care services
  725  is to allow residents, as they become more impaired, the option
  726  of remaining in a familiar setting from which they would
  727  otherwise be disqualified for continued residency. A facility
  728  licensed to provide extended congregate care services may also
  729  admit an individual who exceeds the admission criteria for a
  730  facility with a standard license, if the individual is
  731  determined appropriate for admission to the extended congregate
  732  care facility.
  733         6. Before the admission of an individual to a facility
  734  licensed to provide extended congregate care services, the
  735  individual must undergo a medical examination as provided in s.
  736  429.26(4) and the licensee facility must develop a preliminary
  737  service plan for the individual.
  738         7. When a licensee facility can no longer provide or
  739  arrange for services in accordance with the resident’s service
  740  plan and needs and the licensee’s facility’s policy, the
  741  licensee facility shall make arrangements for relocating the
  742  person in accordance with s. 429.28(1)(k).
  743         8. Failure to provide extended congregate care services may
  744  result in denial of extended congregate care license renewal.
  745         (c) A limited nursing services license shall be issued to a
  746  facility that provides services beyond those authorized in
  747  paragraph (a) and as specified in this paragraph.
  748         1. In order for limited nursing services to be provided in
  749  a facility licensed under this part, the agency must first
  750  determine that all requirements established in law and rule are
  751  met and must specifically designate, on the facility’s license,
  752  that such services may be provided. Such designation may be made
  753  at the time of initial licensure or relicensure, or upon request
  754  in writing by a licensee under this part and part II of chapter
  755  408. Notification of approval or denial of such request shall be
  756  made in accordance with part II of chapter 408. Existing
  757  facilities qualifying to provide limited nursing services shall
  758  have maintained a standard license and may not have been subject
  759  to administrative sanctions that affect the health, safety, and
  760  welfare of residents for the previous 2 years or since initial
  761  licensure if the facility has been licensed for less than 2
  762  years.
  763         2. Facilities that are licensed to provide limited nursing
  764  services shall maintain a written progress report on each person
  765  who receives such nursing services, which report describes the
  766  type, amount, duration, scope, and outcome of services that are
  767  rendered and the general status of the resident’s health. A
  768  registered nurse representing the agency shall visit such
  769  facilities at least twice a year to monitor residents who are
  770  receiving limited nursing services and to determine if the
  771  facility is in compliance with applicable provisions of this
  772  part, part II of chapter 408, and related rules. The monitoring
  773  visits may be provided through contractual arrangements with
  774  appropriate community agencies. A registered nurse shall also
  775  serve as part of the team that inspects such facility.
  776         3. A person who receives limited nursing services under
  777  this part must meet the admission criteria established by the
  778  agency for assisted living facilities. When a resident no longer
  779  meets the admission criteria for a facility licensed under this
  780  part, arrangements for relocating the person shall be made in
  781  accordance with s. 429.28(1)(k), unless the facility is licensed
  782  to provide extended congregate care services.
  783         (4) In accordance with s. 408.805, an applicant or licensee
  784  shall pay a fee for each license application submitted under
  785  this part, part II of chapter 408, and applicable rules. The
  786  amount of the fee shall be established by rule.
  787         (a) The biennial license fee required of a facility is $300
  788  per license, with an additional fee of $71 $50 per resident
  789  based on the total licensed resident capacity of the facility,
  790  except that no additional fee will be assessed for beds used by
  791  designated for recipients of Medicaid home and community-based
  792  waiver programs optional state supplementation payments provided
  793  for in s. 409.212. The total fee may not exceed $13,443 $10,000.
  794         (b) In addition to the total fee assessed under paragraph
  795  (a), the agency shall require facilities that are licensed to
  796  provide extended congregate care services under this part to pay
  797  an additional fee per licensed facility. The amount of the
  798  biennial fee shall be $400 per license, with an additional fee
  799  of $10 per resident based on the total licensed resident
  800  capacity of the facility.
  801         (c) In addition to the total fee assessed under paragraph
  802  (a), the agency shall require facilities that are licensed to
  803  provide limited nursing services under this part to pay an
  804  additional fee per licensed facility. The amount of the biennial
  805  fee shall be $250 per license, with an additional fee of $10 per
  806  resident based on the total licensed resident capacity of the
  807  facility.
  808         (6) In order to determine whether the facility is
  809  adequately protecting residents’ rights as provided in s.
  810  429.28, the agency’s standard license survey shall include
  811  private informal conversations with a sample of residents and
  812  consultation with the ombudsman council in the planning and
  813  service area in which the facility is located to discuss
  814  residents’ experiences within the facility.
  815         (7)An assisted living facility that has been cited within
  816  the previous 24-month period for a class I violation or class II
  817  violation, regardless of the status of any enforcement or
  818  disciplinary action, is subject to periodic unannounced
  819  monitoring to determine if the facility is in compliance with
  820  this part, part II of chapter 408, and applicable rules.
  821  Monitoring may occur through a desk review or an onsite
  822  assessment. If the class I violation or class II violation
  823  relates to providing or failing to provide nursing care, a
  824  registered nurse must participate in the monitoring visits
  825  during the 12-month period following the violation.
  826         Section 8. Paragraph (a) of subsection (2) of section
  827  429.08, Florida Statutes, is amended to read:
  828         429.08 Unlicensed facilities; referral of person for
  829  residency to unlicensed facility; penalties.—
  830         (2) It is unlawful to knowingly refer a person for
  831  residency to an unlicensed assisted living facility; to an
  832  assisted living facility the license of which is under denial or
  833  has been suspended or revoked; or to an assisted living facility
  834  that has a moratorium pursuant to part II of chapter 408.
  835         (a) Any health care practitioner, as defined in s. 456.001,
  836  or emergency medical technician or paramedic certified under
  837  part III of chapter 401, who is aware of the operation of an
  838  unlicensed facility shall report that facility to the agency.
  839  Failure to report a facility that the practitioner knows or has
  840  reasonable cause to suspect is unlicensed shall be reported to
  841  the practitioner’s licensing board.
  842         Section 9. Subsection (8) is added to section 429.11,
  843  Florida Statutes, to read:
  844         429.11 Initial application for license; provisional
  845  license.—
  846         (8) The agency shall develop an abbreviated form for
  847  submission of proof of financial ability to operate under s.
  848  408.810(8) which is specific to applicants for a license to
  849  operate an assisted living facility. The form must request
  850  information that demonstrates the applicant has adequate
  851  resources to sustain operations and has sufficient assets,
  852  credit, and projected revenues to cover liabilities and expenses
  853  of the facility based on the number of beds and services the
  854  applicant will provide.
  855         Section 10. Section 429.12, Florida Statutes, is amended to
  856  read:
  857         429.12 Sale or transfer of ownership of a facility.—It is
  858  the intent of the Legislature to protect the rights of the
  859  residents of an assisted living facility when the facility is
  860  sold or the ownership thereof is transferred. Therefore, In
  861  addition to the requirements of part II of chapter 408, whenever
  862  a facility is sold or the ownership thereof is transferred,
  863  including leasing,:
  864         (1) the transferee shall notify the residents, in writing,
  865  of the change of ownership within 7 days after receipt of the
  866  new license in order to protect the rights of the residents of
  867  an assisted living facility.
  868         (2) The transferor of a facility the license of which is
  869  denied pending an administrative hearing shall, as a part of the
  870  written change-of-ownership contract, advise the transferee that
  871  a plan of correction must be submitted by the transferee and
  872  approved by the agency at least 7 days before the change of
  873  ownership and that failure to correct the condition which
  874  resulted in the moratorium pursuant to part II of chapter 408 or
  875  denial of licensure is grounds for denial of the transferee’s
  876  license.
  877         Section 11. Section 429.14, Florida Statutes, is amended to
  878  read:
  879         429.14 Administrative penalties.—
  880         (1) In addition to the requirements of part II of chapter
  881  408, the agency may deny, revoke, and suspend any license issued
  882  under this part and impose an administrative fine in the manner
  883  provided in chapter 120 against a licensee for a violation of
  884  any provision of this part, part II of chapter 408, or
  885  applicable rules, or for any of the following actions by a
  886  licensee, or for the actions of any person subject to level 2
  887  background screening under s. 408.809, or for the actions of any
  888  facility employee:
  889         (a) An intentional or negligent act seriously affecting the
  890  health, safety, or welfare of a resident of the facility.
  891         (b) The determination by the agency that the owner lacks
  892  the financial ability to provide continuing adequate care to
  893  residents.
  894         (c) Misappropriation or conversion of the property of a
  895  resident of the facility.
  896         (d) Failure to follow the criteria and procedures provided
  897  under part I of chapter 394 relating to the transportation,
  898  voluntary admission, and involuntary examination of a facility
  899  resident.
  900         (d)(e) A citation of any of the following violations
  901  deficiencies as specified in s. 429.19:
  902         1. One or more cited class I violations deficiencies.
  903         2. Three or more cited class II violations deficiencies.
  904         3. Five or more cited class III violations deficiencies
  905  that have been cited on a single survey and have not been
  906  corrected within the times specified.
  907         (e)(f) Failure to comply with the background screening
  908  standards of this part, s. 408.809(1), or chapter 435.
  909         (f)(g) Violation of a moratorium.
  910         (g)(h) Failure of the license applicant, the licensee
  911  during relicensure, or a licensee that holds a provisional
  912  license to meet the minimum license requirements of this part,
  913  or related rules, at the time of license application or renewal.
  914         (h)(i) An intentional or negligent life-threatening act in
  915  violation of the uniform firesafety standards for assisted
  916  living facilities or other firesafety standards that threatens
  917  the health, safety, or welfare of a resident of a facility, as
  918  communicated to the agency by the local authority having
  919  jurisdiction or the State Fire Marshal.
  920         (i)(j) Knowingly operating any unlicensed facility or
  921  providing without a license any service that must be licensed
  922  under this chapter or chapter 400.
  923         (j)(k) Any act constituting a ground upon which application
  924  for a license may be denied.
  925         (2) Upon notification by the local authority having
  926  jurisdiction or by the State Fire Marshal, the agency may deny
  927  or revoke the license of a licensee of an assisted living
  928  facility that fails to correct cited fire code violations that
  929  affect or threaten the health, safety, or welfare of a resident
  930  of a facility.
  931         (3) The agency may deny a license to any applicant or
  932  controlling interest as defined in part II of chapter 408 which
  933  has or had a 25-percent or greater financial or ownership
  934  interest in any other facility licensed under this part, or in
  935  any entity licensed by this state or another state to provide
  936  health or residential care, which facility or entity during the
  937  5 years prior to the application for a license closed due to
  938  financial inability to operate; had a receiver appointed or a
  939  license denied, suspended, or revoked; was subject to a
  940  moratorium; or had an injunctive proceeding initiated against
  941  it.
  942         (4) The agency shall deny or revoke the license of an
  943  assisted living facility that has two or more class I violations
  944  that are similar or identical to violations identified by the
  945  agency during a survey, inspection, monitoring visit, or
  946  complaint investigation occurring within the previous 2 years.
  947         (4)(5) An action taken by the agency to suspend, deny, or
  948  revoke a licensee’s facility’s license under this part or part
  949  II of chapter 408, in which the agency claims that the facility
  950  owner or a staff member an employee of the facility has
  951  threatened the health, safety, or welfare of a resident of the
  952  facility must be heard by the Division of Administrative
  953  Hearings of the Department of Management Services within 120
  954  days after receipt of the facility’s request for a hearing,
  955  unless that time limitation is waived by both parties. The
  956  administrative law judge must render a decision within 30 days
  957  after receipt of a proposed recommended order.
  958         (6) The agency shall provide to the Division of Hotels and
  959  Restaurants of the Department of Business and Professional
  960  Regulation, on a monthly basis, a list of those assisted living
  961  facilities that have had their licenses denied, suspended, or
  962  revoked or that are involved in an appellate proceeding pursuant
  963  to s. 120.60 related to the denial, suspension, or revocation of
  964  a license.
  965         (5)(7) Agency notification of a license suspension or
  966  revocation, or denial of a license renewal, shall be posted and
  967  visible to the public at the facility.
  968         Section 12. Subsections (1), (4), and (5) of section
  969  429.17, Florida Statutes, are amended to read:
  970         429.17 Expiration of license; renewal; conditional
  971  license.—
  972         (1) Limited nursing, Extended congregate care, and limited
  973  mental health licenses shall expire at the same time as the
  974  facility’s standard license, regardless of when issued.
  975         (4) In addition to the license categories available in s.
  976  408.808, a conditional license may be issued to an applicant for
  977  license renewal if the applicant fails to meet all standards and
  978  requirements for licensure. A conditional license issued under
  979  this subsection shall be limited in duration to a specific
  980  period of time not to exceed 6 months, as determined by the
  981  agency, and shall be accompanied by an agency-approved plan of
  982  correction.
  983         (5) When an extended congregate care or limited nursing
  984  license is requested during a facility’s biennial license
  985  period, the fee shall be prorated in order to permit the
  986  additional license to expire at the end of the biennial license
  987  period. The fee shall be calculated as of the date the
  988  additional license application is received by the agency.
  989         Section 13. Subsections (1), (6), (7), and (8) of section
  990  429.178, Florida Statutes, are amended to read:
  991         429.178 Special care for persons with Alzheimer’s disease
  992  or other related disorders.—
  993         (1) A facility that which advertises that it provides
  994  special care for persons with Alzheimer’s disease or other
  995  related disorders must meet the following standards of
  996  operation:
  997         (a)1.If the facility has 17 or more residents, Have an
  998  awake staff member on duty at all hours of the day and night for
  999  each secured unit of the facility which houses any residents who
 1000  have Alzheimer’s disease or other related disorders.; or
 1001         2. If the facility has fewer than 17 residents, have an
 1002  awake staff member on duty at all hours of the day and night or
 1003  have mechanisms in place to monitor and ensure the safety of the
 1004  facility’s residents.
 1005         (b) Offer activities specifically designed for persons who
 1006  are cognitively impaired.
 1007         (c) Have a physical environment that provides for the
 1008  safety and welfare of the facility’s residents.
 1009         (d) Employ staff who have completed the training and
 1010  continuing education required in subsection (2).
 1011  
 1012  For the safety and protection of residents who have Alzheimer’s
 1013  disease, related disorders, or dementia, a secured locked unit
 1014  may be designated. The unit may consist of the entire building
 1015  or a distinct part of the building. Exit doors shall be equipped
 1016  with an operating alarm system that releases upon activation of
 1017  the fire alarm. These units are exempt from specific life safety
 1018  requirements to which assisted living facilities are normally
 1019  subject. A staff member must be awake and present in the secured
 1020  unit at all times.
 1021         (6) The department shall maintain and post on its website
 1022  keep a current list of providers who are approved to provide
 1023  initial and continuing education for staff and direct care staff
 1024  members of facilities that provide special care for persons with
 1025  Alzheimer’s disease or other related disorders.
 1026         (7) Any facility more than 90 percent of whose residents
 1027  receive monthly optional supplementation payments is not
 1028  required to pay for the training and education programs required
 1029  under this section. A facility that has one or more such
 1030  residents shall pay a reduced fee that is proportional to the
 1031  percentage of such residents in the facility. A facility that
 1032  does not have any residents who receive monthly optional
 1033  supplementation payments must pay a reasonable fee, as
 1034  established by the department, for such training and education
 1035  programs.
 1036         (7)(8) The department shall adopt rules to establish
 1037  standards for trainers and training and to implement this
 1038  section.
 1039         Section 14. Subsections (1), (2), (5), (7), (8), and (9) of
 1040  section 429.19, Florida Statutes, are amended to read:
 1041         429.19 Violations; imposition of administrative fines;
 1042  grounds.—
 1043         (1) In addition to the requirements of part II of chapter
 1044  408, the agency shall impose an administrative fine in the
 1045  manner provided in chapter 120 for the violation of any
 1046  provision of this part, part II of chapter 408, and applicable
 1047  rules by an assisted living facility, for the actions of any
 1048  person subject to level 2 background screening under s. 408.809,
 1049  for the actions of any facility employee, or for an intentional
 1050  or negligent act seriously affecting the health, safety, or
 1051  welfare of a resident of the facility.
 1052         (2) Each violation of this part and adopted rules shall be
 1053  classified according to the nature of the violation and the
 1054  gravity of its probable effect on facility residents. The agency
 1055  shall indicate the classification on the written notice of the
 1056  violation as follows:
 1057         (a) Class “I” violations are those conditions or
 1058  occurrences related to the operation and maintenance of a
 1059  facility or to the care of residents which the agency determines
 1060  present an imminent danger to the residents or a substantial
 1061  probability that death or serious physical or emotional harm
 1062  would result. The condition or practice that constitutes a class
 1063  I violation must be abated or eliminated within 24 hours, unless
 1064  a fixed period, as determined by the agency, is required for
 1065  correction defined in s. 408.813. The agency shall impose an
 1066  administrative fine for a cited class I violation in an amount
 1067  not less than $5,000 and not exceeding $10,000 for each
 1068  violation. A fine shall be levied notwithstanding the correction
 1069  of the violation.
 1070         (b) Class “II” violations are those conditions or
 1071  occurrences related to the operation and maintenance of a
 1072  facility or to the care of residents which the agency determines
 1073  directly threaten the physical or emotional health, safety, or
 1074  security of the residents, other than class I violations defined
 1075  in s. 408.813. The agency shall impose an administrative fine
 1076  for a cited class II violation in an amount not less than $1,000
 1077  and not exceeding $5,000 for each violation. A fine shall be
 1078  levied notwithstanding the correction of the violation.
 1079         (c) Class “III” violations are those conditions or
 1080  occurrences related to the operation and maintenance of a
 1081  facility or to the care of residents which the agency determines
 1082  indirectly or potentially threaten the physical or emotional
 1083  health, safety, or security of residents, other than class I
 1084  violations or class II violations defined in s. 408.813. The
 1085  agency shall impose an administrative fine for a cited class III
 1086  violation in an amount not less than $500 and not exceeding
 1087  $1,000 for each violation. If a class III violation is corrected
 1088  within the time specified, a fine may not be imposed.
 1089         (d) Class “IV” violations are those conditions or
 1090  occurrences related to the operation and maintenance of a
 1091  facility or to required reports, forms, or documents which do
 1092  not have the potential of negatively affecting residents. These
 1093  violations are of a type that the agency determines do not
 1094  threaten the health, safety, or security of residents defined in
 1095  s. 408.813. The agency shall impose an administrative fine for a
 1096  cited class IV violation in an amount not less than $100 and not
 1097  exceeding $200 for each violation. A citation for a class IV
 1098  violation must specify the time within which the violation is
 1099  required to be corrected. If a class IV violation is corrected
 1100  within the time specified, a fine may not be imposed.
 1101         (5) Any action taken to correct a violation shall be
 1102  documented in writing by the licensee owner or administrator of
 1103  the facility and verified through followup visits by agency
 1104  personnel or desk review. The agency may impose a fine and, in
 1105  the case of an owner-operated facility, revoke or deny a
 1106  licensee’s facility’s license when the agency has documented
 1107  that a facility administrator has fraudulently misrepresented
 1108  misrepresents action taken to correct a violation.
 1109         (7) In addition to any administrative fines imposed, the
 1110  agency may assess a survey fee, equal to the lesser of one half
 1111  of the facility’s biennial license and bed fee or $500, to cover
 1112  the cost of conducting initial complaint investigations that
 1113  result in the finding of a violation that was the subject of the
 1114  complaint or monitoring visits conducted under s. 429.28(3)(c)
 1115  to verify the correction of the violations.
 1116         (8) During an inspection, the agency shall make a
 1117  reasonable attempt to discuss each violation with the owner or
 1118  administrator of the facility before giving, prior to written
 1119  notification.
 1120         (9) The agency shall develop and disseminate an annual list
 1121  of all facilities sanctioned or fined for violations of state
 1122  standards, the number and class of violations involved, the
 1123  penalties imposed, and the current status of cases. The list
 1124  shall be disseminated, at no charge, to the Department of
 1125  Elderly Affairs, the Department of Health, the Department of
 1126  Children and Family Services, the Agency for Persons with
 1127  Disabilities, the area agencies on aging, the Florida Statewide
 1128  Advocacy Council, and the state and local ombudsman councils.
 1129  The Department of Children and Family Services shall disseminate
 1130  the list to service providers under contract to the department
 1131  who are responsible for referring persons to a facility for
 1132  residency. The agency may charge a fee commensurate with the
 1133  cost of printing and postage to other interested parties
 1134  requesting a copy of this list. This information may be provided
 1135  electronically or through the agency’s Internet site.
 1136         Section 15. Section 429.195, Florida Statutes, is amended
 1137  to read:
 1138         429.195 Rebates prohibited; penalties.—
 1139         (1) It is unlawful for the licensee of any assisted living
 1140  facility licensed under this part to contract or promise to pay
 1141  or receive any commission, bonus, kickback, or rebate or engage
 1142  in any split-fee arrangement in any form whatsoever with any
 1143  health care provider or health care facility under s. 817.505
 1144  physician, surgeon, organization, agency, or person, either
 1145  directly or indirectly, for residents referred to an assisted
 1146  living facility licensed under this part. A facility may employ
 1147  or contract with persons to market the facility, provided the
 1148  employee or contract provider clearly indicates that he or she
 1149  represents the facility. A person or agency independent of the
 1150  facility may provide placement or referral services for a fee to
 1151  individuals seeking assistance in finding a suitable facility;
 1152  however, any fee paid for placement or referral services must be
 1153  paid by the individual looking for a facility, not by the
 1154  facility.
 1155         (2) A violation of this section shall be considered patient
 1156  brokering and is punishable as provided in s. 817.505.
 1157         (3)This section does not apply to:
 1158         (a) Any individual with whom the facility employs or
 1159  contracts with to market the facility if the employee or
 1160  contract provider clearly indicates that he or she works with or
 1161  for the facility.
 1162         (b)A referral service that provides information,
 1163  consultation, or referrals to consumers to assist them in
 1164  finding appropriate care or housing options for seniors or
 1165  disabled adults if such referred consumers are not Medicaid
 1166  recipients.
 1167         (c) A resident of an assisted living facility who refers to
 1168  the assisted living facility a friend, a family member, or other
 1169  individual with whom the resident has a personal relationship.
 1170  Such a referral does not prohibit the assisted living facility
 1171  from providing a monetary reward to the resident for making such
 1172  a referral.
 1173         Section 16. Subsections (2) and (3) of section 429.20,
 1174  Florida Statutes, are amended to read:
 1175         429.20 Certain solicitation prohibited; third-party
 1176  supplementation.—
 1177         (2) Solicitation of contributions of any kind in a
 1178  threatening, coercive, or unduly forceful manner by or on behalf
 1179  of an assisted living facility or facilities by any agent,
 1180  employee, owner, or representative of any assisted living
 1181  facility or facilities is prohibited grounds for denial,
 1182  suspension, or revocation of the license of the assisted living
 1183  facility or facilities by or on behalf of which such
 1184  contributions were solicited.
 1185         (3) The admission or maintenance of assisted living
 1186  facility residents whose care is supported, in whole or in part,
 1187  by state funds may not be conditioned upon the receipt of any
 1188  manner of contribution or donation from any person. The
 1189  solicitation or receipt of contributions in violation of this
 1190  subsection is grounds for denial, suspension, or revocation of
 1191  license, as provided in s. 429.14, for any assisted living
 1192  facility by or on behalf of which such contributions were
 1193  solicited.
 1194         Section 17. Section 429.23, Florida Statutes, is amended to
 1195  read:
 1196         429.23 Internal risk management and quality assurance
 1197  program; adverse incidents and reporting requirements.—
 1198         (1) Every licensed facility licensed under this part may,
 1199  as part of its administrative functions, voluntarily establish a
 1200  risk management and quality assurance program, the purpose of
 1201  which is to assess resident care practices, facility incident
 1202  reports, violations deficiencies cited by the agency, adverse
 1203  incident reports, and resident grievances and develop plans of
 1204  action to correct and respond quickly to identify quality
 1205  differences.
 1206         (2) Every licensed facility licensed under this part is
 1207  required to maintain adverse incident reports. For purposes of
 1208  this section, the term, “adverse incident” means:
 1209         (a) An event over which facility staff personnel could
 1210  exercise control rather than as a result of the resident’s
 1211  condition and results in:
 1212         1. Death;
 1213         2. Brain or spinal damage;
 1214         3. Permanent disfigurement;
 1215         4. Fracture or dislocation of bones or joints;
 1216         5. Any condition that required medical attention to which
 1217  the resident has not given his or her consent, excluding
 1218  proceedings governed by part I of chapter 394, but including
 1219  failure to honor advanced directives;
 1220         6. Any condition that requires the transfer of the resident
 1221  from the facility to a unit providing more acute care due to the
 1222  incident rather than the resident’s condition before the
 1223  incident; or
 1224         7. An event that is reported to law enforcement or its
 1225  personnel for investigation; or
 1226         (b) Resident elopement, if the elopement places the
 1227  resident at risk of harm or injury.
 1228         (3) Licensed facilities shall provide within 1 business day
 1229  after the occurrence of an adverse incident, by electronic mail,
 1230  facsimile, or United States mail, a preliminary report to the
 1231  agency on all adverse incidents specified under this section.
 1232  The report must include information regarding the identity of
 1233  the affected resident, the type of adverse incident, and the
 1234  status of the facility’s investigation of the incident.
 1235         (3)(4)A licensed facility Licensed facilities shall
 1236  provide within 15 business days after the occurrence of an
 1237  adverse incident, by electronic mail, facsimile, or United
 1238  States mail, a full report to the agency on the all adverse
 1239  incident, including information regarding the identity of the
 1240  affected resident, the type of adverse incident, and incidents
 1241  specified in this section. The report must include the results
 1242  of the facility’s investigation into the adverse incident.
 1243         (5) Each facility shall report monthly to the agency any
 1244  liability claim filed against it. The report must include the
 1245  name of the resident, the dates of the incident leading to the
 1246  claim, if applicable, and the type of injury or violation of
 1247  rights alleged to have occurred. This report is not discoverable
 1248  in any civil or administrative action, except in such actions
 1249  brought by the agency to enforce the provisions of this part.
 1250         (4)(6) Abuse, neglect, or exploitation must be reported to
 1251  the Department of Children and Family Services as required under
 1252  chapter 415.
 1253         (5)(7) The information reported to the agency pursuant to
 1254  subsection (3) which relates to persons licensed under chapter
 1255  458, chapter 459, chapter 461, chapter 464, or chapter 465 must
 1256  shall be reviewed by the agency. The agency shall determine
 1257  whether any of the incidents potentially involved conduct by a
 1258  health care professional who is subject to disciplinary action,
 1259  in which case the provisions of s. 456.073 apply. The agency may
 1260  investigate, as it deems appropriate, any such incident and
 1261  prescribe measures that must or may be taken in response to the
 1262  incident. The agency shall review each incident and determine
 1263  whether it potentially involved conduct by a health care
 1264  professional who is subject to disciplinary action, in which
 1265  case the provisions of s. 456.073 apply.
 1266         (6)(8) If the agency, through its receipt of the adverse
 1267  incident reports prescribed in this part or through any
 1268  investigation, has reasonable belief that conduct by a staff
 1269  member or employee of a licensed facility is grounds for
 1270  disciplinary action by the appropriate board, the agency shall
 1271  report this fact to such regulatory board.
 1272         (7)(9) The adverse incident report reports and preliminary
 1273  adverse incident reports required under this section is are
 1274  confidential as provided by law and is are not discoverable or
 1275  admissible in any civil or administrative action, except in
 1276  disciplinary proceedings by the agency or appropriate regulatory
 1277  board.
 1278         (8)(10) The Department of Elderly Affairs may adopt rules
 1279  necessary to administer this section.
 1280         Section 18. Subsections (1) and (2) of section 429.255,
 1281  Florida Statutes, are amended to read:
 1282         429.255 Use of personnel; emergency care.—
 1283         (1)(a) Persons under contract to the facility or, facility
 1284  staff, or volunteers, who are licensed according to part I of
 1285  chapter 464, or those persons exempt under s. 464.022(1), and
 1286  others as defined by rule, may administer medications to
 1287  residents, take residents’ vital signs, manage individual weekly
 1288  pill organizers for residents who self-administer medication,
 1289  give prepackaged enemas ordered by a physician, observe
 1290  residents, document observations on the appropriate resident’s
 1291  record, report observations to the resident’s physician, and
 1292  contract or allow residents or a resident’s representative,
 1293  designee, surrogate, guardian, or attorney in fact to contract
 1294  with a third party, provided residents meet the criteria for
 1295  appropriate placement as defined in s. 429.26. Nursing
 1296  assistants certified pursuant to part II of chapter 464 may take
 1297  residents’ vital signs as directed by a licensed nurse or
 1298  physician. A person under contract to the facility or facility
 1299  staff who is licensed under part I of chapter 464 may provide
 1300  limited nursing services.
 1301         (b) All staff in facilities licensed under this part shall
 1302  exercise their professional responsibility to observe residents,
 1303  to document observations on the appropriate resident’s record,
 1304  and to report the observations to the administrator or the
 1305  administrator’s designee resident’s physician. However, The
 1306  owner or administrator of the facility shall be responsible for
 1307  determining that the resident receiving services is appropriate
 1308  for residence in the assisted living facility.
 1309         (c) In an emergency situation, licensed personnel may carry
 1310  out their professional duties pursuant to part I of chapter 464
 1311  until emergency medical personnel assume responsibility for
 1312  care.
 1313         (2) In facilities licensed to provide extended congregate
 1314  care, persons under contract to the facility or, facility staff,
 1315  or volunteers, who are licensed according to part I of chapter
 1316  464, or those persons exempt under s. 464.022(1), or those
 1317  persons certified as nursing assistants pursuant to part II of
 1318  chapter 464, may also perform all duties within the scope of
 1319  their license or certification, as approved by the facility
 1320  administrator and pursuant to this part.
 1321         Section 19. Subsections (2), (3), and (4) of section
 1322  429.256, Florida Statutes, are amended to read:
 1323         429.256 Assistance with self-administration of medication.—
 1324         (2) Residents who are capable of self-administering their
 1325  own medications without assistance shall be encouraged and
 1326  allowed to do so. However, an unlicensed person may, consistent
 1327  with a dispensed prescription’s label or the package directions
 1328  of an over-the-counter medication, assist a resident whose
 1329  condition is medically stable with the self-administration of
 1330  routine, regularly scheduled medications that are intended to be
 1331  self-administered. Assistance with self-medication by an
 1332  unlicensed person may occur only upon a documented request by,
 1333  and the written informed consent of, a resident or the
 1334  resident’s surrogate, guardian, or attorney in fact. To minimize
 1335  the potential risk for improper dosage administration of
 1336  prescription drugs, a facility may require standard-medication
 1337  dispensing systems for residents’ prescriptions, as specified by
 1338  rule. For the purposes of this section, self-administered
 1339  medications include both legend and over-the-counter oral dosage
 1340  forms, topical dosage forms and topical ophthalmic, otic, and
 1341  nasal dosage forms including solutions, suspensions, sprays, and
 1342  inhalers, and continuous positive airway pressure machines.
 1343         (3) Assistance with self-administration of medication
 1344  includes:
 1345         (a) Taking the medication, in its previously dispensed,
 1346  properly labeled container, from where it is stored, and
 1347  bringing it to the resident.
 1348         (b) In the presence of the resident, reading the label,
 1349  opening the container, removing a prescribed amount of
 1350  medication from the container, and closing the container.
 1351         (c) Placing an oral dosage in the resident’s hand or
 1352  placing the dosage in another container and helping the resident
 1353  by lifting the container to his or her mouth.
 1354         (d) Applying topical medications.
 1355         (e) Returning the medication container to proper storage.
 1356         (f) Keeping a record of when a resident receives assistance
 1357  with self-administration under this section.
 1358         (g)Assisting a resident in holding a nebulizer.
 1359         (h)Using a glucometer to perform blood glucose checks.
 1360         (i)Assisting with the putting on and taking off anti
 1361  embolism stockings.
 1362         (j)Assisting with applying and removing an oxygen cannula.
 1363         (4) Assistance with self-administration does not include:
 1364         (a) Mixing, compounding, converting, or calculating
 1365  medication doses, except for measuring a prescribed amount of
 1366  liquid medication or breaking a scored tablet or crushing a
 1367  tablet as prescribed.
 1368         (b) The preparation of syringes for injection or the
 1369  administration of medications by any injectable route.
 1370         (c) Administration of medications through intermittent
 1371  positive pressure breathing machines or a nebulizer.
 1372         (c)(d) Administration of medications by way of a tube
 1373  inserted in a cavity of the body.
 1374         (d)(e) Administration of parenteral preparations.
 1375         (e)(f) Irrigations or debriding agents used in the
 1376  treatment of a skin condition.
 1377         (f)(g) Rectal, urethral, or vaginal preparations.
 1378         (g)(h) Medications ordered by the physician or health care
 1379  professional with prescriptive authority to be given “as
 1380  needed,” unless the order is written with specific parameters
 1381  that preclude independent judgment on the part of the unlicensed
 1382  person, and at the request of a competent resident.
 1383         (h)(i) Medications for which the time of administration,
 1384  the amount, the strength of dosage, the method of
 1385  administration, or the reason for administration requires
 1386  judgment or discretion on the part of the unlicensed person.
 1387         Section 20. Subsections (3), (7), (8), (9), (10), and (11)
 1388  of section 429.26, Florida Statutes, are amended to read:
 1389         429.26 Appropriateness of placements; examinations of
 1390  residents.—
 1391         (3) Persons licensed under part I of chapter 464 who are
 1392  employed by or under contract with a facility shall, on a
 1393  routine basis or at least monthly, perform a nursing assessment
 1394  of the residents for whom they are providing nursing services
 1395  ordered by a physician, except administration of medication, and
 1396  shall document such assessment, including any significant change
 1397  substantial changes in a resident’s status which may necessitate
 1398  relocation to a nursing home, hospital, or specialized health
 1399  care facility. Such records shall be maintained in the facility
 1400  for inspection by the agency and shall be forwarded to the
 1401  resident’s case manager, if applicable.
 1402         (7) The facility must notify a licensed physician when a
 1403  resident exhibits signs of dementia or cognitive impairment or
 1404  has a change of condition in order to rule out the presence of
 1405  an underlying physiological condition that may be contributing
 1406  to such dementia or impairment. The notification must occur
 1407  within 30 days after the acknowledgment of such signs by
 1408  facility staff. If an underlying condition is determined to
 1409  exist, the facility shall arrange, with the appropriate health
 1410  care provider, the necessary care and services to treat the
 1411  condition.
 1412         (7)(8) The Department of Children and Family Services may
 1413  require an examination for supplemental security income and
 1414  optional state supplementation recipients residing in facilities
 1415  at any time and shall provide the examination whenever a
 1416  resident’s condition requires it. Any facility administrator;
 1417  personnel of the agency, the department, or the Department of
 1418  Children and Family Services; or long-term care ombudsman
 1419  council member who believes a resident needs to be evaluated
 1420  shall notify the resident’s case manager, who shall take
 1421  appropriate action. A report of the examination findings shall
 1422  be provided to the resident’s case manager and the facility
 1423  administrator to help the administrator meet his or her
 1424  responsibilities under subsection (1).
 1425         (8)(9) A terminally ill resident who no longer meets the
 1426  criteria for continued residency may remain in the facility if
 1427  the arrangement is mutually agreeable to the resident and the
 1428  administrator facility; additional care is rendered through a
 1429  licensed hospice, and the resident is under the care of a
 1430  physician who agrees that the physical needs of the resident are
 1431  being met.
 1432         (9)(10) Facilities licensed to provide extended congregate
 1433  care services shall promote aging in place by determining
 1434  appropriateness of continued residency based on a comprehensive
 1435  review of the resident’s physical and functional status; the
 1436  ability of the facility, family members, friends, or any other
 1437  pertinent individuals or agencies to provide the care and
 1438  services required; and documentation that a written service plan
 1439  consistent with facility policy has been developed and
 1440  implemented to ensure that the resident’s needs and preferences
 1441  are addressed.
 1442         (10)(11)A No resident who requires 24-hour nursing
 1443  supervision, except for a resident who is an enrolled hospice
 1444  patient pursuant to part IV of chapter 400, may not shall be
 1445  retained in a licensed facility licensed under this part.
 1446         Section 21. Section 429.27, Florida Statutes, is amended to
 1447  read:
 1448         429.27 Property and personal affairs of residents.—
 1449         (1)(a) A resident shall be given the option of using his or
 1450  her own belongings, as space permits; choosing his or her
 1451  roommate; and, whenever possible, unless the resident is
 1452  adjudicated incompetent or incapacitated under state law,
 1453  managing his or her own affairs.
 1454         (b) The admission of a resident to a facility and his or
 1455  her presence therein does shall not give confer on the facility
 1456  or its licensee, owner, administrator, employees, or
 1457  representatives any authority to manage, use, or dispose of any
 1458  property of the resident; nor shall such admission or presence
 1459  give confer on any of such persons any authority or
 1460  responsibility for the personal affairs of the resident, except
 1461  that which may be necessary for the safe management of the
 1462  facility or for the safety of the resident.
 1463         (2) The licensee, A facility, or an owner, administrator,
 1464  employee of an assisted living facility, or representative
 1465  thereof, may not act as the guardian, trustee, or conservator
 1466  for any resident of the assisted living facility or any of such
 1467  resident’s property. A licensee, An owner, administrator, or
 1468  staff member, or representative thereof, may not act as a
 1469  competent resident’s payee for social security, veteran’s, or
 1470  railroad benefits without the consent of the resident. Any
 1471  facility whose licensee, owner, administrator, or staff, or
 1472  representative thereof, serves as representative payee for any
 1473  resident of the facility shall file a surety bond with the
 1474  agency in an amount equal to twice the average monthly aggregate
 1475  income or personal funds due to residents, or expendable for
 1476  their account, which are received by a facility. Any facility
 1477  whose licensee, owner, administrator, or staff, or a
 1478  representative thereof, is granted power of attorney for any
 1479  resident of the facility shall file a surety bond with the
 1480  agency for each resident for whom such power of attorney is
 1481  granted. The surety bond shall be in an amount equal to twice
 1482  the average monthly income of the resident, plus the value of
 1483  any resident’s property under the control of the attorney in
 1484  fact. The bond shall be executed by the facility’s licensee,
 1485  owner, administrator, or staff, or a representative thereof,
 1486  facility as principal and a licensed surety company. The bond
 1487  shall be conditioned upon the faithful compliance of the
 1488  licensee, owner, administrator, or staff, or a representative
 1489  thereof, of the facility with this section and shall run to the
 1490  agency for the benefit of any resident who suffers a financial
 1491  loss as a result of the misuse or misappropriation by a
 1492  licensee, owner, administrator, or staff, or representative
 1493  thereof, of the facility of funds held pursuant to this
 1494  subsection. Any surety company that cancels or does not renew
 1495  the bond of any licensee shall notify the agency in writing not
 1496  less than 30 days in advance of such action, giving the reason
 1497  for the cancellation or nonrenewal. Any facility’s licensee,
 1498  facility owner, administrator, or staff, or representative
 1499  thereof, who is granted power of attorney for any resident of
 1500  the facility shall, on a monthly basis, be required to provide
 1501  the resident a written statement of any transaction made on
 1502  behalf of the resident pursuant to this subsection, and a copy
 1503  of such statement given to the resident shall be retained in
 1504  each resident’s file and available for agency inspection.
 1505         (3) A facility’s administrator facility, upon mutual
 1506  consent with the resident, shall provide for the safekeeping in
 1507  the facility of personal effects, including funds not in excess
 1508  of $500 and funds of the resident not in excess of $200 cash,
 1509  and shall keep complete and accurate records of all such funds
 1510  and personal effects received. If a resident is absent from a
 1511  facility for 24 hours or more, the facility may provide for the
 1512  safekeeping of the resident’s personal effects, including funds
 1513  in excess of $500.
 1514         (4) Any funds or other property belonging to or due to a
 1515  resident, or expendable for his or her account, which is
 1516  received by the administrator a facility shall be trust funds
 1517  which shall be kept separate from the funds and property of the
 1518  facility and other residents or shall be specifically credited
 1519  to such resident. Such trust funds shall be used or otherwise
 1520  expended only for the account of the resident. Upon written
 1521  request, at least once every 3 months, unless upon order of a
 1522  court of competent jurisdiction, the administrator facility
 1523  shall furnish the resident and his or her guardian, trustee, or
 1524  conservator, if any, a complete and verified statement of all
 1525  funds and other property to which this subsection applies,
 1526  detailing the amount and items received, together with their
 1527  sources and disposition. In any event, the administrator
 1528  facility shall furnish such statement annually and upon the
 1529  discharge or transfer of a resident. Any governmental agency or
 1530  private charitable agency contributing funds or other property
 1531  to the account of a resident shall also be entitled to receive
 1532  such statement annually and upon the discharge or transfer of
 1533  the resident.
 1534         (5) Any personal funds available to facility residents may
 1535  be used by residents as they choose to obtain clothing, personal
 1536  items, leisure activities, and other supplies and services for
 1537  their personal use. An administrator A facility may not demand,
 1538  require, or contract for payment of all or any part of the
 1539  personal funds in satisfaction of the facility rate for supplies
 1540  and services beyond that amount agreed to in writing and may not
 1541  levy an additional charge to the individual or the account for
 1542  any supplies or services that the facility has agreed by
 1543  contract to provide as part of the standard monthly rate. Any
 1544  service or supplies provided by the facility which are charged
 1545  separately to the individual or the account may be provided only
 1546  with the specific written consent of the individual, who shall
 1547  be furnished in advance of the provision of the services or
 1548  supplies with an itemized written statement to be attached to
 1549  the contract setting forth the charges for the services or
 1550  supplies.
 1551         (6)(a) In addition to any damages or civil penalties to
 1552  which a person is subject, any person who:
 1553         1. Intentionally withholds a resident’s personal funds,
 1554  personal property, or personal needs allowance, or who demands,
 1555  beneficially receives, or contracts for payment of all or any
 1556  part of a resident’s personal property or personal needs
 1557  allowance in satisfaction of the facility rate for supplies and
 1558  services; or
 1559         2. Borrows from or pledges any personal funds of a
 1560  resident, other than the amount agreed to by written contract
 1561  under s. 429.24,
 1562  
 1563  commits a misdemeanor of the first degree, punishable as
 1564  provided in s. 775.082 or s. 775.083.
 1565         (b) Any licensee, facility owner, administrator, or staff,
 1566  or representative thereof, who is granted power of attorney for
 1567  any resident of the facility and who misuses or misappropriates
 1568  funds obtained through this power commits a felony of the third
 1569  degree, punishable as provided in s. 775.082, s. 775.083, or s.
 1570  775.084.
 1571         (7) In the event of the death of a resident, a licensee
 1572  shall return all refunds, funds, and property held in trust to
 1573  the resident’s personal representative, if one has been
 1574  appointed at the time the facility disburses such funds, and, if
 1575  not, to the resident’s spouse or adult next of kin named in a
 1576  beneficiary designation form provided by the licensee facility
 1577  to the resident. If the resident has no spouse or adult next of
 1578  kin or such person cannot be located, funds due the resident
 1579  shall be placed in an interest-bearing account, and all property
 1580  held in trust by the licensee facility shall be safeguarded
 1581  until such time as the funds and property are disbursed pursuant
 1582  to the Florida Probate Code. Such funds shall be kept separate
 1583  from the funds and property of the facility and other residents
 1584  of the facility. If the funds of the deceased resident are not
 1585  disbursed pursuant to the Florida Probate Code within 2 years
 1586  after the resident’s death, the funds shall be deposited in the
 1587  Health Care Trust Fund administered by the agency.
 1588         (8) The department may by rule clarify terms and specify
 1589  procedures and documentation necessary to administer the
 1590  provisions of this section relating to the proper management of
 1591  residents’ funds and personal property and the execution of
 1592  surety bonds.
 1593         Section 22. Subsection (4) of section 429.275, Florida
 1594  Statutes, is repealed.
 1595         Section 23. Paragraph (k) of subsection (1) and subsections
 1596  (3), (4), (5), (6), and (7) of section 429.28, Florida Statutes,
 1597  are amended to read:
 1598         429.28 Resident bill of rights.—
 1599         (1) A No resident of a facility may not shall be deprived
 1600  of any civil or legal rights, benefits, or privileges guaranteed
 1601  by law, the Constitution of the State of Florida, or the
 1602  Constitution of the United States as a resident of a facility.
 1603  Every resident of a facility shall have the right to:
 1604         (k) At least 30 45 days’ notice of relocation or
 1605  termination of residency from the facility unless, for medical
 1606  reasons, the resident is certified by a physician to require an
 1607  emergency relocation to a facility providing a more skilled
 1608  level of care or the resident engages in a pattern of conduct
 1609  that is harmful or offensive to other residents. In the case of
 1610  a resident who has been adjudicated mentally incapacitated, the
 1611  guardian shall be given at least 30 45 days’ notice of a
 1612  nonemergency relocation or residency termination. Reasons for
 1613  relocation shall be set forth in writing. In order for a
 1614  facility to terminate the residency of an individual without
 1615  notice as provided herein, the facility shall show good cause in
 1616  a court of competent jurisdiction.
 1617         (3)(a) The agency shall conduct a survey to determine
 1618  general compliance with facility standards and compliance with
 1619  residents’ rights as a prerequisite to initial licensure or
 1620  licensure renewal.
 1621         (b) In order to determine whether the facility is
 1622  adequately protecting residents’ rights, the biennial survey
 1623  shall include private informal conversations with a sample of
 1624  residents and consultation with the ombudsman council in the
 1625  planning and service area in which the facility is located to
 1626  discuss residents’ experiences within the facility.
 1627         (c) During any calendar year in which no survey is
 1628  conducted, the agency shall conduct at least one monitoring
 1629  visit of each facility cited in the previous year for a class I
 1630  or class II violation, or more than three uncorrected class III
 1631  violations.
 1632         (d) The agency may conduct periodic followup inspections as
 1633  necessary to monitor the compliance of facilities with a history
 1634  of any class I, class II, or class III violations that threaten
 1635  the health, safety, or security of residents.
 1636         (e) The agency may conduct complaint investigations as
 1637  warranted to investigate any allegations of noncompliance with
 1638  requirements required under this part or rules adopted under
 1639  this part.
 1640         (3)(4) The administrator shall ensure that facility shall
 1641  not hamper or prevent residents may exercise from exercising
 1642  their rights as specified in this section.
 1643         (4)(5)A staff member No facility or employee of a facility
 1644  may not serve notice upon a resident to leave the premises or
 1645  take any other retaliatory action against any person who:
 1646         (a) Exercises any right set forth in this section.
 1647         (b) Appears as a witness in any hearing, inside or outside
 1648  the facility.
 1649         (c) Files a civil action alleging a violation of the
 1650  provisions of this part or notifies a state attorney or the
 1651  Attorney General of a possible violation of such provisions.
 1652         (5)(6)An administrator may not terminate Any facility
 1653  which terminates the residency of an individual who participated
 1654  in activities specified in subsection (4) (5) shall show good
 1655  cause in a court of competent jurisdiction.
 1656         (6)(7) Any person who submits or reports a complaint
 1657  concerning a suspected violation of the provisions of this part
 1658  or concerning services and conditions in facilities, or who
 1659  testifies in any administrative or judicial proceeding arising
 1660  from such a complaint, shall have immunity from any civil or
 1661  criminal liability therefor, unless such person has acted in bad
 1662  faith or with malicious purpose or the court finds that there
 1663  was a complete absence of a justiciable issue of either law or
 1664  fact raised by the losing party.
 1665         Section 24. Paragraphs (a), (d), (h), (i), (j), and (l) of
 1666  subsection (1) and subsection (5) of section 429.41, Florida
 1667  Statutes, are amended to read:
 1668         429.41 Rules establishing standards.—
 1669         (1) It is the intent of the Legislature that rules
 1670  published and enforced pursuant to this section shall include
 1671  criteria by which a reasonable and consistent quality of
 1672  resident care and quality of life may be ensured and the results
 1673  of such resident care may be demonstrated. Such rules shall also
 1674  ensure a safe and sanitary environment that is residential and
 1675  noninstitutional in design or nature. It is further intended
 1676  that reasonable efforts be made to accommodate the needs and
 1677  preferences of residents to enhance the quality of life in a
 1678  facility. The agency, in consultation with the department, may
 1679  adopt rules to administer the requirements of part II of chapter
 1680  408. In order to provide safe and sanitary facilities and the
 1681  highest quality of resident care accommodating the needs and
 1682  preferences of residents, the department, in consultation with
 1683  the agency, the Department of Children and Family Services, and
 1684  the Department of Health, shall adopt rules, policies, and
 1685  procedures to administer this part, which must include
 1686  reasonable and fair minimum standards in relation to:
 1687         (a) The requirements for and maintenance of facilities, not
 1688  in conflict with the provisions of chapter 553, relating to
 1689  plumbing, heating, cooling, lighting, ventilation, living space,
 1690  and other housing conditions, which will ensure the health,
 1691  safety, and comfort of residents and protection from fire
 1692  hazard, including adequate provisions for fire alarm and other
 1693  fire protection suitable to the size of the structure. Uniform
 1694  firesafety standards shall be established and enforced by the
 1695  State Fire Marshal in cooperation with the agency, the
 1696  department, and the Department of Health.
 1697         1. Evacuation capability determination.—
 1698         a. The provisions of the National Fire Protection
 1699  Association, NFPA 101A, Chapter 5, 1995 edition, shall be used
 1700  for determining the ability of the residents, with or without
 1701  staff assistance, to relocate from or within a licensed facility
 1702  to a point of safety as provided in the fire codes adopted
 1703  herein. An evacuation capability evaluation for initial
 1704  licensure shall be conducted within 6 months after the date of
 1705  licensure. For existing licensed facilities that are not
 1706  equipped with an automatic fire sprinkler system, the
 1707  administrator shall evaluate the evacuation capability of
 1708  residents at least annually. The evacuation capability
 1709  evaluation for each facility not equipped with an automatic fire
 1710  sprinkler system shall be validated, without liability, by the
 1711  State Fire Marshal, by the local fire marshal, or by the local
 1712  authority having jurisdiction over firesafety, before the
 1713  license renewal date. If the State Fire Marshal, local fire
 1714  marshal, or local authority having jurisdiction over firesafety
 1715  has reason to believe that the evacuation capability of a
 1716  facility as reported by the administrator may have changed, it
 1717  may, with assistance from the facility administrator, reevaluate
 1718  the evacuation capability through timed exiting drills.
 1719  Translation of timed fire exiting drills to evacuation
 1720  capability may be determined:
 1721         (I) Three minutes or less: prompt.
 1722         (II) More than 3 minutes, but not more than 13 minutes:
 1723  slow.
 1724         (III) More than 13 minutes: impractical.
 1725         b. The Office of the State Fire Marshal shall provide or
 1726  cause the provision of training and education on the proper
 1727  application of Chapter 5, NFPA 101A, 1995 edition, to its
 1728  employees, to staff of the Agency for Health Care Administration
 1729  who are responsible for regulating facilities under this part,
 1730  and to local governmental inspectors. The Office of the State
 1731  Fire Marshal shall provide or cause the provision of this
 1732  training within its existing budget, but may charge a fee for
 1733  this training to offset its costs. The initial training must be
 1734  delivered within 6 months after July 1, 1995, and as needed
 1735  thereafter.
 1736         c. The Office of the State Fire Marshal, in cooperation
 1737  with provider associations, shall provide or cause the provision
 1738  of a training program designed to inform facility operators on
 1739  how to properly review bid documents relating to the
 1740  installation of automatic fire sprinklers. The Office of the
 1741  State Fire Marshal shall provide or cause the provision of this
 1742  training within its existing budget, but may charge a fee for
 1743  this training to offset its costs. The initial training must be
 1744  delivered within 6 months after July 1, 1995, and as needed
 1745  thereafter.
 1746         d. The administrator of a licensed facility shall sign an
 1747  affidavit verifying the number of residents occupying the
 1748  facility at the time of the evacuation capability evaluation.
 1749         2. Firesafety requirements.—
 1750         a. Except for the special applications provided herein,
 1751  effective January 1, 1996, the provisions of the National Fire
 1752  Protection Association, Life Safety Code, NFPA 101, 1994
 1753  edition, Chapter 22 for new facilities and Chapter 23 for
 1754  existing facilities shall be the uniform fire code applied by
 1755  the State Fire Marshal for assisted living facilities, pursuant
 1756  to s. 633.022.
 1757         b. Any new facility, regardless of size, that applies for a
 1758  license on or after January 1, 1996, must be equipped with an
 1759  automatic fire sprinkler system. The exceptions as provided in
 1760  s. 22-2.3.5.1, NFPA 101, 1994 edition, as adopted herein, apply
 1761  to any new facility housing eight or fewer residents. On July 1,
 1762  1995, local governmental entities responsible for the issuance
 1763  of permits for construction shall inform, without liability, any
 1764  facility whose permit for construction is obtained prior to
 1765  January 1, 1996, of this automatic fire sprinkler requirement.
 1766  As used in this part, the term “a new facility” does not mean an
 1767  existing facility that has undergone change of ownership.
 1768         c. Notwithstanding any provision of s. 633.022 or of the
 1769  National Fire Protection Association, NFPA 101A, Chapter 5, 1995
 1770  edition, to the contrary, any existing facility housing eight or
 1771  fewer residents is not required to install an automatic fire
 1772  sprinkler system, nor to comply with any other requirement in
 1773  Chapter 23, NFPA 101, 1994 edition, that exceeds the firesafety
 1774  requirements of NFPA 101, 1988 edition, that applies to this
 1775  size facility, unless the facility has been classified as
 1776  impractical to evacuate. Any existing facility housing eight or
 1777  fewer residents that is classified as impractical to evacuate
 1778  must install an automatic fire sprinkler system within the
 1779  timeframes granted in this section.
 1780         d. Any existing facility that is required to install an
 1781  automatic fire sprinkler system under this paragraph need not
 1782  meet other firesafety requirements of Chapter 23, NFPA 101, 1994
 1783  edition, which exceed the provisions of NFPA 101, 1988 edition.
 1784  The mandate contained in this paragraph which requires certain
 1785  facilities to install an automatic fire sprinkler system
 1786  supersedes any other requirement.
 1787         e. This paragraph does not supersede the exceptions granted
 1788  in NFPA 101, 1988 edition or 1994 edition.
 1789         f. This paragraph does not exempt a facility facilities
 1790  from other firesafety provisions adopted under s. 633.022 and
 1791  local building code requirements in effect before July 1, 1995.
 1792         g. A local government may charge fees only in an amount not
 1793  to exceed the actual expenses incurred by local government
 1794  relating to the installation and maintenance of an automatic
 1795  fire sprinkler system in an existing and properly licensed
 1796  assisted living facility structure as of January 1, 1996.
 1797         h. If a licensed facility undergoes major reconstruction or
 1798  addition to an existing building on or after January 1, 1996,
 1799  the entire building must be equipped with an automatic fire
 1800  sprinkler system. Major reconstruction of a building means
 1801  repair or restoration that costs in excess of 50 percent of the
 1802  value of the building as reported on the tax rolls, excluding
 1803  land, before reconstruction. Multiple reconstruction projects
 1804  within a 5-year period the total costs of which exceed 50
 1805  percent of the initial value of the building at the time the
 1806  first reconstruction project was permitted are to be considered
 1807  as major reconstruction. Application for a permit for an
 1808  automatic fire sprinkler system is required upon application for
 1809  a permit for a reconstruction project that creates costs that go
 1810  over the 50 percent 50-percent threshold.
 1811         i. Any facility licensed before January 1, 1996, that is
 1812  required to install an automatic fire sprinkler system shall
 1813  ensure that the installation is completed within the following
 1814  timeframes based upon evacuation capability of the facility as
 1815  determined under subparagraph 1.:
 1816         (I) Impractical evacuation capability, 24 months.
 1817         (II) Slow evacuation capability, 48 months.
 1818         (III) Prompt evacuation capability, 60 months.
 1819  
 1820  The beginning date from which the deadline for the automatic
 1821  fire sprinkler installation requirement must be calculated is
 1822  upon receipt of written notice from the local fire official that
 1823  an automatic fire sprinkler system must be installed. The local
 1824  fire official shall send a copy of the document indicating the
 1825  requirement of a fire sprinkler system to the Agency for Health
 1826  Care Administration.
 1827         j. It is recognized that the installation of an automatic
 1828  fire sprinkler system may create financial hardship for some
 1829  facilities. The appropriate local fire official shall, without
 1830  liability, grant two 1-year extensions to the timeframes for
 1831  installation established herein, if an automatic fire sprinkler
 1832  installation cost estimate and proof of denial from two
 1833  financial institutions for a construction loan to install the
 1834  automatic fire sprinkler system are submitted. However, for any
 1835  facility with a class I or class II, or a history of uncorrected
 1836  class III, firesafety deficiencies, an extension must not be
 1837  granted. The local fire official shall send a copy of the
 1838  document granting the time extension to the Agency for Health
 1839  Care Administration.
 1840         k. A facility owner whose facility is required to be
 1841  equipped with an automatic fire sprinkler system under Chapter
 1842  23, NFPA 101, 1994 edition, as adopted herein, must disclose to
 1843  any potential buyer of the facility that an installation of an
 1844  automatic fire sprinkler requirement exists. The sale of the
 1845  facility does not alter the timeframe for the installation of
 1846  the automatic fire sprinkler system.
 1847         l. An existing facility facilities required to install an
 1848  automatic fire sprinkler system as a result of construction-type
 1849  restrictions in Chapter 23, NFPA 101, 1994 edition, as adopted
 1850  herein, or evacuation capability requirements shall be notified
 1851  by the local fire official in writing of the automatic fire
 1852  sprinkler requirement, as well as the appropriate date for final
 1853  compliance as provided in this subparagraph. The local fire
 1854  official shall send a copy of the document to the Agency for
 1855  Health Care Administration.
 1856         m. Except in cases of life-threatening fire hazards, if an
 1857  existing facility experiences a change in the evacuation
 1858  capability, or if the local authority having jurisdiction
 1859  identifies a construction-type restriction, such that an
 1860  automatic fire sprinkler system is required, it shall be
 1861  afforded time for installation as provided in this subparagraph.
 1862  
 1863  Facilities that are fully sprinkled and in compliance with other
 1864  firesafety standards are not required to conduct more than one
 1865  of the required fire drills between the hours of 11 p.m. and 7
 1866  a.m., per year. In lieu of the remaining drills, staff
 1867  responsible for residents during such hours may be required to
 1868  participate in a mock drill that includes a review of evacuation
 1869  procedures. Such standards must be included or referenced in the
 1870  rules adopted by the State Fire Marshal. Pursuant to s.
 1871  633.022(1)(b), the State Fire Marshal is the final
 1872  administrative authority for firesafety standards established
 1873  and enforced pursuant to this section. All licensed facilities
 1874  must have an annual fire inspection conducted by the local fire
 1875  marshal or authority having jurisdiction.
 1876         3. Resident elopement requirements.—Facilities are required
 1877  to conduct a minimum of two resident elopement prevention and
 1878  response drills per year. All administrators and direct care
 1879  staff must participate in the drills which shall include a
 1880  review of procedures to address resident elopement. Facilities
 1881  must document the implementation of the drills and ensure that
 1882  the drills are conducted in a manner consistent with the
 1883  facility’s resident elopement policies and procedures.
 1884         (d) All sanitary conditions within the facility and its
 1885  surroundings which will ensure the health and comfort of
 1886  residents. To ensure that inspections are not duplicative, the
 1887  rules must clearly delineate the responsibilities of the agency
 1888  regarding agency’s licensure and survey inspections staff, the
 1889  county health departments regarding food safety and sanitary
 1890  inspections, and the local fire marshal regarding firesafety
 1891  inspections authority having jurisdiction over firesafety and
 1892  ensure that inspections are not duplicative. The agency may
 1893  collect fees for food service inspections conducted by the
 1894  county health departments and transfer such fees to the
 1895  Department of Health.
 1896         (h) The care and maintenance of residents, which must
 1897  include, but is not limited to:
 1898         1. The supervision of residents;
 1899         2. The provision of personal services;
 1900         3. The provision of, or arrangement for, social and leisure
 1901  activities;
 1902         4. The arrangement for appointments and transportation to
 1903  appropriate medical, dental, nursing, or mental health services,
 1904  as needed by residents;
 1905         5. The management of medication;
 1906         6. The food service nutritional needs of residents; and
 1907         7. Resident records.; and
 1908         8. Internal risk management and quality assurance.
 1909         (i) Facilities holding an a limited nursing, extended
 1910  congregate care, or limited mental health license.
 1911         (j) The establishment of specific criteria to define
 1912  appropriateness of resident admission and continued residency in
 1913  a facility holding a standard, limited nursing, extended
 1914  congregate care, and limited mental health license.
 1915         (l) The establishment of specific policies and procedures
 1916  on resident elopement. Facilities shall conduct a minimum of two
 1917  resident elopement drills each year. All administrators and
 1918  direct care staff shall participate in the drills. Facilities
 1919  shall document the drills.
 1920         (5) Beginning January 1, 2012, the agency shall may use an
 1921  abbreviated biennial standard licensure inspection that consists
 1922  of a review of key quality-of-care standards in lieu of a full
 1923  inspection in a facility that has a good record of past
 1924  performance. However, a full inspection must be conducted in a
 1925  facility that has a history of class I or class II violations,
 1926  uncorrected class III violations, confirmed ombudsman council
 1927  complaints, or confirmed licensure complaints, within the
 1928  previous licensure period immediately preceding the inspection
 1929  or if a potentially serious problem is identified during the
 1930  abbreviated inspection. The agency, in consultation with the
 1931  department, shall develop, maintain, and update the key quality
 1932  of-care standards with input from the State Long-Term Care
 1933  Ombudsman Council and representatives of associations and
 1934  organizations representing assisted living facilities provider
 1935  groups for incorporation into its rules.
 1936         Section 25. Section 429.42, Florida Statutes, is amended to
 1937  read:
 1938         429.42 Pharmacy and dietary services.—
 1939         (1) Any assisted living facility in which the agency has
 1940  documented a class I or class II violation deficiency or
 1941  uncorrected class III violations deficiencies regarding
 1942  medicinal drugs or over-the-counter preparations, including
 1943  their storage, use, delivery, or administration, or dietary
 1944  services, or both, during a biennial survey or a monitoring
 1945  visit or an investigation in response to a complaint, shall, in
 1946  addition to or as an alternative to any penalties imposed under
 1947  s. 429.19, be required to employ the consultant services of a
 1948  licensed pharmacist, a licensed registered nurse, or a
 1949  registered or licensed dietitian, as applicable. The consultant
 1950  shall, at a minimum, provide onsite quarterly consultation until
 1951  the inspection team from the agency determines that such
 1952  consultation services are no longer required.
 1953         (2) A corrective action plan for deficiencies related to
 1954  assistance with the self-administration of medication or the
 1955  administration of medication must be developed and implemented
 1956  by the facility within 48 hours after notification of such
 1957  deficiency, or sooner if the deficiency is determined by the
 1958  agency to be life-threatening.
 1959         (3) The agency shall employ at least two pharmacists
 1960  licensed pursuant to chapter 465 among its personnel who
 1961  biennially inspect assisted living facilities licensed under
 1962  this part, to participate in biennial inspections or consult
 1963  with the agency regarding deficiencies relating to medicinal
 1964  drugs or over-the-counter preparations.
 1965         (2)(4) The department may by rule establish procedures and
 1966  specify documentation as necessary to implement this section.
 1967         Section 26. Section 429.445, Florida Statutes, is amended
 1968  to read:
 1969         429.445 Compliance with local zoning requirements.—No
 1970  facility licensed under this part may commence any construction
 1971  which will expand the size of the existing structure unless the
 1972  licensee first submits to the agency proof that such
 1973  construction will be in compliance with applicable local zoning
 1974  requirements. Facilities with a licensed capacity of less than
 1975  15 persons shall comply with the provisions of chapter 419.
 1976         Section 27. Section 429.47, Florida Statutes, is amended to
 1977  read:
 1978         429.47 Prohibited acts; penalties for violation.—
 1979         (1) While an assisted living a facility is under
 1980  construction or is seeking licensure, the owner may advertise to
 1981  the public prior to obtaining a license. Facilities that are
 1982  certified under chapter 651 shall comply with the advertising
 1983  provisions of s. 651.095 rather than those provided for in this
 1984  subsection.
 1985         (2) A freestanding facility shall not advertise or imply
 1986  that any part of it is a nursing home. For the purpose of this
 1987  subsection, “freestanding facility” means a facility that is not
 1988  operated in conjunction with a nursing home to which residents
 1989  of the facility are given priority when nursing care is
 1990  required. A person who violates this subsection is subject to
 1991  fine as specified in s. 429.19.
 1992         (2)(3) Any facility that which is affiliated with any
 1993  religious organization or which has a name implying religious
 1994  affiliation shall include in its advertising whether or not it
 1995  is affiliated with any religious organization and, if so, which
 1996  organization.
 1997         (3)(4) A facility licensed under this part which is not
 1998  part of a facility authorized under chapter 651 shall include
 1999  the facility’s license number as given by the agency in all
 2000  advertising. A company or person owning more than one facility
 2001  shall include at least one license number per advertisement. All
 2002  advertising shall include the term “assisted living facility” or
 2003  the abbreviation “ALF” before the license number.
 2004         Section 28. Subsection (1) of section 429.49, Florida
 2005  Statutes, is amended to read:
 2006         429.49 Resident records; penalties for alteration.—
 2007         (1) Any person who fraudulently alters, defaces, or
 2008  falsifies any medical record or any resident’s other record of
 2009  an assisted living facility, or causes or procures any such
 2010  offense to be committed, commits a misdemeanor of the second
 2011  degree, punishable as provided in s. 775.082 or s. 775.083.
 2012         Section 29. Subsections (3), (5), and (8) of section
 2013  429.52, Florida Statutes, are amended, present subsection (11)
 2014  of that section is redesignated as subsection (12), and a new
 2015  subsection (11) is added to that section, read:
 2016         429.52 Staff training and educational programs; core
 2017  educational requirement.—
 2018         (3) Effective January 1, 2004, a new facility administrator
 2019  must complete the required training and education, including the
 2020  competency test, within a reasonable time after being employed
 2021  as an administrator, as determined by the department. Failure to
 2022  do so is a violation of this part and subjects the violator to
 2023  an administrative fine as prescribed in s. 429.19.
 2024  Administrators licensed in accordance with part II of chapter
 2025  468 are exempt from this requirement. Other licensed
 2026  professionals may be exempted, as determined by the department
 2027  by rule.
 2028         (5) Staff involved with the management of medications and
 2029  assisting with the self-administration of medications under s.
 2030  429.256 must complete a minimum of 4 additional hours of
 2031  training provided by a registered nurse, licensed pharmacist, or
 2032  department staff and must complete 2 hours of continuing
 2033  education training annually. The department shall establish by
 2034  rule the minimum requirements of this additional training.
 2035         (8) The department shall adopt rules related to these
 2036  training requirements, the competency test, necessary
 2037  procedures, and competency test fees and shall adopt or contract
 2038  with another entity to develop a curriculum, which shall be used
 2039  as the minimum core training requirements. The department shall
 2040  consult with representatives of stakeholder associations,
 2041  organizations representing assisted living facilities, and
 2042  agencies in the development of the curriculum.
 2043         (11)A training provider certified by the department must
 2044  continue to meet continuing education requirements and other
 2045  standards as set forth in rules adopted by the department. A
 2046  training provider or trainee may be sanctioned pursuant to s.
 2047  430.081 for failing to comply with the standards set forth in
 2048  the rules.
 2049         Section 30. Subsections (1) and (2) of section 429.53,
 2050  Florida Statutes, are amended to read:
 2051         429.53 Consultation by the agency.—
 2052         (1) The area offices of licensure and certification of the
 2053  agency shall provide consultation to the following upon request:
 2054         (a) A licensee of a facility.
 2055         (b) A person interested in obtaining a license to operate a
 2056  facility under this part.
 2057         (2) As used in this section, “consultation” includes:
 2058         (a) An explanation of the requirements of this part and
 2059  rules adopted pursuant thereto;
 2060         (b) An explanation of the license application and renewal
 2061  procedures; and
 2062         (c) The provision of a checklist of general local and state
 2063  approvals required prior to constructing or developing a
 2064  facility and a listing of the types of agencies responsible for
 2065  such approvals;
 2066         (d) An explanation of benefits and financial assistance
 2067  available to a recipient of supplemental security income
 2068  residing in a facility;
 2069         (c)(e) Any other information which the agency deems
 2070  necessary to promote compliance with the requirements of this
 2071  part.; and
 2072         (f) A preconstruction review of a facility to ensure
 2073  compliance with agency rules and this part.
 2074         Section 31. Section 429.54, Florida Statutes, is repealed.
 2075         Section 32. Paragraph (a) of subsection (1) and subsections
 2076  (5) and (6) of section 429.71, Florida Statutes, are amended to
 2077  read:
 2078         429.71 Classification of deficiencies; administrative
 2079  fines.—
 2080         (1) In addition to the requirements of part II of chapter
 2081  408 and in addition to any other liability or penalty provided
 2082  by law, the agency may impose an administrative fine on a
 2083  provider according to the following classification:
 2084         (a) Class I violations are those conditions or practices
 2085  related to the operation and maintenance of an adult family-care
 2086  home or to the care of residents which the agency determines
 2087  present an imminent danger to the residents or guests of the
 2088  adult family-care home facility or a substantial probability
 2089  that death or serious physical or emotional harm would result
 2090  therefrom. The condition or practice that constitutes a class I
 2091  violation must be abated or eliminated within 24 hours, unless a
 2092  fixed period, as determined by the agency, is required for
 2093  correction. A class I violation deficiency is subject to an
 2094  administrative fine in an amount not less than $500 and not
 2095  exceeding $1,000 for each violation. A fine may be levied
 2096  notwithstanding the correction of the violation deficiency.
 2097         (5) As an alternative to or in conjunction with an
 2098  administrative action against a provider, the agency may request
 2099  a plan of corrective action that demonstrates a good faith
 2100  effort to remedy each violation by a specific date, subject to
 2101  the approval of the agency.
 2102         (5)(6) The department shall set forth, by rule, notice
 2103  requirements and procedures for correction of violations
 2104  deficiencies.
 2105         Section 33. Subsection (3) is added to section 429.81,
 2106  Florida Statutes, to read:
 2107         429.81 Residency agreements.—
 2108         (3) Each residency agreement must specify that the resident
 2109  must give the provider a 30 days’ written notice of intent to
 2110  terminate his or her residency from the adult family-care home.
 2111         Section 34. Section 430.081, Florida Statutes, is created
 2112  to read:
 2113         430.081Sanctioning of training providers and trainees.—The
 2114  Department of Elderly Affairs may sanction training providers
 2115  and trainees for infractions involving any required training
 2116  that the department has the authority to regulate under chapter
 2117  400, chapter 429, or chapter 430 in order to ensure that such
 2118  training providers and trainees satisfy specific qualification
 2119  requirements and adhere to training curricula that is approved
 2120  by the department. Training infractions include, but are not
 2121  limited to, falsification of training records, falsification of
 2122  training certificates, falsification of a training provider’s
 2123  qualifications, failure to adhere to the required number of
 2124  training hours, failure to use the required curriculum, failure
 2125  to maintain the continuing education for the training provider’s
 2126  recertification, failure to obtain reapproval of a curriculum
 2127  when required, providing false or inaccurate information,
 2128  misrepresentation of the required materials, and use of a false
 2129  identification as a training provider or trainee. Sanctions may
 2130  be progressive in nature and may consist of corrective action
 2131  measures; suspension or termination from participation as an
 2132  approved training provider or trainee, including sitting for any
 2133  required examination; and administrative fines not to exceed
 2134  $1,000 per incident. One or more sanctions may be levied per
 2135  incident.
 2136         Section 35. Paragraph (j) is added to subsection (3) of
 2137  section 817.505, Florida Statutes, to read:
 2138         817.505 Patient brokering prohibited; exceptions;
 2139  penalties.—
 2140         (3) This section shall not apply to:
 2141         (j) Any payments by an assisted living facility, as defined
 2142  in s. 429.02, which are permitted under s. 429.195(3).
 2143         Section 36. Licensure fees adjusted by consumer price index
 2144  increases prior to the effective date of this act are not
 2145  intended to be reset by this act and may continue to accrue as
 2146  authorized by law.
 2147         Section 37. This act shall take effect July 1, 2011.

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