CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 1 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to nursing home facility staffing 2
requirements; amending s. 400.021, F.S.; revising a 3
definition; amending s. 400.23, F.S.; providing 4
definitions; specifying functions that do not 5
constitute direct care staffing hours for purposes of 6
required nursing home staffing ratios; requiring 7
nursing home facilities to determine their direct care 8
staffing needs based on the facility assessment and 9
the individual needs of a resident based on the 10
resident's care plan; revising nursing home staffing 11
requirements; requiring nursing home facilities to 12
maintain and report staffing information consistent 13
with federal law; specifying that evidence of a 14
facility's compliance with the minimum direct care 15
staffing requirements is not admissible as evidence of 16
compliance with certain federal requirements; 17
providing that certain paid feeding assistants and 18
direct care staff count toward compliance with the 19
overall direct care minimum staffing requirement; 20
providing an exception; requiring certain direct care 21
staff to complete a certain feeding assistant training 22
program; authorizing the Agency for Health Care 23
Administration to adopt rules; amending s. 400.024, 24
F.S.; providing that the transferee in a change of 25
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 2 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
ownership of a facility is responsible and liable for 26
any unsatisfied or undischarged adverse final 27
judgements; requiring the licensee or transferor who 28
files an application for a change of ownership to 29
provide written notice to each pending claimant or the 30
claimant's attorney; requiring such notice to be 31
provided within a specified timeframe and by certain 32
methods; providing that a claimant has a specified 33
period to object to an application for a change of 34
ownership; requiring the agency to consider any 35
objection in its decision to approve or deny such 36
application; authorizing a claimant to file a petition 37
to enjoin a change of ownership under certain 38
circumstances; defining the term "claimant"; amending 39
s. 400.141, F.S.; revising provisions relating to a 40
facility's failure to comply with minimum staffing 41
requirements; conforming cross -references and 42
provisions to changes made by the act; providing an 43
effective date. 44
45
Be It Enacted by the Legislature of the State of Florida: 46
47
Section 1. Subsection (18) of section 400.021, Florida 48
Statutes, is amended to read: 49
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 3 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
400.021 Definitions. —When used in this part, unless the 50
context otherwise requires, the term: 51
(18) "Resident care plan" means a written comprehensive 52
person-centered care plan developed in accordance with 42 53
C.F.R. s. 483.21(b) that is , maintained, and reviewed not less 54
than quarterly by a registered nurse, with participation from 55
other facility staff and the resident or his or her designee or 56
legal representative. The resident care plan must include , 57
which includes a comprehensive assessment of the needs of an 58
individual resident; the type and frequency of services 59
required to provide the necessary care for the resident to 60
attain or maintain the highest practicable physical, mental, 61
and psychosocial well -being; a listing of services provided 62
within or outside the facility to meet those needs; and an 63
explanation of service goals. 64
Section 2. Subsection (3) of section 400.23, Florida 65
Statutes, is amended to read: 66
400.23 Rules; evaluation and deficiencies; licensure 67
status.— 68
(3)(a)1. As used in this subsection, the term: 69
a. "Direct care staff" means persons who, through 70
interpersonal contact with residents or resident care 71
management, provide care and services to allow residents to 72
attain or maintain the highest practicable physical, mental, 73
and psychosocial well -being, including, but not limited to, 74
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 4 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
disciplines and professions that must be reported in accordance 75
with 42 C.F.R. s. 483.70(q) in the categories of direct care 76
services physician, nursing, pharmacy, dietary, therapeutic, 77
dental, podiatry, and mental health. The term does not include 78
a person whose primary duty is maintaining the physical 79
environment of the facilit y, including, but not limited to, 80
food preparation, laundry, and housekeeping. 81
b. "Facility assessment" means a process to determine the 82
staff competencies necessary to provide the level and types of 83
care needed for the facility's resident population con sidering 84
the types of diseases, conditions, physical and cognitive 85
disabilities, overall acuity, and other facts pertinent to that 86
resident population, and performed in accordance with 42 C.F.R. 87
s. 483.70(e). 88
2. For purposes of this subsection, direct ca re staffing 89
hours do not include time spent on nursing administration, 90
staff development, staffing coordination, and the 91
administrative portion of the minimum data set and care plan 92
coordination for Medicaid. 93
(b)1. Each facility must determine its direct care 94
staffing needs based on the facility assessment and the 95
individual needs of a resident based on the resident's care 96
plan. At a minimum, staffing The agency shall adopt rules 97
providing minimum staffing requirements for nursing home 98
facilities. These requirements must include, for each facility , 99
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 5 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
the following requirements : 100
a. A minimum weekly average of certified nursing assistant 101
and licensed nursing staffing combined of 3.6 hours of direct 102
care by direct care staff per resident per day. As used in t his 103
sub-subparagraph, a week is defined as Sunday through Saturday. 104
b. A minimum certified nursing assistant staffing of 2.0 105
2.5 hours of direct care by a certified nursing assistant per 106
resident per day. A facility may not staff below one certified 107
nursing assistant per 20 residents. 108
c. A minimum licensed nursing staffing of 1.0 hour of 109
direct care by a licensed nurse per resident per day. A 110
facility may not staff below one licensed nurse per 40 111
residents. 112
2. Nursing assistants employed under s. 400. 211(2) may be 113
included in computing the hours of direct care provided by 114
certified nursing assistants and may be included in computing 115
the staffing ratio for certified nursing assistants if their 116
job responsibilities include only nursing -assistant-related 117
duties. 118
3. Each nursing home facility must document compliance 119
with staffing standards as required under this paragraph and 120
post daily the names of licensed nurses and certified nursing 121
assistants staff on duty for the benefit of facility residents 122
and the public. Facilities must maintain the records 123
documenting compliance with minimum staffing standards for a 124
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 6 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
period of 5 years and must report staffing in accordance with 125
42 C.F.R. s. 483.70(q). 126
4. The agency must shall recognize the use of licensed 127
nurses for compliance with minimum staffing requirements for 128
certified nursing assistants if the nursing home facility 129
otherwise meets the minimum staffing requirements for licensed 130
nurses and the licensed nurses are performing the duties of a 131
certified nursing assistant. Unless otherwise approved by the 132
agency, licensed nurses counted toward the minimum staffing 133
requirements for certified nursing assistants must exclusively 134
perform the duties of a certified nursing assistant for the 135
entire shift and not also b e counted toward the minimum 136
staffing requirements for licensed nurses. If the agency 137
approved a facility's request to use a licensed nurse to 138
perform both licensed nursing and certified nursing assistant 139
duties, the facility must allocate the amount of st aff time 140
specifically spent on certified nursing assistant duties for 141
the purpose of documenting compliance with minimum staffing 142
requirements for certified and licensed nursing staff. The 143
hours of a licensed nurse with dual job responsibilities may 144
not be counted twice. 145
5. Evidence that a facility complied with the minimum 146
direct care staffing requirements under subparagraph 1. is not 147
admissible as evidence of compliance with the nursing services 148
requirements under 42 C.F.R. s. 483.35 or 42 C.F.R. s. 483 .70. 149
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 7 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(c)(b) Paid feeding assistants and direct care nonnursing 150
staff who provide providing eating assistance to residents 151
shall not count toward compliance with overall direct care 152
minimum staffing hours, but not the hours of direct care 153
required for certified nursing assistants or licensed nurses. 154
Direct care staff who are not certified nursing assistants or 155
licensed nurses must successfully complete the feeding 156
assistant training program under s. 400.141(1)(v) for purposes 157
of this paragraph standards. 158
(d)(c) Licensed practical nurses licensed under chapter 159
464 who provide are providing nursing services in nursing home 160
facilities under this part may supervise the activities of 161
other licensed practical nurses, certified nursing assistants , 162
and other unlicensed personnel providing services in such 163
facilities in accordance with rules adopted by the Board of 164
Nursing. 165
(e) The agency may adopt rules to implement this 166
subsection. 167
Section 3. Subsection (4) of section 400.024, Florida 168
Statutes, is amended to read: 169
400.024 Failure to satisfy a judgment or settlement 170
agreement.— 171
(4) If, After the agency is placed on notice pursuant to 172
subsection (2), the following applies and: 173
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 8 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(a) If the license is subject to renewal, the agency may 174
deny the license renewal unless compliance with this section is 175
achieved.; and 176
(b) If a change of ownership application for the facility 177
at issue is submitted by the licensee, by a person or entity 178
identified as having a controlling interest in the licensee, or 179
by a related party, the unsatisfied or undischarged adverse 180
final judgment under subsection (1) becomes the responsibility 181
and liability of the transferee and the agency shall deny the 182
change of ownership application unless compliance with this 183
section is achieved. 184
(c) If a change of ownership application for the facility 185
at issue is filed by the licensee, by a person or entity 186
identified as having a controlling interest in the licensee, or 187
by a related party: 188
1. The licensee or transferor must provi de written notice 189
of the filing of the application to each pending claimant or 190
the claimant's attorney of record, if applicable. The written 191
notice must be provided within 14 days after the date the 192
application is filed with the agency. 193
2. Notice must be provided by certified mail, return 194
receipt requested, or other method that provides verification 195
of receipt. 196
3. A claimant has 30 days after the date of receipt of the 197
written notice to object to the application if the claimant has 198
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 9 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
reason to believe tha t the approval of the application would 199
facilitate a fraudulent transfer or allow the transferor to 200
avoid financial responsibility for the claimant's pending 201
claim. 202
4. The agency must consider any objection brought pursuant 203
to this subsection in its deci sion to approve or deny an 204
application for change of ownership under this part and part II 205
of chapter 408. 206
5. If a claim is pending in arbitration at the time that 207
the application for change of ownership is filed, the claimant 208
may file a petition to enjoin the transfer in circuit court. 209
210
As used in this paragraph, the term "claimant" means a 211
resident, the resident's family, or a personal representative 212
who has notified the licensee or facility of a potential claim 213
by written notice of intent or who ha s initiated an action, 214
claim, or arbitration proceeding against the licensee or 215
facility. 216
Section 4. Paragraphs (g), (n), and (r) of subsection (1) 217
of section 400.141, Florida Statutes, are amended to read: 218
400.141 Administration and management of nu rsing home 219
facilities.— 220
(1) Every licensed facility shall comply with all 221
applicable standards and rules of the agency and shall: 222
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 10 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(g) If the facility has a standard license, exceeds the 223
minimum required hours of direct care provided by licensed 224
nurses nursing and certified nursing assistants assistant 225
direct care per resident per day, and is part of a continuing 226
care facility licensed under chapter 651 or is a retirement 227
community that offers other services pursuant to part III of 228
this chapter or part I or part III of chapter 429 on a single 229
campus, be allowed to share programming and staff. At the time 230
of inspection, a continuing care facility or retirement 231
community that uses this option must demonstrate through 232
staffing records that minimum staffing r equirements for the 233
facility were met. Licensed nurses and certified nursing 234
assistants who work in the facility may be used to provide 235
services elsewhere on campus if the facility exceeds the 236
minimum number of direct care hours required per resident per 237
day and the total number of residents receiving direct care 238
services from a licensed nurse or a certified nursing assistant 239
does not cause the facility to violate the staffing ratios 240
required under s. 400.23(3)(b) s. 400.23(3)(a). Compliance with 241
the minimum staffing ratios must be based on the total number 242
of residents receiving direct care services, regardless of 243
where they reside on campus. If the facility receives a 244
conditional license, it may not share staff until the 245
conditional license status ends. Th is paragraph does not 246
restrict the agency's authority under federal or state law to 247
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 11 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
require additional staff if a facility is cited for 248
deficiencies in care which are caused by an insufficient number 249
of certified nursing assistants or licensed nurses. The agency 250
may adopt rules for the documentation necessary to determine 251
compliance with this provision. 252
(n) Comply with state minimum -staffing requirements: 253
1. A facility that has failed to comply with state 254
minimum-staffing requirements for 48 2 consecutive hours days 255
is prohibited from accepting new admissions until the facility 256
has achieved the minimum -staffing requirements for 6 257
consecutive days. For the purposes of this subparagraph, any 258
person who was a resident of the facility and was absent from 259
the facility for the purpose of receiving medical care at a 260
separate location or was on a leave of absence is not 261
considered a new admission. Failure by the facility to impose 262
such an admissions moratorium is subject to a $1,000 fine. 263
2. A facility that doe s not have a conditional license may 264
be cited for failure to comply with the standards in s. 265
400.23(3)(b)1.b. and c. s. 400.23(3)(a)1.b. and c. only if it 266
has failed to meet those standards for 48 on 2 consecutive 267
hours days or if it has failed to meet at least 97 percent of 268
those standards on any one day. 269
3. A facility that has a conditional license must be in 270
compliance with the standards in s. 400.23(3)(b) s. 271
400.23(3)(a) at all times. 272
CS/HB 1239 2022
CODING: Words stricken are deletions; words underlined are additions.
hb1239-01-c1
Page 12 of 12
F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(r) Maintain in the medical record for each resident a 273
daily chart of direct care certified nursing assistant services 274
provided to the resident. The direct care staff certified 275
nursing assistant who is caring for the resident must complete 276
this record by the end of his or her shift. This record must 277
indicate assistance with activities of daily living, assistance 278
with eating, and assistance with drinking, and must record each 279
offering of nutrition and hydration for those residents whose 280
plan of care or assessment indicates a risk for malnutrition or 281
dehydration. 282
Section 5. This act shall take effect upon becoming a law. 283