HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 987 In-person Visitation
SPONSOR(S): Health & Human Services Committee
TIED BILLS: IDEN./SIM. BILLS:
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Finance & Facilities Subcommittee 17 Y, 0 N, As CS Guzzo Lloyd
2) Children, Families & Seniors Subcommittee 14 Y, 0 N Guzzo Brazzell
3) Health & Human Services Committee 15 Y, 2 N, As CS Guzzo Calamas
SUMMARY ANALYSIS
Due to the COVID-19 pandemic, from March 2020, to March 2021, residents of 11 different facility types in
Florida were not allowed to receive visitors. The effects of social isolation and loneliness are known to be very
harmful to older adults. According to the Centers for Disease Control and Prevention, social isolation
significantly increases the risk of premature death from all causes.
To protect Florida’s most vulnerable residents from the effects of social isolation, the bill allows a resident of an
intermediate care facility for the developmentally disabled (ICFDD), nursing home, assisted living facility (ALF),
hospital, or hospice to designate an essential caregiver who must be allowed in-person visitation for at least
two hours per day regardless of the facility’s visiting hours or any other restriction on visitation. An essential
caregiver can be a family member, friend, guardian, or other individual.
The bill creates uniform visitation rights for visitors of ICFDDs, nursing homes, ALFs, hospitals and hospices. The
bill requires facilities to establish visitation policies and procedures, which must address : infection control and
education; screening, personal protective equipment, and other infection control protocols for visitors; permissible
length of visits and number of visitors, which must meet or exceed the current standards for nursing homes and
ALFs; and designation of a person responsible for ensuring that staff adhere to the policies and procedures.
The visitation policies and procedures must allow in-person visitation, unless the patient objects, when a
resident, client, or patient:
Is in an end-of-life situation;
Was living with his or her family before recently being admitted to the provider’s facility is struggling with
the change in environment and lack of physical family support;
Is making one or more major medical decisions;
Is experiencing emotional distress, or grieving the loss of a friend or family member who rec ently died;
Needs cueing or encouragement to eat or drink that was previously provided by a family member or
caregiver, and the client is experiencing weight loss or dehydration;
Used to talk and interact with others is experiencing emotional distress or is seldom speaking; and
Is receiving pediatric care.
The policies and procedures for hospitals must allow in-person visitation for childbirth, including labor and delivery.
The bill authorizes a provider to suspend in-person visitation for a specific visitor if the visitor violates the
provider’s policies and procedures. It also requires providers to submit their visitation policies and procedures
to AHCA and to make them available for review upon a request by AHCA at any time.
The bill requires providers to make their visitation policies and procedures available on its website within 24
hours of establishing such policies and procedures. It also requires AHCA to explain visitation requirements on
a stand-alone page on its website, which must include a link to AHCA’s online complaint portal for individuals
to submit complaints.
The bill has no fiscal impact on state or local government.
The bill is effective upon becoming a law.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0987f.HHS
DATE: 2/28/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
The COVID-19 Pandemic
The novel human coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China, in
December of 2019, when dozens of cases of pneumonia of unknown etiology were first reported. By
early January, 2020, Chinese authorities identified a novel coronavirus as the cause of the outbreak.
Shortly thereafter, the first cases of COVID-19—officially named by the World Health Organization
(WHO) on February 11, 2020—were detected in Japan and Thailand. On January 20, 2020, the U.S.
Centers for Disease Control and Prevention confirmed the first case of COVID-19 in the United States
appearing in Washington State. On January 31, 2020, the U.S. Secretary of Health and Human
services declared COVID19 a public health emergency and on March 11, 2020, the WHO declared
COVID-19 a pandemic.1
On March 1, 2020, Florida’s Surgeon General declared a public health emergency. 2 On March 9, 2020,
the Governor issued an executive order to declare a state of emergency and delegate certain powers to
the Director of the Division of Emergency Management (DEM), including the ability to restrict visitation
in certain health care and long-term care facilities.3
Visitation Restrictions During COVID-19
On March 15, 2020, DEM issued an emergency order to require certain facilities to prohibit the entry of
any individual except in specified circumstances. 4 The emergency order applied to the following facility
types:
Nursing homes;
Assisted living facilities;
Intermediate care facilities for the developmentally disabled;
Transitional living facilities;
Adult mental health and treatment facilities;
Adult forensic facilities;
Civil facilities;
Adult family care homes;
Group homes;
Homes for special services; and
Long-term care hospitals.5
The emergency order authorized the following individuals to enter a facility:
1 Centers for Disease Control and Prevention, COVID-19 Timeline, David J. Spencer CDC Museum: In Association With the
Smithsonian Institution, available at https://www.cdc.gov/museum/timeline/covid19.html (last accessed January 24, 2022).
2 Florida Department of Health Declaration of Public Health Emergency, March 1, 2020, available at
https://floridahealthcovid19.gov/wp-content/uploads/2020/03/declaration-of-public-health-emergency-covid-19-3.1.20.pdf (last accessed
January 24, 2022).
3 State of Florida, Office of the Governor, Executive Order Number 20 -52, Emergency Management – COVID-19 Public Health
Emergency (March 9, 2020), available at https://www.flgov.com/wp-content/uploads/orders/2020/EO_20-52.pdf (last accessed January
24, 2022).
4 State of Florida, Division of Emergency Management, Emergency Order Number 20-006 (March 15, 2020) available at
https://www.floridadisaster.org/globalassets/executive-orders/covid-19/dem-order-no.-20-006-in-re-covid-19-public-health-emergency-
issued-march-15-2020.pdf (last accessed January 24, 2022).
5 Id.
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Facility residents;
Facility staff;
Family members and friends during end of life situations;
Hospice or palliative care workers caring for residents in end-of-life situations;
Any individual providing necessary health care to a resident;
Attorneys of record for residents in adult mental health facilities for court related matters if
virtual or telephone means are unavailable; and
Representatives of the state and federal government seeking entry as part of their official
duties, including, but not limited to, the Long-Term Care Ombudsman program,
representatives of the Department of Children and Families, the Department of Health, the
Department of Elderly Affairs, the Agency for Health Care Administration, the Agency for
Persons with Disabilities (APD), protection and advocacy organizations for individuals with
developmental disabilities, the Office of the Attorney General, any law enforcement officer, and
any emergency medical personnel.6
Further, the emergency order prohibited any of the above individuals from entering a facility if they
failed to meet certain screening criteria, including:
Being infected with COVID-19 without having two consecutive negative test results separated
by 24 hours;
Showing signs or symptoms of, or disclosing the presence of a respiratory infection, including
cough, fever, shortness of breath or sore throat;
Being in contact with any person known to be infected with COVID-19, who has not tested
negative within the past 14 days.7
The emergency order was extended on May 18, 2020. 8 On September 1, 2020, DEM extended the
order again and modified it to allow visitation by essential caregivers 9 and compassionate care
visitors 10 under certain circumstances.11 On October 22, 2020, DEM extended the order for a second
time and modified it to allow general visitors under certain circumstances. 12 Finally, on March 22,
2021, DEM rescinded the previous executive orders that prohibited visitation and instead required all
affected facilities to maintain visitation and infection control policies in accordance with all state and
federal laws.13
Post-COVID-19 Visitation Reform in Other States
The visitation restrictions imposed on different types of long-term care facilities across the nation,
while necessary for the overall wellbeing of those residents, still had negative effects on the residents
and their families. A recent study concluded that when implementing visiting restrictions in health care
6 Id.
7 Id.
8 State of Florida, Division of Emergency Management, Em ergency Order Number 20-007 (May 18, 2020), available at
https://www.floridadisaster.org/globalassets/executive-orders/covid-19/dem-order-no.-20-007-in-re-covif-19-public-health-emergency-
issued-may-18-2020.pdf (last accessed January 24, 2022).
9 Essential caregivers are those who have been given consent by the resident or his or her repre sentative to provide services and/or
assistance with activities of daily living to help maintain or improve the quality of care or quality of life for a facility resident. Essential
caregivers include persons who provided services before the pandemic and those who request to provide services.
10 Compassionate care visitors provide emotional support to help a resident deal with a difficult transition or loss, upsetting event, or
end-of-life. Compassionate care visitors may be allowed entry into facilities on a limited basis for these specific purposes.
11 State of Florida, Division of Emergency Management, Emergency Order Number 20 -009 (September 1, 2020), available at
https://www.floridadisaster.org/globalassets/covid19/dem-order-20-009-signed.pdf (last accessed January 24, 2022).
12 State of Florida, Division of Emergency Management, Emergency Order Number 20 -011 (October 22, 2020), available at
https://www.floridadisaster.org/globalassets/executive-orders/covid-19/dem-order-no.-20-011-in-re-covid-19-public-health-emergency-
issued-october-22-2020.pdf (last accessed January 24, 2022).
13 State of Florida, Division of Emergency Management, Emergency Order Number 21 -001 (March 22, 2021), available at
https://ahca.myflorida.com/docs/DEM_Emergency_Order_21-001.pdf (last accessed January 24, 2022).
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services, decision makers and nurses need to be aware of their potential negative effects and adapt
the provision of care to compensate for such effects. 14
Several states have recently passed legislation to find a common ground between protecting
residents of long-term care facilities and over-protecting them.
Alabama
Requires health care facilities, including nursing homes, to allow at least one caregiver or visitor to
visit each patient or resident during a public health emergency. 15
Connecticut,16 Indiana,17 North Dakota,18 Oklahoma,19 and Texas 20
Allow long-term care facility residents to designate essential support persons who may visit and
support their physical, emotional, psychological, and socialization needs.
New Jersey
Requires each long-term care facility to adopt and institute a written isolation prevention plan and
have appropriate technology, staff, and other capabilities in place to prevent the facility’s resident
from becoming isolated during public emergencies. 21
South Dakota
Allows residents of an ALF to receive visitors of their choosing, at the time of their choosing, provided
the visitation does not impose upon the rights of another resident. 22
Intermediate Care Facilities for the Developmentally Disabled
An intermediate care facility for the developmentally disabled (ICFDD) provides institutional care for
individuals with developmental disabilities. A developmental disability is a disorder or syndrome that
is attributable to intellectual disability, cerebral palsy, autism, spina bifida, Down syndrome, Phelan-
McDermid syndrome, or Prader-Willi syndrome; that manifests before the age of 18; and that
constitutes a substantial handicap that can reasonably be expected to continue indefinitely. 23
ICFDDs are licensed and regulated by the Agency for Health Care Administration (AHCA) under Part
VIII of ch. 400, F.S., and Chapter 59A-26, F.A.C. ICFDDs provide the following services: nursing
services, activity services, dental services, dietary services, pharmacy services, physician services,
rehabilitative care services, room/bed and maintenance services and social services. 24 ICFDD
services are only covered by the Medicaid program. Individuals who have a developmental disability
and who meet Medicaid eligibility requirements may receive services in an ICFDD.
14 Karen Hugelius, Nahoko Harada, Miki Marutani, Consequences of Visiting Restrictions During the COVID-19 Pandemic: An
Integrative Review, International Journal of Nursing Studies, vol. 121 (September 2021), available at
https://www.sciencedirect.com/science/article/pii/S0020748921001474 (last accessed January 24, 2022).
15 2021-470,§ 1, eff. 5/18/2021.
16 Conn. Gen. Stat. § 31-NEW-Connecticut Essential Workers COVID-19 Assistance Program and Fund Established.
17 Indiana Public Law 142 (April 29, 2021).
18 N.D. Cent. Code § 50-10.3 (2021).
19 Oklahoma HB 2566-2021 Legislative Session, enacted April 27, 2021.
20 Texas Senate Joint Resolution 19-2021 Legislative Session, filed with the Secretary of State June 1, 2021.
21 New Jersey P.L. 2020, c. 113.
22 South Dakota, 2021 H.J. 570.
23 See s. 393.063(12), F.S.
24 Agency for Health Care Administration, Intermediate Care Facility for Individuals with Intellectual Disab ilities (ICF/DD) Services,
available at: https://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/behavioral_health_coverage/bhfu/Intermediate_Care.shtml
(last accessed January 22, 2022).
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There are also two public ICF/DDs known as developmental disabilities centers that are operated by
APD — Sunland in Marianna, and Tacachale in Gainesville.
As of December 21, 2021, there are 104 licensed ICFDDs in Florida with a total of 2,806 beds. 25
ICFDD Visitation Requirements
Florida law requires ICFDDs to ensure that all residents of ICFDDs have an unrestricted right to
visitation, subject to reasonable rules of the facility.26
The Centers for Medicare and Medicaid Services (CMS) conditions of participation require ICFDDs to
promote visits by individuals with a relationship to the client and promote visits by parents or
guardians to any area of the facility that provides direct client care services to the client, consistent
with the rights of the client and privacy of other clients.27 On June 3, 2021, CMS issued a memo to
require all ICFDDs to allow indoor visitation at all times. 28
ICFDDs are not currently required to establish a visitation schedule to allow visitation for any period
of time and visitation logs are not required. Currently, ICFDDs are not required to implement safety
protocols relating to resident visitation.
ICFDD Fines and Penalties
APD is authorized to revoke or suspend a license of an ICFDD or impose an administrative fine on a
facility of up to $1,000 per day for failure to comply any of the requirements in ch. 393, F.S. The
aggregate amount of any fine may not be more than $10,000. 29 AHCA is also authorized to impose
an immediate moratorium or emergency suspension on an ICFDD for any condition that poses a
threat to the health, safety, or welfare of a client.30
Nursing Homes
Nursing homes provide 2