Bill Text: FL S7018 | 2010 | Regular Session | Introduced

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Bill Title: Assisted Living Facilities

Spectrum: Unknown

Status: (N/A - Dead) 2010-01-13 - Submit as committee bill by Health Regulation (SB 1816) [S7018 Detail]

Download: Florida-2010-S7018-Introduced.html

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Florida Senate - 2010         (PROPOSED COMMITTEE BILL) SPB 7018 
 
FOR CONSIDERATION By the Committee on Health Regulation 
588-01025-10                                          20107018__ 
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 Agency for Health Care 
11         Administration to conduct monitoring visits at least 
12         twice a year to facilities providing limited nursing 
13         services; establishing a monitoring fee for each 
14         quarter in which a facility provides limited nursing 
15         services; amending s. 429.17, F.S.; deleting 
16         provisions related to the limited nursing services 
17         license; amending s. 429.41, F.S.; conforming 
18         provisions to changes made by the act; requiring the 
19         Department of Elderly Affairs to adopt rules that 
20         establish the frequency of monitoring visits to 
21         licensed facilities providing limited nursing services 
22         or extended congregate care services, that provide for 
23         collecting monitoring fees, and that require the 
24         quarterly submission of data concerning the facility’s 
25         resident population; amending s. 429.54, F.S.; 
26         requiring licensed assisted living facilities to 
27         submit reports electronically each quarter to the 
28         Agency for Health Care Administration; requiring the 
29         first data submission to cover data for the first 
30         calendar quarter of 2011; providing effective dates. 
31 
32  Be It Enacted by the Legislature of the State of Florida: 
33 
34         Section 1. Effective April 1, 2011, subsections (3) and (4) 
35  of section 429.07, Florida Statutes, are amended to read: 
36         429.07 License required; fee.— 
37         (3) In addition to the requirements of s. 408.806, each 
38  license granted by the agency must state the type of care for 
39  which the license is granted. Licenses shall be issued for one 
40  or more of the following categories of care: standard, extended 
41  congregate care, limited nursing services, or limited mental 
42  health. 
43         (a) A standard license shall be issued to facilities 
44  providing one or more of the personal services identified in s. 
45  429.02. Such facilities may provide limited nursing services as 
46  provided in this paragraph and may also employ or contract with 
47  a person licensed under part I of chapter 464 to administer 
48  medications and perform other tasks as specified in s. 429.255. 
49         1. A facility that provides limited nursing services shall 
50  maintain a written progress report for each person who receives 
51  such nursing services, and the report must describe the type, 
52  amount, duration, scope, and outcome of services that are 
53  rendered and the general status of the resident’s health. A 
54  registered nurse representing the agency shall visit such 
55  facility to monitor residents who are receiving limited nursing 
56  services and to determine if the facility is in compliance with 
57  applicable provisions of this part, part II of chapter 408, and 
58  related rules. The frequency of monitoring visits shall be 
59  determined by rule. The monitoring visits may be provided 
60  through contractual arrangements with appropriate community 
61  agencies. A registered nurse shall also serve as part of the 
62  team that inspects such facility. 
63         2. A person who receives limited nursing services under 
64  this paragraph must meet the admission and continued residency 
65  criteria established by the agency for assisted living 
66  facilities. When a resident no longer meets the admission and 
67  continued residency criteria for a facility licensed under this 
68  paragraph, arrangements for relocating the person shall be made 
69  in accordance with s. 429.28(1)(k), unless the facility is 
70  licensed to provide extended congregate care services. 
71         (b) An extended congregate care license shall be issued to 
72  facilities providing, directly or through contract, services 
73  beyond those authorized in paragraph (a), including acts 
74  performed pursuant to part I of chapter 464 by persons licensed 
75  thereunder, and supportive services defined by rule to persons 
76  who otherwise would be disqualified from continued residence in 
77  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 the facility’s 
82  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 facility facilities qualifying to 
89  provide extended congregate care services must have maintained a 
90  standard license and may not have been subject to administrative 
91  sanctions during the previous 2 years, or since initial 
92  licensure if the facility has been licensed 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 to this part or part 
110  II of chapter 408 or initiation of injunctive proceedings. 
111         2. A facility Facilities that is are licensed to provide 
112  extended congregate care services shall maintain a written 
113  progress report for on each person who receives such services, 
114  and the which report must describe describes the 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, 
117  or appropriate designee, representing the agency shall visit 
118  such facility facilities at least quarterly to monitor residents 
119  who are receiving extended congregate care services and to 
120  determine if the facility is in compliance with this part, part 
121  II of chapter 408, and rules that relate to extended congregate 
122  care. The frequency of monitoring visits shall be determined by 
123  rule. One of these visits may be in conjunction with the regular 
124  survey. The monitoring visits may be provided through 
125  contractual arrangements with appropriate community agencies. A 
126  registered nurse shall serve as part of the team that inspects 
127  such facility. The agency may waive one of the required yearly 
128  monitoring visits for a facility that has been licensed for at 
129  least 24 months to provide extended congregate care services, 
130  if, during the inspection, the registered nurse determines that 
131  extended congregate care services are being provided 
132  appropriately, and if the facility has no class I or class II 
133  violations and no uncorrected class III violations. Before such 
134  decision is made, the agency shall consult with the long-term 
135  care ombudsman council for the area in which the facility is 
136  located to determine if any complaints have been made and 
137  substantiated about the quality of services or care. The agency 
138  may not waive one of the required yearly monitoring visits if 
139  complaints have been made and substantiated. 
140         3. Facilities that are licensed to provide extended 
141  congregate care services shall: 
142         a. Demonstrate the capability to meet unanticipated 
143  resident service needs. 
144         b. Offer a physical environment that promotes a homelike 
145  setting, provides for resident privacy, promotes resident 
146  independence, and allows sufficient congregate space as defined 
147  by rule. 
148         c. Have sufficient staff available, taking into account the 
149  physical plant and firesafety features of the building, to 
150  assist with the evacuation of residents in an emergency, as 
151  necessary. 
152         d. Adopt and follow policies and procedures that maximize 
153  resident independence, dignity, choice, and decisionmaking to 
154  permit residents to age in place to the extent possible, so that 
155  moves due to changes in functional status are minimized or 
156  avoided. 
157         e. Allow residents or, if applicable, a resident’s 
158  representative, designee, surrogate, guardian, or attorney in 
159  fact to make a variety of personal choices, participate in 
160  developing service plans, and share responsibility in 
161  decisionmaking. 
162         f. Implement the concept of managed risk. 
163         g. Provide, either directly or through contract, the 
164  services of a person licensed pursuant to part I of chapter 464. 
165         h. In addition to the training mandated in s. 429.52, 
166  provide specialized training as defined by rule for facility 
167  staff. 
168         4. Facilities licensed to provide extended congregate care 
169  services are exempt from the criteria for continued residency as 
170  set forth in rules adopted under s. 429.41. Facilities so 
171  licensed shall adopt their own requirements within guidelines 
172  for continued residency set forth by rule. However, such 
173  facilities may not serve residents who require 24-hour nursing 
174  supervision. Facilities licensed to provide extended congregate 
175  care services shall provide each resident with a written copy of 
176  facility 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 facility 
181  licensed to provide extended congregate care services may also 
182  admit an individual who exceeds the admission criteria for a 
183  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 facility can no longer provide or arrange for 
192  services in accordance with the resident’s service plan and 
193  needs and the facility’s policy, the facility shall make 
194  arrangements for relocating the person in accordance with s. 
195  429.28(1)(k). 
196         8. Failure to provide extended congregate care services may 
197  result in denial of extended congregate care license renewal. 
198         9. No later than January 1 of each year, the department, in 
199  consultation with the agency, shall prepare and submit to the 
200  Governor, the President of the Senate, the Speaker of the House 
201  of Representatives, and the chairs of appropriate legislative 
202  committees, a report on the status of, and recommendations 
203  related to, extended congregate care services. The status report 
204  must include, but need not be limited to, the following 
205  information: 
206         a. A description of the facilities licensed to provide such 
207  services, including total number of beds licensed under this 
208  part. 
209         b. The number and characteristics of residents receiving 
210  such services. 
211         c. The types of services rendered that could not be 
212  provided through a standard license. 
213         d. An analysis of deficiencies cited during licensure 
214  inspections. 
215         e. The number of residents who required extended congregate 
216  care services at admission and the source of admission. 
217         f. Recommendations for statutory or regulatory changes. 
218         g. The availability of extended congregate care to state 
219  clients residing in facilities licensed under this part and in 
220  need of additional services, and recommendations for 
221  appropriations to subsidize extended congregate care services 
222  for such persons. 
223         h. Such other information as the department considers 
224  appropriate. 
225         (c) A limited nursing services license shall be issued to a 
226  facility that provides services beyond those authorized in 
227  paragraph (a) and as specified in this paragraph. 
228         1. In order for limited nursing services to be provided in 
229  a facility licensed under this part, the agency must first 
230  determine that all requirements established in law and rule are 
231  met and must specifically designate, on the facility’s license, 
232  that such services may be provided. Such designation may be made 
233  at the time of initial licensure or relicensure, or upon request 
234  in writing by a licensee under this part and part II of chapter 
235  408. Notification of approval or denial of such request shall be 
236  made in accordance with part II of chapter 408. Existing 
237  facilities qualifying to provide limited nursing services shall 
238  have maintained a standard license and may not have been subject 
239  to administrative sanctions that affect the health, safety, and 
240  welfare of residents for the previous 2 years or since initial 
241  licensure if the facility has been licensed for less than 2 
242  years. 
243         2. Facilities that are licensed to provide limited nursing 
244  services shall maintain a written progress report on each person 
245  who receives such nursing services, which report describes the 
246  type, amount, duration, scope, and outcome of services that are 
247  rendered and the general status of the resident’s health. A 
248  registered nurse representing the agency shall visit such 
249  facilities at least twice a year to monitor residents who are 
250  receiving limited nursing services and to determine if the 
251  facility is in compliance with applicable provisions of this 
252  part, part II of chapter 408, and related rules. The monitoring 
253  visits may be provided through contractual arrangements with 
254  appropriate community agencies. A registered nurse shall also 
255  serve as part of the team that inspects such facility. 
256         3. A person who receives limited nursing services under 
257  this part must meet the admission criteria established by the 
258  agency for assisted living facilities. When a resident no longer 
259  meets the admission criteria for a facility licensed under this 
260  part, arrangements for relocating the person shall be made in 
261  accordance with s. 429.28(1)(k), unless the facility is licensed 
262  to 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 $300 
268  per license, with an additional fee of $50 per resident based on 
269  the total licensed resident capacity of the facility, except 
270  that no additional fee will be assessed for beds designated for 
271  recipients of optional state supplementation payments provided 
272  for in s. 409.212. The total fee under this paragraph may not 
273  exceed $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 $400 per license, with an additional fee 
279  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 paragraph 
282  (a), the agency shall require facilities that are licensed to 
283  provide limited nursing services under this part to pay an 
284  additional monitoring fee quarterly for each quarter in which 
285  the facility provides limited nursing services. The quarterly 
286  monitoring fee shall be $75 plus $10 for each resident who 
287  received limited nursing services during the quarter. This 
288  monitoring fee shall be adjusted by not more than the change in 
289  the Consumer Price Index based on the 12 months immediately 
290  preceding the increase. fee per licensed facility. The amount of 
291  the biennial fee shall be $250 per license, with an additional 
292  fee of $10 per resident based on the total licensed resident 
293  capacity of the facility. 
294         Section 2. Effective April 1, 2011, subsections (1) and (5) 
295  of section 429.17, Florida Statutes, are amended to read: 
296         429.17 Expiration of license; renewal; conditional 
297  license.— 
298         (1) Limited nursing, Extended congregate care, and limited 
299  mental health licenses shall expire at the same time as the 
300  facility’s standard license, regardless of when issued. 
301         (5) When an extended care or limited nursing license is 
302  requested during a facility’s biennial license period, the fee 
303  shall be prorated in order to permit the additional license to 
304  expire at the end of the biennial license period. The fee shall 
305  be calculated as of the date the additional license application 
306  is received by the agency. 
307         Section 3. Paragraphs (i) and (j) of subsection (1) of 
308  section 429.41, Florida Statutes, are amended, and paragraphs 
309  (m), (n), and (o) are added to that subsection, to read: 
310         429.41 Rules establishing standards.— 
311         (1) It is the intent of the Legislature that rules 
312  published and enforced pursuant to this section shall include 
313  criteria by which a reasonable and consistent quality of 
314  resident care and quality of life may be ensured and the results 
315  of such resident care may be demonstrated. Such rules shall also 
316  ensure a safe and sanitary environment that is residential and 
317  noninstitutional in design or nature. It is further intended 
318  that reasonable efforts be made to accommodate the needs and 
319  preferences of residents to enhance the quality of life in a 
320  facility. The agency, in consultation with the department, may 
321  adopt rules to administer the requirements of part II of chapter 
322  408. In order to provide safe and sanitary facilities and the 
323  highest quality of resident care accommodating the needs and 
324  preferences of residents, the department, in consultation with 
325  the agency, the Department of Children and Family Services, and 
326  the Department of Health, shall adopt rules, policies, and 
327  procedures to administer this part, which must include 
328  reasonable and fair minimum standards in relation to: 
329         (i) Facilities holding an a limited nursing, extended 
330  congregate care, or limited mental health license. 
331         (j) The establishment of specific criteria to define 
332  appropriateness of resident admission and continued residency in 
333  a facility holding a standard, limited nursing, extended 
334  congregate care, and limited mental health license. 
335         (m) The frequency of the monitoring visits to licensed 
336  facilities that provide limited nursing services or extended 
337  congregate care services. The frequency of monitoring visits 
338  shall be based on factors such as, but not limited to: the 
339  number of residents receiving limited nursing services or 
340  extended congregate care services; the type, amount, duration, 
341  and scope of limited nursing services or extended congregate 
342  care services provided by the facility; the health status of the 
343  residents receiving the limited nursing services or extended 
344  congregate services; whether the registered nurse has determined 
345  during inspections that have occurred within the last 24 months 
346  that the facility has provided limited nursing services or 
347  extended congregate care services appropriately; whether the 
348  facility has no class I or class II violations and no 
349  uncorrected class III violations; and the existence of any 
350  complaints made to and substantiated by the long-term care 
351  ombudsman council for the area in which the facility is located 
352  concerning the limited nursing services or extended congregate 
353  care services provided by that facility. 
354         (n) The process for collecting the monitoring fee from 
355  licensed facilities providing limited nursing services. 
356         (o) The submission of aggregate data concerning the 
357  resident population as required by s. 429.54. 
358         Section 4. Section 429.54, Florida Statutes, is amended to 
359  read: 
360         429.54 Collection of information; local subsidy.— 
361         (1) Facilities that are licensed under this part must 
362  report electronically to the agency quarterly data related to 
363  the characteristics, attributes, and health status of the 
364  resident population and the type, amount, duration, and scope of 
365  services provided to residents. The department, in consultation 
366  with the agency, shall adopt rules for the submission of 
367  aggregate data. The first data submission to the agency shall 
368  cover data for the calendar quarter January 1 through March 31, 
369  2011. 
370         (2)(1) To enable the department to collect the information 
371  requested by the Legislature regarding the actual cost of 
372  providing room, board, and personal care in facilities, the 
373  department is authorized to conduct field visits and audits of 
374  facilities as may be necessary. The owners of randomly sampled 
375  facilities shall submit such reports, audits, and accountings of 
376  cost as the department may require by rule; provided that such 
377  reports, audits, and accountings shall be the minimum necessary 
378  to implement the provisions of this section. Any facility 
379  selected to participate in the study shall cooperate with the 
380  department by providing cost of operation information to 
381  interviewers. 
382         (3)(2) Local governments or organizations may contribute to 
383  the cost of care of local facility residents by further 
384  subsidizing the rate of state-authorized payment to such 
385  facilities. Implementation of local subsidy shall require 
386  departmental approval and shall not result in reductions in the 
387  state supplement. 
388         Section 5. Except as otherwise expressly provided in this 
389  act, this act shall take effect July 1, 2010.