Bill Text: FL S1724 | 2013 | Regular Session | Comm Sub
Bill Title: Transitional Living Facilities
Spectrum: Bipartisan Bill
Status: (Failed) 2013-05-03 - Died in Appropriations Subcommittee on Health and Human Services, companion bill(s) passed, see CS/CS/HB 1159 (Ch. 2013-153) [S1724 Detail]
Download: Florida-2013-S1724-Comm_Sub.html
Florida Senate - 2013 CS for CS for SB 1724 By the Committees on Health Policy; and Children, Families, and Elder Affairs; and Senators Garcia and Grimsley 588-03975-13 20131724c2 1 A bill to be entitled 2 An act relating to transitional living facilities; 3 creating part XI of ch. 400, F.S., entitled 4 “Transitional Living Facilities”; creating s. 5 400.9970, F.S.; providing legislative intent; creating 6 s. 400.9971, F.S.; providing definitions; creating s. 7 400.9972, F.S.; requiring the licensure of 8 transitional living facilities; providing fees; 9 providing license application requirements; creating 10 s. 400.9973, F.S.; providing requirements for 11 transitional living facilities relating to client 12 admission, transfer, and discharge; creating s. 13 400.9974, F.S.; requiring a comprehensive treatment 14 plan to be developed for each client; providing plan 15 requirements; creating s. 400.9975, F.S.; providing 16 licensee responsibilities; providing notice 17 requirements; prohibiting a licensee or employee of a 18 facility from serving notice upon a client to leave 19 the premises or take other retaliatory action; 20 requiring the client and client’s representative to be 21 provided with certain information; requiring the 22 licensee to develop and implement certain policies and 23 procedures; creating s. 400.9976, F.S.; providing 24 licensee requirements relating to medication 25 practices; creating s. 400.9977, F.S.; providing 26 requirements for the screening of potential employees 27 and monitoring of employees for the protection of 28 clients; requiring licensees to implement certain 29 procedures; creating s. 400.9978, F.S.; requiring a 30 facility to provide a therapeutic milieu that supports 31 a culture of individual empowerment and 32 responsibility; providing that the health and safety 33 of the client is the primary concern of the facility; 34 providing requirements and limitations for the use of 35 physical restraints, seclusion, and chemical restraint 36 medication on clients; requiring the Agency for Health 37 Care Administration to adopt rules; creating s. 38 400.9979, F.S.; providing background screening 39 requirements; requiring the licensee to maintain 40 certain personnel records; providing administrative 41 responsibilities for licensees; providing 42 recordkeeping requirements; creating s. 400.9980, 43 F.S.; providing requirements relating to property and 44 personal affairs of clients; providing requirements 45 for a licensee with respect to obtaining surety bonds; 46 providing recordkeeping requirements relating to the 47 safekeeping of personal effects; providing 48 requirements for trust funds received by licensee and 49 credited to the client; providing a penalty for 50 certain misuse of a resident’s personal needs 51 allowance; providing criminal penalties for 52 violations; providing for the disposition of property 53 in the event of the death of a client; authorizing the 54 Agency for Health Care Administration to adopt rules; 55 creating s. 400.9981, F.S.; authorizing the agency to 56 adopt and enforce certain rules; creating s. 400.9982, 57 F.S.; providing procedures relating to violations and 58 penalties; providing administrative fines for 59 specified classes of violations; creating s. 400.9983, 60 F.S.; authorizing the agency to apply certain 61 provisions with regard to receivership proceedings; 62 creating s. 400.9984, F.S.; requiring the Agency for 63 Health Care Administration, the Department of Health, 64 the Agency for Persons with Disabilities, and the 65 Department of Children and Families to develop 66 electronic systems for certain purposes; repealing s. 67 400.805, F.S., relating to transitional living 68 facilities; providing that every transitional living 69 facility licensed under s. 400.805, F.S., on or before 70 a specified date is licensed under the provisions of 71 the act; amending s. 381.745, F.S.; revising a 72 definition; amending s. 381.75, F.S.; revising the 73 duties of the Department of Health as they relate to 74 transitional living facilities; amending s. 381.78, 75 F.S.; conforming provisions to changes made by the 76 act; amending ss. 408.802 and 408.820, F.S.; 77 conforming a provision to changes made by the act; 78 amending s. 400.93, F.S.; providing that transitional 79 living facilities licensed under part XI of ch. 400, 80 F.S., are exempt from home medical equipment provider 81 licensure; amending s. 400.9905, F.S.; revising a 82 definition; providing an effective date. 83 84 Be It Enacted by the Legislature of the State of Florida: 85 86 Section 1. Sections 400.9970 through 400.9984, Florida 87 Statutes, are designated as part XI of chapter 400, Florida 88 Statutes, entitled “Transitional Living Facilities.” 89 Section 2. Section 400.9970, Florida Statutes, is created 90 to read: 91 400.9970 Legislative intent.—It is the intent of the 92 Legislature to provide for the licensure of transitional living 93 facilities and require the development, establishment, and 94 enforcement of basic standards by the Agency for Health Care 95 Administration to ensure quality of care and services to clients 96 in transitional living facilities. It is the policy of the state 97 that the least restrictive appropriate available treatment be 98 used based on the individual needs and best interest of the 99 client and consistent with optimum improvement of the client’s 100 condition. The goal of a transitional living program for 101 individuals who have brain or spinal cord injuries is to assist 102 each individual who has such an injury to achieve a higher level 103 of independent functioning and to enable that individual to 104 reenter the community. It is also the policy of this state that 105 the use of restraints and seclusion on clients is justified only 106 as an emergency safety measure to be used in response to danger 107 to the client or others. It is, therefore, the intent of the 108 Legislature to achieve an ongoing reduction in the use of 109 restraints and seclusion in programs and facilities that serve 110 persons who have brain injury or spinal cord injuries. 111 Section 3. Section 400.9971, Florida Statutes, is created 112 to read: 113 400.9971 Definitions.—As used in this part, the term: 114 (1) “Agency” means the Agency for Health Care 115 Administration. 116 (2) “Chemical restraint” means a pharmacologic drug that 117 physically limits, restricts, or deprives an individual of 118 movement or mobility, is used for client protection or safety, 119 and is not required for the treatment of medical conditions or 120 symptoms. 121 (3) “Client’s representative” means the parent of a child 122 client or the client’s guardian, designated representative or 123 designee, surrogate, or attorney in fact. 124 (4) “Department” means the Department of Health. 125 (5) “Physical restraint” means any manual method to 126 restrict freedom of movement of or normal access to an 127 individual’s body or a physical or mechanical device, material, 128 or equipment attached or adjacent to the individual’s body so 129 that he or she cannot easily remove the restraint and which 130 restricts freedom of movement of or normal access to one’s body, 131 including, but not limited to, a half-bed rail, a full-bed rail, 132 a geriatric chair, and a posey restraint. The term includes any 133 device that was not specifically manufactured as a restraint but 134 which has been altered, arranged, or otherwise used for this 135 purpose. The term does not include bandage material used for the 136 purpose of binding a wound or injury. 137 (6) “Seclusion” means the physical segregation of a person 138 in any fashion or the involuntary isolation of a person in a 139 room or area from which the person is prevented from leaving. 140 The prevention may be by physical barrier or by a staff member 141 who is acting in a manner, or who is physically situated, so as 142 to prevent the person from leaving the room or area. For 143 purposes of this chapter, the term does not mean isolation due 144 to a person’s medical condition or symptoms. 145 (7) “Transitional living facility” means a site where 146 specialized health care services are provided, including, but 147 not limited to, rehabilitative services, behavior modification, 148 community reentry training, aids for independent living, and 149 counseling to individuals who have brain injuries or spinal cord 150 injuries. The term does not require a provider that is licensed 151 by the agency to obtain a separate transitional living facility 152 license to serve persons who have brain injuries or spinal cord 153 injuries as long as the services provided are within the scope 154 of the provider’s license. 155 Section 4. Section 400.9972, Florida Statutes, is created 156 to read: 157 400.9972 License required; fee; application.— 158 (1) The requirements of part II of chapter 408 apply to the 159 provision of services that require licensure pursuant to this 160 part and part II of chapter 408 and to entities licensed by or 161 applying for such licensure from the agency pursuant to this 162 part. A license issued by the agency is required for the 163 operation of a transitional living facility in this state. 164 (2) In accordance with this part, an applicant or a 165 licensee shall pay a fee for each license application submitted 166 under this part. The license fee shall consist of a $4,588 167 license fee and a $90 per-bed fee per biennium and shall conform 168 to the annual adjustment authorized in s. 408.805. 169 (3) Each applicant for licensure must provide the 170 following: 171 (a) The location of the facility for which a license is 172 sought and documentation, signed by the appropriate local 173 government official, which states that the applicant has met 174 local zoning requirements. 175 (b) Proof of liability insurance as provided in s. 624.605. 176 (c) Proof of compliance with local zoning requirements, 177 including compliance with the requirements of chapter 419 if the 178 proposed facility is a community residential home. 179 (d) Proof that the facility has received a satisfactory 180 firesafety inspection. 181 (e) Documentation of a satisfactory sanitation inspection 182 of the facility by the county health department. 183 184 The applicant’s proposed facility must attain and continuously 185 maintain accreditation by an accrediting organization 186 specializing in evaluating rehabilitation facilities whose 187 standards incorporate comparable licensure regulations required 188 by the state. An applicant for licensure as a transitional 189 living facility must acquire accreditation within 12 months 190 after the issuance of an initial license. The agency shall 191 accept the accreditation survey report of the accrediting 192 organization in lieu of conducting a licensure inspection if the 193 standards included in the survey report are determined by the 194 agency to document that the facility is in substantial 195 compliance with state licensure requirements. The applicant 196 shall submit to the agency within 10 days after receipt a copy 197 of any accreditation survey report and evidence of the 198 accreditation decision subsequent to a survey by the accrediting 199 organization on the facility. This part does not preclude the 200 agency from conducting periodic inspections of a transitional 201 living facility to ensure compliance with all licensure 202 requirements, and as it deems necessary to carry out the 203 functions of the agency. An inspection may be conducted to 204 ensure compliance with licensure requirements of this part, to 205 validate the inspection process of accrediting organizations, to 206 respond to licensure complaints, or to protect the public health 207 and safety. 208 Section 5. Section 400.9973, Florida Statutes, is created 209 to read: 210 400.9973 Client admission, transfer, and discharge.— 211 (1) Each transitional living facility must have written 212 policies and procedures governing the admission, transfer, and 213 discharge of clients. 214 (2) The admission of each client to a transitional living 215 facility must be in accordance with the licensee’s policies and 216 procedures. 217 (3) A client admitted to a transitional living facility 218 must have a brain or spinal cord injury, such as a lesion to the 219 spinal cord or cauda equina syndrome, with evidence of 220 significant involvement of two of the following deficits or 221 dysfunctions: 222 (a) A motor deficit. 223 (b) A sensory deficit. 224 (c) Bowel and bladder dysfunction. 225 (d) An acquired internal or external injury to the skull, 226 the brain, or the brain’s covering, whether caused by a 227 traumatic or nontraumatic event, which produces an altered state 228 of consciousness or an anatomic motor, sensory, cognitive, or 229 behavioral deficit. 230 (4) A client whose medical condition and diagnosis does not 231 positively identify a cause of the client’s condition, whose 232 symptoms are inconsistent with the known cause of injury, or 233 whose recovery is inconsistent with the known medical condition 234 may be admitted to a transitional living facility for evaluation 235 for a period not to exceed 90 days. 236 (5) A client admitted to a transitional living facility 237 must be admitted upon prescription by a licensed physician and 238 must remain under the care of a licensed physician for the 239 duration of the client’s stay in the facility. 240 (6) A transitional living facility may not admit a client 241 whose primary admitting diagnosis is mental illness or an 242 intellectual or a developmental disability. 243 (7) An individual may not be admitted to a transitional 244 living facility if the individual: 245 (a) Presents significant risk of infection to other clients 246 or personnel. A health care practitioner must provide 247 documentation that the individual is free of apparent signs and 248 symptoms of communicable disease; 249 (b) Is a danger to self or others as determined by a 250 physician or mental health practitioner licensed under chapter 251 490 or chapter 491, unless the facility provides adequate 252 staffing and support to ensure patient safety; 253 (c) Is bedridden; or 254 (d) Requires 24-hour nursing supervision. 255 (8) If the client meets the admission criteria, the medical 256 or nursing director of the facility must complete an initial 257 evaluation of the client’s functional skills, behavioral status, 258 cognitive status, educational or vocational potential, medical 259 status, psychosocial status, sensorimotor capacity, and other 260 related skills and abilities within the first 72 hours after the 261 client’s admission to the facility. An initial comprehensive 262 treatment plan that delineates services to be provided and 263 appropriate sources for such services must be implemented within 264 the first 4 days after admission. 265 (9) Each transitional living facility shall develop a 266 discharge plan for each client before or upon admission to the 267 facility. The discharge plan must identify the intended 268 discharge site and possible alternative discharge sites. For 269 each discharge site identified, the discharge plan must identify 270 the skills, behaviors, and other conditions that the client must 271 achieve to be appropriate for discharge. Discharge plans must be 272 reviewed and updated as necessary, but no less often than once 273 monthly. 274 (10) As soon as practicable, a transitional living facility 275 shall discharge a client when he or she no longer requires any 276 of the specialized services described in s. 400.9971(7) or is 277 not making measurable progress in accordance with his or her 278 comprehensive treatment plan, or if the transitional living 279 facility is no longer the most appropriate, least restrictive 280 treatment option. 281 (11) Each transitional living facility shall provide at 282 least 30 days’ notice to clients of transfer or discharge plans, 283 including the location of an acceptable transfer location if the 284 client is unable to live independently. This requirement does 285 not apply if a client voluntarily terminates residency. 286 Section 6. Section 400.9974, Florida Statutes, is created 287 to read: 288 400.9974 Client comprehensive treatment plans; client 289 services.— 290 (1) Each transitional living facility shall develop a 291 comprehensive treatment plan for each client as soon as 292 possible, but no later than 30 days following development of the 293 initial comprehensive treatment plan. Comprehensive treatment 294 plans must be reviewed and updated if the client fails to meet 295 projected improvements in the plan or if a significant change in 296 the client’s condition occurs. Comprehensive treatment plans 297 must be reviewed and updated at least once monthly. 298 Comprehensive treatment plans must be developed by an 299 interdisciplinary team consisting of the case manager, the 300 program director, the nurse, and appropriate therapists. The 301 client or, if appropriate, the client’s representative must be 302 included in developing the comprehensive treatment plan. 303 (2) The comprehensive treatment plan must include the 304 following: 305 (a) The physician’s orders and the client’s diagnosis, 306 medical history, physical examination, and rehabilitative or 307 restorative needs. 308 (b) A preliminary nursing evaluation with physician’s 309 orders for immediate care, completed on admission. 310 (c) A comprehensive, accurate, reproducible, and 311 standardized assessment of the client’s functional capability; 312 the treatments designed to achieve skills, behaviors, and other 313 conditions necessary to return to the community; and specific 314 measurable goals. 315 (d) Steps necessary for the client to achieve transition to 316 the community and estimated length of time to achieve the goals. 317 (3) The client or, if appropriate, the client’s 318 representative must consent to the continued treatment at the 319 transitional living facility. Consent may be for a period of up 320 to 3 months. If such consent is not given, the transitional 321 living facility shall discharge the client as soon as 322 practicable. 323 (4) Each client must receive the professional program 324 services needed to implement the client’s comprehensive 325 treatment plan. 326 (5) The licensee must employ qualified professional staff 327 to carry out and monitor the various professional interventions 328 in accordance with the stated goals and objectives of every 329 client’s comprehensive treatment plan. 330 (6) Each client must receive a continuous treatment program 331 that includes appropriate, consistent implementation of a 332 program of specialized and general training, treatment, health 333 services, and related services which is directed toward: 334 (a) The acquisition of the behaviors and skills necessary 335 for the client to function with as much self-determination and 336 independence as possible; 337 (b) The prevention or deceleration of regression or loss of 338 current optimal functional status; and 339 (c) The management of behavioral issues that preclude 340 independent functioning in the community. 341 Section 7. Section 400.9975, Florida Statutes, is created 342 to read: 343 400.9975 Licensee responsibilities.— 344 (1) The licensee shall ensure that each client: 345 (a) Lives in a safe environment free from abuse, neglect, 346 and exploitation. 347 (b) Is treated with consideration and respect and with due 348 recognition of personal dignity, individuality, and the need for 349 privacy. 350 (c) Retains and uses his or her own clothes and other 351 personal property in his or her immediate living quarters, so as 352 to maintain individuality and personal dignity, except when the 353 licensee can demonstrate that such retention and use would be 354 unsafe, impractical, or an infringement upon the rights of other 355 clients. 356 (d) Has unrestricted private communication, including 357 receiving and sending unopened correspondence, access to a 358 telephone, and visiting with any person of his or her choice. 359 Upon request, the licensee shall make provisions to modify 360 visiting hours for caregivers and guests. The facility shall 361 restrict communication in accordance with any court order or 362 written instruction of a client’s representative. Any 363 restriction on a client’s communication for therapeutic reasons 364 shall be documented and reviewed at least weekly and shall be 365 removed as soon as it is no longer clinically indicated. The 366 basis for the restriction shall be explained to the client and, 367 if applicable, the client’s representative. The client shall 368 nonetheless retain the right to call the abuse hotline, the 369 agency, and Disability Rights Florida at any and all times. 370 (e) Has the opportunity to participate in and benefits from 371 community services and activities to achieve the highest 372 possible level of independence, autonomy, and interaction within 373 the community. 374 (f) Has the opportunity to manage his or her financial 375 affairs unless the client or, if applicable, the client’s 376 representative authorizes the administrator of the facility to 377 provide safekeeping for funds as provided in this part. 378 (g) Has reasonable opportunity for regular exercise several 379 times a week and to be outdoors at regular and frequent 380 intervals except when prevented by inclement weather. 381 (h) Has the opportunity to exercise civil and religious 382 liberties, including the right to independent personal 383 decisions. No religious belief or practice, including attendance 384 at religious services, shall be imposed upon any client. 385 (i) Has access to adequate and appropriate health care 386 consistent with established and recognized standards within the 387 community. 388 (j) Has the ability to present grievances and recommend 389 changes in policies, procedures, and services to the staff of 390 the licensee, governing officials, or any other person without 391 restraint, interference, coercion, discrimination, or reprisal. 392 Each licensee shall establish a grievance procedure to 393 facilitate a client’s ability to present grievances, including a 394 system for investigating, tracking, managing, and responding to 395 complaints by persons receiving services or individuals acting 396 on their behalf, and an appeals process. This process must 397 include access to Disability Rights Florida and other advocates 398 and the right to be a member of, be active in, and associate 399 with advocacy or special interest groups. 400 (2) The licensee shall: 401 (a) Promote participation of each client’s representative 402 in the process of providing treatment to the client unless the 403 representative’s participation is unobtainable or inappropriate. 404 (b) Answer communications from each client’s family, 405 guardians, and friends promptly and appropriately. 406 (c) Promote visits by individuals with a relationship to 407 the client at any reasonable hour, without requiring prior 408 notice, or in any area of the facility which provides direct 409 client care services to the client, consistent with the client’s 410 and other clients’ privacy, unless the interdisciplinary team 411 determines that such a visit would not be appropriate. 412 (d) Promote leave from the facility for visits, trips, or 413 vacations. 414 (e) Promptly notify the client’s representative of any 415 significant incidents or changes in the client’s condition, 416 including, but not limited to, serious illness, accident, abuse, 417 unauthorized absence, or death. 418 (3) The administrator of a facility shall ensure that a 419 written notice of licensee responsibilities is posted in a 420 prominent place in each building where clients reside and read 421 or explained to clients who cannot read. This notice shall 422 include the statewide toll-free telephone number for reporting 423 complaints to the agency, must be provided to clients in a 424 manner that is clearly legible, and must include the words: “To 425 report a complaint regarding the services you receive, please 426 call toll-free ...[telephone number]... or Disability Rights 427 Florida ...[telephone number]...”; and the statewide toll-free 428 telephone number for the central abuse hotline must be provided 429 to clients in a manner that is clearly legible and must include 430 the words: “To report abuse, neglect or exploitation, please 431 call toll-free ...[telephone number where complaints may be 432 lodged]....” The licensee must ensure a client’s access to a 433 telephone, where telephone numbers required in this subsection 434 are readily available to call the agency, central abuse hotline, 435 or Disability Rights Florida. 436 (4) A licensee or employee of a facility may not serve 437 notice upon a client to leave the premises or take any other 438 retaliatory action against any person solely due to the 439 following: 440 (a) The client or other person files an internal or 441 external complaint or grievance regarding the facility. 442 (b) The client or other person appears as a witness in any 443 hearing inside or outside the facility. 444 (5) Before or at the time of admission, the client and the 445 client’s representative shall be provided with a copy of the 446 licensee’s responsibilities as provided in this section, 447 including grievance procedures and the telephone numbers 448 provided in this section. 449 (6) The licensee must develop and implement policies and 450 procedures governing the release of any client information, 451 including consent necessary from the client or the client’s 452 representative. 453 Section 8. Section 400.9976, Florida Statutes, is created 454 to read: 455 400.9976 Medication practices.— 456 (1) An individual medication administration record must be 457 maintained for each client. Each dose of medication, including a 458 self-administered dose, shall be properly recorded in the 459 client’s record. Each client who self-administers medication 460 shall be given a pill organizer. Medication must be placed in 461 the pill organizer by a nurse. A nurse shall document the date 462 and time medication is placed into each client’s pill organizer. 463 All medications must be administered in compliance with the 464 physician’s orders. 465 (2) If the interdisciplinary team determines that self 466 administration of medications is an appropriate objective, and 467 if the physician does not specify otherwise, a client must be 468 taught to self-administer his or her medication without a staff 469 person. This includes all forms of administration, including 470 orally, via injection, and via suppository. The client’s 471 physician must be informed of the interdisciplinary team’s 472 decision that self-administration of medications is an objective 473 for the client. A client may not self-administer medication 474 until he or she demonstrates the competency to take the correct 475 medication in the correct dosage at the correct time, to respond 476 to missed doses, and to contact an appropriate person with 477 questions. 478 (3) Medication administration discrepancies and adverse 479 drug reactions must be recorded and reported immediately to a 480 physician. 481 Section 9. Section 400.9977, Florida Statutes, is created 482 to read: 483 400.9977 Protection from abuse, neglect, mistreatment, and 484 exploitation.—The licensee must develop and implement policies 485 and procedures for the screening and training of employees, the 486 protection of clients, and the prevention, identification, 487 investigation, and reporting of abuse, neglect, and 488 exploitation. This includes the licensee’s identification of 489 clients whose personal histories render them at risk for abusing 490 other clients, development of intervention strategies to prevent 491 occurrences, monitoring for changes that would trigger abusive 492 behavior, and reassessment of the interventions on a regular 493 basis. A licensee shall implement procedures to: 494 (1) Screen potential employees for a history of abuse, 495 neglect, or mistreatment of clients. The screening shall include 496 an attempt to obtain information from previous employers and 497 current employers and verification with the appropriate 498 licensing boards. 499 (2) Train employees, through orientation and ongoing 500 sessions, on issues related to abuse prohibition practices, 501 including identification of abuse, neglect, mistreatment, and 502 exploitation, appropriate interventions to deal with aggressive 503 or catastrophic reactions of clients, the process to report 504 allegations without fear of reprisal, and recognition of signs 505 of frustration and stress that may lead to abuse. 506 (3) Provide clients, families, and staff with information 507 on how and to whom they may report concerns, incidents, and 508 grievances without the fear of retribution and provide feedback 509 regarding the concerns that have been expressed. A licensee must 510 identify, correct, and intervene in situations in which abuse, 511 neglect, mistreatment, or exploitation is likely to occur, 512 including: 513 (a) Evaluating the physical environment of the facility to 514 identify characteristics that may make abuse or neglect more 515 likely to occur, such as secluded areas. 516 (b) Providing sufficient staff on each shift to meet the 517 needs of the clients, and ensuring that the staff assigned have 518 knowledge of the individual clients’ care needs. The licensee 519 shall identify inappropriate behaviors of its staff, such as 520 using derogatory language, rough handling, ignoring clients 521 while giving care, and directing clients who need toileting 522 assistance to urinate or defecate in their beds. 523 (c) Assessing, planning care for, and monitoring clients 524 with needs and behaviors that might lead to conflict or neglect, 525 such as clients with a history of aggressive behaviors, clients 526 who have behaviors such as entering other clients’ rooms, 527 clients with self-injurious behaviors, clients with 528 communication disorders, and clients who require heavy nursing 529 care or are totally dependent on staff. 530 (4) Identify events, such as suspicious bruising of 531 clients, occurrences, patterns, and trends that may constitute 532 abuse and determine the direction of the investigation. 533 (5) Investigate different types of incidents, identify the 534 staff member responsible for the initial reporting, investigate 535 alleged violations, and report results to the proper 536 authorities. The licensee must analyze the occurrences to 537 determine what changes are needed, if any, to policies and 538 procedures to prevent further occurrences and to take all 539 necessary corrective action depending on the results of the 540 investigation. 541 (6) Protect clients from harm during an investigation. 542 (7) Report all alleged violations and all substantiated 543 incidents, as required under chapters 39 and 415, to the 544 licensing authorities and all other agencies as required and to 545 report any knowledge it has of any actions by a court of law 546 that would indicate an employee is unfit for service. 547 Section 10. Section 400.9978, Florida Statutes, is created 548 to read: 549 400.9978 Restraints and seclusion; client safety.— 550 (1) Each facility shall provide a therapeutic milieu that 551 supports a culture of individual empowerment and responsibility. 552 The health and safety of the client shall be the primary concern 553 at all times. 554 (2) The use of physical restraints must be ordered and 555 documented by a physician and must be consistent with policies 556 and procedures adopted by the facility. The client or, if 557 applicable, the client’s representative must be informed of the 558 facility’s physical restraint policies and procedures at the 559 time of the client’s admission. 560 (3) The use of chemical restraints is limited to prescribed 561 dosages of medications as ordered by a physician and must be 562 consistent with the client’s diagnosis and the policies and 563 procedures adopted by the facility. The client and, if 564 applicable, the client’s representative must be informed of the 565 facility’s chemical restraint policies and procedures at the 566 time of the client’s admission. 567 (4) Based on a physician’s assessment, if a client exhibits 568 symptoms that present an immediate risk of injury or death to 569 self or others, a physician may issue an emergency treatment 570 order to immediately administer rapid response psychotropic 571 medications or other chemical restraints. Each emergency 572 treatment order must be documented and maintained in the 573 client’s record. 574 (a) An emergency treatment order is effective for no more 575 than 24 hours. 576 (b) Whenever a client is medicated in accordance with this 577 subsection, the client’s representative or responsible party and 578 the client’s physician must be notified as soon as practicable. 579 (5) A client who is prescribed and receiving a medication 580 that can serve as a chemical restraint for a purpose other than 581 an emergency treatment order must be evaluated by his or her 582 physician at least monthly to assess the following: 583 (a) The continued need for the medication. 584 (b) The level of the medication in the client’s blood, as 585 appropriate. 586 (c) The need for adjustments in the prescription. 587 (6) The licensee shall ensure that clients are free from 588 unnecessary drugs and physical restraints and are provided 589 treatment to reduce dependency on drugs and physical restraints. 590 (7) The licensee may use physical restraints and seclusion 591 only as authorized by the facility’s written physical restraint 592 and seclusion policies, which must be in compliance with this 593 section and applicable rules. 594 (8) Interventions to manage dangerous client behavior must 595 be employed with sufficient safeguards and supervision to ensure 596 that the safety, welfare, and civil and human rights of each 597 client are adequately protected. 598 (9) A facility shall notify the parent or guardian of a 599 client each time restraint or seclusion is used. Such 600 notification must be within 24 hours from the time the restraint 601 or seclusion occurs. Reasonable efforts must be taken to notify 602 the parent or guardian by telephone or e-mail, or both, and 603 these efforts must be documented. 604 (10) The agency may adopt by rule standards and procedures 605 relating to the use of restraints, restraint positioning, 606 seclusion, and emergency treatment orders for psychotropic 607 medications, restraint, and seclusion. These rules must include 608 duration of restraint use, staff training, client observation 609 during restraint, and documentation and reporting standards. 610 Section 11. Section 400.9979, Florida Statutes, is created 611 to read: 612 400.9979 Background screening; administration and 613 management.— 614 (1) The agency shall require level 2 background screening 615 for personnel as required in s. 408.809(1)(e) pursuant to 616 chapter 435 and s. 408.809. 617 (2) The licensee shall maintain personnel records for each 618 staff member which contain, at a minimum, documentation of 619 background screening, if applicable, a job description, 620 documentation of compliance with all training requirements of 621 this part or applicable rule, the employment application, 622 references, a copy of all job performance evaluations, and, for 623 each staff member who performs services for which licensure or 624 certification is required, a copy of all licenses or 625 certification held by the staff member. 626 (3) The licensee must: 627 (a) Develop and implement infection control policies and 628 procedures and include such policies and procedures in the 629 licensee’s policy manual. 630 (b) Maintain liability insurance as defined in s. 624.605. 631 (c) Designate one person as an administrator who is 632 responsible and accountable for the overall management of the 633 facility. 634 (d) Designate a person in writing to be responsible for the 635 facility when the administrator is absent from the facility for 636 more than 24 hours. 637 (e) Designate in writing a program director who is 638 responsible for supervising the therapeutic and behavioral 639 staff, determining the levels of supervision, and determining 640 room placement for each client. 641 (f) Designate in writing a person to be responsible when 642 the program director is absent from the facility for more than 643 24 hours. 644 (g) Obtain approval of the comprehensive emergency 645 management plan, pursuant to s. 400.9981(2)(e), from the local 646 emergency management agency. Pending the approval of the plan, 647 the local emergency management agency shall ensure that the 648 following agencies, at a minimum, are given the opportunity to 649 review the plan: the Department of Health, the Agency for Health 650 Care Administration, and the Division of Emergency Management. 651 Appropriate volunteer organizations must also be given the 652 opportunity to review the plan. The local emergency management 653 agency shall complete its review within 60 days and either 654 approve the plan or advise the licensee of necessary revisions. 655 (h) Maintain written records in a form and system that 656 comply with medical and business practices and make such records 657 available in the facility for review or submission to the agency 658 upon request. The records shall include: 659 1. A daily census record that indicates the number of 660 clients currently receiving services in the facility, including 661 information regarding any public funding of such clients. 662 2. A record of all accidents or unusual incidents involving 663 any client or staff member that caused, or had the potential to 664 cause, injury or harm to any person or property within the 665 facility. Such records must contain a clear description of each 666 accident or incident, the names of the persons involved, a 667 description of all medical or other services provided to these 668 persons specifying who provided such services, and the steps 669 taken to prevent recurrence of such accidents or incidents. 670 3. A copy of current agreements with third-party providers. 671 4. A copy of current agreements with each consultant 672 employed by the licensee and documentation of each consultant’s 673 visits and required written, dated reports. 674 Section 12. Section 400.9980, Florida Statutes, is created 675 to read: 676 400.9980 Property and personal affairs of clients.— 677 (1) A client shall be given the option of using his or her 678 own belongings, as space permits; choosing his or her roommate 679 if practical and not clinically contraindicated; and, whenever 680 possible, unless the client is adjudicated incompetent or 681 incapacitated under state law, managing his or her own affairs. 682 (2) The admission of a client to a facility and his or her 683 presence therein shall not confer on a licensee, administrator, 684 employee, or representative thereof any authority to manage, 685 use, or dispose of any property of the client, nor shall such 686 admission or presence confer on any of such persons any 687 authority or responsibility for the personal affairs of the 688 client except that which may be necessary for the safe 689 management of the facility or for the safety of the client. 690 (3) A licensee, administrator, employee, or representative 691 thereof may: 692 (a) Not act as the guardian, trustee, or conservator for 693 any client or any of such client’s property. 694 (b) Act as a competent client’s payee for social security, 695 veteran’s, or railroad benefits if the client provides consent 696 and the licensee files a surety bond with the agency in an 697 amount equal to twice the average monthly aggregate income or 698 personal funds due to the client, or expendable for the client’s 699 account, that are received by a licensee. 700 (c) Act as the power of attorney for a client if the 701 licensee has filed a surety bond with the agency in an amount 702 equal to twice the average monthly income of the client, plus 703 the value of any client’s property under the control of the 704 attorney in fact. 705 706 The bond under paragraph (b) or paragraph (c) shall be executed 707 by the licensee as principal and a licensed surety company. The 708 bond shall be conditioned upon the faithful compliance of the 709 licensee with the requirements of licensure and shall be payable 710 to the agency for the benefit of any client who suffers a 711 financial loss as a result of the misuse or misappropriation of 712 funds held pursuant to this subsection. Any surety company that 713 cancels or does not renew the bond of any licensee shall notify 714 the agency in writing not less than 30 days in advance of such 715 action, giving the reason for the cancellation or nonrenewal. 716 Any licensee, administrator, employee, or representative thereof 717 who is granted power of attorney for any client of the facility 718 shall, on a monthly basis, notify the client in writing of any 719 transaction made on behalf of the client pursuant to this 720 subsection, and a copy of such notification given to the client 721 shall be retained in each client’s file and available for agency 722 inspection. 723 (4) A licensee, upon mutual consent with the client, shall 724 provide for the safekeeping in the facility of the client’s 725 personal effects of a value not in excess of $1,000 and the 726 client’s funds not in excess of $500 cash and shall keep 727 complete and accurate records of all such funds and personal 728 effects received. If a client is absent from a facility for 24 729 hours or more, the licensee may provide for the safekeeping of 730 the client’s personal effects of a value in excess of $1,000. 731 (5) Any funds or other property belonging to or due to a 732 client or expendable for his or her account that is received by 733 licensee shall be trust funds and shall be kept separate from 734 the funds and property of the licensee and other clients or 735 shall be specifically credited to such client. Such trust funds 736 shall be used or otherwise expended only for the account of the 737 client. At least once every month, unless upon order of a court 738 of competent jurisdiction, the licensee shall furnish the client 739 and the client’s representative a complete and verified 740 statement of all funds and other property to which this 741 subsection applies, detailing the amount and items received, 742 together with their sources and disposition. In any event, the 743 licensee shall furnish such statement annually and upon the 744 discharge or transfer of a client. Any governmental agency or 745 private charitable agency contributing funds or other property 746 to the account of a client shall also be entitled to receive 747 such statement monthly and upon the discharge or transfer of the 748 client. 749 (6)(a) In addition to any damages or civil penalties to 750 which a person is subject, any person who: 751 1. Intentionally withholds a client’s personal funds, 752 personal property, or personal needs allowance, or who demands, 753 beneficially receives, or contracts for payment of all or any 754 part of a client’s personal property or personal needs allowance 755 in satisfaction of the facility rate for supplies and services; 756 or 757 2. Borrows from or pledges any personal funds of a client, 758 other than the amount agreed to by written contract under s. 759 429.24, 760 761 commits a misdemeanor of the first degree, punishable as 762 provided in s. 775.082 or s. 775.083. 763 (b) Any licensee, administrator, employee, or 764 representative thereof who is granted power of attorney for any 765 client of the facility and who misuses or misappropriates funds 766 obtained through this power commits a felony of the third 767 degree, punishable as provided in s. 775.082, s. 775.083, or s. 768 775.084. 769 (7) In the event of the death of a client, a licensee shall 770 return all refunds, funds, and property held in trust to the 771 client’s personal representative, if one has been appointed at 772 the time the licensee disburses such funds, or, if not, to the 773 client’s spouse or adult next of kin named in a beneficiary 774 designation form provided by the licensee to the client. If the 775 client has no spouse or adult next of kin or such person cannot 776 be located, funds due the client shall be placed in an interest 777 bearing account and all property held in trust by the licensee 778 shall be safeguarded until such time as the funds and property 779 are disbursed pursuant to the Florida Probate Code. Such funds 780 shall be kept separate from the funds and property of the 781 licensee and other clients of the facility. If the funds of the 782 deceased client are not disbursed pursuant to the Florida 783 Probate Code within 2 years after the client’s death, the funds 784 shall be deposited in the Health Care Trust Fund administered by 785 the agency. 786 (8) The agency, by rule, may clarify terms and specify 787 procedures and documentation necessary to administer the 788 provisions of this section relating to the proper management of 789 clients’ funds and personal property and the execution of surety 790 bonds. 791 Section 13. Section 400.9981, Florida Statutes, is created 792 to read: 793 400.9981 Rules establishing standards.— 794 (1) It is the intent of the Legislature that rules 795 published and enforced pursuant to this part and part II of 796 chapter 408 include criteria to ensure reasonable and consistent 797 quality of care and client safety. Rules should make reasonable 798 efforts to accommodate the needs and preferences of clients to 799 enhance the quality of life in transitional living facilities. 800 (2) The agency may adopt and enforce rules to implement 801 this part and part II of chapter 408, which shall include 802 reasonable and fair criteria in relation to the following: 803 (a) The location of transitional living facilities. 804 (b) The number of qualifications of all personnel, 805 including management, medical, nursing, and other professional 806 personnel and nursing assistants and support personnel having 807 responsibility for any part of the care given to clients. The 808 licensee must have enough qualified professional staff available 809 to carry out and monitor the various professional interventions 810 in accordance with the stated goals and objectives of each 811 comprehensive treatment plan. 812 (c) Requirements for personnel procedures, reporting 813 procedures, and documentation necessary to implement this part. 814 (d) Services provided to clients of transitional living 815 facilities. 816 (e) The preparation and annual update of a comprehensive 817 emergency management plan in consultation with the Division of 818 Emergency Management. At a minimum, the rules must provide for 819 plan components that address emergency evacuation 820 transportation; adequate sheltering arrangements; postdisaster 821 activities, including provision of emergency power, food, and 822 water; postdisaster transportation; supplies; staffing; 823 emergency equipment; individual identification of clients and 824 transfer of records; communication with families; and responses 825 to family inquiries. 826 Section 14. Section 400.9982, Florida Statutes, is created 827 to read: 828 400.9982 Violations; penalties.— 829 (1) Each violation of this part and rules adopted pursuant 830 thereto shall be classified according to the nature of the 831 violation and the gravity of its probable effect on facility 832 clients. The agency shall indicate the classification on the 833 written notice of the violation as follows: 834 (a) Class “I” violations are defined in s. 408.813. The 835 agency shall issue a citation regardless of correction and 836 impose an administrative fine of $5,000 for an isolated 837 violation, $7,500 for a patterned violation, and $10,000 for a 838 widespread violation. Violations may be identified and a fine 839 must be levied notwithstanding the correction of the deficiency 840 giving rise to the violation. 841 (b) Class “II” violations are defined in s. 408.813. The 842 agency shall impose an administrative fine of $1,000 for an 843 isolated violation, $2,500 for a patterned violation, and $5,000 844 for a widespread violation. A fine must be levied 845 notwithstanding the correction of the deficiency giving rise to 846 the violation. 847 (c) Class “III” violations are defined in s. 408.813. The 848 agency shall impose an administrative fine of $500 for an 849 isolated violation, $750 for a patterned violation, and $1,000 850 for a widespread violation. If a deficiency giving rise to a 851 class “III” violation is corrected within the time specified by 852 the agency, a fine may not be imposed. 853 (d) Class “IV” violations are defined in s. 408.813. The 854 agency shall impose an administrative fine for a cited class IV 855 violation in an amount not less than $100 and not exceeding $200 856 for each violation. If a deficiency giving rise to a class “IV” 857 violation is corrected within the time specified by the agency, 858 a fine may not be imposed. 859 Section 15. Section 400.9983, Florida Statutes, is created 860 to read: 861 400.9983 Receivership proceedings.—The agency may apply s. 862 429.22 with regard to receivership proceedings for transitional 863 living facilities. 864 Section 16. Section 400.9984, Florida Statutes, is created 865 to read: 866 400.9984 Interagency communication.—The agency, the 867 department, the Agency for Persons with Disabilities, and the 868 Department of Children and Families shall develop electronic 869 systems to ensure that relevant information pertaining to the 870 regulation of transitional living facilities and clients is 871 timely and effectively communicated among agencies in order to 872 facilitate the protection of clients. Electronic sharing of 873 information shall include, at a minimum, a brain and spinal cord 874 injury registry and a client abuse registry. 875 Section 17. Section 400.805, Florida Statutes, is repealed. 876 Every transitional living facility licensed under s. 400.805 on 877 or before July 1, 2013, shall be licensed under the provisions 878 of this act. 879 Section 18. Subsection (9) of section 381.745, Florida 880 Statutes, is amended to read: 881 381.745 Definitions; ss. 381.739-381.79.—As used in ss. 882 381.739-381.79, the term: 883 (9) “Transitional living facility,” for the purpose of this 884 part, means a state-approved facility, as defined and licensed 885 under chapter 400or chapter 429, or a facility approved by the886brain and spinal cord injury program in accordance with this887chapter. 888 Section 19. Section 381.75, Florida Statutes, is amended to 889 read: 890 381.75 Duties and responsibilities of the department, of891transitional living facilities, and of residents.—Consistent 892 with the mandate of s. 381.7395, the department shall develop 893 and administer a multilevel treatment program for individuals 894 who sustain brain or spinal cord injuries and who are referred 895 to the brain and spinal cord injury program. 896 (1) Within 15 days after any report of an individual who 897 has sustained a brain or spinal cord injury, the department 898 shall notify the individual or the most immediate available 899 family members of their right to assistance from the state, the 900 services available, and the eligibility requirements. 901 (2) The department shall refer individuals who have brain 902 or spinal cord injuries to other state agencies to assure that 903 rehabilitative services, if desired, are obtained by that 904 individual. 905 (3) The department, in consultation with emergency medical 906 service, shall develop standards for an emergency medical 907 evacuation system that will ensure that all individuals who 908 sustain traumatic brain or spinal cord injuries are transported 909 to a department-approved trauma center that meets the standards 910 and criteria established by the emergency medical service and 911 the acute-care standards of the brain and spinal cord injury 912 program. 913 (4) The department shall develop standards for designation 914 of rehabilitation centers to provide rehabilitation services for 915 individuals who have brain or spinal cord injuries. 916 (5) The department shall determine the appropriate number 917 of designated acute-care facilities, inpatient rehabilitation 918 centers, and outpatient rehabilitation centers, needed based on 919 incidence, volume of admissions, and other appropriate criteria. 920 (6) The department shall develop standards for designation 921 of transitional living facilities to provide transitional living 922 services for individuals who participate in the brain and spinal 923 cord injury programthe opportunity to adjust to their924disabilities and to develop physical and functional skills in a925supported living environment. 926(a) The Agency for Health Care Administration, in927consultation with the department, shall develop rules for the928licensure of transitional living facilities for individuals who929have brain or spinal cord injuries.930(b) The goal of a transitional living program for931individuals who have brain or spinal cord injuries is to assist932each individual who has such a disability to achieve a higher933level of independent functioning and to enable that person to934reenter the community. The program shall be focused on preparing935participants to return to community living.936(c) A transitional living facility for an individual who937has a brain or spinal cord injury shall provide to such938individual, in a residential setting, a goal-oriented treatment939program designed to improve the individual’s physical,940cognitive, communicative, behavioral, psychological, and social941functioning, as well as to provide necessary support and942supervision. A transitional living facility shall offer at least943the following therapies: physical, occupational, speech,944neuropsychology, independent living skills training, behavior945analysis for programs serving brain-injured individuals, health946education, and recreation.947(d) All residents shall use the transitional living948facility as a temporary measure and not as a permanent home or949domicile. The transitional living facility shall develop an950initial treatment plan for each resident within 3 days after the951resident’s admission. The transitional living facility shall952develop a comprehensive plan of treatment and a discharge plan953for each resident as soon as practical, but no later than 30954days after the resident’s admission. Each comprehensive955treatment plan and discharge plan must be reviewed and updated956as necessary, but no less often than quarterly. This subsection957does not require the discharge of an individual who continues to958require any of the specialized services described in paragraph959(c) or who is making measurable progress in accordance with that960individual’s comprehensive treatment plan. The transitional961living facility shall discharge any individual who has an962appropriate discharge site and who has achieved the goals of his963or her discharge plan or who is no longer making progress toward964the goals established in the comprehensive treatment plan and965the discharge plan. The discharge location must be the least966restrictive environment in which an individual’s health, well967being, and safety is preserved.968(7) Recipients of services, under this section, from any of969the facilities referred to in this section shall pay a fee based970on ability to pay.971 Section 20. Subsection (4) of section 381.78, Florida 972 Statutes, is amended to read: 973 381.78 Advisory council on brain and spinal cord injuries.— 974 (4) The council shall:975(a)provide advice and expertise to the department in the 976 preparation, implementation, and periodic review of the brain 977 and spinal cord injury program. 978(b) Annually appoint a five-member committee composed of979one individual who has a brain injury or has a family member980with a brain injury, one individual who has a spinal cord injury981or has a family member with a spinal cord injury, and three982members who shall be chosen from among these representative983groups: physicians, other allied health professionals,984administrators of brain and spinal cord injury programs, and985representatives from support groups with expertise in areas986related to the rehabilitation of individuals who have brain or987spinal cord injuries, except that one and only one member of the988committee shall be an administrator of a transitional living989facility. Membership on the council is not a prerequisite for990membership on this committee.9911. The committee shall perform onsite visits to those992transitional living facilities identified by the Agency for993Health Care Administration as being in possible violation of the994statutes and rules regulating such facilities. The committee995members have the same rights of entry and inspection granted996under s.400.805(4) to designated representatives of the agency.9972. Factual findings of the committee resulting from an998onsite investigation of a facility pursuant to subparagraph 1.999shall be adopted by the agency in developing its administrative1000response regarding enforcement of statutes and rules regulating1001the operation of the facility.10023. Onsite investigations by the committee shall be funded1003by the Health Care Trust Fund.10044. Travel expenses for committee members shall be1005reimbursed in accordance with s.112.061.10065. Members of the committee shall recuse themselves from1007participating in any investigation that would create a conflict1008of interest under state law, and the council shall replace the1009member, either temporarily or permanently.1010 Section 21. Subsection (21) of section 408.802, Florida 1011 Statutes, is amended to read: 1012 408.802 Applicability.—The provisions of this part apply to 1013 the provision of services that require licensure as defined in 1014 this part and to the following entities licensed, registered, or 1015 certified by the agency, as described in chapters 112, 383, 390, 1016 394, 395, 400, 429, 440, 483, and 765: 1017 (21) Transitional living facilities, as provided under part 1018 XIVof chapter 400. 1019 Section 22. Subsection (20) of section 408.820, Florida 1020 Statutes, is amended to read: 1021 408.820 Exemptions.—Except as prescribed in authorizing 1022 statutes, the following exemptions shall apply to specified 1023 requirements of this part: 1024 (20) Transitional living facilities, as provided under part 1025 XIVof chapter 400, are exempt from s. 408.810(10). 1026 Section 23. Subsection (5) of section 400.93, Florida 1027 Statutes, is amended to read: 1028 400.93 Licensure required; exemptions; unlawful acts; 1029 penalties.— 1030 (5) The following are exempt from home medical equipment 1031 provider licensure, unless they have a separate company, 1032 corporation, or division that is in the business of providing 1033 home medical equipment and services for sale or rent to 1034 consumers at their regular or temporary place of residence 1035 pursuant to the provisions of this part: 1036 (a) Providers operated by the Department of Health or 1037 Federal Government. 1038 (b) Nursing homes licensed under part II. 1039 (c) Assisted living facilities licensed under chapter 429, 1040 when serving their residents. 1041 (d) Home health agencies licensed under part III. 1042 (e) Hospices licensed under part IV. 1043 (f) Intermediate care facilities, homes for special 1044 services, and transitional living facilities licensed under part 1045 V. 1046 (g) Transitional living facilities licensed under part XI. 1047 (h)(g)Hospitals and ambulatory surgical centers licensed 1048 under chapter 395. 1049 (i)(h)Manufacturers and wholesale distributors when not 1050 selling directly to consumers. 1051 (j)(i)Licensed health care practitioners who utilize home 1052 medical equipment in the course of their practice, but do not 1053 sell or rent home medical equipment to their patients. 1054 (k)(j)Pharmacies licensed under chapter 465. 1055 Section 24. Paragraph (l) of subsection (4) of section 1056 400.9905, Florida Statutes, is amended to read: 1057 400.9905 Definitions.— 1058 (4) “Clinic” means an entity where health care services are 1059 provided to individuals and which tenders charges for 1060 reimbursement for such services, including a mobile clinic and a 1061 portable equipment provider. As used in this part, the term does 1062 not include and the licensure requirements of this part do not 1063 apply to: 1064 (l) Orthotic,orprosthetic, pediatric cardiology, or 1065 perinatology clinical facilities or anesthesia clinical 1066 facilities that are not otherwise exempt under paragraph (a) or 1067 paragraph (k) and that are a publicly traded corporation orthat1068 are wholly owned, directly or indirectly, by a publicly traded 1069 corporation. As used in this paragraph, a publicly traded 1070 corporation is a corporation that issues securities traded on an 1071 exchange registered with the United States Securities and 1072 Exchange Commission as a national securities exchange. 1073 1074 Notwithstanding this subsection, an entity shall be deemed a 1075 clinic and must be licensed under this part in order to receive 1076 reimbursement under the Florida Motor Vehicle No-Fault Law, ss. 1077 627.730-627.7405, unless exempted under s. 627.736(5)(h). 1078 Section 25. This act shall take effect July 1, 2013.