The purpose of the proposed rule amendments is to incorporate additional definitions; specific definitions regarding reporting requirements; changes in licensure requirements, including an application form; changes to the reporting requirements ...

 

DEPARTMENT OF ELDER AFFAIRS
Federal Aging Programs

RULE NO: RULE TITLE
58A-2: HOSPICE
58A-2.002: Definitions
58A-2.003: License Required
58A-2.004: Licensure Procedure
58A-2.005: Administration of the Hospice
58A-2.012: Program Reporting
58A-2.0236: Residential Units
58A-2.025: Physical Plant Requirements (Inpatient Facility and Unit)
58A-2.026: Comprehensive Emergency Management Plan
PURPOSE AND EFFECT: The purpose of the proposed rule amendments is to incorporate additional definitions; specific definitions regarding reporting requirements; changes in licensure requirements, including an application form; changes to the reporting requirements pursuant to Chapter 2006-155, Section 7, Laws of Florida, including two newly developed reporting forms incorporated by reference in Rule 58A-2.012, F.A.C.; changes in Section 400.610(1)(b)1., F.S., in accordance with Chapter 2006-71, Section 24, Laws of Florida, regarding the hospice’s responsibility to provide the same type and quantity of services to hospice patients in a special needs shelter that were being provided prior to evacuation, and changes to the Hospice Comprehensive Emergency Management reporting form; changes in accordance with Chapter 2006-155, Section 7, Laws of Florida, requiring development of outcome measures, and adoption of national initiatives such as those developed by the National Hospice and Palliative Care Organization; deletion of physical plant standards in Rules 58A-2.0236, Residential Units, and 58A-2.025, Physical Plant Requirements (Inpatient Facility and Unit), F.A.C., which are to be incorporated under the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437.
SUBJECT AREA TO BE ADDRESSED: Additional definitions; licensure requirements, including an application form; definitions regarding reporting requirements; changes in reporting requirements including two new reporting forms; responsibility of hospices to provide the same type and quantity of services to hospice patients in special needs shelters that were being provided prior to evacuation; changes in the Hospice Comprehensive Emergency Management Plan reporting form; development of outcome measures; adoption of national initiatives developed by the National Hospice and Palliative Care Organization; and deletion of physical plant standards for residential units and for inpatient facilities, which will be included under the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437.
SPECIFIC AUTHORITY: 400.605, 400.60501, 400.610(1)(b), 408.802(19), 408.805(1) FS.
LAW IMPLEMENTED: 400.610, 408.802(19), 408.805(1), 400.832 FS., Ch. 2006-197, Laws of Florida.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: December 8, 2006, 1:00 p.m. – 4:30 p.m.

PLACE: Department of Elder Affairs, 4040 Esplanade Way, Conference Room 225F, Tallahassee, Florida

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 72 hours before the workshop/meeting by contacting: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399; Telephone number: [phone]; Email address: crochethj@ elderaffairs.org. 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).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT IS: Jim Crochet, Department of Elder Affairs, 4040 Esplanade Way, Tallahassee, Florida 32399; Telephone number: [phone]; Email address: [e-mail]

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

58A-2.002 Definitions.

In addition to definitions contained in Chapter 400, Part IV VI, F.S., the following terms shall apply:

(1) Advertisement: Any written, printed, oral, or electronic promotion, statement of availability, qualifications, services offered, or other similar communication appearing in or on television, radio, the Internet, billboards, newspapers, magazines, business cards, flyers, brochures, or other medium for the purpose of attracting potential residents. A listing of a licensed facility’s name, address, and telephone number in the telephone directory shall not be considered advertising.

(2) AHCA: Agency for Health Care Administration.

(3)(1) Autonomous: A means a separate and distinct operational entity, which functions under its own administration and bylaws, either within or independently of a parent organization.

(4)(2) Branch office: An means an office or other physical location serving as a contact point for patients, which is remote from the provider’s principal office of the provider, but is not separately licensed, and which shares administration with the principal office which serves as a contact point for patients.

(5)(3) Employ: To means to engage the services of an individual, on either a salary or volunteer basis.

(6)(4) Home: The means the patient’s current place of residence, including a private residence, assisted living facility, nursing home, hospice residential unit, or other place of permanent or temporary residence.

(7)(5) Home Health Aide: An means an individual who provides personal health care services for a patient in the patient’s home or place of residence under the supervision of a registered nurse.

(8)(6) Licensed Practical Nurse: An means an individual licensed pursuant to Chapter 464, F.S., to practice practical nursing.

(9)(7) Patient Care Staff: means those Ppersons involved in direct care of the patient, including registered nurses, practical nurses and home health aides, social workers and other mental health professionals, and clergy or pastoral counselors.

(10)(8) Patient’s Family; The means that person or those persons designated by the patient as having primary responsibility for care, or persons who are closely linked with the patient and are involved in the health and supportive care of the patient.

(11)(9) Patient and Family Unit: The means the patient and the patient’s family.

(12)(10) Registered Nurse: An means an individual who is licensed pursuant to Chapter 464, F.S., to practice professional nursing.

Specific Authority 400.605 FS. Law Implemented Ch. 400, Part IV VI FS. History–New 5-6-82, Formerly 10A-12.02, 10A-12.002, Amended 4-27-94, Formerly 59A-2.002, Amended 6-5-97,_________.

 

58A-2.003 License Requirements Required.

(1) The face of the license shall contain the following information:

(a) The name and address of the provider, including the principal office and all branch offices;

(b) All freestanding hospice inpatient facilities and residential units;

(c) All counties served by the hospice;

(d) The name of the owner; and

(e) The effective and expiration dates of the license.

(2) The hospice shall notify the agency and the department in writing at least sixty (60) days before making a change in name or address of the provider’s principal or branch offices. the name and address of the provider, including the principal office and all branch offices, all hospice residences and inpatient facilities, all counties served by the hospice, the name of the owner, and the effective and expiration dates of the license. The hospice shall notify AHCA and the Department in writing at least sixty (60) days before making a change in name or address of the provider.

(3)(2) If a change of ownership as defined in Section 408.803(5), F.S., is contemplated, the new owner shall submit a license, or cause to be submitted, an application for license and shall receive a license prior to commencement of operation of the hospice. The following materials shall accompany the license application:

(a) A signed agreement to correct any existing licensure deficiencies;

(b) Documented evidence that the change of ownership has taken place; and

(c) A statement that records pertaining to the administrative operation of the provider shall be retained and made available for official inspection by the agency.

A signed agreement to correct any existing licensure deficiencies shall accompany the license application, together with documentation to evidence that the ownership change has taken place, and a statement that records pertaining to the administrative operation of the provider will be retained and available for official inspection by the AHCA.

(4)(3) If a merger of two or more hospice providers is contemplated, the legal and incorporated entity that will be responsible for the operational function of the hospice after the merger shall notify the agency AHCA prior to the merger. Notification shall will include the anticipated date for the merger and the reason for the merger. The agency AHCA shall require the legal entity to submit a license an application for license, including a revised plan for the delivery of hospice care to terminally ill patients and their families who will be affected by the merger.

Specific Authority 400.605 FS. Law Implemented Ch. 400, Part IV, VI FS. History–New 5-6-82, Formerly 10A-12.03, 10A-12.003, Amended 4-27-94, Formerly 59A-2.003, Amended 6-5-97,_________.

 

58A-2.004 Licensure Procedure.

(1) Biennial lLicenses issued by the agency AHCA to operate a hospice shall be contigent based upon the results of an agency a survey conducted by the AHCA to determine compliance with the requirements of Chapter 400, Part IVVI, F.S., Chapter 408, Part II, F.S., and with these rules. A license shall be issued to any not-for-profit public or private agency who meets all federal, state and local requirements.

(2) Application for a license shall be made by completing to the AHCA Form 3110-4001 on forms prescribed by the AHCA.

(a) The form is hereby incorporated by reference and may be obtained from the agency Web site at http://ahca.myflorida.com under “Licensing and Certification”, “Hospices.”   If the provider is unable to obtain the forms from the Web site, the forms may be obtained from the Agency for Health Care Administration, Licensed Home Health Programs Unit, 2727 Mahan Drive, Tallahassee, Florida 32308 or by contacting [phone].

(b) The application shall be accompanied by a biennial licensure fee of one thousand two hundred dollars ($1,200) as provided under Sections 400.606, F.S., and Chapter 408, Part II, F.S., payable by check or money order to the Agency for Health Care Administration.

The application shall be accompanied by a license fee of six hundred dollars ($600.00) as provided under Section 400.606, F.S., in check or money order, payable to the Agency for Health Care Administration.

(3) In addition to the information required in Section 400.606(1), F.S., the following information is required for the licensure application:

(a) The name of the hospice’s administrator and the administrator’s license number if the administrator is a licensed professional; the name and license number of the hospice’s medical director; the number and types of licensed professionals, including clergy, employed or to be employed by the hospice; the number of home health aides employed or to be employed by the hospice; and the number and types of other personnel employed or to be employed by the hospice and assigned to a hospice care team or teams.

(b) For initial licensure only, the Certificate of Need and certificates of occupancy signed by local authorized zoning, building and electrical officials shall be attached to the application. For relocation of the principal office and addition or relocation of branch offices, certificates of occupancy signed by local authorized zoning, building and electrical officials shall be submitted to the agency in accordance with subsection 58A-2.003(2), F.A.C. If initial licensure, where there are no municipal, county or electrical building codes, the applicant shall provide a written statement of compliance with these regulations from a registered architect or professional engineer who shall substitute for the authorities specified above. A separate survey for fire safety and physical plant requirements of residential and freestanding inpatient facilities operated by the hospice shall be made by the agency AHCA prior to the opening of the facilities and on a periodic basis thereafter.

(c) As a condition of initial licensure, each successful applicant shall submit the names and professions for all hospice care team staff, and professional license numbers held by licensed hospice care team members staff who are licensed, no later than three (3) months after the license is issued.

Specific Authority 400.605, 408.802(19), 408.805(1) FS. Law Implemented 400.605(1)(a), 408.802(19), 408.805(1), 408.832 FS., Ch. 2006-197, Laws of Florida. History–New 5-6-82, Formerly 10A-12.04, Amended 10-6-91, Formerly 10A-12.004, Amended 4-27-94, Formerly 59A-2.004, Amended 6-5-97, 8-10-03,_________.

 

58A-2.005 Administration of the Hospice.

(1) Governing Body. – The hospice shall establish written bylaws for There shall be a governing body established by written bylaws of the hospice with autonomous authority for the conduct of the hospice program. The governing body and which shall satisfy the following requirements:

(a) Members of the governing body shall reside or work in the hospice’s service area as defined in paragraph 59C-1.0355(2)(k), F.A.C.

(b) No change.

(c) Duties of the governing body shall include:

1. Adoption in writing, with updates as necessary, of the following documents which shall be in compliance with provisions of Chapter 400, Part IV VI, F.S., and these rules, with updates as necessary:

a. through c. No change.

d. A comprehensive emergency management plan for all administrative, residential, free-standing inpatient facilities, and hospice services designed to protect the safety of patients and their families and hospice staff; and

e. No change.

2. Promulgation of rules and bylaws which include at least the following:

a. through c. No change.

d. The qualifications, method of selection and terms of office of members and chairpersons of the governing body and committees; and

e. A mechanism for the administrator’s appointment by the administrator of the medical director and other professional and ancillary personnel.

(2) Administrative Officer. – The hospice shall employ an administrator whose duties shall be outlined enumerated in a written job description, including job qualifications., The administrator which shall be approved by the governing body. The job description shall be and kept in an administrative file.

(a) No change.

(b) The administrator shall be responsible for maintaining an administrative office facility for the purpose of the operations of the hospice.

(3) Administrative Policies and Practices.

(a) The administrator shall be responsible for developing, documenting, and implementing administrative policies and practices which are consistent with these rules, and the bylaws by-laws, and the plans and decisions adopted by the governing body., These policies and practices shall and which ensure the most efficient operation of the hospice program and the safe and adequate care of the patient and family units. At a minimum, tThese policies and practices shall include:

1. through 2. No change.

3. A plan for orientation and training of all staff, including volunteers, which shall ensure that all staff receive this training prior to the delivery of their delivering services of any kind to patients and their families. This plan shall describe the method of assessing training needs and designing training to meet those needs, and shall include a curriculum outline with specific objectives.

4. No change.

5. Policies for administering drugs and biologicals in the home which shall include:

a. through b. No change.

c. All verbal orders for medication or treatments, or changes in medication or treatment orders shall be taken by a licensed health professional and recorded in the patient’s record reduced to writing., Verbal orders shall be and signed by the physician within fourteen (14) days;

d. The use of experimental drugs, or any drug approved by the FDA or included under Chapter 500, F.S., approved drug in a non-approved manner, shall not be given without the consent of the patient or the patient’s surrogate or proxy. The program administering such drugs shall be fully informed patients of any risks, receive written consent for the use of such drugs, and be prepared to invoke remedial action should an adverse reaction occur. A copy of the signed consent shall be kept in the patient’s record.

6. No change.

7. Policies and procedures approved by the medical director and governing body pertaining to the drug control system in the hospice including which shall include specific policies and procedures for disposal of Class II drugs upon the death of a patient.

8. No change.

9. Policies and procedures for mMaintenance, confidentiality, and retention of clinical records for a minimum five-year period following the patient’s death.

10. through 11. No change.

12. Notice to the public that the hospice provides services regardless of ability to pay.

13. through 14. No change.

15. Policies and procedures for cCompletion, retention, and submission of reports and records as required by the dDepartment, agency, the AHCA and other authorized agencies.

16. No change.

(b) Equipment and personnel, under medical supervision, shall be provided for diagnostic procedures to meet the needs of the hospice inpatient, residential and home-care programs. This shall include the services of a clinical laboratory and radiological services, which shall meet all standards of the State of Florida. Unless provided on the premises of the hospice, there shall be written agreements or contracts for such services. The hospice program shall ensure that the sum of services are available under contract and services provided directly by the hospice shall assure twenty-four (24) hours a day, seven (7) days a week, either through contractual agreement, written agreement, or direct service provision by the hospice availability.

(c) No change.

(4) Benchmarks and Outcome Measures.

In addition to the outcome measure pursuant to Section 400.60501, F.S., each hospice shall adopt outcome measures related to safe and comfortable dying, self determined life closure, and effective grieving to evaluate the efficacy of end of life care. At a minimum these measures shall include:

(a) The percentage of patients, with pain levels verbalized as “uncomfortable” on admission, who report a “comfortable” level was reached within 72 hours following admission.

1. The measure shall be collected only from individuals able to self-report their level of pain within the 24 hours following the 72-hour period following admission.

2. The acceptable standard for this measure shall be 82 percent.

(b) The percentage of family members, who cared for patients at home and responded to a two-month post-mortem survey, who report that the hospice increased their confidence to safely care for their loved one as death approached. The acceptable standard for this measure shall be 95 percent.

(c) Percentage of patients discharged, who had expressed a preference to avoid hospitalization, for whom no hospital admission occurred. The acceptable standard for this measure shall be 94.5 percent.

(d) Percentage of patients discharged, who had expressed a preference not to have cardiopulmonary resuscitation (CPR), for whom CPR did not occur. The acceptable standard for this measure shall be 99 percent.

(e) The percentage of caregivers responding to a two-month post-mortem survey who report that hospice staff helped them prepare for the death of their loved one. The acceptable standard for this measure shall be 93 percent.

(f) The percentage of family members responding to a thirteen-month post-mortem survey who report that hospice staff helped them cope with life changes since the death of their loved one. The acceptable standard for this measure shall be 95 percent.

(5) Protocols for Measuring Quality of Care.

(a) The protocols for measuring these outcome measures referenced in subsection (4) of this rule are included in DOEA Form H-002, Patient Core Measure Sheet, 2007, and DOEA Form H-003, Grieving Core Measure Sheet –Hospice Outcome Survey 1 and Hospice Outcome Survey 2, 2007, incorporated by reference in Rule 58A-2.012, F.A.C.

(b) The instructions were formulated from information obtained for the Beta Pilot in “Report on the Alpha and Beta Pilots of End Result Outcome Measures Constructed by the Outcomes Forum, A Joint Effort of The National Hospice and Palliative Care Organization and The National Hospice Work Group.” The entire contents of the report is located on the following Web site: http://www.nhpco.org/i4a/pages/index. cfm?pageid=3377&openpage=3377

Specific Authority 400.605, 400.60501 FS. Law Implemented 400.605(1)(c), 400.60501 FS. History–New 5-6-82, Formerly 10A-12.05, 10A-12.005, Amended 4-27-94, Formerly 59A-2.005, Amended 6-5-97, 8-6-02, 8-10-03,________.

 

(Substantial rewording of Rule 58A-2.012 follows. See Florida Administrative Code for the present text.)

58A-2.012 Program Reporting Requirements.

(1) The following definitions pertain specifically to program reporting:

(a) Agency Type: Hospice type based on Medicare filing status. Valid options are: Free standing, hospital based, home health based (private residence), nursing home based.

(b) Birth Date: The date of birth of the patient of record.

(c) Full Time Equivalent (FTE): 2,080 hours per year of staff time (40 hours per week times 52 weeks). To calculate FTE, divide paid staff hours or volunteered hours by 2,080.

(d) Gender: The gender of the patient of record, either male or female.

(e) Hospice operated inpatient facilities: An inpatient facility consisting of one or more beds that are owned or leased by the hospice, is staffed by hospice personnel, and has major policies and procedures set by the hospice.

This includes beds in hospitals or nursing homes that comply with the conditions set forth in this paragraph.

(f) Location of hospice services: The physical location where hospice services are provided. Options are:

1. Private Residence: The residence of the patient of record or another person providing care.

2. Nursing home, hospital, assisted living facility, adult family care home, hospice residential unit or inpatient unit facility as licensed by the state of Florida.

3. Other: A location of hospice services not fitting definitions provided in this section.

(g) Ownership Type: The type of ownership of the hospice. It can be “Proprietary” (for profit) or “Not  for profit” (501c3 or similar U.S. tax code status).

(h) Patient Days: The number of days elapsed during which hospice services were provided for the period of time comprising from start of services until final discharge.

(i) Patient Record: The set of data items relating to a particular patient.

(j) Payer Mix: The distribution of the payments to the hospice by payer.

1. Payers can be:

a. Medicare;

b. Medicaid;

c. Private insurance;

d. Self;

e. Charity;

f. Uncompensated;

g. Non-billable; and

h. Other.

2. When there is no party who will reimburse the hospice for all or part of the service charge, the part of the uncollectible service charge shall be assigned to “Uncompensated”.

3. The portion of the bill paid by a charitable organization shall be assigned to “Charity”.

4. A “non-billable” charge is one for which the hospice had an expense but was prevented from billing for the service. This is a situation where typically an insurer or Medicaid will require the hospice to accept a set amount as full payment even when such set amount is less than the usual and customary charge. In such case, the difference between the reimbursed amount and the usual and customary charge shall be assigned to “Non-billable.”

(k) Primary Diagnosis: The diagnosis chiefly responsible for the services performed by the hospice. This diagnosis must include a valid ICD-9-CM code.

(l) Primary Payer: Describes the primary source of expected reimbursement for services rendered.

(m) Race/ethnicity – A taxonomy based on the patient’s phenotype or self-declared ethnic identity.

(n) Social Security Number (SSN): The social security number of the particular patient referred to in the record. The SSN is a nine-digit character string.

1. Reporting 000000000 is acceptable for infants up to the age of 2.

2. For those patients for whom a SSN has not been assigned by the U.S. Social Security Administration, or where the SSN is unknown, the hospice will assign 777777777.

(o) Patient Zip Code: The five digit United States Postal Service ZIP Code of the patient’s permanent residence.

1. Use 00009 for foreign residences.

2. Use 00007 for homeless patients.

3. Use 00000 where efforts to obtain the information have been unsuccessful.

(p) Service Zip Code: The five digit United States Postal Service ZIP Code of the location of hospice services as defined in paragraph (f) of this subsection.

(2) The forms listed in subsections (3) through (6) of this rule are hereby incorporated by reference and may be obtained from the following address: Department of Elder Affairs, Planning and Evaluation Unit, 4040 Esplanade Way, Tallahassee, FL 32399-7000. The forms may also be obtained from the department’s Web site at: http://elderafairs.state.fl.us.

(3) The hospice shall complete for each patient DOEA Form H-002, Patient Core Measure Sheet, 2007.

(a) The form shall be initiated upon admission and completed after the first seventy-two (72) hours of admission.

(b) The form shall be kept in the patient record and available for inspection.

(c) Responses recorded on the form shall be the basis for determining the outcome measures cited in paragraphs (4)(a), (c) and (d) of Rule 58A-2.005, F.A.C., the results of which are reported on DOEA Form H-004, State of Florida Annual Hospice Report, 2007, referenced in subsection (5) of this rule.

(4) Each hospice shall submit to the primary caregiver of each patient DOEA Form H-003, Grieving Core Measure Sheet – Hospice Outcome Survey 1 and Hospice Outcome Survey 2, 2007, as prescribed in the form instructions. Responses to these surveys shall be the basis for measuring outcome measures cited in paragraphs (4)(d), (e) and (f) of Rule 58A-2.003, F.A.C., the results of which are reported on DOEA Form H-004, State of Florida Annual Hospice Report, 2007, referenced in subsection (5) of this rule.

(5) Each hospice shall complete an annual report for the period January 1 through December 31 of each year and shall submit the report to the department no later than February 28 of the following year.

(a) The report shall be submitted to the following address: Department of Elder Affairs, Planning and Evaluation Unit, 4040 Esplanade Way, Tallahassee, FL 32399-7000. The report may alternately be submitted electronically to the following address: [e-mail].

(b) Effective with the report due in 2008, the information shall be recorded on DOEA Form H-005, State of Florida Hospice Annual Report, 2007. The form shall be completed in its entirety.

(c) A copy of the report shall be available to the public during all hours of operation of the hospice principal office and the department.

(6) No later than February 28, 2008, each hospice shall submit a patient level electronic report using the comma delimited American Standard Code for Information Interchange (ASCII) format containing one record per patient. The reporting period shall be January 1, 2007 through December 31, 2007. Thereafter, the support shall be submitted each year as specified in subsection (5) of this rule.

(a) The information shall be recorded as described using DOEA Form H-005, Hospice Annual Patient Level Electronic Report File Structure, 2007.

(b) The form shall be submitted electronically to the following Website address: [e-mail].

Specific Authority 400.605, 400.60501 FS. Law Implemented Ch. 400, Part IV VI, 400.60501 FS. History–New 5-6-82, Formerly 10A-12.12, 10A-12.012, Amended 4-27-94, Formerly 59A-2.012, Amended 6-5-97,__________.

 

58A-2.0236 Residential Units.

(1) through (6) No change.

(7) Residential units shall comply with the requirements of Section 400.6051, F.S. and Section 553.73(2), F.S., which incorporates the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437. following codes and standards:

(a) All new facilities and additions and renovations to existing facilities shall be in compliance with:

1. The Florida Building Code, as described in Chapter 3 of Section 311.2 (R4) as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206;

2. The National Fire Protection Association Life Safety Code 101, Chapter 32, Residential Board and Care Occupancy and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101; and

3. Chapter 11, Section 11-6.1(1) of the Florida Building Code, as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206.

(b) All existing facilities shall comply with National Fire Protection Association Life Safety Code 101, Chapter 33, Residential Board and Care Occupancy and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts, 02269-9101.

Specific Authority 400.605, 400.6051 FS., Chapter 2005-191, Laws of Florida. Law Implemented 400.605(1)(i), 553.73(2) FS., Chapter 2005-191, Laws of Florida. History–New 4-27-94, Formerly 59A-2.0236, Amended 6-5-97, 8-10-03,_______.

 

58A-2.025 Physical Plant Requirements (Inpatient Facility and Unit).

(1) As used in this rule, “inpatient facility and unit” means the location where inpatient services are provided to hospice patients that are in need of hospice inpatient care.

(2) All new inpatient units and facilities, and additions or renovations to existing units and facilities shall be in compliance with the requirements of Section 400.6051, F.S. and Section 553.73(2), F.S., which incorporates the Florida Building Code, 2004 Edition, 2006 Supplements, Section 437 Codes and Standards.

(a) All new inpatient units and facilities, and additions or renovations to existing units and facilities shall be in compliance with the requirements for:

1. Institutional Occupancy – Group I, Unrestrained, of the Florida Building Code as described in Chapter 3 of Section 309.1 as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03; and

2. The National Fire Protection Association Life Safety Code 101, Chapter 18, New Health Care Occupancy, as described in Rule 4A-3.012, F.A.C., Standards of the National Fire Protection Association and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts, 02269-9101, after 8-10-03. All new inpatient facilities and units will be made accessible and shall comply with the requirements of the Florida Building Code, Chapter 11, as adopted by the Florida Building Commission and Section 11-6.1(1) of the Florida Building Code and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and which is incorporated by reference and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03.

a. In renovations and additions to existing facilities, only that portion of the total facility affected by the project must comply with applicable sections of the codes for new facilities and units, after 8-10-03.

b. Existing portions of the facility that are not included in the renovation or addition but are essential to the functioning of the complete facility, as well as existing areas which receive less than substantial amounts of new work, shall comply with the applicable sections of the codes for existing inpatients facilities and units, after 8-10-03.

(b) All existing inpatient facilities and units licensed by the Agency for Health Care Administration before the date this rule is promulgated, shall be in compliance with National Fire Protection Association Life Safety Code 101, Chapter 19, Existing Health Care Occupancy, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by the Department of Community Affairs and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03.

(3) Construction Requirements. The following shall be provided in each inpatient facility and unit:

(a) The hospice shall be responsible for assuring that the planning and decoration of the facilities, both contractual arrangements and free-standing, shall be coordinated to provide a homelike atmosphere. For purposes of this rule, a “homelike atmosphere” means at a minimum, items typically found at home or in a residence that enhance quality of life. The following items are examples of a “homelike atmosphere”: window treatments, lamps, guest seating, and wall decorations. A hospital or nursing home room shall not be required to be in compliance with this section of the rule by the fact of its licensure.

(b) Each patient sleeping room shall have a minimum room area exclusive of toilet room, or permanently attached or built in closets, lockers or wardrobes, of one hundred (100) square feet (9.29 square meters) per bed for private rooms and eighty (80) square feet (7.70 square meters) per bed for double occupancy rooms.

(c) Each patient sleeping room shall have a window or door with a clear glass light in compliance with Chapter 12 of Section 1203, Light and Ventilation, of the Florida Building Code and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Department of Community Affairs, Building Codes and Standards, 2555 Shumard Oak Boulevard, Tallahassee, Florida 32399-2100, [phone] after 8-10-03. The window or door shall open directly to an atrium or to the outside of the building with a minimum of twenty (20) feet (6.10 meters) in clear and unobstructed vista measured perpendicularly from the window or door.

(d) Each patient sleeping room shall have a wardrobe, locker or closet suitable for hanging clothing of the patient.

(e) Other than a patient sleeping room located in a hospital or nursing home, each patient sleeping room shall have access to a toilet room without having to enter the general corridor area. One toilet room shall serve no more than four beds and no more than two resident rooms. The door shall be side hinged, swing out from the toilet room, and unless otherwise required by this code, be at least 32 inches (81.28 centimeters) wide. The toilet room shall contain a water closet with grab bars on both sides and an emergency nurse call station. The water closet shall be equipped with a bedpan-rinsing device.

(f) A hand washing facility shall be provided within each patient toilet room or within each patient bedroom.

(g) A nurses’ station, clean workroom and soiled workroom shall be provided. Access to these rooms shall be from a corridor.

(h) A charting space for clinical staff shall be provided at each nurses’ station.

(i) A hand washing facility shall be located in or near each nurses’ station.

(j) The clean workroom shall be provided with a work counter, hand wash facility, storage facilities and covered waste receptacle.

(k) The soiled workroom shall be provided with a service sink equipped with rinsing device, work counter, a hand washing facility, storage facilities, covered waste receptacle, and covered linen receptacle.

(l) A drug distribution system shall be provided with provisions for the locked storage of medications. Nothing in this section shall prohibit the use of the clean workroom for drug distribution.

(m) A clean linen storage room or closet shall be provided.

(n) A nourishment station with equipment for preparing or serving nourishments between scheduled meals shall be provided and shall be available for patient, family, volunteers, guests and staff use. Provisions shall be made for the use and storage of small appliances requiring less than 220 volts of service such as coffee makers or toasters.

(o) A nurse calling system accessible by the patient shall be provided.

(p) Storage for administrative supplies shall be provided.

(q) Parking for stretchers and wheelchairs in an area out of the path of normal traffic and of adequate size for the unit shall be provided.

(r) A janitor’s closet with a floor receptor and storage space for housekeeping equipment and supplies shall be provided.

(s) A multi-purpose lounge suitable and furnished for reception, recreation, dining, visitation, group social activities, and worship shall be provided.

(t) A conference or consultation room for patient and family use shall be provided.

(u) A washer and dryer for patients’ personal use shall be provided.

(4) Room furnishings for each patient shall include an adjustable frame hospital type bed with side rails, a bedside stand, an over-the-bed table, an individual reading light easily accessible to the patient, and a comfortable sitting chair.

(5) Room decor shall be non-institutional in design and function. Patients shall be permitted to bring personal items of furniture or furnishings into their rooms unless medically contraindicated.

(6) Details.

(a) Fixtures such as drinking fountains, public telephone, vending machines, and portable equipment shall not be located or stored so as to restrict corridor traffic or reduce the minimum required corridor width.

(b) Doors to patient tub rooms, showers, and water closets that swing into the room shall be equipped with reversible hardware that will allow the door to swing out in an emergency.

(c) Doors, except those to closets or spaces not subject to occupancy, shall not swing into the exit access corridors.

(d) Windows and outer doors, if used for ventilation, shall be equipped with insect screens.

(e) Thresholds and expansion joint covers shall be made flush with the floor surface.

(f) Grab bars shall be provided at all patient toilets, showers, and tubs. The bars shall have a clearance of 1-1/2 inches (38.1 millimeters) to the walls and shall be sufficiently anchored to sustain a concentrated applied load of not less than 250 pounds (113.4 kilograms).

(g) Single paper towel dispensers, soap dispensers and covered waste receptacles shall be provided at all hand washing facilities.

(h) Staff hand washing facilities shall be fitted with wrist blades and a gooseneck type spout.

(i) All hand washing facilities shall be securely anchored to withstand an applied vertical load of not less than two hundred and fifty pounds on the front of the fixture.

(7) Elevators. In new multistory units and facilities an elevator shall be provided in compliance with the requirements of Chapter 30 of the Florida Building Code, as adopted by the Florida Building Commission and incorporated by reference in subsection 9B-3.047(1), F.A.C., dated December 16, 2001, by the Department of Community Affairs and obtainable from the Southern Building Code Congress International, Inc., 900 Montclair Road, Birmingham, Alabama 35213-1206, after 8-10-03. In addition, a hospital-type elevator large enough to accommodate a bed and attending staff shall service all patient sleeping rooms and patient treatment areas located above the ground floor. The car shall be at least 5 feet 8 inches (1.73 meters) wide by 9 feet (2.74 meters) deep and the car doors shall have a clear opening of not less than 4 feet (1.22 meters) wide and 7 feet (2.13 meters) high.

(8) Mechanical System Requirements.

(a) Air conditioning, heating and ventilating systems.

1. All patient occupied areas shall be heated or cooled by individual or central units. Heating units shall be designed to provide a minimum of 72 degrees Fahrenheit (22.22 Celsius) ambient indoor temperature and air conditioning units shall be designed to provide a minimum of 78 degrees Fahrenheit (25.55 Celsius) ambient indoor temperature.

2. All air-supply and air-exhaust systems shall be mechanically operated. Fans serving exhaust systems shall be located at the discharge end of the system.

(b) Plumbing and other piping systems. Water distribution systems shall be arranged to provide hot water at each hot water outlet at all times. Hot water at shower, bathing, and hand washing facilities for patients’ personal use shall not exceed 110 degrees Fahrenheit (43.3 degrees Celsius).

(9) Electrical System Requirements.

(a) Lighting.

1. All spaces occupied by people, machinery, and equipment within the building, approaches to building, and parking areas shall have electric lighting.

2. All patients’ rooms shall have general lighting and night lighting. General room luminaries shall be switched at the entrance to the patient room.

(b) Receptacles. All patient rooms shall have hospital grade duplex grounding type receptacles.

(10) Emergency Electrical System.

(a) A Type 1 essential electrical system shall be provided in all hospice facilities as described in National Fire Protection Association Life Safety Code 99, “Health Care Facilities”, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, by Division of State Fire Marshal at the Department of Finance and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03. The emergency power for this system shall meet the requirements of a Level 1, type 10, Class 48 generator as described in National Fire Protection Association Life Safety Code 110, “Emergency Standby Power Systems”, and incorporated by reference in Rule 4A-3.012, F.A.C., dated November 6, 2001, and obtainable from the National Fire Protection Association, 1 Batterymarch Park, P. O. Box 9101, Quincy, Massachusetts 02269-9101, after 8-10-03.

(b) In new construction, the normal main service equipment shall be separated from the emergency distribution equipment by locating it in a separate room. Transfer switches shall be considered emergency distribution equipment for this purpose.

(c) Switches for critical branch lighting shall be completely separate from normal switching. The devices or cover plates shall be of a distinctive color. Critical branch switches are permitted to be adjacent to normal switches. Switches for life safety lighting are not permitted except as required for dusk-to-dawn automatic control of exterior lighting fixtures.

(d) There shall be selected life safety lighting provided at a minimum of 1 footcandle and designed for automatic dusk-to-dawn operation along the travel paths from the exits to the public way or to safe areas located a minimum of 30 feet (9.14 meters) from the building.

(e) A minimum of one elevator per bank serving any patient use floor shall be connected to the equipment branch of the essential electric system and arranged for manual or automatic operation during loss of normal power. Elevator cab lighting, controls, and communication and signal systems shall be connected to the life safety branch.

(f) There shall be a dedicated low fuel alarm for the day tank supplying the emergency generator driver. A manual pump shall also be provided for the day tank. The alarm shall be located at the generator derangement panel.

(g) Transfer switch contacts shall be of the open type and shall be accessible for inspection and replacement.

(h) If required by the facility’s emergency food plan, there shall be power connected to the equipment branch of the essential electrical system for kitchen refrigerators, freezers and range hood exhaust fans. Selected lighting within the kitchen and dry storage areas shall be connected to the critical branch of the essential electrical system.

Specific Authority 400.605, 400.6051 FS., Chapter 2005-191, Laws of Florida. Law Implemented 400.605(1)(i), 553.73(2) FS., Chapter 2005-191, Laws of Florida. History–New 8-10-03, Amended_______.

 

58A-2.026 Comprehensive Emergency Management Plan.

(1) Pursuant to Section 400.610(1)(b), F.S., each hospice shall prepare and maintain a comprehensive emergency management plan, hereinafter referred to as “the plan,” in accordance with the “Comprehensive Emergency Management Planning Format Criteria for Hospices,” AHCA DOEA Form H-001001H, 2007 October 2001, which is incorporated by reference. This document is available from through the Agency for Health Care Administration, Licensed Home Health Programs Unit, 2727 Mahan Drive, Tallahassee, Florida, 32308, or the agency Web site at http://ahca.myflorida.com under “Licensing and Certification”, “Hospices”, and shall be included as part of the hospice’s comprehensive emergency management plan.

(2) The plan shall be submitted electronically for review to the local cCounty hHealth dDepartment in each county that the hospice is licensed to serve or by the Department of Health  pursuant to Section 400.610(1)(b), F.S., in those counties where the Department of Health receives funding for such reviews, pursuant to Section 381.0303(7), F.S.

(a) Upon approval of the plan by the local County Health Department or the Department of Health, in counties where the Department has authority to approve the plan, the hospice shall provide a copy of the plan to the local emergency management agency in each county served by the hospice.

(3) The hospice shall report cChanges in the after-hours emergency telephone number and address of those staff who are coordinating the hospice’s emergency response shall be reported by the hospice to the hospice’s local emergency management agency and county health department. The telephone numbers must include all numbers where the coordinating staff can be contacted outside the hospice’s regular office hours. All hospices must report these changes, whether the plan has been previously reviewed or not, as defined in subsection (2) above.

(4) Upon a change of ownership, the new owner shall submit a new plan identifying any substantive changes, including facility renovations, and changes noted in subsection (3) above. Those hospices, which previously have had the plan reviewed by the local cCounty hHealth dDepartment or by the Department of Health, as defined in subsection (2) above, shall report any substantive changes to the reviewing entity.

(5) The plan shall describe:

(a) Procedures to ensure adequate preparation of hospice patients for potential or imminent emergencies and disasters.

(b) Procedures for annual review of the plan and for the governing body to incorporate making substantive changes to the plan by the governing body.

(6) In the event of an emergency or disaster, the hospice shall implement the hospice’s plan in accordance with Section 400.610, F.S.

(7) On admission, each hospice patient and, where applicable, home hospice caregiver shall be informed of the hospice plan and of the special-needs registry maintained by the local emergency management agency, pursuant to Section 252.355, F.S. The hospice shall document in the patient’s file if:

(a) If Tthe patient plans to evacuate the patient’s home or the hospice facility;

(b) If during the emergency Tthe caregiver can take responsibility for services normally provided by the hospice during the emergency or disaster to the home patient; or

(c) If  Tthe hospice needs to arrange for alternative caregiver services for the patient.

(8) Upon imminent threat of an emergency or disaster, the hospice shall confirm each patient’s plan during and immediately following an emergency or disaster.

(9) When the hospice is unable to provide services during an emergency or disaster, the hospice shall make all reasonable efforts to inform, where applicable, those facility and home patients whose services will be interrupted during the emergency or disaster, including patients sheltering in place;, and shall inform when services are anticipated to be restored.

(10) Each hospice shall contact each the local emergency management agency in counties each county served by that hospice to determine procedures for registration of special-needs registrants as referenced in Section 252.355, F.S.

(11) Upon admission of a patient, eEach hospice shall collect upon admission registration information for special-needs registrants who will require continuing care or services during a disaster or emergency, consistent with Section 252.355, F.S. This registration information shall be submitted, when collected, to the local emergency management agency, or on a periodic basis as determined by the local emergency management agency.

(12) The hospice shall educate patients registered with the special-needs registry that services provided by the hospice in special-needs shelters shall meet the requirements of Section 400.610(1)(b), F.S. re an option of last resort and that services may not be equal to those received in the hospice programs.

(13) The hospice shall maintain a current list of patients clients who are special-needs registrants, and shall forward this list to the local emergency management agency upon imminent threat of disaster or emergency and in accordance with the local emergency management agency procedures.

(14) Each hospice patient record for patients who are listed in the special-needs registry established pursuant to Section 252.355, F.S., shall include a description of how care or services will be continued in the event of an emergency or disaster pursuant to Section 400.610(1)(b), F.S. The hospice shall discuss the emergency provisions with the patient and the patient’s caregiver, including where and how the patient is to evacuate, procedures for notifying the hospice in the event that the patient evacuates to a location other than the shelter identified in the patient record, and advance directives., and the hospice shall make arrangements to make the list of medications, supplies, and equipment available to each patient in the event of an evacuation.

(15) The hospice shall maintain for each patient who is a special-needs patient registrant a list of client-specific medications, supplies, and equipment required for continuing care and service, should the patient be evacuated. If the hospice provides services to home patients, the hospice shall make arrangements to make the list of medications, supplies, and equipment available to each special-needs registrant in the event of an evacuation. The hospice shall notify the patient registrant that he/she the registrant is responsible for maintaining a supply of medications in the home. The list of medication shall include the names of all medications, dose, frequency, times, and any other special considerations for administration, any allergies, names of physicians and telephone numbers, and name and telephone number of the patient’s pharmacy. If the patient gives consent, the list may also include the patient’s diagnosis.

Specific Authority 400.605, 400.610(1)(b) FS. Law Implemented 400.605, 400.610 FS. History–New 8-6-02, Amended________.