Florida Legislature Passes Assisted Living Facility Reform Bill

By: I. Paul Mandelkern

Mandelkern-webAfter several years of trying, the 2015 Florida Legislature passed a comprehensive assisted living facility reform bill. If signed into law by Governor Scott this legislation will be effective on July 1, 2015, and will impact the licensure and operation of ALFs. The following is a summary of the key provisions of the bill:

Limited Mental Health License
The bill amends current law to require that facilities with a standard ALF license that have one or more mental health residents, instead of three or more as now required, must obtain a specialty limited mental health license. The bill also requires that the community living support plan, that must be completed for each mental health resident, shall be updated not only annually as required by current law, but when there is a “significant change in the resident’s behavioral health status.” Another new requirement states that the resident’s case manager must keep a two-year record of any face-to-face interaction with the resident and make the record available for inspection.

Extended Congregate Care License
The bill revises current law regarding the regulation of ALFs with extended congregate care (ECC) specialty licenses. These revisions include:
• Requiring that an ALF be licensed for two or more years before being issued an ECC license that is not provisional.
• Creating a provisional ECC license for ALFs that have been licensed for less than two years, and the provisional ECC license may not exceed six months.
• Requiring the ALF to notify the Florida Agency for Health Care Administration (AHCA) when it has admitted at least one ECC resident, after which AHCA will make an unannounced inspection of the ALF to determine its compliance with the requirements of an ECC license.  If the ALF with a provisional ECC license demonstrates compliance with the ECC license requirements during the inspection, AHCA must issue it a non-provisional ECC license.  However, if the ALF fails to demonstrate compliance with the ECC license requirements during the inspection, then in addition to sanctions that may be imposed by AHCA, the ALF must immediately suspend ECC services and the provisional ECC license will expire.
• Reducing the number of required monitoring visits by AHCA for ALFs with an ECC specialty license from quarterly to twice a year.
• Clarifying under what circumstances AHCA may waive one of the required monitoring visits.

Limited Nursing Services License
An ALF with a limited nursing services (LNS) license may provide nursing services beyond those provided by a facility with a standard ALF license.  However, under current law a licensed registered nurse in a facility with an LNS license may only perform certain nursing services that are specified in the applicable AHCA administrative rule.  The bill broadens those services so that a licensed registered nurse in an LNS licensed ALF may perform all nursing services that may be carried out by a registered nurse under Florida law. The bill also reduces the number of required monitoring visits by AHCA for ALFs with an LNS specialty license from twice a year to annually, and it sets forth the criteria by which AHCA may waive the annual monitoring visit.

Resident Grievances
Current law requires that upon admission to an ALF the resident or the representative of the resident must be provided information regarding the purpose of the State Long-Term Care Ombudsman Program and the statewide toll-free number for receiving residents’ complaints and other relevant information regarding how to contact that program.  The bill amends current law to require that the new resident or the representative must also be informed that retaliatory action cannot be taken against a resident for presenting grievances or for exercising any other resident right.

Assistance with Self-Administration of Medication
Current law permits a specially trained unlicensed ALF staff member to assist a resident with self-administration of medication but limits the assistance to only the activities listed in the relevant statute.  The bill expands the permitted assistance to include using a glucometer to perform blood-glucose level checks; assisting with the putting on and taking off of anti-embolism stockings; applying and removing an oxygen cannula (but not titrating the prescribed oxygen setting); assisting with the use of a nebulizer; assisting with the use of a continuous positive airway pressure (CPAP) device; assisting with measuring vital signs; and assisting with colostomy bags.

Consumer Website
AHCA is required to create a consumer website by November 1, 2015 which must contain certain information about each licensed ALF in Florida including the name of the owner of the ALF; the types of licenses held by the facility; the number of licensed beds; the most recent occupancy levels; the religious affiliation, if any, of the ALF; the forms of payment the facility accepts; and the ALF’s survey and violation information for the previous five years, which must be updated monthly and include a summary of the violation, the sanctions imposed by AHCA, and the date the corrective action was confirmed by AHCA.

Other Changes
The bill also provides that:
• AHCA must pay for the expense of copying the ALF’s records during a regulatory inspection.
• A fine of $500 will be imposed by AHCA each time an ALF does not comply with the background screening requirements.
• The amount of a resident’s personal funds for which an ALF must provide safekeeping is increased from $200 to $500.
• AHCA must inspect every licensed ALF at least every 24 months to determine compliance with applicable Florida law and the AHCA administrative rules. However, if an ALF is cited for a Class I violation or three or more Class II violations from separate surveys within a 60 day period or due to unrelated circumstances during the same survey, AHCA must conduct an additional inspection within six months.
• AHCA must impose an immediate moratorium on any ALF that fails to provide the agency with access to the facility or restricts agency staff from conducting confidential interviews with the facility’s staff or its residents.

If you have any questions, please contact Paul Mandelkern at paul.mandelkern@lowndes-law.com.

Should you need assistance regarding this issue, please contact I. Paul Mandelkern or any member of the firm’s Senior Housing Group

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