Bill Text: FL S1292 | 2012 | Regular Session | Comm Sub
Bill Title: Health Care Facilities
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2012-03-09 - Laid on Table, refer to CS/CS/HB 787 -SJ 1260 [S1292 Detail]
Download: Florida-2012-S1292-Comm_Sub.html
Florida Senate - 2012 CS for SB 1292 By the Committee on Health Regulation; and Senator Bogdanoff 588-03531-12 20121292c1 1 A bill to be entitled 2 An act relating to health care facilities; amending s. 3 400.021, F.S.; revising definitions of the terms 4 “geriatric outpatient clinic” and “resident care plan” 5 and defining the term “therapeutic spa services”; 6 amending s. 400.141, F.S.; revising provisions 7 relating to facilities eligible to share programming 8 and staff; deleting requirements for the submission of 9 certain reports to the Agency for Health Care 10 Administration; creating s. 400.172, F.S.; providing 11 requirements for a nursing home facility operated by a 12 licensee that provides respite care services; 13 providing for rights of persons receiving respite care 14 in nursing home facilities; requiring a prospective 15 respite care recipient to provide certain information 16 to the nursing home facility; amending s. 400.141, 17 F.S.; revising provisions relating to other needed 18 services provided by licensed nursing home facilities, 19 including respite care, adult day, and therapeutic spa 20 services; amending s. 408.036, F.S.; adding to the 21 exemptions from agency review and from the requirement 22 of a certificate of need a pilot project to construct 23 a nursing home that is affiliated with an accredited 24 nursing school in a private accredited university and 25 that meets certain criteria; providing an exception to 26 a moratorium on new construction of nursing home beds; 27 providing for expiration of the provision; amending s. 28 429.195, F.S.; revising provisions prohibiting certain 29 rebates relating to assisted living facilities; 30 amending s. 429.905, F.S.; defining the term “day” for 31 purposes of day care services provided to adults who 32 are not residents; amending ss. 458.3265 and 459.0137, 33 F.S.; revising the definition of the term “chronic 34 nonmalignant pain”; requiring that a pain-management 35 clinic register with the Department of Health unless 36 the clinic is wholly owned by certain board-eligible 37 or board-certified physicians or medical specialists, 38 organized as a physician-owned group practice, or 39 wholly owned by physicians who are not board eligible 40 or board certified but who have completed specified 41 residency programs and have a specified number of 42 years of full-time practice in pain medicine; amending 43 s. 651.118, F.S.; providing a funding limitation on 44 sheltered nursing home beds used to provide assisted 45 living, rather than extended congregate care services; 46 authorizing certain sharing of areas, services, and 47 staff between such sheltered beds and nursing home 48 beds in those facilities; amending s. 817.505, F.S.; 49 conforming provisions to changes made by the act; 50 providing an effective date. 51 52 Be It Enacted by the Legislature of the State of Florida: 53 54 Section 1. Subsections (8) and (16) of section 400.021, 55 Florida Statutes, are amended, and subsection (19) is added to 56 that section, to read: 57 400.021 Definitions.—When used in this part, unless the 58 context otherwise requires, the term: 59 (8) “Geriatric outpatient clinic” means a site for 60 providing outpatient health care to persons 60 years of age or 61 older, which is staffed by a registered nurse,ora physician 62 assistant, or a licensed practical nurse under the direct 63 supervision of a registered nurse, advanced registered nurse 64 practitioner, physician assistant, or physician. 65 (16) “Resident care plan” means a written plan developed, 66 maintained, and reviewed not less than quarterly by a registered 67 nurse, with participation from other facility staff and the 68 resident or his or her designee or legal representative, which 69 includes a comprehensive assessment of the needs of an 70 individual resident; the type and frequency of services required 71 to provide the necessary care for the resident to attain or 72 maintain the highest practicable physical, mental, and 73 psychosocial well-being; a listing of services provided within 74 or outside the facility to meet those needs; and an explanation 75 of service goals.The resident care plan must be signed by the76director of nursing or another registered nurse employed by the77facility to whom institutional responsibilities have been78delegated and by the resident, the resident’s designee, or the79resident’s legal representative. The facility may not use an80agency or temporary registered nurse to satisfy the foregoing81requirement and must document the institutional responsibilities82that have been delegated to the registered nurse.83 (19) “Therapeutic spa services” means bathing, nail, and 84 hair care services and other similar services related to 85 personal hygiene. 86 Section 2. Paragraph (g) of subsection (1) of section 87 400.141, Florida Statutes, is amended to read: 88 400.141 Administration and management of nursing home 89 facilities.— 90 (1) Every licensed facility shall comply with all 91 applicable standards and rules of the agency and shall: 92 (g) If the facility has a standard licenseor is a Gold93Seal facility, exceeds the minimum required hours of licensed 94 nursing and certified nursing assistant direct care per resident 95 per day, and is part of a continuing care facility licensed 96 under chapter 651 or a retirement community that offers other 97 services pursuant to part III of this chapter or part I or part 98 III of chapter 429 on a single campus, be allowed to share 99 programming and staff. At the time of inspectionand in the100semiannual report required pursuant to paragraph (o), a 101 continuing care facility or retirement community that uses this 102 option must demonstrate through staffing records that minimum 103 staffing requirements for the facility were met. Licensed nurses 104 and certified nursing assistants who work in thenursing home105 facility may be used to provide services elsewhere on campus if 106 the facility exceeds the minimum number of direct care hours 107 required per resident per day and the total number of residents 108 receiving direct care services from a licensed nurse or a 109 certified nursing assistant does not cause the facility to 110 violate the staffing ratios required under s. 400.23(3)(a). 111 Compliance with the minimum staffing ratios mustshallbe based 112 on the total number of residents receiving direct care services, 113 regardless of where they reside on campus. If the facility 114 receives a conditional license, it may not share staff until the 115 conditional license status ends. This paragraph does not 116 restrict the agency’s authority under federal or state law to 117 require additional staff if a facility is cited for deficiencies 118 in care which are caused by an insufficient number of certified 119 nursing assistants or licensed nurses. The agency may adopt 120 rules for the documentation necessary to determine compliance 121 with this provision. 122 Section 3. Section 400.172, Florida Statutes, is created to 123 read: 124 400.172 Respite care provided in nursing home facilities.— 125 (1) For each person admitted for respite care as authorized 126 under s. 400.141(1)(f), a nursing home facility operated by a 127 licensee must: 128 (a) Have a written abbreviated plan of care that, at a 129 minimum, includes nutritional requirements, medication orders, 130 physician orders, nursing assessments, and dietary preferences. 131 The nursing or physician assessments may take the place of all 132 other assessments required for full-time residents. 133 (b) Have a contract that, at a minimum, specifies the 134 services to be provided to a resident receiving respite care, 135 including charges for services, activities, equipment, emergency 136 medical services, and the administration of medications. If 137 multiple admissions for a single person for respite care are 138 anticipated, the original contract is valid for 1 year after the 139 date the contract is executed. 140 (c) Ensure that each resident is released to his or her 141 caregiver or an individual designated in writing by the 142 caregiver. 143 (2) A person admitted under the respite care program shall: 144 (a) Be exempt from department rules relating to the 145 discharge planning process. 146 (b) Be covered by the residents’ rights specified in s. 147 400.022(1)(a)-(o) and (r)-(t). Funds or property of the resident 148 are not be considered trust funds subject to the requirements of 149 s. 400.022(1)(h) until the resident has been in the facility for 150 more than 14 consecutive days. 151 (c) Be allowed to use his or her personal medications 152 during the respite stay if permitted by facility policy. The 153 facility must obtain a physician’s order for the medications. 154 The caregiver may provide information regarding the medications 155 as part of the nursing assessment and that information must 156 agree with the physician’s order. Medications shall be released 157 with the resident upon discharge in accordance with current 158 physician’s orders. 159 (d) Be entitled to reside in the facility for a total of 60 160 days within a contract year or for a total of 60 days within a 161 calendar year if the contract is for less than 12 months. 162 However, each single stay may not exceed 14 days. If a stay 163 exceeds 14 consecutive days, the facility must comply with all 164 assessment and care planning requirements applicable to nursing 165 home residents. 166 (e) Reside in a licensed nursing home bed. 167 (3) A prospective respite care resident must provide 168 medical information from a physician, physician assistant, or 169 nurse practitioner and any other information provided by the 170 primary caregiver required by the facility before or when the 171 person is admitted to receive respite care. The medical 172 information must include a physician’s order for respite care 173 and proof of a physical examination by a licensed physician, 174 physician assistant, or nurse practitioner. The physician’s 175 order and physical examination may be used to provide 176 intermittent respite care for up to 12 months after the date the 177 order is written. 178 (4) The facility shall assume the duties of the primary 179 caregiver. To ensure continuity of care and services, the 180 resident may retain his or her personal physician and shall have 181 access to medically necessary services such as physical therapy, 182 occupational therapy, or speech therapy, as needed. The facility 183 shall arrange for transportation of the resident to these 184 services, if necessary. 185 Section 4. Paragraph (f) of subsection (1) of section 186 400.141, Florida Statutes, is amended to read: 187 400.141 Administration and management of nursing home 188 facilities.— 189 (1) Every licensed facility shall comply with all 190 applicable standards and rules of the agency and shall: 191 (f) Be allowed and encouraged by the agency to provide 192 other needed services under certain conditions. If the facility 193 has a standard licensure status,and has had no class I or class194II deficiencies during the past 2 years or has been awarded a195Gold Seal under the program established in s.400.235,it maybe196encouraged by the agency toprovide services, including, but not 197 limited to, respite, therapeutic spa, and adult day services to 198 nonresidents, which enable individuals to move in and outof the 199 facility. A facility is not subject to any additional licensure 200 requirements for providing these services. Respite care may be 201 offered to persons in need of short-term or temporary nursing 202 home services. Respite care must be provided in accordance with 203 this partand rules adopted by the agency. However, the agency204shall, by rule, adopt modified requirements for resident205assessment, resident care plans, resident contracts, physician206orders, and other provisions, as appropriate, for short-term or207temporary nursing home services. Providers of adult day services 208 must comply with the requirements of s. 429.905(2). The agency 209 shall allow for shared programming and staff in a facility which 210 meets minimum standards and offers services pursuant to this 211 paragraph, but, if the facility is cited for deficiencies in 212 patient care, may require additional staff and programs 213 appropriate to the needs of service recipients. A person who 214 receives respite care may not be counted as a resident of the 215 facility for purposes of the facility’s licensed capacity unless 216 that person receives 24-hour respite care. A person receiving 217 either respite care for 24 hours or longer or adult day services 218 must be included when calculating minimum staffing for the 219 facility. Any costs and revenues generated by a nursing home 220 facility from nonresidential programs or services shall be 221 excluded from the calculations of Medicaid per diems for nursing 222 home institutional care reimbursement. 223 Section 5. Paragraph (t) is added to subsection (3) of 224 section 408.036, Florida Statutes, to read: 225 408.036 Projects subject to review; exemptions.— 226 (3) EXEMPTIONS.—Upon request, the following projects are 227 subject to exemption from the provisions of subsection (1): 228 (t)1. There shall be a pilot project in the agency-planning 229 subdistrict 4-1, 4-2, or 4-3 for the construction of a nursing 230 home that has 150 or fewer beds. In order to qualify for the 231 pilot project, the nursing home must: 232 a. Be affiliated with an accredited nursing school offering 233 a bachelor of science, master of science, and doctorate of 234 science degree program within a private accredited university; 235 b. Be constructed on or abutting property of the private 236 accredited university; 237 c. Once licensed, have at all times an affiliation with the 238 private accredited university; and 239 d. Employ or otherwise make positions available for the 240 education and training of nursing students in the field of long 241 term care or geriatric nursing. 242 2. Notwithstanding any moratorium, existing or planned, on 243 new construction of nursing home beds, a pilot project meeting 244 the provisions of this paragraph may proceed with construction, 245 licensure, and operation. Construction must begin within 11 246 months after this exemption becomes law. This exemption expires 247 June 30, 2014. 248 Section 6. Section 429.195, Florida Statutes, is amended to 249 read: 250 429.195 Rebates prohibited; penalties.— 251 (1) It is unlawful for ananyassisted living facility 252 licensed under this part to contract or promise to pay or 253 receive any commission, bonus, kickback, or rebate or engage in 254 any split-fee arrangement in any form whatsoever with any 255 person, health care provider, or health care facility as 256 provided under s. 817.505physician, surgeon, organization,257agency, or person, either directly or indirectly, for residents258referred to an assisted living facility licensed under this259part.A facility may employ or contract with persons to market260the facility, provided the employee or contract provider clearly261indicates that he or she represents the facility. A person or262agency independent of the facility may provide placement or263referral services for a fee to individuals seeking assistance in264finding a suitable facility; however, any fee paid for placement265or referral services must be paid by the individual looking for266a facility, not by the facility.267 (2) This section does not apply to: 268 (a) An individual employed by the assisted living facility, 269 or with whom the facility contracts to provide marketing 270 services for the facility, if the individual clearly indicates 271 that he or she works with or for the facility. 272 (b) Payments by an assisted living facility to a referral 273 service that provides information, consultation, or referrals to 274 consumers to assist them in finding appropriate care or housing 275 options for seniors or disabled adults if the referred consumers 276 are not Medicaid recipients. 277 (c) A resident of an assisted living facility who refers a 278 friend, family members, or other individuals with whom the 279 resident has a personal relationship to the assisted living 280 facility, in which case the assisted living facility may provide 281 a monetary reward to the resident for making such referral. 282 (3)(2)A violation of this section isshall be considered283 patient brokering and is punishable as provided in s. 817.505. 284 Section 7. Subsection (2) of section 429.905, Florida 285 Statutes, is amended to read: 286 429.905 Exemptions; monitoring of adult day care center 287 programs colocated with assisted living facilities or licensed 288 nursing home facilities.— 289 (2) A licensed assisted living facility, a licensed 290 hospital, or a licensed nursing home facility may provide 291 services during the day which include, but are not limited to, 292 social, health, therapeutic, recreational, nutritional, and 293 respite services, to adults who are not residents. Such a 294 facility need not be licensed as an adult day care center; 295 however, the agency must monitor the facility during the regular 296 inspection and at least biennially to ensure adequate space and 297 sufficient staff. If an assisted living facility, a hospital, or 298 a nursing home holds itself out to the public as an adult day 299 care center, it must be licensed as such and meet all standards 300 prescribed by statute and rule. For the purpose of this 301 subsection, the term “day” means any portion of a 24-hour day. 302 Section 8. Paragraph (a) of subsection (1) of section 303 458.3265, Florida Statutes, is amended to read: 304 458.3265 Pain-management clinics.— 305 (1) REGISTRATION.— 306 (a)1. As used in this section, the term: 307 a. “Chronic nonmalignant pain” means pain unrelated to 308 cancer,orrheumatoid arthritis, or sickle cell anemia which 309 persists beyond the usual course of disease or beyond the injury 310 that is the cause of the pain or which persists more than 90 311 days after surgery. 312 b. “Pain-management clinic” or “clinic” means any publicly 313 or privately owned facility: 314 (I) That advertises in any medium for any type of pain 315 management services; or 316 (II) Where in any month a majority of patients are 317 prescribed opioids, benzodiazepines, barbiturates, or 318 carisoprodol for the treatment of chronic nonmalignant pain. 319 2. Each pain-management clinic must register with the 320 department unless: 321 a. TheThatclinic is licensed as a facility pursuant to 322 chapter 395; 323 b. The majority of the physicians who provide services in 324 the clinicprimarilyprovide primarily surgical services; 325 c. The clinic is owned by a publicly held corporation whose 326 shares are traded on a national exchange or on the over-the 327 counter market and whose total assets at the end of the 328 corporation’s most recent fiscal quarter exceeded $50 million; 329 d. The clinic is affiliated with an accredited medical 330 school at which training is provided for medical students, 331 residents, or fellows; 332 e. The clinic does not prescribe controlled substances for 333 the treatment of pain; 334 f. The clinic is owned by a corporate entity exempt from 335 federal taxation under 26 U.S.C. s. 501(c)(3); 336 g. The clinic is wholly ownedand operatedby one or more 337 board-eligible or board-certified anesthesiologists, 338 physiatrists, psychiatrists, rheumatologists, or neurologists; 339or340 h. The clinic is wholly ownedand operatedby one or more 341 board-eligible or board-certified medical specialists who have 342 also completed fellowships in pain medicine approved by the 343 Accreditation Council for Graduate Medical Education, or who are 344 also board-eligible or board-certified in pain medicine by a 345 board approved by the American Board of Pain Medicine or the 346 American Board of Medical Specialties and perform interventional 347 pain procedures of the type routinely billed using surgical 348 codes;.349 i. The clinic is organized as a physician-owned group 350 practice as defined in 42 C.F.R. 411,352; or 351 j. Before June 1, 2011, the clinic was wholly owned by 352 physicians who are not board eligible or board certified but who 353 successfully completed a residency program in anesthesiology, 354 physiatry, psychiatry, rheumatology, or neurology and who have 7 355 years of documented, full-time practice in pain medicine in this 356 state. For purposes of this paragraph, the term “full-time” is 357 defined as practicing an average of 20 hours per week each year 358 in pain medicine. 359 Section 9. Paragraph (a) of subsection (1) of section 360 459.0137, Florida Statutes, is amended to read: 361 459.0137 Pain-management clinics.— 362 (1) REGISTRATION.— 363 (a)1. As used in this section, the term: 364 a. “Chronic nonmalignant pain” means pain unrelated to 365 cancer,orrheumatoid arthritis, or sickle cell anemia which 366 persists beyond the usual course of disease or beyond the injury 367 that is the cause of the pain or which persists more than 90 368 days after surgery. 369 b. “Pain-management clinic” or “clinic” means any publicly 370 or privately owned facility: 371 (I) That advertises in any medium for any type of pain 372 management services; or 373 (II) Where in any month a majority of patients are 374 prescribed opioids, benzodiazepines, barbiturates, or 375 carisoprodol for the treatment of chronic nonmalignant pain. 376 2. Each pain-management clinic must register with the 377 department unless: 378 a. TheThatclinic is licensed as a facility pursuant to 379 chapter 395; 380 b. The majority of the physicians who provide services in 381 the clinicprimarilyprovide primarily surgical services; 382 c. The clinic is owned by a publicly held corporation whose 383 shares are traded on a national exchange or on the over-the 384 counter market and whose total assets at the end of the 385 corporation’s most recent fiscal quarter exceeded $50 million; 386 d. The clinic is affiliated with an accredited medical 387 school at which training is provided for medical students, 388 residents, or fellows; 389 e. The clinic does not prescribe controlled substances for 390 the treatment of pain; 391 f. The clinic is owned by a corporate entity exempt from 392 federal taxation under 26 U.S.C. s. 501(c)(3); 393 g. The clinic is wholly ownedand operatedby one or more 394 board-eligible or board-certified anesthesiologists, 395 physiatrists, psychiatrists, rheumatologists, or neurologists; 396 or 397 h. The clinic is wholly ownedand operatedby one or more 398 board-eligible or board-certified medical specialists who have 399 also completed fellowships in pain medicine approved by the 400 Accreditation Council for Graduate Medical Education or the 401 American Osteopathic Association, or who are also board-eligible 402 or board-certified in pain medicine by a board approved by the 403 American Board of Medical Specialties, the American Association 404 of Physician Specialties, or the American Board of Pain 405 Medicine, or the American Osteopathic Association and perform 406 interventional pain procedures of the type routinely billed 407 using surgical codes. 408 Section 10. Subsection (8) of section 651.118, Florida 409 Statutes, is amended to read: 410 651.118 Agency for Health Care Administration; certificates 411 of need; sheltered beds; community beds.— 412 (8) A provider may petition the Agency for Health Care 413 Administration to use a designated number of sheltered nursing 414 home beds to provide assisted livingextended congregate care as415defined in s.429.02if the beds are in a distinct area of the 416 nursing home which can be adapted to meet the requirements for 417 an assisted living facility as defined in s. 429.02extended418congregate care. The provider may subsequently use such beds as 419 sheltered beds after notifying the agency of the intended 420 change. Any sheltered beds used to provide assisted living 421extended congregate carepursuant to this subsection may not 422 qualify for funding under the Medicaid waiver. Any sheltered 423 beds used to provide assisted livingextended congregate care424 pursuant to this subsection may share common areas, services, 425 and staff with beds designated for nursing home care, provided 426 that all of the beds are under common ownership. For the 427 purposes of this subsection, fire and life safety codes 428 applicable to nursing home facilities shall apply. 429 Section 11. Paragraph (j) is added to subsection (3) of 430 section 817.505, Florida Statutes, to read: 431 817.505 Patient brokering prohibited; exceptions; 432 penalties.— 433 (3) This section shall not apply to: 434 (j) Any exemptions relating to assisted living facilities 435 provided under s. 429.195(2). 436 Section 12. This act shall take effect July 1, 2012.