(b) A licensee that elects to provide palliative care pursuant to this section shall provide the department with the date the licensee intends to begin providing the palliative care no less than 45 days before that date and all of the following:

1. (1) The completed relevant portions of a form HS 200, or a successor form, as determined by the department.
2. (2) A complete federal form CMS 417, or a successor form, as determined by the department.

(c)

1. (1) The department shall not require the documents submitted pursuant to subdivision (b) to be approved prior to the licensee providing palliative care pursuant to this section.
2. (2) The department shall not charge an application fee to provide any care or services pursuant to this section.

(d)

1. (1) On or before April 30, 2022, and each April thereafter until April 30, 2025, a licensee shall provide the department with information for the period of time in the prior calendar year during which the licensee provided palliative care pursuant to this section through the department’s online reporting portal, including, but not limited to, all of the following:

   1. (A) The number of nonhospice patients who received palliative care pursuant to this section.
   2. (B) The number of patients enrolled in hospice.
   3. (C) The primary diagnoses of the patients for which the licensee provided palliative care pursuant to this section.
   4. (D) The numbers and types of providers hired during the previous 12 months.
   5. (E) The numbers and types of providers who left employment during the previous 12 months.

   6. (F) Complaints received by the licensee during the previous 12 months that related to all the following:

      1. (i) Events that caused or were likely to cause serious injury, harm, impairment, or death.
      2. (ii) Events or incidents that negatively impacted a patient’s mental, physical, or psychosocial status and were of such consequence to the patient’s well-being that a rapid response was required.
      3. (iii) Delays in patient care for hospice and nonhospice patients who received palliative care pursuant to this section.
      4. (iv) Qualifications of staff.
2. (2) A licensee that has been approved by the department to provide palliative care pursuant to this section that has either provided the department with the date the licensee intends to begin providing palliative care pursuant to this section, or has notified the department of its cessation of palliative care provision pursuant to subdivision (g), shall report to the department pursuant to paragraph (1) regardless of whether the licensee provided palliative care pursuant to this section during the prior calendar year.