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3 | 3 | | HB 1519 2023 |
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9 | 9 | | Page 1 of 8 |
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10 | 10 | | 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 |
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14 | 14 | | A bill to be entitled 1 |
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15 | 15 | | An act relating to assisted care communities; amending 2 |
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16 | 16 | | s. 409.908, F.S.; authorizing the Agency for Health 3 |
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17 | 17 | | Care Administration to reimburse adult day care 4 |
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18 | 18 | | services on a fee-for-service basis under the Medicaid 5 |
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19 | 19 | | program; amending s. 429.41, F.S.; specifying 6 |
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20 | 20 | | requirements for certain standards for assisted living 7 |
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21 | 21 | | facilities the agency is required to adopt by rule; 8 |
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22 | 22 | | creating s. 429.932, F.S.; providing a purpose; 9 |
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23 | 23 | | requiring operators of adult day care centers to 10 |
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24 | 24 | | annually complete specified continuing education; 11 |
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25 | 25 | | providing requirements for the content and approval of 12 |
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26 | 26 | | such continuing education courses; authorizing 13 |
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27 | 27 | | approved courses to be offered in person and online; 14 |
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28 | 28 | | providing requirements for courses completed online; 15 |
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29 | 29 | | providing additional methods to satisfy the contin uing 16 |
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30 | 30 | | education requirements; providing that compliance with 17 |
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31 | 31 | | the continuing education requirements is a condition 18 |
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32 | 32 | | precedent for licensure; authorizing the Department of 19 |
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33 | 33 | | Elderly Affairs to grant an extension, not to exceed 1 20 |
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34 | 34 | | year, for completion of the conti nuing education under 21 |
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35 | 35 | | certain circumstances; requiring persons or entities 22 |
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36 | 36 | | offering continuing education courses to submit 23 |
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37 | 37 | | certain information to the department within a 24 |
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38 | 38 | | specified timeframe; providing applicability; 25 |
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40 | 40 | | HB 1519 2023 |
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46 | 46 | | Page 2 of 8 |
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47 | 47 | | 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 |
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51 | 51 | | authorizing certain operators to request a waiver from 26 |
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52 | 52 | | the continuing education requirements; prohibiting the 27 |
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53 | 53 | | department from renewing the license of an adult day 28 |
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54 | 54 | | care center under certain circumstances; providing an 29 |
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55 | 55 | | exception; providing an effective date. 30 |
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56 | 56 | | 31 |
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57 | 57 | | Be It Enacted by the Legislature o f the State of Florida: 32 |
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58 | 58 | | 33 |
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59 | 59 | | Section 1. Present paragraphs (a) through (u) of 34 |
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60 | 60 | | subsection (3) of section 409.908, Florida Statutes, are 35 |
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61 | 61 | | redesignated as paragraphs (b) through (v), respectively, a new 36 |
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62 | 62 | | paragraph (a) is added to that subsection, and subsection (8) of 37 |
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63 | 63 | | that section is amended, to read: 38 |
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64 | 64 | | 409.908 Reimbursement of Medicaid providers. —Subject to 39 |
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65 | 65 | | specific appropriations, the agency shall reimburse Medicaid 40 |
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66 | 66 | | providers, in accordance with state and federal law, according 41 |
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67 | 67 | | to methodologies set forth in th e rules of the agency and in 42 |
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68 | 68 | | policy manuals and handbooks incorporated by reference therein. 43 |
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69 | 69 | | These methodologies may include fee schedules, reimbursement 44 |
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70 | 70 | | methods based on cost reporting, negotiated fees, competitive 45 |
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71 | 71 | | bidding pursuant to s. 287.057, and othe r mechanisms the agency 46 |
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72 | 72 | | considers efficient and effective for purchasing services or 47 |
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73 | 73 | | goods on behalf of recipients. If a provider is reimbursed based 48 |
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74 | 74 | | on cost reporting and submits a cost report late and that cost 49 |
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75 | 75 | | report would have been used to set a lower reimbursement rate 50 |
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83 | 83 | | Page 3 of 8 |
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84 | 84 | | 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 |
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88 | 88 | | for a rate semester, then the provider's rate for that semester 51 |
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89 | 89 | | shall be retroactively calculated using the new cost report, and 52 |
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90 | 90 | | full payment at the recalculated rate shall be effected 53 |
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91 | 91 | | retroactively. Medicare -granted extensions for filin g cost 54 |
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92 | 92 | | reports, if applicable, shall also apply to Medicaid cost 55 |
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93 | 93 | | reports. Payment for Medicaid compensable services made on 56 |
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94 | 94 | | behalf of Medicaid-eligible persons is subject to the 57 |
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95 | 95 | | availability of moneys and any limitations or directions 58 |
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96 | 96 | | provided for in the G eneral Appropriations Act or chapter 216. 59 |
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97 | 97 | | Further, nothing in this section shall be construed to prevent 60 |
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98 | 98 | | or limit the agency from adjusting fees, reimbursement rates, 61 |
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99 | 99 | | lengths of stay, number of visits, or number of services, or 62 |
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100 | 100 | | making any other adjustments necessary to comply with the 63 |
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101 | 101 | | availability of moneys and any limitations or directions 64 |
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102 | 102 | | provided for in the General Appropriations Act, provided the 65 |
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103 | 103 | | adjustment is consistent with legislative intent. 66 |
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104 | 104 | | (3) Subject to any limitations or directions provided fo r 67 |
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105 | 105 | | in the General Appropriations Act, the following Medicaid 68 |
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106 | 106 | | services and goods may be reimbursed on a fee -for-service basis. 69 |
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107 | 107 | | For each allowable service or goods furnished in accordance with 70 |
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108 | 108 | | Medicaid rules, policy manuals, handbooks, and state and federal 71 |
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109 | 109 | | law, the payment shall be the amount billed by the provider, the 72 |
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110 | 110 | | provider's usual and customary charge, or the maximum allowable 73 |
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111 | 111 | | fee established by the agency, whichever amount is less, with 74 |
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112 | 112 | | the exception of those services or goods for which the agency 75 |
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121 | 121 | | 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 |
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125 | 125 | | makes payment using a methodology based on capitation rates, 76 |
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126 | 126 | | average costs, or negotiated fees. 77 |
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127 | 127 | | (a) Adult day care services. 78 |
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128 | 128 | | (8) A provider of home -based or community-based services 79 |
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129 | 129 | | rendered pursuant to a federally approved waiver shall be 80 |
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130 | 130 | | reimbursed based on an established or negotiated rate for each 81 |
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131 | 131 | | service, except that adult day care services shall be reimbursed 82 |
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132 | 132 | | on a fee-for-service basis as provided in subsection (3) . These 83 |
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133 | 133 | | rates shall be established according to an analysis of the 84 |
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134 | 134 | | expenditure history a nd prospective budget developed by each 85 |
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135 | 135 | | contract provider participating in the waiver program, or under 86 |
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136 | 136 | | any other methodology adopted by the agency and approved by the 87 |
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137 | 137 | | Federal Government in accordance with the waiver. Privately 88 |
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138 | 138 | | owned and operated community -based residential facilities which 89 |
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139 | 139 | | meet agency requirements and which formerly received Medicaid 90 |
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140 | 140 | | reimbursement for the optional intermediate care facility for 91 |
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141 | 141 | | the intellectually disabled service may participate in the 92 |
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142 | 142 | | developmental services waiver as part of a home-and-community-93 |
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143 | 143 | | based continuum of care for Medicaid recipients who receive 94 |
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144 | 144 | | waiver services. 95 |
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145 | 145 | | Section 2. Subsection (2) of section 429.41, Florida 96 |
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146 | 146 | | Statutes, is amended to read: 97 |
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147 | 147 | | 429.41 Rules establishing standards. — 98 |
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148 | 148 | | (2) In adopting any rules pursuant to this part, the 99 |
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149 | 149 | | agency shall make distinct standards for facilities based upon 100 |
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157 | 157 | | Page 5 of 8 |
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158 | 158 | | 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 |
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162 | 162 | | facility size; the types of care provided; the physical and 101 |
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163 | 163 | | mental capabilities and needs of residents; the type, frequency, 102 |
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164 | 164 | | and amount of services and care offered; and the staffing 103 |
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165 | 165 | | characteristics of the facility. Rules developed pursuant to 104 |
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166 | 166 | | this section may not restrict the use of shared staffing and 105 |
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167 | 167 | | shared programming in facilities that are part of retirement 106 |
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168 | 168 | | communities that provide multiple levels of care and ot herwise 107 |
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169 | 169 | | meet the requirements of law and rule. If a continuing care 108 |
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170 | 170 | | facility licensed under chapter 651 or a retirement community 109 |
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171 | 171 | | offering multiple levels of care licenses a building or part of 110 |
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172 | 172 | | a building designated for independent living for assisted 111 |
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173 | 173 | | living, staffing requirements established in rule apply only to 112 |
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174 | 174 | | residents who receive personal, limited nursing, or extended 113 |
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175 | 175 | | congregate care services under this part. Such facilities shall 114 |
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176 | 176 | | retain a log listing the names and unit number for residents 115 |
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177 | 177 | | receiving these services. The log must be available to surveyors 116 |
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178 | 178 | | upon request. The agency shall adopt by rule separate and 117 |
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179 | 179 | | distinct standards for facilities with 16 or fewer beds and for 118 |
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180 | 180 | | facilities with 17 or more beds ; however, minimum staffing 119 |
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181 | 181 | | standards for facili ties with 6 or fewer beds may not exceed 168 120 |
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182 | 182 | | hours per week. The standards for facilities with 16 or fewer 121 |
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183 | 183 | | beds must be appropriate for a noninstitutional residential 122 |
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184 | 184 | | environment; however, the structure may not be more than two 123 |
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185 | 185 | | stories in height and all pe rsons who cannot exit the facility 124 |
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186 | 186 | | unassisted in an emergency must reside on the first floor. The 125 |
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194 | 194 | | Page 6 of 8 |
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195 | 195 | | 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 |
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199 | 199 | | agency may make other distinctions among types of facilities as 126 |
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200 | 200 | | necessary to enforce this part. When Where appropriate, the 127 |
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201 | 201 | | agency shall offer alternate solut ions for complying with 128 |
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202 | 202 | | established standards, based on distinctions made by the agency 129 |
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203 | 203 | | relative to the physical characteristics of facilities and the 130 |
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204 | 204 | | types of care offered. 131 |
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205 | 205 | | Section 3. Section 429.932, Florida Statutes, is created 132 |
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206 | 206 | | to read: 133 |
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207 | 207 | | 429.932 Continuing education requirements. — 134 |
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208 | 208 | | (1) The purpose of this section is to establish 135 |
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209 | 209 | | requirements and standards for continuing education courses for 136 |
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210 | 210 | | an operator handling the day -to-day operations of an adult day 137 |
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211 | 211 | | care center licensed under this part. 138 |
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212 | 212 | | (2) In addition to any existing adult day care center 139 |
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213 | 213 | | staff training requirements required under this part or by 140 |
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214 | 214 | | department rule, each operator must complete at least 8 hours of 141 |
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215 | 215 | | continuing education each calendar year, which must include 1 142 |
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216 | 216 | | hour of training in e ach of the following topic areas: 143 |
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217 | 217 | | (a) Compliance with requirements of the Agency for Health 144 |
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218 | 218 | | Care Administration. 145 |
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219 | 219 | | (b) Alzheimer's disease and related disorders. 146 |
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220 | 220 | | (c) State and local comprehensive emergency management 147 |
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221 | 221 | | plans. 148 |
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222 | 222 | | (d) Anti-fraud laws and regulations. 149 |
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223 | 223 | | (e) Nonemergency medical transportation. 150 |
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232 | 232 | | 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 |
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236 | 236 | | (f) Daily management of facility operations. 151 |
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237 | 237 | | (g) Staff compliance. 152 |
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238 | 238 | | (h) The Health Insurance Portability and Accountability 153 |
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239 | 239 | | Act and related requirements. 154 |
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240 | 240 | | (3) The continuing education courses mu st be developed and 155 |
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241 | 241 | | offered by the Florida Adult Day Services Association and 156 |
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242 | 242 | | approved by the department. Courses may also be provided by any 157 |
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243 | 243 | | other educational provider approved by the department. 158 |
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244 | 244 | | (4) Approved courses may be offered in person or online. 159 |
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245 | 245 | | Upon completion of an online course, an operator must pass an 160 |
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246 | 246 | | online department-approved exam with a minimum score of 80 161 |
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247 | 247 | | percent or higher. An operator attending an in -person course is 162 |
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248 | 248 | | exempt from the exam requirement. An individual teaching an 163 |
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249 | 249 | | approved course or lecturing at an approved seminar and 164 |
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250 | 250 | | attending the entire course or seminar qualifies for the same 165 |
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251 | 251 | | number of classroom hours as would be granted to a person taking 166 |
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252 | 252 | | and successfully completing such course or seminar. Such credit 167 |
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253 | 253 | | is limited to the nu mber of hours actually taught by the 168 |
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254 | 254 | | individual unless he or she attends the entire course or 169 |
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255 | 255 | | seminar. 170 |
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256 | 256 | | (5) Compliance with the continuing education requirements 171 |
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257 | 257 | | of this section is a condition precedent to the issuance, 172 |
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258 | 258 | | continuation, reinstatement, or ren ewal of an operator's adult 173 |
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259 | 259 | | day care center license subject to this part. However, for good 174 |
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260 | 260 | | cause shown, the department may grant the operator an extension 175 |
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269 | 269 | | 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 |
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273 | 273 | | of time, not to exceed 1 year, to complete the continuing 176 |
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274 | 274 | | education required under this section. 177 |
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275 | 275 | | (6) Each person or entity offering a course for continuing 178 |
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276 | 276 | | education credit under this section must submit to the 179 |
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277 | 277 | | department, within 30 days after completion of the course, in a 180 |
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278 | 278 | | form satisfactory to the department or its designee, a roster 181 |
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279 | 279 | | including the adult day care license number and the name of the 182 |
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280 | 280 | | operator who successfully completed such course and is 183 |
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281 | 281 | | requesting credit. 184 |
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282 | 282 | | (7) Except as otherwise provided in this section, this 185 |
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283 | 283 | | section applies to all operators handling the day -to-day 186 |
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284 | 284 | | operations of adult d ay care centers licensed under this part. 187 |
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285 | 285 | | Operators who are unable to comply with the continuing education 188 |
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286 | 286 | | requirements due to active duty in the military may submit a 189 |
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287 | 287 | | written request for a waiver to the department. 190 |
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288 | 288 | | (8) Unless the operator has been grant ed an extension or a 191 |
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289 | 289 | | waiver by the department, the department may not renew the 192 |
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290 | 290 | | license of an adult day care center whose operator has failed to 193 |
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291 | 291 | | complete the continuing education required under this section 194 |
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292 | 292 | | until such time as the operator completes such co ntinuing 195 |
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293 | 293 | | education. 196 |
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294 | 294 | | Section 4. This act shall take effect July 1, 2023. 197 |
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