Bill Text: FL S7010 | 2013 | Regular Session | Introduced


Bill Title: Assisted Living Facilities

Spectrum: Committee Bill

Status: (N/A - Dead) 2013-02-06 - Submit as committee bill by Children, Families, and Elder Affairs (SB 646) [S7010 Detail]

Download: Florida-2013-S7010-Introduced.html
       Florida Senate - 2013         (PROPOSED COMMITTEE BILL) SPB 7010
       
       
       
       FOR CONSIDERATION By the Committee on Children, Families, and
       Elder Affairs
       
       
       
       586-00828B-13                                         20137010__
    1                        A bill to be entitled                      
    2         An act relating to assisted living facilities;
    3         amending s. 394.4574, F.S.; providing that Medicaid
    4         prepaid behavioral health plans are responsible for
    5         enrolled mental health residents; providing that
    6         managing entities under contract with the Department
    7         of Children and Families are responsible for mental
    8         health residents who are not enrolled with a Medicaid
    9         prepaid behavioral health plan; deleting a provision
   10         to conform to changes made by the act; requiring the
   11         community living support plan to be updated when there
   12         is a significant change to the mental health
   13         resident’s behavioral health; requiring the case
   14         manager assigned to a mental health resident of an
   15         assisted living facility that holds a limited mental
   16         health license to keep a record of the date and time
   17         of face-to-face interactions with the resident and to
   18         make the record available to the responsible entity
   19         for inspection; requiring that the record be
   20         maintained for a specified time; requiring the
   21         responsible entity to ensure that there is adequate
   22         and consistent monitoring and enforcement of community
   23         living support plans and cooperative agreements and
   24         that concerns are reported to the appropriate
   25         regulatory oversight organization under certain
   26         circumstances; amending s. 400.0074, F.S.; providing
   27         that an administrative assessment conducted by a local
   28         council be comprehensive in nature and focus on
   29         factors affecting the rights, health, safety, and
   30         welfare of the residents of a nursing home; requiring
   31         a local council to conduct an exit consultation with
   32         the facility administrator or administrator designee
   33         to discuss issues and concerns and make
   34         recommendations for improvement; amending s. 400.0078,
   35         F.S.; requiring that residents of long-term care
   36         facilities be informed about the confidentiality of
   37         the subject matter and identity of the complainant of
   38         a complaint received by the State Long-Term Care
   39         Ombudsman Program; amending s. 429.07, F.S.; providing
   40         that an extended congregate care license is issued to
   41         certain facilities that have been licensed as assisted
   42         living facilities under certain circumstances;
   43         providing the purpose of an extended congregate care
   44         license; providing that the initial extended
   45         congregate care license of an assisted living facility
   46         is provisional under certain circumstances; requiring
   47         the licensee to notify the Agency for Health Care
   48         Administration whenever it accepts a resident who
   49         qualifies for extended congregate care services;
   50         requiring the agency to inspect the facility for
   51         compliance with the requirements of an extended
   52         congregate care license; authorizing the agency to
   53         waive one of the required yearly monitoring visits
   54         under certain circumstances; authorizing the agency to
   55         deny or revoke a facility’s extended congregate care
   56         license for certain reasons or on certain grounds;
   57         requiring a registered nurse representing the agency
   58         to visit the facility at least annually, rather than
   59         twice a year, to monitor residents who are receiving
   60         limited nursing services; providing that the agency’s
   61         monitoring visits may be in conjunction with other
   62         agency inspections; authorizing the agency to waive
   63         one of the required yearly monitoring visits for
   64         certain facilities; amending s. 429.075, F.S.;
   65         requiring an assisted living facility that serves one
   66         or more mental health residents to obtain a limited
   67         mental health license; amending s. 429.14, F.S.;
   68         authorizing the agency to deny, revoke, or suspend a
   69         license of an assisted living facility for a negligent
   70         act of any facility staff which seriously affects the
   71         health, safety, or welfare of a resident; requiring
   72         the agency to deny or revoke the license of an
   73         assisted living facility under certain circumstances;
   74         requiring the agency to impose an immediate moratorium
   75         on the license of an assisted living facility under
   76         certain circumstances; deleting a provision requiring
   77         the agency to provide a list of facilities with
   78         denied, suspended, or revoked licenses to the
   79         Department of Business and Professional Regulation;
   80         amending s. 429.178, F.S.; conforming cross
   81         references; amending s. 429.19, F.S.; revising the
   82         amounts and uses of administrative fines; requiring
   83         the agency to levy a fine for violations that are
   84         corrected before an inspection if noncompliance
   85         occurred within a specified period of time; deleting
   86         factors that the agency is required to consider to
   87         determine penalties and fines; amending s. 429.28,
   88         F.S.; requiring residents of facilities to be informed
   89         about the confidentiality of the subject matter and
   90         identity of the resident and complainant of a
   91         complaint made to the State Long-Term Care Ombudsman
   92         Program; providing that a facility that terminates an
   93         individual’s residency is fined if good cause is not
   94         shown in court; amending s. 429.34, F.S.; requiring
   95         certain persons to report elder abuse in assisted
   96         living facilities; requiring the agency to regularly
   97         inspect every licensed assisted living facility;
   98         requiring the agency to conduct more frequent
   99         inspections under certain circumstances; requiring the
  100         licensee to pay a fee for the cost of additional
  101         inspections; requiring the agency to adjust the fee;
  102         amending s. 429.52, F.S.; requiring each newly hired
  103         employee of an assisted living facility to attend a
  104         preservice orientation provided by the assisted living
  105         facility; requiring the employee and administrator to
  106         sign an affidavit upon completion of the preservice
  107         orientation; requiring the assisted living facility to
  108         maintain the signed affidavit in each employee’s work
  109         file; conforming a cross-reference; requiring the
  110         Agency for Health Care Administration to study the
  111         reliability of facility surveys and submit to the
  112         Governor and the Legislature its findings and
  113         recommendations; requiring the agency to propose a
  114         rating system of assisted living facilities for
  115         consumers and create content for the agency’s website
  116         that makes available to consumers information
  117         regarding assisted living facilities; providing
  118         criteria for the content; providing an effective date.
  119  
  120  Be It Enacted by the Legislature of the State of Florida:
  121  
  122         Section 1. Section 394.4574, Florida Statutes, is amended
  123  to read:
  124         394.4574 Department Responsibilities for coordination of
  125  services for a mental health resident who resides in an assisted
  126  living facility that holds a limited mental health license.—
  127         (1) As used in this section, the term “mental health
  128  resident” “mental health resident,” for purposes of this
  129  section, means an individual who receives social security
  130  disability income due to a mental disorder as determined by the
  131  Social Security Administration or receives supplemental security
  132  income due to a mental disorder as determined by the Social
  133  Security Administration and receives optional state
  134  supplementation.
  135         (2) Medicaid prepaid behavioral health plans are
  136  responsible for enrolled mental health residents, and managing
  137  entities under contract with the department are responsible for
  138  mental health residents who are not enrolled with a Medicaid
  139  prepaid behavioral health plan. Each responsible entity shall
  140  The department must ensure that:
  141         (a) A mental health resident has been assessed by a
  142  psychiatrist, clinical psychologist, clinical social worker, or
  143  psychiatric nurse, or an individual who is supervised by one of
  144  these professionals, and determined to be appropriate to reside
  145  in an assisted living facility. The documentation must be
  146  provided to the administrator of the facility within 30 days
  147  after the mental health resident has been admitted to the
  148  facility. An evaluation completed upon discharge from a state
  149  mental hospital meets the requirements of this subsection
  150  related to appropriateness for placement as a mental health
  151  resident if it was completed within 90 days before prior to
  152  admission to the facility.
  153         (b) A cooperative agreement, as required in s. 429.075, is
  154  developed between the mental health care services provider that
  155  serves a mental health resident and the administrator of the
  156  assisted living facility with a limited mental health license in
  157  which the mental health resident is living. Any entity that
  158  provides Medicaid prepaid health plan services shall ensure the
  159  appropriate coordination of health care services with an
  160  assisted living facility in cases where a Medicaid recipient is
  161  both a member of the entity’s prepaid health plan and a resident
  162  of the assisted living facility. If the entity is at risk for
  163  Medicaid targeted case management and behavioral health
  164  services, the entity shall inform the assisted living facility
  165  of the procedures to follow should an emergent condition arise.
  166         (c) The community living support plan, as defined in s.
  167  429.02, has been prepared by a mental health resident and a
  168  mental health case manager of that resident in consultation with
  169  the administrator of the facility or the administrator’s
  170  designee. The plan must be provided to the administrator of the
  171  assisted living facility with a limited mental health license in
  172  which the mental health resident lives. The support plan and the
  173  agreement may be in one document.
  174         (d) The assisted living facility with a limited mental
  175  health license is provided with documentation that the
  176  individual meets the definition of a mental health resident.
  177         (e) The mental health services provider assigns a case
  178  manager to each mental health resident for whom the entity is
  179  responsible who lives in an assisted living facility with a
  180  limited mental health license. The case manager is responsible
  181  for coordinating the development of and implementation of the
  182  community living support plan defined in s. 429.02. The plan
  183  must be updated at least annually, or when there is a
  184  significant change to the resident’s behavioral health status,
  185  such as an inpatient admission or a change in behavioral status,
  186  medications, level of service, or residence. Each case manager
  187  shall keep a record of the date and time of any face-to-face
  188  interaction with the resident and make the record available to
  189  the responsible entity for inspection. The record must be
  190  retained for at least 2 years after the date of the most recent
  191  interaction.
  192         (f)Adequate and consistent monitoring and enforcement of
  193  community living support plans and cooperative agreements are
  194  conducted by the resident’s case manager.
  195         (g) Concerns are reported to the appropriate regulatory
  196  oversight organization if a regulated provider fails to deliver
  197  appropriate services or otherwise acts in a manner that has the
  198  potential to result in harm to the resident.
  199         (3) The Secretary of Children and Family Services, in
  200  consultation with the Agency for Health Care Administration,
  201  shall annually require each district administrator to develop,
  202  with community input, a detailed annual plan that demonstrates
  203  detailed plans that demonstrate how the district will ensure the
  204  provision of state-funded mental health and substance abuse
  205  treatment services to residents of assisted living facilities
  206  that hold a limited mental health license. These plans must be
  207  consistent with the substance abuse and mental health district
  208  plan developed pursuant to s. 394.75 and must address case
  209  management services; access to consumer-operated drop-in
  210  centers; access to services during evenings, weekends, and
  211  holidays; supervision of the clinical needs of the residents;
  212  and access to emergency psychiatric care.
  213         Section 2. Subsection (1) of section 400.0074, Florida
  214  Statutes, is amended, and paragraph (h) is added to subsection
  215  (2) of that section, to read:
  216         400.0074 Local ombudsman council onsite administrative
  217  assessments.—
  218         (1) In addition to any specific investigation conducted
  219  pursuant to a complaint, the local council shall conduct, at
  220  least annually, an onsite administrative assessment of each
  221  nursing home, assisted living facility, and adult family-care
  222  home within its jurisdiction. This administrative assessment
  223  must be comprehensive in nature and must shall focus on factors
  224  affecting the rights, health, safety, and welfare of the
  225  residents. Each local council is encouraged to conduct a similar
  226  onsite administrative assessment of each additional long-term
  227  care facility within its jurisdiction.
  228         (2) An onsite administrative assessment conducted by a
  229  local council shall be subject to the following conditions:
  230         (h) The local council shall conduct an exit consultation
  231  with the facility administrator or administrator designee to
  232  discuss issues and concerns and make recommendations for
  233  improvement, if any.
  234         Section 3. Subsection (2) of section 400.0078, Florida
  235  Statutes, is amended to read:
  236         400.0078 Citizen access to State Long-Term Care Ombudsman
  237  Program services.—
  238         (2) Every resident or representative of a resident shall
  239  receive, Upon admission to a long-term care facility, each
  240  resident or representative of a resident must receive
  241  information regarding the purpose of the State Long-Term Care
  242  Ombudsman Program, the statewide toll-free telephone number for
  243  receiving complaints, the confidentiality of the subject matter
  244  of a complaint and the complainant’s name and identity, and
  245  other relevant information regarding how to contact the program.
  246  Residents or their representatives must be furnished additional
  247  copies of this information upon request.
  248         Section 4. Paragraphs (b) and (c) of subsection (3) of
  249  section 429.07, Florida Statutes, are amended to read:
  250         429.07 License required; fee.—
  251         (3) In addition to the requirements of s. 408.806, each
  252  license granted by the agency must state the type of care for
  253  which the license is granted. Licenses shall be issued for one
  254  or more of the following categories of care: standard, extended
  255  congregate care, limited nursing services, or limited mental
  256  health.
  257         (b) An extended congregate care license shall be issued to
  258  facilities that have been licensed as assisted living facilities
  259  for 2 or more years and that provide providing, directly or
  260  through contract, services beyond those authorized in paragraph
  261  (a), including services performed by persons licensed under part
  262  I of chapter 464 and supportive services, as defined by rule, to
  263  persons who would otherwise be disqualified from continued
  264  residence in a facility licensed under this part. The purpose of
  265  an extended congregate care license is to enable residents to
  266  age in place in a residential environment despite mental or
  267  physical limitations that might otherwise disqualify them from
  268  residency in a facility licensed under this part.
  269         1. In order for extended congregate care services to be
  270  provided, the agency must first determine that all requirements
  271  established in law and rule are met and must specifically
  272  designate, on the facility’s license, that such services may be
  273  provided and whether the designation applies to all or part of
  274  the facility. Such designation may be made at the time of
  275  initial licensure or relicensure, or upon request in writing by
  276  a licensee under this part and part II of chapter 408. The
  277  notification of approval or the denial of the request shall be
  278  made in accordance with part II of chapter 408. Existing
  279  facilities qualifying to provide extended congregate care
  280  services must have maintained a standard license and may not
  281  have been subject to administrative sanctions during the
  282  previous 2 years, or since initial licensure if the facility has
  283  been licensed for less than 2 years, for any of the following
  284  reasons:
  285         a. A class I or class II violation;
  286         b. Three or more repeat or recurring class III violations
  287  of identical or similar resident care standards from which a
  288  pattern of noncompliance is found by the agency;
  289         c. Three or more class III violations that were not
  290  corrected in accordance with the corrective action plan approved
  291  by the agency;
  292         d. Violation of resident care standards which results in
  293  requiring the facility to employ the services of a consultant
  294  pharmacist or consultant dietitian;
  295         e. Denial, suspension, or revocation of a license for
  296  another facility licensed under this part in which the applicant
  297  for an extended congregate care license has at least 25 percent
  298  ownership interest; or
  299         f. Imposition of a moratorium pursuant to this part or part
  300  II of chapter 408 or initiation of injunctive proceedings.
  301         2.If an assisted living facility has been licensed for
  302  less than 2 years, the initial extended congregate care license
  303  must be provisional and may not exceed 6 months. Within the
  304  first 3 months after the provisional license is issued, the
  305  licensee shall notify the agency when it has admitted an
  306  extended congregate care resident, after which an unannounced
  307  inspection shall be made to determine compliance with
  308  requirements of an extended congregate care license. If the
  309  licensee demonstrates compliance with all of the requirements of
  310  an extended congregate care license during the inspection, the
  311  licensee shall be issued an extended congregate care license. In
  312  addition to sanctions authorized under this part, if violations
  313  are found during the inspection and the licensee fails to
  314  demonstrate compliance with all assisted living requirements
  315  during a followup inspection, the licensee shall immediately
  316  suspend extended congregate care services, and the provisional
  317  extended congregate care license expires.
  318         3.2. A facility that is licensed to provide extended
  319  congregate care services shall maintain a written progress
  320  report on each person who receives services which describes the
  321  type, amount, duration, scope, and outcome of services that are
  322  rendered and the general status of the resident’s health. A
  323  registered nurse, or appropriate designee, representing the
  324  agency shall visit the facility at least twice a year quarterly
  325  to monitor residents who are receiving extended congregate care
  326  services and to determine if the facility is in compliance with
  327  this part, part II of chapter 408, and relevant rules. One of
  328  the visits may be in conjunction with the regular survey. The
  329  monitoring visits may be provided through contractual
  330  arrangements with appropriate community agencies. A registered
  331  nurse shall serve as part of the team that inspects the
  332  facility. The agency may waive one of the required yearly
  333  monitoring visits for a facility that has been licensed for at
  334  least 24 months to provide extended congregate care services,
  335  if, during the inspection, the registered nurse determines that
  336  extended congregate care services are being provided
  337  appropriately, and if the facility has held an extended
  338  congregate care license during the last 24 months, has had no
  339  class I or class II violations, has had and no uncorrected class
  340  III violations, and has had no confirmed ombudsman council
  341  complaints that resulted in a citation for licensure. The agency
  342  must first consult with the long-term care ombudsman council for
  343  the area in which the facility is located to determine if any
  344  complaints have been made and substantiated about the quality of
  345  services or care. The agency may not waive one of the required
  346  yearly monitoring visits if complaints have been made and
  347  substantiated.
  348         4.3. A facility that is licensed to provide extended
  349  congregate care services must:
  350         a. Demonstrate the capability to meet unanticipated
  351  resident service needs.
  352         b. Offer a physical environment that promotes a homelike
  353  setting, provides for resident privacy, promotes resident
  354  independence, and allows sufficient congregate space as defined
  355  by rule.
  356         c. Have sufficient staff available, taking into account the
  357  physical plant and firesafety features of the building, to
  358  assist with the evacuation of residents in an emergency.
  359         d. Adopt and follow policies and procedures that maximize
  360  resident independence, dignity, choice, and decisionmaking to
  361  permit residents to age in place, so that moves due to changes
  362  in functional status are minimized or avoided.
  363         e. Allow residents or, if applicable, a resident’s
  364  representative, designee, surrogate, guardian, or attorney in
  365  fact to make a variety of personal choices, participate in
  366  developing service plans, and share responsibility in
  367  decisionmaking.
  368         f. Implement the concept of managed risk.
  369         g. Provide, directly or through contract, the services of a
  370  person licensed under part I of chapter 464.
  371         h. In addition to the training mandated in s. 429.52,
  372  provide specialized training as defined by rule for facility
  373  staff.
  374         5.4. A facility that is licensed to provide extended
  375  congregate care services is exempt from the criteria for
  376  continued residency set forth in rules adopted under s. 429.41.
  377  A licensed facility must adopt its own requirements within
  378  guidelines for continued residency set forth by rule. However,
  379  the facility may not serve residents who require 24-hour nursing
  380  supervision. A licensed facility that provides extended
  381  congregate care services must also provide each resident with a
  382  written copy of facility policies governing admission and
  383  retention.
  384         5. The primary purpose of extended congregate care services
  385  is to allow residents, as they become more impaired, the option
  386  of remaining in a familiar setting from which they would
  387  otherwise be disqualified for continued residency. A facility
  388  licensed to provide extended congregate care services may also
  389  admit an individual who exceeds the admission criteria for a
  390  facility with a standard license, if the individual is
  391  determined appropriate for admission to the extended congregate
  392  care facility.
  393         6. Before the admission of an individual to a facility
  394  licensed to provide extended congregate care services, the
  395  individual must undergo a medical examination as provided in s.
  396  429.26(4) and the facility must develop a preliminary service
  397  plan for the individual.
  398         7. If When a facility can no longer provide or arrange for
  399  services in accordance with the resident’s service plan and
  400  needs and the facility’s policy, the facility must shall make
  401  arrangements for relocating the person in accordance with s.
  402  429.28(1)(k).
  403         8. Failure to provide extended congregate care services may
  404  result in denial of extended congregate care license renewal.
  405  
  406  The agency may deny or revoke a facility’s extended congregate
  407  care license for not meeting the standards of an extended
  408  congregate care license or for any of the grounds listed in this
  409  subsection.
  410         (c) A limited nursing services license shall be issued to a
  411  facility that provides services beyond those authorized in
  412  paragraph (a) and as specified in this paragraph.
  413         1. In order for limited nursing services to be provided in
  414  a facility licensed under this part, the agency must first
  415  determine that all requirements established in law and rule are
  416  met and must specifically designate, on the facility’s license,
  417  that such services may be provided. Such designation may be made
  418  at the time of initial licensure or licensure renewal
  419  relicensure, or upon request in writing by a licensee under this
  420  part and part II of chapter 408. Notification of approval or
  421  denial of such request shall be made in accordance with part II
  422  of chapter 408. An existing facility that qualifies facilities
  423  qualifying to provide limited nursing services must shall have
  424  maintained a standard license and may not have been subject to
  425  administrative sanctions that affect the health, safety, and
  426  welfare of residents for the previous 2 years or since initial
  427  licensure if the facility has been licensed for less than 2
  428  years.
  429         2. A facility Facilities that is are licensed to provide
  430  limited nursing services shall maintain a written progress
  431  report on each person who receives such nursing services. The,
  432  which report must describe describes the type, amount, duration,
  433  scope, and outcome of services that are rendered and the general
  434  status of the resident’s health. A registered nurse representing
  435  the agency shall visit the facility such facilities at least
  436  annually twice a year to monitor residents who are receiving
  437  limited nursing services and to determine if the facility is in
  438  compliance with applicable provisions of this part, part II of
  439  chapter 408, and related rules. The monitoring visits may be
  440  provided through contractual arrangements with appropriate
  441  community agencies. A registered nurse shall also serve as part
  442  of the team that inspects such facility. Visits may be in
  443  conjunction with other agency inspections. The agency may waive
  444  one of the required yearly monitoring visits for a facility that
  445  has:
  446         a. A limited nursing services license for at least 24
  447  months;
  448         b. No class I or class II violations and no uncorrected
  449  class III violations; and
  450         c. No confirmed ombudsman council complaints that resulted
  451  in a citation for licensure.
  452         3. A person who receives limited nursing services under
  453  this part must meet the admission criteria established by the
  454  agency for assisted living facilities. When a resident no longer
  455  meets the admission criteria for a facility licensed under this
  456  part, arrangements for relocating the person shall be made in
  457  accordance with s. 429.28(1)(k), unless the facility is licensed
  458  to provide extended congregate care services.
  459         Section 5. Section 429.075, Florida Statutes, is amended to
  460  read:
  461         429.075 Limited mental health license.—An assisted living
  462  facility that serves one three or more mental health residents
  463  must obtain a limited mental health license.
  464         (1) To obtain a limited mental health license, a facility
  465  must hold a standard license as an assisted living facility,
  466  must not have any current uncorrected deficiencies or
  467  violations, and must ensure that, within 6 months after
  468  receiving a limited mental health license, the facility
  469  administrator and the staff of the facility who are in direct
  470  contact with mental health residents must complete training of
  471  no less than 6 hours related to their duties. Such designation
  472  may be made at the time of initial licensure or relicensure or
  473  upon request in writing by a licensee under this part and part
  474  II of chapter 408. Notification of approval or denial of such
  475  request shall be made in accordance with this part, part II of
  476  chapter 408, and applicable rules. This training must will be
  477  provided by or approved by the Department of Children and Family
  478  Services.
  479         (2) A facility that is Facilities licensed to provide
  480  services to mental health residents must shall provide
  481  appropriate supervision and staffing to provide for the health,
  482  safety, and welfare of such residents.
  483         (3) A facility that has a limited mental health license
  484  must:
  485         (a) Have a copy of each mental health resident’s community
  486  living support plan and the cooperative agreement with the
  487  mental health care services provider. The support plan and the
  488  agreement may be combined.
  489         (b) Have documentation that is provided by the Department
  490  of Children and Family Services that each mental health resident
  491  has been assessed and determined to be able to live in the
  492  community in an assisted living facility that has with a limited
  493  mental health license.
  494         (c) Make the community living support plan available for
  495  inspection by the resident, the resident’s legal guardian, the
  496  resident’s health care surrogate, and other individuals who have
  497  a lawful basis for reviewing this document.
  498         (d) Assist the mental health resident in carrying out the
  499  activities identified in the individual’s community living
  500  support plan.
  501         (4) A facility that has with a limited mental health
  502  license may enter into a cooperative agreement with a private
  503  mental health provider. For purposes of the limited mental
  504  health license, the private mental health provider may act as
  505  the case manager.
  506         Section 6. Section 429.14, Florida Statutes, is amended to
  507  read:
  508         429.14 Administrative penalties.—
  509         (1) In addition to the requirements of part II of chapter
  510  408, the agency may deny, revoke, and suspend any license issued
  511  under this part and impose an administrative fine in the manner
  512  provided in chapter 120 against a licensee for a violation of
  513  any provision of this part, part II of chapter 408, or
  514  applicable rules, or for any of the following actions by a
  515  licensee, for the actions of any person subject to level 2
  516  background screening under s. 408.809, or for the actions of any
  517  facility staff employee:
  518         (a) A An intentional or negligent act seriously affecting
  519  the health, safety, or welfare of a resident of the facility.
  520         (b) A The determination by the agency that the owner lacks
  521  the financial ability to provide continuing adequate care to
  522  residents.
  523         (c) Misappropriation or conversion of the property of a
  524  resident of the facility.
  525         (d) Failure to follow the criteria and procedures provided
  526  under part I of chapter 394 relating to the transportation,
  527  voluntary admission, and involuntary examination of a facility
  528  resident.
  529         (e) A citation of any of the following deficiencies as
  530  specified in s. 429.19:
  531         1. One or more cited class I deficiencies.
  532         2. Three or more cited class II deficiencies.
  533         3. Five or more cited class III deficiencies that have been
  534  cited on a single survey and have not been corrected within the
  535  times specified.
  536         (f) Failure to comply with the background screening
  537  standards of this part, s. 408.809(1), or chapter 435.
  538         (g) Violation of a moratorium.
  539         (h) Failure of the license applicant, the licensee during
  540  relicensure, or a licensee that holds a provisional license to
  541  meet the minimum license requirements of this part, or related
  542  rules, at the time of license application or renewal.
  543         (i) An intentional or negligent life-threatening act in
  544  violation of the uniform firesafety standards for assisted
  545  living facilities or other firesafety standards which that
  546  threatens the health, safety, or welfare of a resident of a
  547  facility, as communicated to the agency by the local authority
  548  having jurisdiction or the State Fire Marshal.
  549         (j) Knowingly operating any unlicensed facility or
  550  providing without a license any service that must be licensed
  551  under this chapter or chapter 400.
  552         (k) Any act constituting a ground upon which application
  553  for a license may be denied.
  554         (2) Upon notification by the local authority having
  555  jurisdiction or by the State Fire Marshal, the agency may deny
  556  or revoke the license of an assisted living facility that fails
  557  to correct cited fire code violations that affect or threaten
  558  the health, safety, or welfare of a resident of a facility.
  559         (3) The agency may deny or revoke a license of an to any
  560  applicant or controlling interest as defined in part II of
  561  chapter 408 which has or had a 25-percent or greater financial
  562  or ownership interest in any other facility that is licensed
  563  under this part, or in any entity licensed by this state or
  564  another state to provide health or residential care, if that
  565  which facility or entity during the 5 years prior to the
  566  application for a license closed due to financial inability to
  567  operate; had a receiver appointed or a license denied,
  568  suspended, or revoked; was subject to a moratorium; or had an
  569  injunctive proceeding initiated against it.
  570         (4) The agency shall deny or revoke the license of an
  571  assisted living facility if:
  572         (a)A resident’s health, safety, or welfare has been
  573  seriously affected by an intentional act of facility staff;
  574         (b)There are two moratoria issued pursuant to this part,
  575  or part II of chapter 408, which are imposed by final order
  576  within a 2-year period;
  577         (c)The facility is conditionally licensed for 180 or more
  578  consecutive days;
  579         (d)The facility is cited for two or more class I
  580  violations arising from unrelated circumstances during the same
  581  survey or investigation; or
  582         (e)The facility is cited for two or more class I
  583  violations arising from separate surveys or investigations
  584  within a 2-year period that has two or more class I violations
  585  that are similar or identical to violations identified by the
  586  agency during a survey, inspection, monitoring visit, or
  587  complaint investigation occurring within the previous 2 years.
  588         (5) An action taken by the agency to suspend, deny, or
  589  revoke a facility’s license under this part or part II of
  590  chapter 408, in which the agency claims that the facility owner
  591  or an employee of the facility has threatened the health,
  592  safety, or welfare of a resident of the facility must be heard
  593  by the Division of Administrative Hearings of the Department of
  594  Management Services within 120 days after receipt of the
  595  facility’s request for a hearing, unless that time limitation is
  596  waived by both parties. The administrative law judge shall must
  597  render a decision within 30 days after receipt of a proposed
  598  recommended order.
  599         (6) The agency shall impose an immediate moratorium, as
  600  provided under s. 408.814, on an assisted living facility that
  601  fails to provide the agency access to the facility or prohibits
  602  the agency from conducting a regulatory inspection. The licensee
  603  may not restrict agency staff in accessing and copying records
  604  or in conducting confidential interviews with facility staff or
  605  any individual who receives services from the facility provide
  606  to the Division of Hotels and Restaurants of the Department of
  607  Business and Professional Regulation, on a monthly basis, a list
  608  of those assisted living facilities that have had their licenses
  609  denied, suspended, or revoked or that are involved in an
  610  appellate proceeding pursuant to s. 120.60 related to the
  611  denial, suspension, or revocation of a license.
  612         (7) Agency notification of a license suspension or
  613  revocation, or denial of a license renewal, shall be posted and
  614  visible to the public at the facility.
  615         Section 7. Paragraphs (a) and (b) of subsection (2) of
  616  section 429.178, Florida Statutes, are amended to read:
  617         429.178 Special care for persons with Alzheimer’s disease
  618  or other related disorders.—
  619         (2)(a) An individual who is employed by a facility that
  620  provides special care for residents with Alzheimer’s disease or
  621  other related disorders, and who has regular contact with such
  622  residents, must complete up to 4 hours of initial dementia
  623  specific training developed or approved by the department. The
  624  training must shall be completed within 3 months after beginning
  625  employment and satisfy shall satisfy the core training
  626  requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  627         (b) A direct caregiver who is employed by a facility that
  628  provides special care for residents with Alzheimer’s disease or
  629  other related disorders, and who provides direct care to such
  630  residents, must complete the required initial training and 4
  631  additional hours of training developed or approved by the
  632  department. The training must shall be completed within 9 months
  633  after beginning employment and satisfy shall satisfy the core
  634  training requirements of s. 429.52(3)(g) s. 429.52(2)(g).
  635         Section 8. Section 429.19, Florida Statutes, is amended to
  636  read:
  637         429.19 Violations; imposition of administrative fines;
  638  grounds.—
  639         (1) In addition to the requirements of part II of chapter
  640  408, the agency shall impose an administrative fine in the
  641  manner provided in chapter 120 for the violation of any
  642  provision of this part, part II of chapter 408, and applicable
  643  rules by an assisted living facility, for the actions of any
  644  person subject to level 2 background screening under s. 408.809,
  645  for the actions of any facility employee, or for an intentional
  646  or negligent act seriously affecting the health, safety, or
  647  welfare of a resident of the facility.
  648         (2) Each violation of this part and adopted rules must
  649  shall be classified according to the nature of the violation and
  650  the gravity of its probable effect on facility residents. The
  651  agency shall indicate the classification on the written notice
  652  of the violation as follows:
  653         (a) Class “I” violations are defined in s. 408.813. The
  654  agency shall impose an administrative fine of $7,500 for each a
  655  cited class I violation in a facility that is licensed for fewer
  656  than 100 beds at the time of the violation in an amount not less
  657  than $5,000 and not exceeding $10,000 for each violation. The
  658  agency shall impose an administrative fine of $11,250 for each
  659  cited class I violation in a facility that is licensed for 100
  660  or more beds at the time of the violation. If the noncompliance
  661  occurs within the prior 12 months, the fine must be levied for
  662  violations that are corrected before an inspection.
  663         (b) Class “II” violations are defined in s. 408.813. The
  664  agency shall impose an administrative fine of $3,000 for each a
  665  cited class II violation in a facility that is licensed for
  666  fewer than 100 beds at the time of the violation in an amount
  667  not less than $1,000 and not exceeding $5,000 for each
  668  violation. The agency shall impose an administrative fine of
  669  $4,500 for each cited class II violation in a facility that is
  670  licensed for 100 or more beds at the time of the violation.
  671         (c) Class “III” violations are defined in s. 408.813. The
  672  agency shall impose an administrative fine of $750 for each a
  673  cited class III violation in a facility that is licensed for
  674  fewer than 100 beds at the time of the violation in an amount
  675  not less than $500 and not exceeding $1,000 for each violation.
  676  The agency shall impose an administrative fine of $1,125 for
  677  each cited class III violation in a facility that is licensed
  678  for 100 or more beds at the time of the violation.
  679         (d) Class “IV” violations are defined in s. 408.813. The
  680  agency shall impose an administrative fine of $150 for each a
  681  cited class IV violation in a facility that is licensed for
  682  fewer than 100 beds at the time of the violation in an amount
  683  not less than $100 and not exceeding $200 for each violation.
  684  The agency shall impose an administrative fine of $225 for each
  685  cited class IV violation in a facility that is licensed for 100
  686  or more beds at the time of the violation.
  687         (e) Any fine imposed for class I and class II violations
  688  must be doubled if a facility was previously cited for one or
  689  more class I or class II violations during the agency’s last
  690  licensure inspection or any inspection or complaint
  691  investigation since the last licensure inspection.
  692         (f) Notwithstanding any other provision of law, a fine must
  693  be imposed for each class III and class IV violation, regardless
  694  of correction, if a facility was previously cited for one or
  695  more class III or class IV violations during the agency’s last
  696  licensure inspection or any inspection or complaint
  697  investigation since the last licensure inspection, for the same
  698  regulatory violation. A fine imposed for class III or class IV
  699  violations must be doubled if a facility was previously cited
  700  for one or more class III or class IV violations during the
  701  agency’s last two licensure inspections for the same regulatory
  702  violation.
  703         (g) In addition to the fines listed in paragraphs (a)-(d),
  704  the agency shall impose an administrative fine of $500 if a
  705  facility is found not to be in compliance with the background
  706  screening requirements as provided in s. 408.809.
  707         (3) For purposes of this section, in determining if a
  708  penalty is to be imposed and in fixing the amount of the fine,
  709  the agency shall consider the following factors:
  710         (a) The gravity of the violation, including the probability
  711  that death or serious physical or emotional harm to a resident
  712  will result or has resulted, the severity of the action or
  713  potential harm, and the extent to which the provisions of the
  714  applicable laws or rules were violated.
  715         (b) Actions taken by the owner or administrator to correct
  716  violations.
  717         (c) Any previous violations.
  718         (d) The financial benefit to the facility of committing or
  719  continuing the violation.
  720         (e) The licensed capacity of the facility.
  721         (3)(4) Each day of continuing violation after the date
  722  established by the agency fixed for correction termination of
  723  the violation, as ordered by the agency, constitutes an
  724  additional, separate, and distinct violation.
  725         (4)(5)An Any action taken to correct a violation shall be
  726  documented in writing by the owner or administrator of the
  727  facility and verified through followup visits by agency
  728  personnel. The agency may impose a fine and, in the case of an
  729  owner-operated facility, revoke or deny a facility’s license
  730  when a facility administrator fraudulently misrepresents action
  731  taken to correct a violation.
  732         (5)(6)A Any facility whose owner fails to apply for a
  733  change-of-ownership license in accordance with part II of
  734  chapter 408 and operates the facility under the new ownership is
  735  subject to a fine of $5,000.
  736         (6)(7) In addition to any administrative fines imposed, the
  737  agency may assess a survey fee, equal to the lesser of one half
  738  of the facility’s biennial license and bed fee or $500, to cover
  739  the cost of conducting initial complaint investigations that
  740  result in the finding of a violation that was the subject of the
  741  complaint or monitoring visits conducted under s. 429.28(3)(c)
  742  to verify the correction of the violations.
  743         (7)(8) During an inspection, the agency shall make a
  744  reasonable attempt to discuss each violation with the owner or
  745  administrator of the facility, prior to written notification.
  746         (8)(9) The agency shall develop and disseminate an annual
  747  list of all facilities sanctioned or fined for violations of
  748  state standards, the number and class of violations involved,
  749  the penalties imposed, and the current status of cases. The list
  750  shall be disseminated, at no charge, to the Department of
  751  Elderly Affairs, the Department of Health, the Department of
  752  Children and Family Services, the Agency for Persons with
  753  Disabilities, the area agencies on aging, the Florida Statewide
  754  Advocacy Council, and the state and local ombudsman councils.
  755  The Department of Children and Family Services shall disseminate
  756  the list to service providers under contract to the department
  757  who are responsible for referring persons to a facility for
  758  residency. The agency may charge a fee commensurate with the
  759  cost of printing and postage to other interested parties
  760  requesting a copy of this list. This information may be provided
  761  electronically or through the agency’s Internet site.
  762         Section 9. Subsections (2) and (6) of section 429.28,
  763  Florida Statutes, are amended to read:
  764         429.28 Resident bill of rights.—
  765         (2) The administrator of a facility shall ensure that a
  766  written notice of the rights, obligations, and prohibitions set
  767  forth in this part is posted in a prominent place in each
  768  facility and read or explained to residents who cannot read. The
  769  This notice must shall include the name, address, and telephone
  770  numbers of the local ombudsman council and central abuse hotline
  771  and, if when applicable, the Advocacy Center for Persons with
  772  Disabilities, Inc., and the Florida local advocacy council,
  773  where complaints may be lodged. The notice must state that the
  774  subject matter of a complaint made to the Office of State Long
  775  Term Care Ombudsman or a local long-term care ombudsman council
  776  and the names and identities of the residents involved in the
  777  complaint and the complainants are kept confidential pursuant to
  778  s. 400.0077. The facility must ensure a resident’s access to a
  779  telephone to call the local ombudsman council, central abuse
  780  hotline, Advocacy Center for Persons with Disabilities, Inc.,
  781  and the Florida local advocacy council.
  782         (6) A Any facility that which terminates the residency of
  783  an individual who participated in activities specified in
  784  subsection (5) must shall show good cause in a court of
  785  competent jurisdiction. If good cause is not shown, the agency
  786  shall impose a fine of $2,500 in addition to any other penalty
  787  assessed against the facility.
  788         Section 10. Section 429.34, Florida Statutes, is amended to
  789  read:
  790         429.34 Right of entry and inspection.—
  791         (1) In addition to the requirements of s. 408.811, any duly
  792  designated officer or employee of the department, the Department
  793  of Children and Family Services, the Medicaid Fraud Control Unit
  794  of the Office of the Attorney General, the state or local fire
  795  marshal, or a member of the state or local long-term care
  796  ombudsman council has shall have the right to enter unannounced
  797  upon and into the premises of any facility licensed pursuant to
  798  this part in order to determine the state of compliance with the
  799  provisions of this part, part II of chapter 408, and applicable
  800  rules. Data collected by the state or local long-term care
  801  ombudsman councils or the state or local advocacy councils may
  802  be used by the agency in investigations involving violations of
  803  regulatory standards. A person specified in this section who
  804  knows or has reasonable cause to suspect that a vulnerable adult
  805  has been or is being abused, neglected, or exploited shall
  806  immediately report such knowledge or suspicion to the central
  807  abuse hotline pursuant to chapter 415.
  808         (2) Each licensed assisted living facility must be
  809  inspected by the agency at least once every 24 months to
  810  determine compliance with this chapter and related rules. If an
  811  assisted living facility is cited for one or more class I
  812  violations or two or more class II violations arising from
  813  separate surveys within a 60-day period or due to unrelated
  814  circumstances during the same survey, the agency must conduct an
  815  additional licensure inspection within 6 months. In addition to
  816  any fines imposed on the facility under s. 429.19, the licensee
  817  must pay a fee for the cost of the additional inspection
  818  equivalent to the standard assisted living facility license and
  819  per-bed fees, without exception for beds designated for
  820  recipients of optional state supplementation. The agency shall
  821  adjust the fee in accordance with s. 408.805.
  822         Section 11. Present subsections (1) through (11) of section
  823  429.52, Florida Statutes, are redesignated as subsections (2)
  824  through (12), respectively, a new subsection (1) is added to
  825  that section, and present subsection (9) of that section is
  826  amended, to read:
  827         429.52 Staff training and educational programs; core
  828  educational requirement.—
  829         (1) Effective October 1, 2013, each new assisted living
  830  facility employee who has not previously completed core training
  831  must attend a preservice orientation provided by the facility
  832  before interacting with residents. The preservice orientation
  833  must be at least 2 hours in duration and cover topics that help
  834  the employee provide responsible care and respond to the needs
  835  of residents of the facility. Upon completion, the employee and
  836  the administrator of the facility must sign an affidavit stating
  837  that the employee completed the required preservice orientation.
  838  The facility must keep the affidavit in the employee’s work
  839  file.
  840         (10)(9) The training required by this section must shall be
  841  conducted by persons registered with the department as having
  842  the requisite experience and credentials to conduct the
  843  training. A person seeking to register as a trainer must provide
  844  the department with proof of completion of the minimum core
  845  training education requirements, successful passage of the
  846  competency test established under this section, and proof of
  847  compliance with the continuing education requirement in
  848  subsection (5)(4).
  849         Section 12. The Legislature finds that consistent
  850  regulation of assisted living facilities benefits residents and
  851  operators of such facilities. To determine whether surveys are
  852  consistent between surveys and surveyors, the Agency for Health
  853  Care Administration shall conduct a study of intersurveyor
  854  reliability for assisted living facilities. By November 1, 2013,
  855  the agency shall report to the Governor, the President of the
  856  Senate, and the Speaker of the House of Representatives its
  857  findings and make any recommendations to improve intersurveyor
  858  reliability.
  859         Section 13. The Legislature finds that consumers need
  860  additional information on the quality of care and service in
  861  assisted living facilities in order to select the best facility
  862  for themselves or their loved ones. Therefore, the Agency for
  863  Health Care Administration shall:
  864         (1)Propose a rating system for assisted living facilities
  865  similar to that used for nursing homes. The proposal must
  866  include, but is not limited to, the data elements to be used,
  867  the method of collecting the data, the method of determining the
  868  rating, an estimate of the initial and ongoing costs of a rating
  869  system to both the agency and assisted living facilities, and a
  870  timetable for the implementation of the rating system for
  871  assisted living facilities. The agency shall submit its proposal
  872  to the Governor, the President of the Senate, and the Speaker of
  873  the House of Representatives by November 1, 2013.
  874         (2) By January 1, 2014, create a content that is easily
  875  accessible through the front page of the agency’s website. At a
  876  minimum, the content must include:
  877         (a)Information on each licensed assisted living facility,
  878  including, but not limited to:
  879         1.The name and address of the facility.
  880         2.The number and type of licensed beds in the facility.
  881         3.The types of licenses held by the facility.
  882         4.The facility’s license expiration date and status.
  883         5.Other relevant information that the agency currently
  884  collects.
  885         (b)A list of the facility’s cited violations and a summary
  886  of each violation which is presented in an understandable manner
  887  to the general public.
  888         (c)Links to inspection reports that the agency has on
  889  file.
  890         (d)A monitored comment page, maintained by the agency,
  891  which allows citizens to anonymously comment on assisted living
  892  facilities that are licensed to operate in the state. This
  893  comment page must, at a minimum, allow members of the public to
  894  post comments on their experiences with, or observations of, an
  895  assisted living facility and to review other people’s comments.
  896  Comments posted to the agency’s comment page may not contain
  897  profanity and are intended to provide meaningful feedback about
  898  the assisted living facility. The agency shall provide for a
  899  webpage moderator to review comments for profane content before
  900  the comments are posted to the page. An employee, owner, or
  901  controlling interest in an assisted living facility is
  902  prohibited from posting comments on the page.
  903         Section 14. This act shall take effect July 1, 2013.

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