Bill Text: FL S1816 | 2010 | Regular Session | Introduced
Bill Title: Assisted Living Facilities [SPSC]
Spectrum: Unknown
Status: (Failed) 2010-04-30 - Died in Messages, companion bill(s) passed, see CS/CS/SB 1412 (Ch. 2010-102) [S1816 Detail]
Download: Florida-2010-S1816-Introduced.html
Florida Senate - 2010 SB 1816 By the Committee on Health Regulation 588-02055B-10 20101816__ 1 A bill to be entitled 2 An act relating to assisted living facilities; 3 amending s. 429.07, F.S.; deleting the requirement for 4 an assisted living facility to obtain an additional 5 license in order to provide limited nursing services; 6 deleting the requirement for the Agency for Health 7 Care Administration to conduct quarterly monitoring 8 visits of facilities that hold a license to provide 9 extended congregate care services; deleting the 10 requirement for the Department of Elderly Affairs to 11 report annually on the status of and recommendations 12 related to extended congregate care; deleting the 13 requirement for the Agency for Health Care 14 Administration to conduct monitoring visits at least 15 twice a year to facilities providing limited nursing 16 services; increasing the licensure fees and the 17 maximum fee required for the standard license; 18 increasing the licensure fees for the extended 19 congregate care license; eliminating the license fee 20 for the limited nursing services license; transferring 21 from another provision of law the requirement that a 22 biennial survey of an assisted living facility include 23 specific actions to determine whether the facility is 24 adequately protecting residents’ rights; providing 25 that an assisted living facility that has a class I 26 violation or a class II violation is subject to 27 monitoring visits; requiring a registered nurse to 28 participate in certain monitoring visits; amending s. 29 429.17, F.S.; deleting provisions related to the 30 limited nursing services license; amending s. 429.19, 31 F.S.; clarifying that a monitoring fee may be assessed 32 in addition to an administrative fine; amending s. 33 429.255, F.S.; eliminating provisions authorizing the 34 use of volunteers to provide certain health-care 35 related services in assisted living facilities; 36 authorizing assisted living facilities to provide 37 limited nursing services; requiring an assisted living 38 facility to be responsible for certain recordkeeping 39 and staff to be trained to monitor residents receiving 40 certain health-care-related services; repealing s. 41 429.28(3), F.S., relating to a requirement for a 42 biennial survey of an assisted living facility, to 43 conform to changes made by the act; amending s. 44 429.41, F.S., relating to rulemaking; conforming 45 provisions to changes made by the act; amending s. 46 429.54, F.S.; requiring licensed assisted living 47 facilities to electronically report certain data 48 semiannually to the Agency for Health Care 49 Administration in accordance with rules adopted by the 50 Department of Elderly Affairs; providing an effective 51 date. 52 53 Be It Enacted by the Legislature of the State of Florida: 54 55 Section 1. Subsections (3) and (4) of section 429.07, 56 Florida Statutes, are amended, and subsections (6) and (7) are 57 added to that section, to read: 58 429.07 License required; fee; inspections.— 59 (3) In addition to the requirements of s. 408.806, each 60 license granted by the agency must state the type of care for 61 which the license is granted. Licenses shall be issued for one 62 or more of the following categories of care: standard, extended 63 congregate care,limited nursing services,or limited mental 64 health. 65 (a) A standard license shall be issued to a facility 66facilitiesproviding one or more of the personal services 67 identified in s. 429.02. Such licenseefacilitiesmay also 68 employ or contract with a personlicensed under part I of69chapter 464toadminister medications andperform other tasks as 70 specified in s. 429.255. 71 (b) An extended congregate care license shall be issued to 72 a licenseefacilitiesproviding, directly or through contract, 73 services beyond those authorized in paragraph (a), including 74 acts performed pursuant to part I of chapter 464 by persons 75 licensed thereunder, and supportive services defined by rule to 76 persons who otherwise would be disqualified from continued 77 residence in a facility licensed under this part. 78 1. In order for extended congregate care services to be 79 provided in a facility licensed under this part, the agency must 80 first determine that all requirements established in law and 81 rule are met and must specifically designate, on thefacility’s82 license, that such services may be provided and whether the 83 designation applies to all or part of a facility. Such 84 designation may be made at the time of initial licensure or 85 relicensure, or upon request in writing by a licensee under this 86 part and part II of chapter 408. Notification of approval or 87 denial of such request shall be made in accordance with part II 88 of chapter 408. An existing licenseefacilitiesqualifying to 89 provide extended congregate care services must have maintained a 90 standard license andmaynot have been subject to administrative 91 sanctions during the previous 2 years, or since initial 92 licensure ifthe facility has beenlicensed for less than 2 93 years, for any of the following reasons: 94 a. A class I or class II violation; 95 b. Three or more repeat or recurring class III violations 96 of identical or similar resident care standards as specified in 97 rule from which a pattern of noncompliance is found by the 98 agency; 99 c. Three or more class III violations that were not 100 corrected in accordance with the corrective action plan approved 101 by the agency; 102 d. Violation of resident care standards resulting in a 103 requirement to employ the services of a consultant pharmacist or 104 consultant dietitian; 105 e. Denial, suspension, or revocation of a license for 106 another facility under this part in which the applicant for an 107 extended congregate care license has at least 25 percent 108 ownership interest; or 109 f. Imposition of a moratorium pursuant tothis part orpart 110 II of chapter 408 or initiation of injunctive proceedings. 111 2. A licenseeFacilitiesthat isarelicensed to provide 112 extended congregate care services shall maintain a written 113 progress report foroneach person who receives such services, 114 and thewhichreport must describedescribesthe type, amount, 115 duration, scope, and outcome of services that are rendered and 116 the general status of the resident’s health.A registered nurse,117or appropriate designee, representing the agency shall visit118such facilities at least quarterly to monitor residents who are119receiving extended congregate care services and to determine if120the facility is in compliance with this part, part II of chapter121408, and rules that relate to extended congregate care. One of122these visits may be in conjunction with the regular survey. The123monitoring visits may be provided through contractual124arrangements with appropriate community agencies. A registered125nurse shall serve as part of the team that inspects such126facility. The agency may waive one of the required yearly127monitoring visits for a facility that has been licensed for at128least 24 months to provide extended congregate care services,129if, during the inspection, the registered nurse determines that130extended congregate care services are being provided131appropriately, and if the facility has no class I or class II132violations and no uncorrected class III violations. Before such133decision is made, the agency shall consult with the long-term134care ombudsman council for the area in which the facility is135located to determine if any complaints have been made and136substantiated about the quality of services or care. The agency137may not waive one of the required yearly monitoring visits if138complaints have been made and substantiated.139 3. LicenseesFacilitiesthat are licensed to provide 140 extended congregate care services shall: 141 a. Demonstrate the capability to meet unanticipated 142 resident service needs. 143 b. Offer a physical environment that promotes a homelike 144 setting, provides for resident privacy, promotes resident 145 independence, and allows sufficient congregate space as defined 146 by rule. 147 c. Have sufficient staff available, taking into account the 148 physical plant and firesafety features of the building, to 149 assist with the evacuation of residents in an emergency, as150necessary. 151 d. Adopt and follow policies and procedures that maximize 152 resident independence, dignity, choice, and decisionmaking to 153 permit residents to age in place to the extent possible, so that 154 moves due to changes in functional status are minimized or 155 avoided. 156 e. Allow residents or, if applicable, a resident’s 157 representative, designee, surrogate, guardian, or attorney in 158 fact to make a variety of personal choices, participate in 159 developing service plans, and share responsibility in 160 decisionmaking. 161 f. Implement the concept of managed risk. 162 g. Provide, either directly or through contract, the 163 services of a person licensed pursuant to part I of chapter 464. 164 h. In addition to the training mandated in s. 429.52, 165 provide specialized training as defined by rule for facility 166 staff. 167 4. LicenseesFacilitieslicensed to provide extended 168 congregate care services are exempt from the criteria for 169 continued residency as set forth in rules adopted under s. 170 429.41. LicenseesFacilities so licensedshall adopt their own 171 requirements within guidelines for continued residency set forth 172 by rule. However, such licenseesfacilitiesmay not serve 173 residents who require 24-hour nursing supervision. Licensees 174Facilitieslicensed to provide extended congregate care services 175 shall provide each resident with a written copy of facility 176 policies governing admission and retention. 177 5. The primary purpose of extended congregate care services 178 is to allow residents, as they become more impaired, the option 179 of remaining in a familiar setting from which they would 180 otherwise be disqualified for continued residency. A licensee 181facilitylicensed to provide extended congregate care services 182 may also admit an individual who exceeds the admission criteria 183 for a facility with a standard license, if the individual is 184 determined appropriate for admission to the extended congregate 185 care facility. 186 6. Before admission of an individual to a facility licensed 187 to provide extended congregate care services, the individual 188 must undergo a medical examination as provided in s. 429.26(4) 189 and the facility must develop a preliminary service plan for the 190 individual. 191 7. When a licenseefacilitycan no longer provide or 192 arrange for services in accordance with the resident’s service 193 plan and needs and the licensee’sfacility’spolicy, the 194 licenseefacilityshall make arrangements for relocating the 195 person in accordance with s. 429.28(1)(k). 196 8. Failure to provide extended congregate care services may 197 result in denial of extended congregate care license renewal. 1989.No later than January 1 of each year, the department, in199consultation with the agency, shall prepare and submit to the200Governor, the President of the Senate, the Speaker of the House201of Representatives, and the chairs of appropriate legislative202committees, a report on the status of, and recommendations203related to, extended congregate care services. The status report204must include, but need not be limited to, the following205information:206a.A description of the facilities licensed to provide such207services, including total number of beds licensed under this208part.209b.The number and characteristics of residents receiving210such services.211c.The types of services rendered that could not be212provided through a standard license.213d.An analysis of deficiencies cited during licensure214inspections.215e.The number of residents who required extended congregate216care services at admission and the source of admission.217f.Recommendations for statutory or regulatory changes.218g.The availability of extended congregate care to state219clients residing in facilities licensed under this part and in220need of additional services, and recommendations for221appropriations to subsidize extended congregate care services222for such persons.223h.Such other information as the department considers224appropriate.225(c)A limited nursing services license shall be issued to a226facility that provides services beyond those authorized in227paragraph (a) and as specified in this paragraph.2281.In order for limited nursing services to be provided in229a facility licensed under this part, the agency must first230determine that all requirements established in law and rule are231met and must specifically designate, on the facility’s license,232that such services may be provided. Such designation may be made233at the time of initial licensure or relicensure, or upon request234in writing by a licensee under this part and part II of chapter235408. Notification of approval or denial of such request shall be236made in accordance with part II of chapter 408. Existing237facilities qualifying to provide limited nursing services shall238have maintained a standard license and may not have been subject239to administrative sanctions that affect the health, safety, and240welfare of residents for the previous 2 years or since initial241licensure if the facility has been licensed for less than 2242years.2432.Facilities that are licensed to provide limited nursing244services shall maintain a written progress report on each person245who receives such nursing services, which report describes the246type, amount, duration, scope, and outcome of services that are247rendered and the general status of the resident’s health. A248registered nurse representing the agency shall visit such249facilities at least twice a year to monitor residents who are250receiving limited nursing services and to determine if the251facility is in compliance with applicable provisions of this252part, part II of chapter 408, and related rules. The monitoring253visits may be provided through contractual arrangements with254appropriate community agencies. A registered nurse shall also255serve as part of the team that inspects such facility.2563.A person who receives limited nursing services under257this part must meet the admission criteria established by the258agency for assisted living facilities. When a resident no longer259meets the admission criteria for a facility licensed under this260part, arrangements for relocating the person shall be made in261accordance with s.429.28(1)(k), unless the facility is licensed262to provide extended congregate care services.263 (4) In accordance with s. 408.805, an applicant or licensee 264 shall pay a fee for each license application submitted under 265 this part, part II of chapter 408, and applicable rules. The 266 amount of the fee shall be established by rule. 267 (a) The biennial license fee required of a facility is $356 268$300per license, with an additional fee of $67.50$50per 269 resident based on the total licensed resident capacity of the 270 facility, except that no additional fee will be assessed for 271 beds designated for recipients of optional state supplementation 272 payments provided for in s. 409.212. The total fee may not 273 exceed $18,500$10,000. 274 (b) In addition to the total fee assessed under paragraph 275 (a), the agency shall require facilities that are licensed to 276 provide extended congregate care services under this part to pay 277 an additional fee per licensed facility. The amount of the 278 biennial fee shall be $501$400per license, with an additional 279 fee of $10 per resident based on the total licensed resident 280 capacity of the facility. 281(c)In addition to the total fee assessed under paragraph282(a), the agency shall require facilities that are licensed to283provide limited nursing services under this part to pay an284additional fee per licensed facility. The amount of the biennial285fee shall be $250 per license, with an additional fee of $10 per286resident based on the total licensed resident capacity of the287facility.288 (6) In order to determine whether the licensee is 289 adequately protecting residents’ rights as provided in s. 290 429.28, the biennial survey shall include private informal 291 conversations with a sample of residents and consultation with 292 the ombudsman council in the planning and service area in which 293 the facility is located to discuss residents’ experiences within 294 the facility. 295 (7) An assisted living facility that has been cited within 296 the previous 24-month period for a class I violation or a class 297 II violation, regardless of the status of any enforcement or 298 disciplinary action, is subject to periodic unannounced 299 monitoring to determine if the facility is in compliance with 300 this part, part II of chapter 408, and applicable rules. 301 Monitoring may occur through a desk review or onsite. If a cited 302 violation relates to providing or failing to provide nursing 303 care, a registered nurse must participate in at least two onsite 304 monitoring visits within a 12-month period. 305 Section 2. Subsections (1) and (5) of section 429.17, 306 Florida Statutes, are amended to read: 307 429.17 Expiration of license; renewal; conditional 308 license.— 309 (1)Limited nursing,Extended congregate care,and limited 310 mental health licenses shall expire at the same time as the 311 facility’s standard license, regardless of when issued. 312 (5) When an extended congregate careor limited nursing313 license is requested during a facility’s biennial license 314 period, the fee shall be prorated in order to permit the 315 additional license to expire at the end of the biennial license 316 period. The fee shall be calculated as of the date the 317 additional license application is received by the agency. 318 Section 3. Subsection (7) of section 429.19, Florida 319 Statutes, is amended to read: 320 429.19 Violations; imposition of administrative fines; 321 grounds.— 322 (7) In addition to any administrative fines imposed, the 323 agency may assess a survey or monitoring fee, equal to the 324 lesser of one half of the facility’s biennial license and bed 325 fee or $500, to cover the cost of conducting initial complaint 326 investigations that result in the finding of a violation that 327 was the subject of the complaint or monitoring visitsconducted328under s.429.28(3)(c)to verify the correction of the 329 violations, or to monitor the health, safety, or security of 330 residents under s. 429.07(7). 331 Section 4. Section 429.255, Florida Statutes, is amended to 332 read: 333 429.255 Use of personnel; emergency care.— 334 (1)(a) Persons under contract to the facility or,facility 335 staff, or volunteers,who are licensed according to part I of 336 chapter 464,orthose persons exempt under s. 464.022(1), and 337 others as defined by rule, may administer medications to 338 residents, take residents’ vital signs, manage individual weekly 339 pill organizers for residents who self-administer medication, 340 give prepackaged enemas ordered by a physician, observe 341 residents, document observations on the appropriate resident’s 342 record, report observations to the resident’s physician, and 343 contract or allow residents or a resident’s representative, 344 designee, surrogate, guardian, or attorney in fact to contract 345 with a third party, provided residents meet the criteria for 346 appropriate placement as defined in s. 429.26. Persons under 347 contract to the facility or facility staff who are licensed 348 according to part I of chapter 464 may provide limited nursing 349 services. Nursing assistants certified pursuant to part II of 350 chapter 464 may take residents’ vital signs as directed by a 351 licensed nurse or physician. The licensee is responsible for 352 maintaining documentation of services provided under this 353 paragraph as required by rule and ensuring that staff are 354 adequately trained to monitor residents receiving these 355 services. 356 (b) All staff in facilities licensed under this part shall 357 exercise their professional responsibility to observe residents, 358 to document observations on the appropriate resident’s record, 359 and to report the observations to the resident’s physician. 360 However, the owner or administrator of the facility shall be 361 responsible for determining that the resident receiving services 362 is appropriate for residence in the facility. 363 (c) In an emergency situation, licensed personnel may carry 364 out their professional duties pursuant to part I of chapter 464 365 until emergency medical personnel assume responsibility for 366 care. 367 (2) In facilities licensed to provide extended congregate 368 care, persons under contract to the facility or,facility staff,369or volunteers,who are licensed according to part I of chapter 370 464,orthose persons exempt under s. 464.022(1), or those 371 persons certified as nursing assistants pursuant to part II of 372 chapter 464, may also perform all duties within the scope of 373 their license or certification, as approved by the facility 374 administrator and pursuant to this part. 375 (3) Facility staff may withhold or withdraw cardiopulmonary 376 resuscitation if presented with an order not to resuscitate 377 executed pursuant to s. 401.45. The department shall adopt rules 378 providing for the implementation of such orders. Facility staff 379 and facilities shall not be subject to criminal prosecution or 380 civil liability, nor be considered to have engaged in negligent 381 or unprofessional conduct, for withholding or withdrawing 382 cardiopulmonary resuscitation pursuant to such an order and 383 rules adopted by the department. The absence of an order to 384 resuscitate executed pursuant to s. 401.45 does not preclude a 385 physician from withholding or withdrawing cardiopulmonary 386 resuscitation as otherwise permitted by law. 387 Section 5. Subsection (3) of section 429.28, Florida 388 Statutes, is repealed. 389 Section 6. Paragraphs (i) and (j) of subsection (1) of 390 section 429.41, Florida Statutes, are amended to read: 391 429.41 Rules establishing standards.— 392 (1) It is the intent of the Legislature that rules 393 published and enforced pursuant to this section shall include 394 criteria by which a reasonable and consistent quality of 395 resident care and quality of life may be ensured and the results 396 of such resident care may be demonstrated. Such rules shall also 397 ensure a safe and sanitary environment that is residential and 398 noninstitutional in design or nature. It is further intended 399 that reasonable efforts be made to accommodate the needs and 400 preferences of residents to enhance the quality of life in a 401 facility. The agency, in consultation with the department, may 402 adopt rules to administer the requirements of part II of chapter 403 408. In order to provide safe and sanitary facilities and the 404 highest quality of resident care accommodating the needs and 405 preferences of residents, the department, in consultation with 406 the agency, the Department of Children and Family Services, and 407 the Department of Health, shall adopt rules, policies, and 408 procedures to administer this part, which must include 409 reasonable and fair minimum standards in relation to: 410 (i) Facilities holding ana limited nursing,extended 411 congregate care,or limited mental health license. 412 (j) The establishment of specific criteria to define 413 appropriateness of resident admission and continued residency in 414 a facility holding a standard,limited nursing,extended 415 congregate care, and limited mental health license. 416 Section 7. Section 429.54, Florida Statutes, is amended to 417 read: 418 429.54 Collection of information; local subsidy.— 419 (1) Facilities that are licensed under this part must 420 report electronically to the agency semiannually, or more 421 frequently as determined by rule, data related to the facility, 422 including, but not limited to: the total number of residents, 423 the number of residents who are receiving limited mental health 424 services, the number of residents who are receiving extended 425 congregate care services, the number of residents who are 426 receiving limited nursing services, funding sources of the 427 residents, and professional staffing employed by or under 428 contract with the licensee to provide resident services. The 429 department, in consultation with the agency, shall adopt rules 430 to administer this subsection. 431 (2)(1)To enable the department to collect the information 432 requested by the Legislature regarding the actual cost of 433 providing room, board, and personal care in facilities, the 434 department is authorized to conduct field visits and audits of 435 facilities as may be necessary. The owners of randomly sampled 436 facilities shall submit such reports, audits, and accountings of 437 cost as the department may require by rule; provided that such 438 reports, audits, and accountings shall be the minimum necessary 439 to implement the provisions of this section. Any facility 440 selected to participate in the study shall cooperate with the 441 department by providing cost of operation information to 442 interviewers. 443 (3)(2)Local governments or organizations may contribute to 444 the cost of care of local facility residents by further 445 subsidizing the rate of state-authorized payment to such 446 facilities. Implementation of local subsidy shall require 447 departmental approval and shall not result in reductions in the 448 state supplement. 449 Section 8. This act shall take effect July 1, 2010.