Bill Text: FL S1486 | 2014 | Regular Session | Introduced


Bill Title: Transitional Living Facilities

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2014-05-01 - Laid on Table [S1486 Detail]

Download: Florida-2014-S1486-Introduced.html
       Florida Senate - 2014                                    SB 1486
       
       
        
       By Senator Garcia
       
       
       
       
       
       38-00318A-14                                          20141486__
    1                        A bill to be entitled                      
    2         An act relating to transitional living
    3         facilities; creating part XI of ch. 400, F.S.;
    4         providing legislative intent; providing definitions;
    5         requiring the licensure of transitional living
    6         facilities; providing license fees and application
    7         requirements; requiring accreditation of licensed
    8         facilities; providing requirements for transitional
    9         living facility policies and procedures governing
   10         client admission, transfer, and discharge; requiring a
   11         comprehensive treatment plan to be developed for each
   12         client; providing plan and staffing requirements;
   13         requiring certain consent for continued treatment in a
   14         transitional living facility; providing licensee
   15         responsibilities; providing notice requirements;
   16         prohibiting a licensee or employee of a facility from
   17         serving notice upon a client to leave the premises or
   18         take other retaliatory action under certain
   19         circumstances; requiring the client and client’s
   20         representative to be provided with certain
   21         information; requiring the licensee to develop and
   22         implement certain policies and procedures; providing
   23         licensee requirements relating to administration of
   24         medication; requiring maintenance of medication
   25         administration records; providing requirements for
   26         administration of medications by unlicensed staff;
   27         specifying who may conduct training of staff;
   28         requiring licensees to adopt policies and procedures
   29         for administration of medications by trained staff;
   30         requiring the Agency for Health Care Administration to
   31         adopt rules; providing requirements for the screening
   32         of potential employees and training and monitoring of
   33         employees for the protection of clients; requiring
   34         licensees to implement certain policies and procedures
   35         to protect clients; providing conditions for
   36         investigating and reporting incidents of abuse,
   37         neglect, mistreatment, or exploitation of clients;
   38         providing requirements and limitations for the use of
   39         physical restraints, seclusion, and chemical restraint
   40         medication on clients; providing a limitation on the
   41         duration of an emergency treatment order; requiring
   42         notification of certain persons when restraint or
   43         seclusion is imposed; authorizing the agency to adopt
   44         rules; providing background screening requirements;
   45         requiring the licensee to maintain certain personnel
   46         records; providing administrative responsibilities for
   47         licensees; providing recordkeeping requirements;
   48         providing licensee responsibilities with respect to
   49         the property and personal affairs of clients;
   50         providing requirements for a licensee with respect to
   51         obtaining surety bonds; providing recordkeeping
   52         requirements relating to the safekeeping of personal
   53         effects; providing requirements for trust funds or
   54         other property received by a licensee and credited to
   55         the client; providing a penalty for certain misuse of
   56         a client’s personal funds, property, or personal needs
   57         allowance; providing criminal penalties for
   58         violations; providing for the disposition of property
   59         in the event of the death of a client; authorizing the
   60         agency to adopt rules; providing legislative intent;
   61         authorizing the agency to adopt and enforce rules
   62         establishing standards for transitional living
   63         facilities and personnel thereof; classifying
   64         violations and providing penalties therefor; providing
   65         administrative fines for specified classes of
   66         violations; authorizing the agency to apply certain
   67         provisions with regard to receivership proceedings;
   68         requiring the agency, the Department of Health, the
   69         Agency for Persons with Disabilities, and the
   70         Department of Children and Families to develop
   71         electronic information systems for certain purposes;
   72         repealing s. 400.805, F.S., relating to transitional
   73         living facilities; revising the title of part V of ch.
   74         400, F.S.; amending s. 381.745, F.S.; revising the
   75         definition of the term “transitional living facility,”
   76         to conform; amending s. 381.75, F.S.; revising the
   77         duties of the Department of Health and the agency
   78         relating to transitional living facilities; amending
   79         ss. 381.78, 400.93, 408.802, and 408.820, F.S.;
   80         conforming provisions to changes made by the act;
   81         providing applicability with respect to transitional
   82         living facilities licensed before a specified date;
   83         providing effective dates.
   84          
   85  Be It Enacted by the Legislature of the State of Florida:
   86  
   87         Section 1. Part XI of chapter 400, Florida Statutes,
   88  consisting of sections 400.997 through 400.9985, is created to
   89  read:
   90                               PART XI                             
   91                   TRANSITIONAL LIVING FACILITIES                  
   92         400.997 Legislative intent.—It is the intent of the
   93  Legislature to provide for the licensure of transitional living
   94  facilities and require the development, establishment, and
   95  enforcement of basic standards by the Agency for Health Care
   96  Administration to ensure quality of care and services to clients
   97  in transitional living facilities. It is the policy of the state
   98  that the least restrictive appropriate available treatment be
   99  used based on the individual needs and best interest of the
  100  client, consistent with optimum improvement of the client’s
  101  condition. The goal of a transitional living program for persons
  102  who have brain or spinal cord injuries is to assist each person
  103  who has such an injury to achieve a higher level of independent
  104  functioning and to enable the person to reenter the community.
  105  It is also the policy of the state that the restraint or
  106  seclusion of a client is justified only as an emergency safety
  107  measure used in response to danger to the client or others. It
  108  is therefore the intent of the Legislature to achieve an ongoing
  109  reduction in the use of restraint or seclusion in programs and
  110  facilities that serve persons who have brain or spinal cord
  111  injuries.
  112         400.9971 Definitions.—As used in this part, the term:
  113         (1) “Agency” means the Agency for Health Care
  114  Administration.
  115         (2) “Chemical restraint” means a pharmacologic drug that
  116  physically limits, restricts, or deprives a person of movement
  117  or mobility, is used for client protection or safety, and is not
  118  required for the treatment of medical conditions or symptoms.
  119         (3) “Client’s representative” means the parent of a child
  120  client or the client’s guardian, designated representative,
  121  designee, surrogate, or attorney in fact.
  122         (4) “Department” means the Department of Health.
  123         (5) “Physical restraint” means a manual method to restrict
  124  freedom of movement of or normal access to a person’s body, or a
  125  physical or mechanical device, material, or equipment attached
  126  or adjacent to the person’s body that the person cannot easily
  127  remove and that restricts freedom of movement of or normal
  128  access to the person’s body, including, but not limited to, a
  129  half-bed rail, a full-bed rail, a geriatric chair, or a Posey
  130  restraint. The term includes any device that is not specifically
  131  manufactured as a restraint but is altered, arranged, or
  132  otherwise used for this purpose. The term does not include
  133  bandage material used for the purpose of binding a wound or
  134  injury.
  135         (6) “Seclusion” means the physical segregation of a person
  136  in any fashion or the involuntary isolation of a person in a
  137  room or area from which the person is prevented from leaving.
  138  Such prevention may be accomplished by imposition of a physical
  139  barrier or by action of a staff member to prevent the person
  140  from leaving the room or area. For purposes of this part, the
  141  term does not mean isolation due to a person’s medical condition
  142  or symptoms.
  143         (7) “Transitional living facility” means a site where
  144  specialized health care services are provided to persons who
  145  have brain or spinal cord injuries, including, but not limited
  146  to, rehabilitative services, behavior modification, community
  147  reentry training, aids for independent living, and counseling.
  148         400.9972 License required; fee; application.—
  149         (1) The requirements of part II of chapter 408 apply to the
  150  provision of services that require licensure pursuant to this
  151  part and part II of chapter 408 and to entities licensed by or
  152  applying for licensure from the agency pursuant to this part. A
  153  license issued by the agency is required for the operation of a
  154  transitional living facility in this state. However, this part
  155  does not require a provider licensed by the agency to obtain a
  156  separate transitional living facility license to serve persons
  157  who have brain or spinal cord injuries as long as the services
  158  provided are within the scope of the provider’s license.
  159         (2) In accordance with this part, an applicant or a
  160  licensee shall pay a fee for each license application submitted
  161  under this part. The license fee shall consist of a $4,588
  162  license fee and a $90 per-bed fee per biennium and shall conform
  163  to the annual adjustment authorized in s. 408.805.
  164         (3) An applicant for licensure must provide:
  165         (a) The location of the facility for which the license is
  166  sought and documentation, signed by the appropriate local
  167  government official, which states that the applicant has met
  168  local zoning requirements.
  169         (b) Proof of liability insurance as defined in s.
  170  624.605(1)(b).
  171         (c) Proof of compliance with local zoning requirements,
  172  including compliance with the requirements of chapter 419 if the
  173  proposed facility is a community residential home.
  174         (d) Proof that the facility has received a satisfactory
  175  firesafety inspection.
  176         (e) Documentation that the facility has received a
  177  satisfactory sanitation inspection by the county health
  178  department.
  179         (4) The applicant’s proposed facility must attain and
  180  continuously maintain accreditation by an accrediting
  181  organization that specializes in evaluating rehabilitation
  182  facilities whose standards incorporate licensure regulations
  183  comparable to those required by the state. An applicant for
  184  licensure as a transitional living facility must acquire
  185  accreditation within 12 months after issuance of an initial
  186  license. The agency shall accept the accreditation survey report
  187  of the accrediting organization in lieu of conducting a
  188  licensure inspection if the standards included in the survey
  189  report are determined by the agency to document that the
  190  facility substantially complies with state licensure
  191  requirements. Within 10 days after receiving the accreditation
  192  survey report, the applicant shall submit to the agency a copy
  193  of the report and evidence of the accreditation decision as a
  194  result of the report. The agency may conduct an inspection of a
  195  transitional living facility to ensure compliance with the
  196  licensure requirements of this part, to validate the inspection
  197  process of the accrediting organization, to respond to licensure
  198  complaints, or to protect the public health and safety.
  199         400.9973 Client admission, transfer, and discharge.—
  200         (1) A transitional living facility shall have written
  201  policies and procedures governing the admission, transfer, and
  202  discharge of clients.
  203         (2) The admission of a client to a transitional living
  204  facility must be in accordance with the licensee’s policies and
  205  procedures.
  206         (3) A client admitted to a transitional living facility
  207  must have a brain or spinal cord injury, such as a lesion to the
  208  spinal cord or cauda equina syndrome, with evidence of
  209  significant involvement of at least two of the following
  210  deficits or dysfunctions:
  211         (a) A motor deficit.
  212         (b) A sensory deficit.
  213         (c) Bowel and bladder dysfunction.
  214         (d) An acquired internal or external injury to the skull,
  215  the brain, or the brain’s covering, whether caused by a
  216  traumatic or nontraumatic event, which produces an altered state
  217  of consciousness or an anatomic motor, sensory, cognitive, or
  218  behavioral deficit.
  219         (4) A client whose medical condition and diagnosis do not
  220  positively identify a cause of the client’s condition, whose
  221  symptoms are inconsistent with the known cause of injury, or
  222  whose recovery is inconsistent with the known medical condition
  223  may be admitted to a transitional living facility for evaluation
  224  for a period not to exceed 90 days.
  225         (5) A client admitted to a transitional living facility
  226  must be admitted upon prescription by a licensed physician,
  227  physician assistant, or advanced registered nurse practitioner
  228  and must remain under the care of a licensed physician,
  229  physician assistant, or advanced registered nurse practitioner
  230  for the duration of the client’s stay in the facility.
  231         (6) A transitional living facility may not admit a person
  232  whose primary admitting diagnosis is mental illness or an
  233  intellectual or developmental disability.
  234         (7) A person may not be admitted to a transitional living
  235  facility if the person:
  236         (a) Presents significant risk of infection to other clients
  237  or personnel. A health care practitioner must provide
  238  documentation that the person is free of apparent signs and
  239  symptoms of communicable disease;
  240         (b) Is a danger to himself or herself or others as
  241  determined by a physician, physician assistant, or advanced
  242  registered nurse practitioner or a mental health practitioner
  243  licensed under chapter 490 or chapter 491, unless the facility
  244  provides adequate staffing and support to ensure patient safety;
  245         (c) Is bedridden; or
  246         (d) Requires 24-hour nursing supervision.
  247         (8) If the client meets the admission criteria, the medical
  248  or nursing director of the facility must complete an initial
  249  evaluation of the client’s functional skills, behavioral status,
  250  cognitive status, educational or vocational potential, medical
  251  status, psychosocial status, sensorimotor capacity, and other
  252  related skills and abilities within the first 72 hours after the
  253  client’s admission to the facility. An initial comprehensive
  254  treatment plan that delineates services to be provided and
  255  appropriate sources for such services must be implemented within
  256  the first 4 days after admission.
  257         (9) A transitional living facility shall develop a
  258  discharge plan for each client before or upon admission to the
  259  facility. The discharge plan must identify the intended
  260  discharge site and possible alternative discharge sites. For
  261  each discharge site identified, the discharge plan must identify
  262  the skills, behaviors, and other conditions that the client must
  263  achieve to be eligible for discharge. A discharge plan must be
  264  reviewed and updated as necessary but at least once monthly.
  265         (10) A transitional living facility shall discharge a
  266  client as soon as practicable when the client no longer requires
  267  the specialized services described in s. 400.9971(7), when the
  268  client is not making measurable progress in accordance with the
  269  client’s comprehensive treatment plan, or when the transitional
  270  living facility is no longer the most appropriate and least
  271  restrictive treatment option.
  272         (11) A transitional living facility shall provide at least
  273  30 days’ notice to a client of transfer or discharge plans,
  274  including the location of an acceptable transfer location if the
  275  client is unable to live independently. This subsection does not
  276  apply if a client voluntarily terminates residency.
  277         400.9974 Client comprehensive treatment plans; client
  278  services.—
  279         (1) A transitional living facility shall develop a
  280  comprehensive treatment plan for each client as soon as
  281  practicable but no later than 30 days after the initial
  282  comprehensive treatment plan is developed. The comprehensive
  283  treatment plan must be developed by an interdisciplinary team
  284  consisting of the case manager, the program director, the
  285  advanced registered nurse practitioner, and appropriate
  286  therapists. The client or, if appropriate, the client’s
  287  representative must be included in developing the comprehensive
  288  treatment plan. The comprehensive treatment plan must be
  289  reviewed and updated if the client fails to meet projected
  290  improvements outlined in the plan or if a significant change in
  291  the client’s condition occurs. The comprehensive treatment plan
  292  must be reviewed and updated at least once monthly.
  293         (2) The comprehensive treatment plan must include:
  294         (a) Orders obtained from the physician, physician
  295  assistant, or advanced registered nurse practitioner and the
  296  client’s diagnosis, medical history, physical examination, and
  297  rehabilitative or restorative needs.
  298         (b) A preliminary nursing evaluation, including orders for
  299  immediate care provided by the physician, physician assistant,
  300  or advanced registered nurse practitioner, which shall be
  301  completed when the client is admitted.
  302         (c) A comprehensive, accurate, reproducible, and
  303  standardized assessment of the client’s functional capability;
  304  the treatments designed to achieve skills, behaviors, and other
  305  conditions necessary for the client to return to the community;
  306  and specific measurable goals.
  307         (d) Steps necessary for the client to achieve transition
  308  into the community and estimated length of time to achieve those
  309  goals.
  310         (3) The client or, if appropriate, the client’s
  311  representative must consent to the continued treatment at the
  312  transitional living facility. Consent may be for a period of up
  313  to 3 months. If such consent is not given, the transitional
  314  living facility shall discharge the client as soon as
  315  practicable.
  316         (4) A client must receive the professional program services
  317  needed to implement the client’s comprehensive treatment plan.
  318         (5) The licensee must employ qualified professional staff
  319  to carry out and monitor the various professional interventions
  320  in accordance with the stated goals and objectives of the
  321  client’s comprehensive treatment plan.
  322         (6) A client must receive a continuous treatment program
  323  that includes appropriate, consistent implementation of
  324  specialized and general training, treatment, health services,
  325  and related services and that is directed toward:
  326         (a) The acquisition of the behaviors and skills necessary
  327  for the client to function with as much self-determination and
  328  independence as possible.
  329         (b) The prevention or deceleration of regression or loss of
  330  current optimal functional status.
  331         (c) The management of behavioral issues that preclude
  332  independent functioning in the community.
  333         400.9975 Licensee responsibilities.—
  334         (1) The licensee shall ensure that each client:
  335         (a) Lives in a safe environment free from abuse, neglect,
  336  and exploitation.
  337         (b) Is treated with consideration and respect and with due
  338  recognition of personal dignity, individuality, and the need for
  339  privacy.
  340         (c) Retains and uses his or her own clothes and other
  341  personal property in his or her immediate living quarters to
  342  maintain individuality and personal dignity, except when the
  343  licensee demonstrates that such retention and use would be
  344  unsafe, impractical, or an infringement upon the rights of other
  345  clients.
  346         (d) Has unrestricted private communication, including
  347  receiving and sending unopened correspondence, access to a
  348  telephone, and visits with any person of his or her choice. Upon
  349  request, the licensee shall modify visiting hours for caregivers
  350  and guests. The facility shall restrict communication in
  351  accordance with any court order or written instruction of a
  352  client’s representative. Any restriction on a client’s
  353  communication for therapeutic reasons shall be documented and
  354  reviewed at least weekly and shall be removed as soon as no
  355  longer clinically indicated. The basis for the restriction shall
  356  be explained to the client and, if applicable, the client’s
  357  representative. The client shall retain the right to call the
  358  central abuse hotline, the agency, and Disability Rights Florida
  359  at any time.
  360         (e) Has the opportunity to participate in and benefit from
  361  community services and activities to achieve the highest
  362  possible level of independence, autonomy, and interaction within
  363  the community.
  364         (f) Has the opportunity to manage his or her financial
  365  affairs unless the client or, if applicable, the client’s
  366  representative authorizes the administrator of the facility to
  367  provide safekeeping for funds as provided under this part.
  368         (g) Has reasonable opportunity for regular exercise more
  369  than once per week and to be outdoors at regular and frequent
  370  intervals except when prevented by inclement weather.
  371         (h) Has the opportunity to exercise civil and religious
  372  liberties, including the right to independent personal
  373  decisions. However, a religious belief or practice, including
  374  attendance at religious services, may not be imposed upon any
  375  client.
  376         (i) Has access to adequate and appropriate health care
  377  consistent with established and recognized community standards.
  378         (j) Has the opportunity to present grievances and recommend
  379  changes in policies, procedures, and services to the staff of
  380  the licensee, governing officials, or any other person without
  381  restraint, interference, coercion, discrimination, or reprisal.
  382  A licensee shall establish a grievance procedure to facilitate a
  383  client’s ability to present grievances, including a system for
  384  investigating, tracking, managing, and responding to complaints
  385  by a client or, if applicable, the client’s representative and
  386  an appeals process. The appeals process must include access to
  387  Disability Rights Florida and other advocates and the right to
  388  be a member of, be active in, and associate with advocacy or
  389  special interest groups.
  390         (2) The licensee shall:
  391         (a) Promote participation of the client’s representative in
  392  the process of providing treatment to the client unless the
  393  representative’s participation is unobtainable or inappropriate.
  394         (b) Answer communications from the client’s family,
  395  guardians, and friends promptly and appropriately.
  396         (c) Promote visits by persons with a relationship to the
  397  client at any reasonable hour, without requiring prior notice,
  398  in any area of the facility that provides direct care services
  399  to the client, consistent with the client’s and other clients’
  400  privacy, unless the interdisciplinary team determines that such
  401  a visit would not be appropriate.
  402         (d) Promote opportunities for the client to leave the
  403  facility for visits, trips, or vacations.
  404         (e) Promptly notify the client’s representative of a
  405  significant incident or change in the client’s condition,
  406  including, but not limited to, serious illness, accident, abuse,
  407  unauthorized absence, or death.
  408         (3) The administrator of a facility shall ensure that a
  409  written notice of licensee responsibilities is posted in a
  410  prominent place in each building where clients reside and is
  411  read or explained to clients who cannot read. This notice shall
  412  be provided to clients in a manner that is clearly legible,
  413  shall include the statewide toll-free telephone number for
  414  reporting complaints to the agency, and shall include the words:
  415  “To report a complaint regarding the services you receive,
  416  please call toll-free ...[telephone number]... or Disability
  417  Rights Florida ...[telephone number]....” The statewide toll
  418  free telephone number for the central abuse hotline shall be
  419  provided to clients in a manner that is clearly legible and
  420  shall include the words: “To report abuse, neglect, or
  421  exploitation, please call toll-free ...[telephone number]....”
  422  The licensee shall ensure a client’s access to a telephone where
  423  telephone numbers are posted as required by this subsection.
  424         (4) A licensee or employee of a facility may not serve
  425  notice upon a client to leave the premises or take any other
  426  retaliatory action against another person solely because of the
  427  following:
  428         (a) The client or other person files an internal or
  429  external complaint or grievance regarding the facility.
  430         (b) The client or other person appears as a witness in a
  431  hearing inside or outside the facility.
  432         (5) Before or at the time of admission, the client and, if
  433  applicable, the client’s representative shall receive a copy of
  434  the licensee’s responsibilities, including grievance procedures
  435  and telephone numbers, as provided in this section.
  436         (6) The licensee must develop and implement policies and
  437  procedures governing the release of client information,
  438  including consent necessary from the client or, if applicable,
  439  the client’s representative.
  440         400.9976 Administration of medication.—
  441         (1) An individual medication administration record must be
  442  maintained for each client. A dose of medication, including a
  443  self-administered dose, shall be properly recorded in the
  444  client’s record. A client who self-administers medication shall
  445  be given a pill organizer. Medication must be placed in the pill
  446  organizer by a nurse. A nurse shall document the date and time
  447  that medication is placed into each client’s pill organizer. All
  448  medications must be administered in compliance with orders of a
  449  physician, physician assistant, or advanced registered nurse
  450  practitioner.
  451         (2) If an interdisciplinary team determines that self
  452  administration of medication is an appropriate objective, and if
  453  the physician, physician assistant, or advanced registered nurse
  454  practitioner does not specify otherwise, the client must be
  455  instructed by the physician, physician assistant, or advanced
  456  registered nurse practitioner to self-administer his or her
  457  medication without the assistance of a staff person. All forms
  458  of self-administration of medication, including administration
  459  orally, by injection, and by suppository, shall be included in
  460  the training. The client’s physician, physician assistant, or
  461  advanced registered nurse practitioner must be informed of the
  462  interdisciplinary team’s decision that self-administration of
  463  medication is an objective for the client. A client may not
  464  self-administer medication until he or she demonstrates the
  465  competency to take the correct medication in the correct dosage
  466  at the correct time, to respond to missed doses, and to contact
  467  the appropriate person with questions.
  468         (3) Medication administration discrepancies and adverse
  469  drug reactions must be recorded and reported immediately to a
  470  physician, physician assistant, or advanced registered nurse
  471  practitioner.
  472         400.9977 Assistance with medication.—
  473         (1) Notwithstanding any provision of part I of chapter 464,
  474  the Nurse Practice Act, unlicensed direct care services staff
  475  who provide services to clients in a facility licensed under
  476  this chapter or chapter 429 may administer prescribed,
  477  prepackaged, and premeasured medications under the general
  478  supervision of a registered nurse as provided under this section
  479  and applicable rules.
  480         (2) Training required by this section and applicable rules
  481  shall be conducted by a registered nurse licensed under chapter
  482  464, a physician licensed under chapter 458 or chapter 459, or a
  483  pharmacist licensed under chapter 465.
  484         (3) A facility that allows unlicensed direct care service
  485  staff to administer medications pursuant to this section shall:
  486         (a) Develop and implement policies and procedures that
  487  include a plan to ensure the safe handling, storage, and
  488  administration of prescription medications.
  489         (b) Maintain written evidence of the expressed and informed
  490  consent for each client.
  491         (c) Maintain a copy of the written prescription, including
  492  the name of the medication, the dosage, and the administration
  493  schedule and termination date.
  494         (d) Maintain documentation of compliance with required
  495  training.
  496         (4) The agency shall adopt rules to implement this section.
  497         400.9978 Protection of clients from abuse, neglect,
  498  mistreatment, and exploitation.—The licensee shall develop and
  499  implement policies and procedures for the screening and training
  500  of employees; the protection of clients; and the prevention,
  501  identification, investigation, and reporting of abuse, neglect,
  502  mistreatment, and exploitation. The licensee shall identify
  503  clients whose personal histories render them at risk for abusing
  504  other clients, develop intervention strategies to prevent
  505  occurrences of abuse, monitor clients for changes that would
  506  trigger abusive behavior, and reassess the interventions on a
  507  regular basis. A licensee shall:
  508         (1) Screen each potential employee for a history of abuse,
  509  neglect, mistreatment, or exploitation of clients. The screening
  510  shall include an attempt to obtain information from previous and
  511  current employers and verification of screening information by
  512  the appropriate licensing boards.
  513         (2) Train employees through orientation and ongoing
  514  sessions regarding issues related to abuse prohibition
  515  practices, including identification of abuse, neglect,
  516  mistreatment, and exploitation; appropriate interventions to
  517  address aggressive or catastrophic reactions of clients; the
  518  process for reporting allegations without fear of reprisal; and
  519  recognition of signs of frustration and stress that may lead to
  520  abuse.
  521         (3) Provide clients, families, and staff with information
  522  regarding how and to whom they may report concerns, incidents,
  523  and grievances without fear of retribution and provide feedback
  524  regarding the concerns that are expressed. A licensee shall
  525  identify, correct, and intervene in situations in which abuse,
  526  neglect, mistreatment, or exploitation is likely to occur,
  527  including:
  528         (a) Evaluating the physical environment of the facility to
  529  identify characteristics that may make abuse or neglect more
  530  likely to occur, such as secluded areas.
  531         (b) Providing sufficient staff on each shift to meet the
  532  needs of the clients and ensuring that the assigned staff have
  533  knowledge of each client’s care needs.
  534         (c) Identifying inappropriate staff behaviors, such as
  535  using derogatory language, rough handling of clients, ignoring
  536  clients while giving care, and directing clients who need
  537  toileting assistance to urinate or defecate in their beds.
  538         (d) Assessing, monitoring, and planning care for clients
  539  with needs and behaviors that might lead to conflict or neglect,
  540  such as a history of aggressive behaviors including entering
  541  other clients’ rooms without permission, exhibiting self
  542  injurious behaviors or communication disorders, requiring
  543  intensive nursing care, or being totally dependent on staff.
  544         (4) Identify events, such as suspicious bruising of
  545  clients, occurrences, patterns, and trends that may constitute
  546  abuse and determine the direction of the investigation.
  547         (5) Investigate alleged violations and different types of
  548  incidents, identify the staff member responsible for initial
  549  reporting, and report results to the proper authorities. The
  550  licensee shall analyze the incidents to determine whether
  551  policies and procedures need to be changed to prevent further
  552  incidents and take necessary corrective actions.
  553         (6) Protect clients from harm during an investigation.
  554         (7) Report alleged violations and substantiated incidents,
  555  as required under chapters 39 and 415, to the licensing
  556  authorities and all other agencies, as required, and report any
  557  knowledge of actions by a court of law that would indicate an
  558  employee is unfit for service.
  559         400.9979 Restraint and seclusion; client safety.—
  560         (1) A facility shall provide a therapeutic milieu that
  561  supports a culture of individual empowerment and responsibility.
  562  The health and safety of the client shall be the facility’s
  563  primary concern at all times.
  564         (2) The use of physical restraints must be ordered and
  565  documented by a physician, physician assistant, or advanced
  566  registered nurse practitioner and must be consistent with the
  567  policies and procedures adopted by the facility. The client or,
  568  if applicable, the client’s representative shall be informed of
  569  the facility’s physical restraint policies and procedures when
  570  the client is admitted.
  571         (3) The use of chemical restraints shall be limited to
  572  prescribed dosages of medications as ordered by a physician,
  573  physician assistant, or advanced registered nurse practitioner
  574  and must be consistent with the client’s diagnosis and the
  575  policies and procedures adopted by the facility. The client and,
  576  if applicable, the client’s representative shall be informed of
  577  the facility’s chemical restraint policies and procedures when
  578  the client is admitted.
  579         (4) Based on the assessment by a physician, physician
  580  assistant, or advanced registered nurse practitioner, if a
  581  client exhibits symptoms that present an immediate risk of
  582  injury or death to himself or herself or others, a physician,
  583  physician assistant, or advanced registered nurse practitioner
  584  may issue an emergency treatment order to immediately administer
  585  rapid-response psychotropic medications or other chemical
  586  restraints. Each emergency treatment order must be documented
  587  and maintained in the client’s record.
  588         (a) An emergency treatment order is not effective for more
  589  than 24 hours.
  590         (b) Whenever a client is medicated under this subsection,
  591  the client’s representative or a responsible party and the
  592  client’s physician, physician assistant, or advanced registered
  593  nurse practitioner shall be notified as soon as practicable.
  594         (5) A client who is prescribed and receives a medication
  595  that can serve as a chemical restraint for a purpose other than
  596  an emergency treatment order must be evaluated by his or her
  597  physician, physician assistant, or advanced registered nurse
  598  practitioner at least monthly to assess:
  599         (a) The continued need for the medication.
  600         (b) The level of the medication in the client’s blood.
  601         (c) The need for adjustments to the prescription.
  602         (6) The licensee shall ensure that clients are free from
  603  unnecessary drugs and physical restraints and are provided
  604  treatment to reduce dependency on drugs and physical restraints.
  605         (7) The licensee may only employ physical restraints and
  606  seclusion as authorized by the facility’s written policies,
  607  which shall comply with this section and applicable rules.
  608         (8) Interventions to manage dangerous client behavior shall
  609  be employed with sufficient safeguards and supervision to ensure
  610  that the safety, welfare, and civil and human rights of a client
  611  are adequately protected.
  612         (9) A facility shall notify the parent, guardian, or, if
  613  applicable, the client’s representative when restraint or
  614  seclusion is employed. The facility must provide the
  615  notification within 24 hours after the restraint or seclusion is
  616  employed. Reasonable efforts must be taken to notify the parent,
  617  guardian, or, if applicable, the client’s representative by
  618  telephone or e-mail, or both, and these efforts must be
  619  documented.
  620         (10) The agency may adopt rules that establish standards
  621  and procedures for the use of restraints, restraint positioning,
  622  seclusion, and emergency treatment orders for psychotropic
  623  medications, restraint, and seclusion. These rules must include
  624  duration of restraint, staff training, observation of the client
  625  during restraint, and documentation and reporting standards.
  626         400.998 Personnel background screening; administration and
  627  management procedures.—
  628         (1) The agency shall require level 2 background screening
  629  for licensee personnel as required in s. 408.809(1)(e) and
  630  pursuant to chapter 435 and s. 408.809.
  631         (2) The licensee shall maintain personnel records for each
  632  staff member that contain, at a minimum, documentation of
  633  background screening, a job description, documentation of
  634  compliance with the training requirements of this part and
  635  applicable rules, the employment application, references, a copy
  636  of each job performance evaluation, and, for each staff member
  637  who performs services for which licensure or certification is
  638  required, a copy of all licenses or certification held by that
  639  staff member.
  640         (3) The licensee must:
  641         (a) Develop and implement infection control policies and
  642  procedures and include the policies and procedures in the
  643  licensee’s policy manual.
  644         (b) Maintain liability insurance as defined in s.
  645  624.605(1)(b).
  646         (c) Designate one person as an administrator to be
  647  responsible and accountable for the overall management of the
  648  facility.
  649         (d) Designate in writing a person to be responsible for the
  650  facility when the administrator is absent from the facility for
  651  more than 24 hours.
  652         (e) Designate in writing a program director to be
  653  responsible for supervising the therapeutic and behavioral
  654  staff, determining the levels of supervision, and determining
  655  room placement for each client.
  656         (f) Designate in writing a person to be responsible when
  657  the program director is absent from the facility for more than
  658  24 hours.
  659         (g) Obtain approval of the comprehensive emergency
  660  management plan, pursuant to s. 400.9982(2)(e), from the local
  661  emergency management agency. Pending the approval of the plan,
  662  the local emergency management agency shall ensure that the
  663  following agencies, at a minimum, are given the opportunity to
  664  review the plan: the Department of Health, the Agency for Health
  665  Care Administration, and the Division of Emergency Management.
  666  Appropriate volunteer organizations shall also be given the
  667  opportunity to review the plan. The local emergency management
  668  agency shall complete its review within 60 days after receipt of
  669  the plan and either approve the plan or advise the licensee of
  670  necessary revisions.
  671         (h) Maintain written records in a form and system that
  672  comply with medical and business practices and make the records
  673  available by the facility for review or submission to the agency
  674  upon request. The records shall include:
  675         1. A daily census record that indicates the number of
  676  clients currently receiving services in the facility, including
  677  information regarding any public funding of such clients.
  678         2. A record of each accident or unusual incident involving
  679  a client or staff member that caused, or had the potential to
  680  cause, injury or harm to any person or property within the
  681  facility. The record shall contain a clear description of each
  682  accident or incident; the names of the persons involved; a
  683  description of medical or other services provided to these
  684  persons, including the provider of the services; and the steps
  685  taken to prevent recurrence of such accident or incident.
  686         3. A copy of current agreements with third-party providers.
  687         4. A copy of current agreements with each consultant
  688  employed by the licensee and documentation of a consultant’s
  689  visits and required written and dated reports.
  690         400.9981 Property and personal affairs of clients.—
  691         (1) A client shall be given the option of using his or her
  692  own belongings, as space permits; choosing a roommate if
  693  practical and not clinically contraindicated; and, whenever
  694  possible, unless the client is adjudicated incompetent or
  695  incapacitated under state law, managing his or her own affairs.
  696         (2) The admission of a client to a facility and his or her
  697  presence therein does not confer on a licensee or administrator,
  698  or an employee or representative thereof, any authority to
  699  manage, use, or dispose of the property of the client, and the
  700  admission or presence of a client does not confer on such person
  701  any authority or responsibility for the personal affairs of the
  702  client except that which may be necessary for the safe
  703  management of the facility or for the safety of the client.
  704         (3) A licensee or administrator, or an employee or
  705  representative thereof, may:
  706         (a) Not act as the guardian, trustee, or conservator for a
  707  client or a client’s property.
  708         (b) Act as a competent client’s payee for social security,
  709  veteran’s, or railroad benefits if the client provides consent
  710  and the licensee files a surety bond with the agency in an
  711  amount equal to twice the average monthly aggregate income or
  712  personal funds due to the client, or expendable for the client’s
  713  account, that are received by a licensee.
  714         (c) Act as the attorney in fact for a client if the
  715  licensee files a surety bond with the agency in an amount equal
  716  to twice the average monthly income of the client, plus the
  717  value of a client’s property under the control of the attorney
  718  in fact.
  719  
  720  The surety bond required under paragraph (b) or paragraph (c)
  721  shall be executed by the licensee as principal and a licensed
  722  surety company. The bond shall be conditioned upon the faithful
  723  compliance of the licensee with the requirements of licensure
  724  and is payable to the agency for the benefit of a client who
  725  suffers a financial loss as a result of the misuse or
  726  misappropriation of funds held pursuant to this subsection. A
  727  surety company that cancels or does not renew the bond of a
  728  licensee shall notify the agency in writing at least 30 days
  729  before the action, giving the reason for cancellation or
  730  nonrenewal. A licensee or administrator, or an employee or
  731  representative thereof, who is granted power of attorney for a
  732  client of the facility shall, on a monthly basis, notify the
  733  client in writing of any transaction made on behalf of the
  734  client pursuant to this subsection, and a copy of the
  735  notification given to the client shall be retained in the
  736  client’s file and available for agency inspection.
  737         (4) A licensee, with the consent of the client, shall
  738  provide for safekeeping in the facility of the client’s personal
  739  effects of a value not in excess of $1,000 and the client’s
  740  funds not in excess of $500 cash and shall keep complete and
  741  accurate records of the funds and personal effects received. If
  742  a client is absent from a facility for 24 hours or more, the
  743  licensee may provide for safekeeping of the client’s personal
  744  effects of a value in excess of $1,000.
  745         (5) Funds or other property belonging to or due to a client
  746  or expendable for the client’s account that are received by a
  747  licensee shall be regarded as funds held in trust and shall be
  748  kept separate from the funds and property of the licensee and
  749  other clients or shall be specifically credited to the client.
  750  The funds held in trust shall be used or otherwise expended only
  751  for the account of the client. At least once every month, except
  752  pursuant to an order of a court of competent jurisdiction, the
  753  licensee shall furnish the client and, if applicable, the
  754  client’s representative with a complete and verified statement
  755  of all funds and other property to which this subsection
  756  applies, detailing the amount and items received, together with
  757  their sources and disposition. The licensee shall furnish the
  758  statement annually and upon discharge or transfer of a client. A
  759  governmental agency or private charitable agency contributing
  760  funds or other property to the account of a client is also
  761  entitled to receive a statement monthly and upon the discharge
  762  or transfer of the client.
  763         (6)(a) In addition to any damages or civil penalties to
  764  which a person is subject, a person who:
  765         1. Intentionally withholds a client’s personal funds,
  766  personal property, or personal needs allowance;
  767         2. Demands, beneficially receives, or contracts for payment
  768  of all or any part of a client’s personal property or personal
  769  needs allowance in satisfaction of the facility rate for
  770  supplies and services; or
  771         3. Borrows from or pledges any personal funds of a client,
  772  other than the amount agreed to by written contract under s.
  773  429.24,
  774  
  775  commits a misdemeanor of the first degree, punishable as
  776  provided in s. 775.082 or s. 775.083.
  777         (b) A licensee or administrator, or an employee, or
  778  representative thereof, who is granted power of attorney for a
  779  client and who misuses or misappropriates funds obtained through
  780  this power commits a felony of the third degree, punishable as
  781  provided in s. 775.082, s. 775.083, or s. 775.084.
  782         (7) In the event of the death of a client, a licensee shall
  783  return all refunds, funds, and property held in trust to the
  784  client’s personal representative, if one has been appointed at
  785  the time the licensee disburses such funds, or, if not, to the
  786  client’s spouse or adult next of kin named in a beneficiary
  787  designation form provided by the licensee to the client. If the
  788  client does not have a spouse or adult next of kin or such
  789  person cannot be located, funds due to be returned to the client
  790  shall be placed in an interest-bearing account, and all property
  791  held in trust by the licensee shall be safeguarded until such
  792  time as the funds and property are disbursed pursuant to the
  793  Florida Probate Code. The funds shall be kept separate from the
  794  funds and property of the licensee and other clients of the
  795  facility. If the funds of the deceased client are not disbursed
  796  pursuant to the Florida Probate Code within 2 years after the
  797  client’s death, the funds shall be deposited in the Health Care
  798  Trust Fund administered by the agency.
  799         (8) The agency, by rule, may clarify terms and specify
  800  procedures and documentation necessary to administer the
  801  provisions of this section relating to the proper management of
  802  clients’ funds and personal property and the execution of surety
  803  bonds.
  804         400.9982 Rules establishing standards.—
  805         (1) It is the intent of the Legislature that rules adopted
  806  and enforced pursuant to this part and part II of chapter 408
  807  include criteria to ensure reasonable and consistent quality of
  808  care and client safety. The rules should make reasonable efforts
  809  to accommodate the needs and preferences of the client to
  810  enhance the client’s quality of life while residing in a
  811  transitional living facility.
  812         (2) The agency may adopt and enforce rules to implement
  813  this part and part II of chapter 408, which shall include
  814  reasonable and fair criteria with respect to:
  815         (a) The location of transitional living facilities.
  816         (b) The qualifications of personnel, including management,
  817  medical, nursing, and other professional personnel and nursing
  818  assistants and support staff, who are responsible for client
  819  care. The licensee must employ enough qualified professional
  820  staff to carry out and monitor interventions in accordance with
  821  the stated goals and objectives of each comprehensive treatment
  822  plan.
  823         (c) Requirements for personnel procedures, reporting
  824  procedures, and documentation necessary to implement this part.
  825         (d) Services provided to clients of transitional living
  826  facilities.
  827         (e) The preparation and annual update of a comprehensive
  828  emergency management plan in consultation with the Division of
  829  Emergency Management. At a minimum, the rules must provide for
  830  plan components that address emergency evacuation
  831  transportation; adequate sheltering arrangements; postdisaster
  832  activities, including provision of emergency power, food, and
  833  water; postdisaster transportation; supplies; staffing;
  834  emergency equipment; individual identification of clients and
  835  transfer of records; communication with families; and responses
  836  to family inquiries.
  837         400.9983 Violations; penalties.—A violation of this part or
  838  any rule adopted pursuant thereto shall be classified according
  839  to the nature of the violation and the gravity of its probable
  840  effect on facility clients. The agency shall indicate the
  841  classification on the written notice of the violation as
  842  follows:
  843         (1) Class “I” violations are defined in s. 408.813. The
  844  agency shall issue a citation regardless of correction and
  845  impose an administrative fine of $5,000 for an isolated
  846  violation, $7,500 for a patterned violation, or $10,000 for a
  847  widespread violation. Violations may be identified, and a fine
  848  must be levied, notwithstanding the correction of the deficiency
  849  giving rise to the violation.
  850         (2) Class “II” violations are defined in s. 408.813. The
  851  agency shall impose an administrative fine of $1,000 for an
  852  isolated violation, $2,500 for a patterned violation, or $5,000
  853  for a widespread violation. A fine must be levied
  854  notwithstanding the correction of the deficiency giving rise to
  855  the violation.
  856         (3) Class “III” violations are defined in s. 408.813. The
  857  agency shall impose an administrative fine of $500 for an
  858  isolated violation, $750 for a patterned violation, or $1,000
  859  for a widespread violation. If a deficiency giving rise to a
  860  class III violation is corrected within the time specified by
  861  the agency, the fine may not be imposed.
  862         (4) Class “IV” violations are defined in s. 408.813. The
  863  agency shall impose for a cited class IV violation an
  864  administrative fine of at least $100 but not exceeding $200 for
  865  each violation. If a deficiency giving rise to a class IV
  866  violation is corrected within the time specified by the agency,
  867  the fine may not be imposed.
  868         400.9984 Receivership proceedings.—The agency may apply s.
  869  429.22 with regard to receivership proceedings for transitional
  870  living facilities.
  871         400.9985 Interagency communication.—The agency, the
  872  department, the Agency for Persons with Disabilities, and the
  873  Department of Children and Families shall develop electronic
  874  systems to ensure that relevant information pertaining to the
  875  regulation of transitional living facilities and clients is
  876  timely and effectively communicated among agencies in order to
  877  facilitate the protection of clients. Electronic sharing of
  878  information shall include, at a minimum, a brain and spinal cord
  879  injury registry and a client abuse registry.
  880         Section 2. Section 400.805, Florida Statutes, is repealed.
  881         Section 3. The title of part V of chapter 400, Florida
  882  Statutes, consisting of sections 400.701-400.801, is
  883  redesignated as “INTERMEDIATE CARE FACILITIES.”
  884         Section 4. Subsection (9) of section 381.745, Florida
  885  Statutes, is amended to read:
  886         381.745 Definitions; ss. 381.739-381.79.—As used in ss.
  887  381.739-381.79, the term:
  888         (9) “Transitional living facility” means a state-approved
  889  facility, as defined and licensed under chapter 400 or chapter
  890  429, or a facility approved by the brain and spinal cord injury
  891  program in accordance with this chapter.
  892         Section 5. Section 381.75, Florida Statutes, is amended to
  893  read:
  894         381.75 Duties and responsibilities of the department, of
  895  transitional living facilities, and of residents.—Consistent
  896  with the mandate of s. 381.7395, the department shall develop
  897  and administer a multilevel treatment program for individuals
  898  who sustain brain or spinal cord injuries and who are referred
  899  to the brain and spinal cord injury program.
  900         (1) Within 15 days after any report of an individual who
  901  has sustained a brain or spinal cord injury, the department
  902  shall notify the individual or the most immediate available
  903  family members of their right to assistance from the state, the
  904  services available, and the eligibility requirements.
  905         (2) The department shall refer individuals who have brain
  906  or spinal cord injuries to other state agencies to ensure assure
  907  that rehabilitative services, if desired, are obtained by that
  908  individual.
  909         (3) The department, in consultation with emergency medical
  910  service, shall develop standards for an emergency medical
  911  evacuation system that will ensure that all individuals who
  912  sustain traumatic brain or spinal cord injuries are transported
  913  to a department-approved trauma center that meets the standards
  914  and criteria established by the emergency medical service and
  915  the acute-care standards of the brain and spinal cord injury
  916  program.
  917         (4) The department shall develop standards for designation
  918  of rehabilitation centers to provide rehabilitation services for
  919  individuals who have brain or spinal cord injuries.
  920         (5) The department shall determine the appropriate number
  921  of designated acute-care facilities, inpatient rehabilitation
  922  centers, and outpatient rehabilitation centers, needed based on
  923  incidence, volume of admissions, and other appropriate criteria.
  924         (6) The department shall develop standards for designation
  925  of transitional living facilities to provide transitional living
  926  services for individuals who participate in the brain and spinal
  927  cord injury program the opportunity to adjust to their
  928  disabilities and to develop physical and functional skills in a
  929  supported living environment.
  930         (a) The Agency for Health Care Administration, in
  931  consultation with the department, shall develop rules for the
  932  licensure of transitional living facilities for individuals who
  933  have brain or spinal cord injuries.
  934         (b) The goal of a transitional living program for
  935  individuals who have brain or spinal cord injuries is to assist
  936  each individual who has such a disability to achieve a higher
  937  level of independent functioning and to enable that person to
  938  reenter the community. The program shall be focused on preparing
  939  participants to return to community living.
  940         (c) A transitional living facility for an individual who
  941  has a brain or spinal cord injury shall provide to such
  942  individual, in a residential setting, a goal-oriented treatment
  943  program designed to improve the individual’s physical,
  944  cognitive, communicative, behavioral, psychological, and social
  945  functioning, as well as to provide necessary support and
  946  supervision. A transitional living facility shall offer at least
  947  the following therapies: physical, occupational, speech,
  948  neuropsychology, independent living skills training, behavior
  949  analysis for programs serving brain-injured individuals, health
  950  education, and recreation.
  951         (d) All residents shall use the transitional living
  952  facility as a temporary measure and not as a permanent home or
  953  domicile. The transitional living facility shall develop an
  954  initial treatment plan for each resident within 3 days after the
  955  resident’s admission. The transitional living facility shall
  956  develop a comprehensive plan of treatment and a discharge plan
  957  for each resident as soon as practical, but no later than 30
  958  days after the resident’s admission. Each comprehensive
  959  treatment plan and discharge plan must be reviewed and updated
  960  as necessary, but no less often than quarterly. This subsection
  961  does not require the discharge of an individual who continues to
  962  require any of the specialized services described in paragraph
  963  (c) or who is making measurable progress in accordance with that
  964  individual’s comprehensive treatment plan. The transitional
  965  living facility shall discharge any individual who has an
  966  appropriate discharge site and who has achieved the goals of his
  967  or her discharge plan or who is no longer making progress toward
  968  the goals established in the comprehensive treatment plan and
  969  the discharge plan. The discharge location must be the least
  970  restrictive environment in which an individual’s health, well
  971  being, and safety is preserved.
  972         (7) Recipients of services, under this section, from any of
  973  the facilities referred to in this section shall pay a fee based
  974  on ability to pay.
  975         Section 6. Subsection (4) of section 381.78, Florida
  976  Statutes, is amended to read:
  977         381.78 Advisory council on brain and spinal cord injuries.—
  978         (4) The council shall:
  979         (a) provide advice and expertise to the department in the
  980  preparation, implementation, and periodic review of the brain
  981  and spinal cord injury program.
  982         (b) Annually appoint a five-member committee composed of
  983  one individual who has a brain injury or has a family member
  984  with a brain injury, one individual who has a spinal cord injury
  985  or has a family member with a spinal cord injury, and three
  986  members who shall be chosen from among these representative
  987  groups: physicians, other allied health professionals,
  988  administrators of brain and spinal cord injury programs, and
  989  representatives from support groups with expertise in areas
  990  related to the rehabilitation of individuals who have brain or
  991  spinal cord injuries, except that one and only one member of the
  992  committee shall be an administrator of a transitional living
  993  facility. Membership on the council is not a prerequisite for
  994  membership on this committee.
  995         1. The committee shall perform onsite visits to those
  996  transitional living facilities identified by the Agency for
  997  Health Care Administration as being in possible violation of the
  998  statutes and rules regulating such facilities. The committee
  999  members have the same rights of entry and inspection granted
 1000  under s. 400.805(4) to designated representatives of the agency.
 1001         2. Factual findings of the committee resulting from an
 1002  onsite investigation of a facility pursuant to subparagraph 1.
 1003  shall be adopted by the agency in developing its administrative
 1004  response regarding enforcement of statutes and rules regulating
 1005  the operation of the facility.
 1006         3. Onsite investigations by the committee shall be funded
 1007  by the Health Care Trust Fund.
 1008         4. Travel expenses for committee members shall be
 1009  reimbursed in accordance with s. 112.061.
 1010         5. Members of the committee shall recuse themselves from
 1011  participating in any investigation that would create a conflict
 1012  of interest under state law, and the council shall replace the
 1013  member, either temporarily or permanently.
 1014         Section 7. Subsection (5) of section 400.93, Florida
 1015  Statutes, is amended to read:
 1016         400.93 Licensure required; exemptions; unlawful acts;
 1017  penalties.—
 1018         (5) The following are exempt from home medical equipment
 1019  provider licensure, unless they have a separate company,
 1020  corporation, or division that is in the business of providing
 1021  home medical equipment and services for sale or rent to
 1022  consumers at their regular or temporary place of residence
 1023  pursuant to the provisions of this part:
 1024         (a) Providers operated by the Department of Health or
 1025  Federal Government.
 1026         (b) Nursing homes licensed under part II.
 1027         (c) Assisted living facilities licensed under chapter 429,
 1028  when serving their residents.
 1029         (d) Home health agencies licensed under part III.
 1030         (e) Hospices licensed under part IV.
 1031         (f) Intermediate care facilities and, homes for special
 1032  services, and transitional living facilities licensed under part
 1033  V.
 1034         (g) Transitional living facilities licensed under part XI.
 1035         (h)(g) Hospitals and ambulatory surgical centers licensed
 1036  under chapter 395.
 1037         (i)(h) Manufacturers and wholesale distributors when not
 1038  selling directly to consumers.
 1039         (j)(i) Licensed health care practitioners who use utilize
 1040  home medical equipment in the course of their practice, but do
 1041  not sell or rent home medical equipment to their patients.
 1042         (k)(j) Pharmacies licensed under chapter 465.
 1043         Section 8. Subsection (21) of section 408.802, Florida
 1044  Statutes, is amended to read:
 1045         408.802 Applicability.—The provisions of this part apply to
 1046  the provision of services that require licensure as defined in
 1047  this part and to the following entities licensed, registered, or
 1048  certified by the agency, as described in chapters 112, 383, 390,
 1049  394, 395, 400, 429, 440, 483, and 765:
 1050         (21) Transitional living facilities, as provided under part
 1051  XI V of chapter 400.
 1052         Section 9. Subsection (20) of section 408.820, Florida
 1053  Statutes, is amended to read:
 1054         408.820 Exemptions.—Except as prescribed in authorizing
 1055  statutes, the following exemptions shall apply to specified
 1056  requirements of this part:
 1057         (20) Transitional living facilities, as provided under part
 1058  XI V of chapter 400, are exempt from s. 408.810(10).
 1059         Section 10. Effective July 1, 2015, a transitional living
 1060  facility licensed before the effective date of this act pursuant
 1061  to s. 400.805, Florida Statutes, must be licensed under part XI
 1062  of chapter 400, Florida Statutes, as created by this act.
 1063         Section 11. Except as otherwise expressly provided in this
 1064  act, this act shall take effect July 1, 2014.

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