Bill Amendment: FL S0474 | 2017 | Regular Session
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: Hospice Care
Status: 2017-06-19 - Chapter No. 2017-119 [S0474 Detail]
Download: Florida-2017-S0474-Senate_Committee_Amendment_479570.html
Bill Title: Hospice Care
Status: 2017-06-19 - Chapter No. 2017-119 [S0474 Detail]
Download: Florida-2017-S0474-Senate_Committee_Amendment_479570.html
Florida Senate - 2017 COMMITTEE AMENDMENT Bill No. SB 474 Ì4795709Î479570 LEGISLATIVE ACTION Senate . House . . . . . ————————————————————————————————————————————————————————————————— ————————————————————————————————————————————————————————————————— The Committee on Health Policy (Grimsley) recommended the following: 1 Senate Amendment (with title amendment) 2 3 Delete everything after the enacting clause 4 and insert: 5 Section 1. Section 400.6005, Florida Statutes, is amended 6 to read: 7 400.6005 Legislative findings and intent.—The Legislature 8 finds that a terminally ill patientindividuals and their9families,who isareno longer pursuing curative medical 10 treatment and the patient’s family,should have the opportunity 11 to select a support system that allowspermitsthe patient to 12 exercise maximum independence and dignity during the final days 13 of life. The Legislature also finds that a seriously ill patient 14 and the patient’s family should have the opportunity to select a 15 support system that provides palliative care and supportive care 16 and allows the patient to exercise maximum independence while 17 receiving such care. The Legislature finds that hospice care 18 provides a cost-effective and less intrusive form of medical 19 care while meeting the social, psychological, and spiritual 20 needs of terminally ill and seriously ill patients and their 21 families. The intent of this part is to provide for the 22 development, establishment, and enforcement of basic standards 23 to ensure the safe and adequate care of persons receiving 24 hospice services. 25 Section 2. Section 400.601, Florida Statutes, is amended to 26 read: 27 400.601 Definitions.—As used in this part, the term: 28 (1) “Agency” means the Agency for Health Care 29 Administration. 30 (2) “Department” means the Department of Elderly Affairs. 31 (3) “Hospice” means a centrally administered corporation or 32 a limited liability company that provides a continuum of 33 palliative care and supportive care for athe terminally ill34 patient and his or her family. 35 (4) “Hospice care team” means an interdisciplinary team of 36 qualified professionals and volunteers who, in consultation with 37 athepatient, the patient’s family, and the patient’s primary 38 or attending physician, collectively assess, coordinate, and 39 provide the appropriate palliative care and supportive care to 40 hospice patients and their families. 41 (5) “Hospice program” means a program offered by a hospice 42 which provides a continuum of palliative care and supportive 43 care for a patient and his or her family. 44 (6)(5)“Hospice residential unit” means a homelike living 45 facility, other than a facility licensed under other parts of 46 this chapter, under chapter 395, or under chapter 429, which 47thatis operated by a hospice for the benefit of its patients 48 and is considered by a patient who lives there to be his or her 49 primary residence. 50 (7)(6)“Hospice services” means items and services 51 furnished to a terminally ill patient and family by a hospice, 52 or by others under arrangements with such a program, in a place 53 of temporary or permanent residence used as the patient’s home 54 for the purpose of maintaining the patient at home; or, if the 55 patient needs short-term institutionalization, the services 56 shall be furnished in cooperation with those contracted 57 institutions or in the hospice inpatient facility. 58 (8)(7)“Palliative care” means services or interventions 59 furnished to a seriously ill patient and family which are not 60 curative but are provided for the reduction or abatement of pain 61 and human suffering. 62 (9)(8)“Patient” means the terminally or seriously ill 63 individual receivinghospiceservices from a hospice. 64 (10)(9)“Plan of care” means a written assessment by the 65 hospice of each patient’s and family’s needs and preferences, 66 and the services to be provided by the hospice to meet those 67 needs. 68 (11) “Seriously ill” means that the person has a life 69 threatening medical condition that may be irreversible and may 70 continue indefinitely, and such condition may be managed through 71 palliative care. 72 (12)(10)“Terminally ill” means that the patient has a 73 medical prognosis that his or her life expectancy is 1 year or 74 less if the illness runs its normal course. 75 Section 3. Section 400.60501, Florida Statutes, is amended 76 to read: 77 400.60501 Outcome measures; adoption of federal quality 78 measures; public reportingnational initiatives; annual report.— 79 (1) No later than December 31, 20192007, the departmentof80Elderly Affairs, in conjunction with the agencyfor Health Care81Administration, shalldevelopadopt the national hospice outcome 82 measures in 42 C.F.R. part 418 to determine the quality and 83 effectiveness of hospice care for hospices licensed in the 84 state.At a minimum, these outcome measures shall include a85requirement that 50 percent of patients who report severe pain86on a 0-to-10 scale must report a reduction to 5 or less by the87end of the 4th day of care on the hospice program.88 (2)For hospices licensed in the state,The departmentof89Elderly Affairs, in conjunction with the agencyfor Health Care90Administration, shall: 91 (a) Make available to the public the national hospice 92 outcome measures in a format that is comprehensible by a 93 layperson and that allows a consumer to compare such measures of 94 one or more hospices.Consider andadopt national initiatives,95such as those developed by the national hospiceand Palliative96Care Organization, to set benchmarks for measuring the quality97of hospice care provided in the state. 98 (b) Develop an annual report that analyzes and evaluates 99 the information collected under this act and any other data 100 collection or reporting provisions of law. 101 Section 4. Section 400.609, Florida Statutes, is amended to 102 read: 103 400.609 Hospice services.—Each hospice shall provide a 104 continuum of hospice services which affordsaffordthe 105 terminally ill patient and the family of the patient a range of 106 service delivery which can be tailored to specific needs and 107 preferences of the terminally ill patient and family at any 108 pointin timethroughout the length of carefor the terminally109ill patientand during the bereavement period. These services 110 must be available 24 hours a day, 7 days a week, and must 111 include: 112 (1) SERVICES.— 113 (a) The hospice care team shall directly provide the 114 following core services: nursing services, social work services, 115 pastoral or counseling services, dietary counseling, and 116 bereavement counseling services. Physician services may be 117 provided by the hospice directly or through contract. A hospice 118 may also use contracted staff if necessary to supplement hospice 119 employees in order to meet the needs of patients during periods 120 of peak patient loads or under extraordinary circumstances. 121 (b) Each hospice must also provide or arrange for such 122 additional services as are needed to meet the palliative and 123 support needs of the patient and family. These services may 124 include, but are not limited to, physical therapy, occupational 125 therapy, speech therapy, massage therapy, home health aide 126 services, infusion therapy, provision of medical supplies and 127 durable medical equipment, day care, homemaker and chore 128 services, and funeral services. 129 (2) HOSPICE HOME CARE.—Hospice care and services provided 130 in a private home shall be the primary form of care. The goal of 131 hospice home care shall be to provide adequate training and 132 support to encourage self-sufficiency and allow patients and 133 families to maintain the patient comfortably at home for as long 134 as possible. The services of the hospice home care program shall 135 be of the highest quality and shall be provided by the hospice 136 care team. 137 (3) HOSPICE RESIDENTIAL CARE.—Hospice care and services, to 138 the extent practicable and compatible with the needs and 139 preferences of the patient, may be provided by the hospice care 140 team to a patient living in an assisted living facility, adult 141 family-care home, nursing home, hospice residential unit or 142 facility, or other nondomestic place of permanent or temporary 143 residence. A resident or patient living in an assisted living 144 facility, adult family-care home, nursing home, or other 145 facility subject to state licensing who has been admitted to a 146 hospice program shall be considered a hospice patient, and the 147 hospice program shall be responsible for coordinating and 148 ensuring the delivery of hospice care and services to such 149 person pursuant to the standards and requirements of this part 150 and rules adopted under this part. 151 (4) HOSPICE INPATIENT CARE.—The inpatient component of care 152 is a short-term adjunct to hospice home care and hospice 153 residential care and shall be used only for pain control, 154 symptom management, or respite care. The total number of 155 inpatient days for all hospice patients in any 12-month period 156 may not exceed 20 percent of the total number of hospice days 157 for all the hospice patients of the licensed hospice. Hospice 158 inpatient care shall be under the direct administration of the 159 hospice, whether the inpatient facility is a freestanding 160 hospice facility or part of a facility licensed pursuant to 161 chapter 395 or part II of this chapter. The facility or rooms 162 within a facility used for the hospice inpatient component of 163 care shall be arranged, administered, and managed in such a 164 manner as to provide privacy, dignity, comfort, warmth, and 165 safety for the terminally ill patient and the family. Every 166 possible accommodation must be made to create as homelike an 167 atmosphere as practicable. To facilitate overnight family 168 visitation within the facility, rooms must be limited to no more 169 than double occupancy; and, whenever possible, both occupants 170 must be hospice patients. There must be a continuum of care and 171 a continuity of caregivers between the hospice home program and 172 the inpatient aspect of care to the extent practicable and 173 compatible with the preferences of the patient and his or her 174 family. Fees charged for hospice inpatient care, whether 175 provided directly by the hospice or through contract, must be 176 made available upon request to the Agency for Health Care 177 Administration. The hours for daily operation and the location 178 of the place where the services are provided must be determined, 179 to the extent practicable, by the accessibility of such services 180 to the patients and families served by the hospice. 181 (5) BEREAVEMENT COUNSELING.—The hospice bereavement program 182 must be a comprehensive program, under professional supervision, 183 that provides a continuum of formal and informal supportive 184 services to the family for a minimum of 1 year after the 185 patient’s death. This subsection does not constitute an 186 additional exemption from chapter 490 or chapter 491. 187 Section 5. Section 400.6093, Florida Statutes, is created 188 to read: 189 400.6093 Community palliative care services.—A hospice may 190 provide palliative care to a seriously ill patient and his or 191 her family members. Such palliative care may be provided to 192 manage the side effects of treatment for a progressive disease 193 or medical or surgical condition. Such care may also be provided 194 directly by the hospice or by other providers under contract 195 with the hospice. This section does not preclude the provision 196 of palliative care to seriously ill patients or their family 197 members by any other health care provider or health care 198 facility otherwise authorized to provide such care. This section 199 does not mandate or prescribe additional Medicaid coverage. 200 Section 6. Subsections (1) and (2) of section 400.6095, 201 Florida Statutes, are amended to read: 202 400.6095 Patient admission; assessment; plan of care; 203 discharge; death.— 204 (1) Each hospice shall make its services available to all 205 terminally ill patientspersonsand their families without 206 regard to age, gender, national origin, sexual orientation, 207 disability, diagnosis, cost of therapy, ability to pay, or life 208 circumstances. A hospice mayshallnot impose any value or 209 belief system on its patients or their families and shall 210 respect the values and belief systems of its patients and their 211 families. 212 (2) Admission of a terminally ill patient to a hospice 213 program shall be made upon a diagnosis and prognosis of terminal 214 illness by a physician licensed pursuant to chapter 458 or 215 chapter 459 and mustshallbe dependent on the expressed request 216 and informed consent of the patient. 217 Section 7. Section 400.6096, Florida Statutes, is created 218 to read: 219 400.6096 Disposal of prescribed controlled substances 220 following the death of a patient in the home.— 221 (1) A hospice physician, nurse, or social worker is 222 authorized to assist in the disposal of a controlled substance 223 prescribed to a patient at the time of the patient’s death 224 pursuant to the disposal regulations in 21 C.F.R. s. 1317. 225 (2) A hospice that assists in the disposal of a prescribed 226 controlled substance found in the patient’s home at the time of 227 the patient’s death must establish a written policy, procedure, 228 or system for acceptable disposal methods. 229 (3) A hospice physician, nurse, or social worker, upon the 230 patient’s death and with the permission of a family member or a 231 caregiver of the patient, may assist in the disposal of an 232 unused controlled substance prescribed to the patient, pursuant 233 to the written policy, procedure, or system established under 234 subsection (2). 235 (4) The prescribed controlled substance disposal procedure 236 must be carried out in the patient’s home. Hospice staff and 237 volunteers are not authorized to remove a prescribed controlled 238 substance from the patient’s home. 239 Section 8. Section 400.611, Florida Statutes, is amended to 240 read: 241 400.611 Interdisciplinary records of care; confidentiality; 242 release of records.— 243 (1) A hospice shall maintain an up-to-date, 244 interdisciplinary record of care being given and patient and 245 family statusshall be kept. Records shall contain pertinent 246 past and current medical, nursing, social, and other therapeutic 247 information and such other information that is necessary for the 248 safe and adequate care of the patient. Notations regarding all 249 aspects of care for the patient and family shall be made in the 250 record. When services are terminated, the record shall show the 251 date and reason for termination. 252 (2) Patient records shall be retained for a period of56 253 years after termination of hospice services, unless otherwise 254 provided by law. In the case of a patient who is a minor, the5255 6-year period shall begin on the date the patient reaches or 256 would have reached the age of majority. 257 (3) The interdisciplinary record of patientrecords ofcare 258 and billing records are confidential. 259 (4) A hospice may not release a patient’s interdisciplinary 260 record or any portion thereof, unless the person requesting the 261 information provides to the hospice: 262 (a) A patient authorization executed by the patient;or263legal guardian has given express written informed consent;264 (b) If the patient is incapacitated, a patient 265 authorization executed before the patient’s death by the 266 patient’s then acting legal guardian, health care surrogate, 267 health care proxy, or agent under power of attorney; 268 (c) A court order appointing the person as the 269 administrator, curator, executor, or personal representative of 270 the patient’s estate with authority to obtain the patient’s 271 medical records; 272 (d) If a judicial appointment has not been made pursuant to 273 paragraph (c), a last will that is self-proved under s. 732.503 274 and designates the person to act as the patient’s personal 275 representative; or 276 (e) An order by a court of competent jurisdiction to 277 release the interdisciplinary record to the personhas so278ordered; or279(c) A state or federal agency, acting under its statutory280authority, requires submission of aggregate statistical data.281Any information obtained from patient records by a state agency282pursuant to its statutory authority is confidential and exempt283from the provisions of s. 119.07(1). 284 (5) For purposes of this section, the term “patient 285 authorization” means an unrevoked written statement by the 286 patient, or an oral statement made by the patient which has been 287 reduced to writing in the patient’s interdisciplinary record of 288 care, or, in the case of an incapacitated patient, by the 289 patient’s then acting legal guardian, health care surrogate, 290 agent under a power of attorney, or health care proxy giving the 291 patient’s permission to release the interdisciplinary record to 292 a person requesting the record. 293 (6) A hospice must release requested aggregate patient 294 statistical data to a state or federal agency acting under its 295 statutory authority. Any information obtained from patient 296 records by a state agency pursuant to its statutory authority is 297 confidential and exempt from s. 119.07(1). 298 Section 9. This act shall take effect July 1, 2017. 299 300 ================= T I T L E A M E N D M E N T ================ 301 And the title is amended as follows: 302 Delete everything before the enacting clause 303 and insert: 304 A bill to be entitled 305 An act relating to hospice care; amending s. 400.6005, 306 F.S.; revising legislative findings and intent; 307 amending s. 400.601, F.S.; redefining the term 308 “hospice”; defining the terms “hospice program” and 309 “seriously ill”; amending s. 400.60501, F.S.; 310 requiring the Department of Elderly Affairs, in 311 conjunction with the Agency for Health Care 312 Administration, to adopt national hospice outcome 313 measures by a specified date and to make such measures 314 available to the public; amending s. 400.609; 315 clarifying provisions relating to hospice services; 316 creating s. 400.6093, F.S.; authorizing hospices, or 317 providers operating under contract with a hospice, to 318 provide palliative care to seriously ill persons and 319 their family members; providing construction; amending 320 s. 400.6095, F.S.; making technical changes; creating 321 s. 400.6096, F.S.; authorizing certain hospice 322 personnel to assist in the disposal of certain 323 prescribed controlled substances; requiring a hospice 324 that chooses to assist in the disposal of certain 325 prescribed controlled substances to establish 326 policies, procedures, and systems for the disposal; 327 authorizing a hospice physician, nurse, or social 328 worker to assist in the disposals of certain 329 prescribed controlled substances; providing 330 requirements for such disposals; amending s. 400.611, 331 F.S.; requiring a hospice to maintain an up-to-date 332 interdisciplinary record of care; revising the patient 333 records retention period; providing for the 334 confidentiality of the interdisciplinary record of 335 patient care; specifying to whom and under what 336 conditions a hospice may release a patient’s 337 interdisciplinary record of care; defining a term; 338 requiring a hospice to release patient statistical 339 data to certain agencies; specifying that information 340 from patient records is confidential and exempt from 341 certain provisions; providing an effective date.