Careers   |   Manage Profile   |   Print Page   |   Contact Us   |   Sign In
Assisted Living Updates
Share |

November 5, 2016

AHCA Rulemaking Workshop – Rule 59A-36.001 Standards and Criteria for Determining Resident Rights – November 6, 2015

The Agency for Health Care Administration (AHCA) has published a Notice of Development of Rulemaking/59A-36.001 Standards and Criteria for Determining Resident Rights for this Friday, November 6, 2015 from 2:00 – 3:00 pm at the AHCA (see notice below). The purpose of the rule is to comply with provisions of CS/HB 1001, enacted by the 2015 Legislature, requiring the agency to adopt rules for uniform standards and criteria to be used to determine compliance with facility standards and with resident rights. [s.429.28(3)(a), FS].

According to Anne Avery, Manager of the Assisted Living Unit, AHCA, a copy of the draft proposed rule will be handed out at the meeting on Friday. LeadingAge Florida staff will be attending the workshop and will distribute the proposed rule language to you following the meeting.

Interested individuals may participate by conference call by dialing: 1 (888) 670-3525 – provide participant passcode: 649 667 9613#

Notice of Development of Rulemaking
AGENCY FOR HEALTH CARE ADMINISTRATION

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 hours before the workshop/meeting by contacting: Catherine Anne Avery, 2727 Mahan Drive, Tallahassee, Florida, (850)412-4505. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

Health Facility and Agency Licensing

RULE NO.: RULE TITLE: 59A-36.001 Standards and Criteria for Determining Resident Rights

PURPOSE AND EFFECT: The Agency is proposing to create a new rule chapter regarding resident rights in Assisted Living Facilities licensed by the Agency. Legislation / new law created in 429.28, F.S. authorized the Agency to adopt rules for uniform standards and criteria that will be used to determine compliance with facility standards and compliance with resident rights.

SUBJECT AREA TO BE ADDRESSED: Standards and criteria for determining resident rights in assisted living facilities licensed by the Agency for Health Care Administration.

RULEMAKING AUTHORITY: 429.28 (3) (a) FS.

LAW IMPLEMENTED: 429.28 FS.

IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: November 6, 2015, 2:00 p.m. ‒ 3:00 p.m.
PLACE: Agency for Health Care Administration, Conference Room C, 2727 Mahan Drive, Building #3, Tallahassee, FL 32308

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Catherine Anne Avery, 2727 Mahan Drive, Tallahassee, Florida, (850)412-4505

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.

When Fri Nov 6, 2015 2pm – 3pm Eastern Time
Where Agency for Health Care Administration, Conference Room C, 2727 Mahan Drive, Building #3, Tallahassee, FL 32308 (map)


September 28, 2015

Second Rule Development Held on September 16, 215 On July 13, 2015, the Department of Elder Affairs held a rule workshop to receive input from the public on rule changes necessitated by CS/CS/HB1001-- specifically provisions that expand the list of medication assistance services that trained unlicensed staff may provide and the content of additional training (4 to 6 hours) required of staff assisting with these services. The new services include: assistance with an insulin syringe prefilled by a pharmacist or an insulin pen prefilled by a manufacturer, assistance with the use of a nebulizer, assistance with a glucometer, assistance with anti-embolism stockings, assistance with oxygen cannula but not titration, assistance with vital signs, and assistance with colostomy bag. The rule will elaborate on how these specific services may be provided and outline the additional training that will be required for staff assisting with the services. Although the law took effect on July 1, 2015, ALFs received a June 29, 2015, memo from AHCA stating that unlicensed staff are not permitted to perform the additional duties until rule 58A- 5.0191, F.A.C., is updated. The memo also summarized other changes in CS/CS/HB 1001.

A second rule development workshop was held on September 16, 2015. The two workshops were intended to solicit ideas from interested parties to include in a draft rule which has not yet been released. The main purpose of the second workshop was to add two additional sections of rule to those that may be amended during the rule-making process. They are sections 58A-5.0181 (Residency Criteria and Admission Procedures) and 58A-5.019 (Staffing Standards).

Action Required: Florida staff attended the September 16, 2015 rule development workshop and submitted recommendations to DOEA a few days later. The letter to DOEA is attached for your review, please click here. As soon as a draft rule is published, we will forward it to members for review and comment.

Two-Hour Pre-service Orientation Takes Effect October 1, 2015 – CS/CS/HB 1001 (s.429.52 (1), F.S.) states “Effective October 1, 2015, each new assisted living facility employee who has not completed core training must attend a pre-service orientation provided by the facility before interacting with residents. The pre-service orientation must be at least 2 hours in duration and cover topics that help the employee provide responsible care and respond to the needs of the facility residents. Upon completion, the employee and the administrator of the facility must sign a statement that the employee completed the required pre-service orientation. The facility must keep the signed statement personnel records.”

Action Required: Training content for the pre-service orientation is not specified in law. It may be included in the rule that is under development. However, at this point, we have no further guidance from DOEA on this topic other than to tell you that surveyors will be verifying compliance with the new requirement for any employee hired after October 1, 2015, who has not completed core training.


September 8, 2015

September 16, 2015 - ALF Rule Development Workshop

The Department of Elder Affairs (DoEA) has scheduled a second rule development workshop to address regulatory changes adopted by the legislature as part of CS/CS/HB 1001, the major ALF bill that passed during the 2015 legislative session.

For the benefit of our ALF members, we requested and were granted a call-in number so you may participate in the process without driving to Tallahassee. LeadingAge Florida staff, Bobby Bernal and Mary Ellen Early, will represent you at the meeting. As soon as a draft rule is available, we will email it to you for your review and comment.

The call-in information for attending the assisted living facility rule workshop on September 16, 2015, is provided below:

Conference Call #: 1-888-670-3525
Participant Code: 5964230985

The rule workshop will begin at 9:30 a.m. and end at 11:30 a.m. Please contact Mary Ellen Early if you have any questions or if you have suggestions for the proposed rule.

Background:

On July 13, 2015, the Department of Elder Affairs held a rule workshop to receive input from the public on rule changes necessitated by CS/CS/HB1001-- specifically provisions that expand the list of medication assistance services that trained unlicensed staff may provide and the content of additional training (4 to 6 hours) required of staff assisting with these services. The new services include: assistance with an insulin syringe prefilled by a pharmacist or an insulin pen prefilled by a manufacturer, assistance with the use of a nebulizer, assistance with a glucometer, assistance with anti-embolism stockings, assistance with oxygen cannula but not titration, assistance with vital signs, and assistance with a colostomy bag. The rule will elaborate on how these specific services may be provided and outline the specific additional training that will be required for staff assisting with such services. Content for the addition two hours of CORE training will be included in the draft rule as well.

Although the law took effect on July 1, 2015, ALFs received a June 29, 2015 memo from AHCA stating that unlicensed staff are not permitted to perform the additional duties until rule 58A- 5.0191, F.A.C., is updated. The memo also summarized other changes in CS/CS/HB 1001.

As of today, DoEA has not released a proposed rule. We are anticipating a draft will be published before the scheduled workshop with a 10 day comment period to follow.

At the July 13 workshop, interested parties suggested items to include in a revised rule. Nothing was available from DoEA to review.

Click here to view the Florida Administrative Register, Vol. 41, number 168, dated August 28, 2015.


July 16, 2015

ALF Rule Workshop Comment Period Ends July 20th; OIR Guidance Memo; Updated Disclosure Checklist; HB 749 PowerPoint Presentation

ALF Rule Workshop Held on Provisions in HB 1001

On July 13, 2015, the Department of Elder Affairs held a workshop to begin the process of revising the assisted living facility rule (58A-5) to provide additional guidance on changes authorized in HB 1001. LeadingAge Florida staff Bobby Bernal and Mary Ellen Early participated.

The purpose of the workshop was to give the public an opportunity to submit suggestions for inclusion in a proposed rule. Most of the comments related to requests for clarification or guidance on specific tasks associated with the expanded medication assistance (assistance with use of the nebulizer, oxygen, colostomy bag, etc.) that trained unlicensed staff may provide in ALFs with a standard license. For example, one attendee asked, if an unlicensed person would be able to calibrate a glucometer and not just clean it?

Participants also provided suggestions about the content of the two hours of additional training which is required as a result of the expanded medication assistance by trained unlicensed staff that is authorized in HB 1001. Anne Avery, Agency for Health Care Administration ALF Specialist, noted three of the top 10 most frequently cited deficiencies were associated with medication assistance, an indicator that training is very important.

Although HB 1001 took effect on July 1, 2015, unlicensed staff are not permitted to provide expanded medication assistance until rule 58A-5 is revised to provide additional guidance and clarification on both the tasks that may be performed and the additional training that must be provided. The rulemaking process typically takes 60 to 90 days at a minimum.

The Department of Elder Affairs will be receiving comments until July 20, 2015. If you have any suggestions that should be considered in the rule development process, please email them to Mary Ellen Early as soon as possible. To review HB 1001, click here.

OIR Guidance Issued on HB 749 and Form and Rate Filing Process -- On July 7, 2015, the Office of Insurance Regulation e-mailed a memo to all continuing care communities providing guidance on the process to use when filing requests for contract changes that may be required as a result of HB 749. A number of helpful tips are included in the memo including links to residency and reservation contract worksheets prepared in a checklist format. To view the OIR memo, click here.

CCRC Updated Disclosure Checklist Available -- Chapter 651, Florida Statutes, contains multiple disclosure requirements. These requirements are not currently contained in one specific section of law, which may complicate compliance. Several years ago, LeadingAge Florida prepared a checklist of the disclosure requirements in Chapter 651 to assist members with compliance. The checklist was updated on June 15, 2015, to include new requirements included in HB 749.

The most frequently cited deficiencies by OIR examiners pertain to failure to comply with one or more disclosure requirements, increasing the importance of the checklist. You must not only make the required disclosures, you must also document in writing they have occurred. To view the updated disclosure checklist click here.

CCRC PowerPoint Presentation on HB 749 Available – For those of you who missed the recent convention session on HB 749, the PowerPoint presentation may be accessed by clicking here. Please feel free to use it to educate your staff or board members about regulatory changes which take effect on October 1, 2015.
 


July 14, 2015

New AHCA Process for Plan of Correction

LeadingAge Florida received the following notification from the Agency for Health Care Administration:

As you know we discontinued requesting a formal plan of correction from ALF providers a couple years ago. While we are not going back to that process of requesting a formal plan of correction, we will be sending to providers a new cover letter with a request to submit to the specific field office their corrective action, and any documentation supporting that corrective action, that the ALF would like the office to consider for correction of the identified deficiencies. The statement of deficiencies will still look the same as before, therefore the evidence of correction would be sent separately to the office for review.

Once the field office receives the documentation, they will be able to review the information submitted, and depending on the findings can correct via desk review and/or go onsite for a revisit survey. This will allow our offices to streamline the process and be more efficient. If the provider does not submit the corrective action and any additional documentation to support correction within the timeframe outlined in the cover letter, the office will need to conduct an onsite revisit to verify correction. Again, the goal is to make this process more efficient for the providers and the field offices.

This new process is effective with any ALF survey activity on or after July 1, 2015. Should you have any questions please let me know.

Kimberly R. Smoak, MSH, QIDP
Agency for Health Care Administration
Health Quality Assurance-Bureau of Field Operations
Kimberly.Smoak@ahca.myflorida.com

If you have any questions please contact Sandie Hugg at shugg@leadingageflorida.org or (386) 208-6268.
 


 

July 10, 2015

ALF Rulemaking Workshop -- Scheduled for Monday, July 13, 2015 in Tallahassee to discuss provisions in the assisted living facility bill (HB 1001) that passed during the 2015 Legislative Session and is now law.

Please note that there is a typo in the rulemaking notice included in this communication. The correct date is July 13, 2015, not July 13, 2013.

You should have received a letter dated June 29, 2015 from AHCA Assisted Living Unit Manager Catherine Anne Avery outlining key components of HB 1001 which took effect on July 1, 2015. The letter explains the Department of Elder Affairs will be working with AHCA to establish training requirements in rule for unlicensed staff to assist residents with expanded duties including: assistance with an insulin syringe or pen prefilled by a pharmacist or manufacturer, assistance with the use of a nebulizer, assistance with anti-embolism stockings, assistance with oxygen cannula but not titration, assistance with vital signs, and assistance with a colostomy bag. In the spring of 2014, rule 58A-5.0181 (Admission Procedures, Appropriateness of Placement And Continued Residency Criteria) was updated to expand and clarify that a licensed nurse in a standard licensed ALF could provide the aforementioned assistance, but the new law goes a step further by allowing trained unlicensed staff to do the same. If you are interested in this topic, you may want to participate in the rule workshop which is the first step in promulgating a new rule.

Another topic that may be discussed is an expansion of the type of nursing services that may be performed in an ALF licensed to provide limited nursing services. According to the new law, a licensed nurse working in a LNS licensed facility is now authorized to perform nursing services within the nurse’s scope of practice to persons who meet ALF eligibility criteria. It does not expand eligibility criteria.

If you did not receive a copy of the June 29, 2015, letter, please click here.


April 29, 2015

 

Comprehensive ALF Bill Passes Legislature 


History:

In 2010, Governor Scott convened a Task Force to study and develop comprehensive regulatory changes to address a Miami Herald investigative report which found some very disturbing and life threatening situations in a few Assisted Living Facilities. Two LeadingAge Florida members (Brian Robare and Darlene Arbeit) served on the Task Force.

After four attempts to pass comprehensive reform, the 2015 Legislature on April 27 finally passed a lengthy ALF bill (CS/CS/HB-1001). Final Senate action on the bill occurred the day before the House abruptly called the 2015 Legislative Session to a close -- three days earlier than scheduled.

Representative Larry Ahern (R) Seminole and Senator Eleanor Sobel (D) Hollywood were the two key players in the passage of this legislation. Both legislators were very receptive and sought input from the various provider representatives. LeadingAge Florida public policy staff joined with other interested parties in advocating for changes to the bill as it made its way through the committee process. We are pleased to report the end product does not include three provisions that LeadingAge Florida members opposed: a revised system for fining ALFs based on the number of licensed beds, a consumer blog, and authority for the Agency for Health Care Administration to pull an Extended Care License if the ALF did not serve residents who needed ECC services over a specified period of time.

To view the enrolled bill CS/CS/HB-1001, click here.

A summary of CS/CS/HB-1001 follows. Please note that changes most important to members are preceded with an asterisk.


Section 1:

  • Amends s. 394.4575 to clarify that Medicaid Managed Care Plans are responsible for enrolled state-supported mental health residents and that managing entities under contract with the DCF are responsible for such residents who are not enrolled with a Medicaid health plan.
  • Requires that the case manager of a mental health resident who resides in and ALF with a limited mental health license be provided to the administrator within 30 days of the resident’s admission a community living support plan.
  • Requires that the case manager update the community living support plan annually or when there is a significant change in the resident’s behavioral health status. Case manager will be required to maintain face to face interaction with the resident and make records available to the responsible entity for inspection.
  • Requires mental health providers to retain records for 2 years.
  • Requires case managers to consistently monitor Community living support plans and cooperative agreements.

Section 2:

  • *Amends s. 429.0074 to require that any administrative assessment of an ALF completed by a representative of the local Ombudsman Council be comprehensive. In addition upon the completion of the assessment, requires the local Ombudsman Council to conduct an exit consultation with the facility’s administrator or designee to discuss issues and concerns in the areas affecting residents, rights, safety, and welfare and, if needed, make recommendations for improvement.

Section 3:

  • Amends s. 400.0078 to require ALFs to inform new residents that retaliatory action cannot be taken against a resident for presenting grievances and/or excising any other right. This must be done in addition to giving information to new residents about the state Long-Term Care Ombudsman Program.

Section 6: Extended Congregate Care/Limited Nursing License

  • Amends s. 429.07 to specify that an ALF must be licensed for at least 2 years to qualify for an ECC license.
  • Clarifies that AHCA may revoke or deny an ECC License for not meeting any of the regulatory criteria in law.
  • Creates a provisional ECC license, not to exceed six months, for an ALF that has been licensed for less than 2 years. Requires such providers to notify AHCA after they admit admits one ECC resident. Authorizes AHCA to issue a regular ECC license if upon inspection the ALF meets all of the requirements for ECC licensure. The Bill does not include language opposed by LeadingAge Florida that would have voided the provisional license if an ECC resident was not enrolled within 3 months of issuance of the license.
  • *Reduces monitoring visits for facilities with an ECC license from quarterly to twice a year and authorizes AHCA to wave one of the monitoring visits if the facility has held an ECC license for at least 24 months and has had no class I or class II violations or uncorrected class III violations and no Ombudsman Council complaints that resulted in a licensure citation.
  • *Reduces the monitoring visit for facilities with a limited nursing license from twice a year to at least annually and authorizes AHCA to make the visit in conjunction with other agency inspections or wave the annual monitoring visit if the facility has no class I and II violations and no uncorrected class III violations and no Ombudsman Council complaint that resulted in a citation for licensure. This change should benefit several LeadingAge Florida members.

Section 8,9 & 10: Violations and Penalties

  • Amends s. 429.14 to replace the term “deficiencies” with “violations.”
  • *Specifies that AHCA must deny or revoke a license for the following:
    • a. 2 or more moratoria issues and in final order within a 2 year period.
      b. 2 or more class I violations arising from unrelated circumstances during the same period of time.
      c. 2 or more class I violation arising from separate surveys or investigation.
  • Requires AHCA to impose an immediate moratorium on an ALF that fails to provide surveyors with access to the facility and prohibits a licensee from restricting access by AHCA staff to any records or from conducting confidential interviews with facility staff and residents.
  • Provides an exemption from the 45-day notice required of ALFs to inform residents of their relocation if the relocation is due to AHCA action.
  • Requires AHCA to impose a $500 if a facility is not in compliance with background screening requirements for staff.

*Section 11: Assistance with Self-Administration of Medication:

  • Amends s. 429.256 to allow ALF staff who have complete required training to the do the following additional tasks:
    • a. Assist with an insulin syringe that is prefilled by a pharmacist and an insulin pen that is prefilled by the manufacture.
      b. Assist with the use of a nebulizer.
      c. Assist with use of a glucometer to perform blood-glucose level checks
      d. Assist with putting on and taking off anti-embolism stockings.
      e. Assist with oxygen cannula but not with titration of the prescribed oxygen settings.
      f. Assist with measuring vital signs.
      g. Assist with colostomy bag.

Section 12: Property and Personal Affairs of Residents:

  • Amends s. 429.27(3) to increases the amount of cash that a facility may provide sake-keeping for a resident from $200 to $500.

Section 13: Resident bill of rights:

  • Amends s 429.28 to require ALFs to include Disability Rights Florida (DRF) in the required posted notice of Residents Rights. The notice must also state that a complaint has been made the names and identities of the residents involved in a complaint to the State Ombudsman Council will remain confidential.
  • Directs AHCA to adopt rules for uniform standards and criteria that will be used to determine compliance with facility standards and compliance with residents’ rights.
  • Requires AHCA to impose a fine of $2,500 if an ALF terminates the residency of an individual who participates in activities to exercise any right under this section, appears as witness in any hearing inside or outside a facility and files a civil action.

Section 14: Right of Entry and Inspection:

  • Amends s. 429.34 to require any person with knowledge or reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected or exploited to immediately report the incident to the central abuse hotline.
  • Requires AHCA to inspect every ALF every 24 months to determine regulatory compliance.

Section 15: Rules establishing standards:

  • *Amends s. 429.41 to clarify that staffing requirements for CCRCs or a community providing multiple levels that license a building designated for independent living for assisted living apply only to residents who receive personal, limited nursing or extended congregate care services. This is a change that LeadingAge Florida pursued successfully to the last ALF rule changes. It is now law so it can no longer be challenged or questioned without a change in law.
  • Required such facilities to retain a log of names and unit numbers of residents receiving ALF services and make this information available to surveyors.

Section 16: Staff training and Educational programs:

  • Amends s. 429.52 to specify that effective October 1, 2015, each NEW facility employee who has not previously completed core training must attend a pre-service orientation of at least 2 hours by the facility before interacting with residents. Requires that a signed statement by employee and administrator be placed in the employee’s file to verify compliance.

Section 17: Web-Page

  • Amends s. 429.55 to create a modified and expanded ALF consumer web-page, expanding on the current information on AHCA’s website that you can find in Healthfinder.gov currently. The expanded web-page will include a significant amount of additional information intended to help consumers when selecting an ALF. There is no “Blog” about the legislation.

Section 18: Effective Date 7/1/15


 

 

Frontline Expose of Florida Assisted Living Facilities

July 31, 2013

Last evening PBS Frontline aired a segment about ALF’s which focused on neglect, poor staff training, low staffing levels and corporate pressure to keep census high. If you did not see the featured segment or want to share the link, it can now be viewed online at http://www.pbs.org/wgbh/pages/frontline/view.

In her summary of this feature, Lauren Shaham, LeadingAge VP, Communications, states: “It's hard to summarize such a multi-faceted and disturbing show, but the stories they featured focused on neglect, poor staff training, low staffing levels and corporate pressure to keep census high even if a prospective resident was not appropriate for assisted living. There was a lot of focus on how Emeritus actively recruited residents with dementia because they could charge more and the company's focus on delivering value to shareholders. Several former staff members were interviewed and discussed pressure they felt from corporate not to report concerns they had about quality. There were several interviews with experts discussing lack of federal regulation of assisted living and the high variability in state regulations. There was discussion of the data analysis that ProPublica did of Emeritus's inspections and citations in California and across the country. Emeritus CEO and two of its vice presidents were interviewed.”

Media coverage has picked up with articles being published by:

ABC News
PBS NewsHour
Marketplace Radio
New York Times New Old Age blog

Most of the long-term care trade publications have published articles as well. As of 11:30 p.m. last night, Google News had 29 news sources with coverage. Many of them are affiliated with PBS.

Next Avenue, a major new PBS system website designed to reach America's booming 50+ population as they plan for and literally define a new life stage, is holding a live web chat today at 2 p.m. Eastern.

LeadingAge has submitted a comment to the New York Times and awaits its publication. Additionally, they have requested space for a guest blog post. Larry Minnix, President & CEO has written to Steve Moran of Senior Housing Forum as well. Dr. Minnix has also released a piece on the LeadingAge Website regarding the expose.

ACTION:

We encourage members to emphasize with constituents:

  • How they carefully assess residents and only take those who they know they can serve well.
  • How they carefully monitor staffing levels.
  • The extensive level of specialized training that staff receives before working with residents with dementia.
  • How you provide higher staffing levels and have a strong commitment to quality.
  • Quality in assisted living should be an automatic public expectation.

In closing, both LeadingAge (national) and LeadingAge Florida (state) are offering assistance with media inquiries or concerned responses from residents, family members, staff, board members, etc.

For assistance please contact:

• LeadingAge: Lauren Shaham, VP, Communications, email , phone (202) 508-1219, cell phone (202) 329-2075.

• LeadingAge Florida: Thomas Randle, Vice President of Public Policy and Government Affairs, phone (850) 702-0307 or (850) 671-3700.

Membership Software Powered by YourMembership  ::  Legal