Amendment
Bill No. 0484

Amendment No. 141867

CHAMBER ACTION
Senate		House
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1	Representative(s) Grimsley offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause and insert:
5	Section 1.  Subsection (2) of section 400.461, Florida
6	Statutes, is amended to read:
7	400.461  Short title; purpose.--
8	(2)  The purpose of this part is to provide for the
9	licensure of every home health agency and nurse registry and to
10	provide for the development, establishment, and enforcement of
11	basic standards that will ensure the safe and adequate care of
12	persons receiving health services in their own homes.
13	Section 2.  Section 400.462, Florida Statutes, is amended
14	to read:
15	400.462  Definitions.--As used in this part, the term:
16	(1)  "Administrator" means a direct employee, as defined in
17	subsection (9) of the home health agency or a related
18	organization, or of a management company that has a contract to
19	manage the home health agency, to whom the governing body has
20	delegated the responsibility for day-to-day administration of
21	the home health agency. The administrator must be a licensed
22	physician, physician assistant, or registered nurse licensed to
23	practice in this state or an individual having at least 1 year
24	of supervisory or administrative experience in home health care
25	or in a facility licensed under chapter 395 or under part II or
26	part III of this chapter. An administrator may manage a maximum
27	of five licensed home health agencies located within one agency
28	service district or within an immediately contiguous county. If
29	the home health agency is licensed under this chapter and is
30	part of a retirement community that provides multiple levels of
31	care, an employee of the retirement community may administer the
32	home health agency and up to a maximum of four entities licensed
33	under this chapter that are owned, operated, or managed by the
34	same corporate entity. An administrator shall designate, in
35	writing, for each licensed entity, a qualified alternate
36	administrator to serve during absences.
37	(2)  "Admission" means a decision by the home health
38	agency, during or after an evaluation visit to the patient's
39	home, that there is reasonable expectation that the patient's
40	medical, nursing, and social needs for skilled care can be
41	adequately met by the agency in the patient's place of
42	residence. Admission includes completion of an agreement with
43	the patient or the patient's legal representative to provide
44	home health services as required in s. 400.487(1).
45	(3)  "Advanced registered nurse practitioner" means a
46	person licensed in this state to practice professional nursing
47	and certified in advanced or specialized nursing practice, as
48	defined in s. 464.003.
49	(4)(2)  "Agency" means the Agency for Health Care
50	Administration.
51	(5)(3)  "Certified nursing assistant" means any person who
52	has been issued a certificate under part II of chapter 464. The
53	licensed home health agency or licensed nurse registry shall
54	ensure that the certified nursing assistant employed by or under
55	contract with the home health agency or licensed nurse registry
56	is adequately trained to perform the tasks of a home health aide
57	in the home setting.
58	(6)(4)  "Client" means an elderly, handicapped, or
59	convalescent individual who receives personal care services,
60	companion services, or homemaker services in the individual's
61	home or place of residence.
62	(7)(5)  "Companion" or "sitter" means a person who spends
63	time with or cares for an elderly, handicapped, or convalescent
64	individual and accompanies such individual on trips and outings
65	and may prepare and serve meals to such individual. A companion
66	may not provide hands-on personal care to a client.
67	(8)(6)  "Department" means the Department of Children and
68	Family Services.
69	(9)  "Direct employee" means an employee for whom one of
70	the following entities pays withholding taxes: a home health
71	agency; a management company that has a contract to manage the
72	home health agency on a day-to-day basis; or an employee leasing
73	company that has a contract with the home health agency to
74	handle the payroll and payroll taxes for the home health agency.
75	(10)(7)  "Director of nursing" means a registered nurse who
76	is a and direct employee, as defined in subsection (9), of the
77	agency and or related business entity who is a graduate of an
78	approved school of nursing and is licensed in this state; who
79	has at least 1 year of supervisory experience as a registered
80	nurse in a licensed home health agency, a facility licensed
81	under chapter 395, or a facility licensed under part II or part
82	III of this chapter; and who is responsible for overseeing the
83	professional nursing and home health aid delivery of services of
84	the agency. A director of nursing An employee may be the
85	director of nursing of a maximum of five licensed home health
86	agencies operated by a related business entity and located
87	within one agency service district or within an immediately
88	contiguous county. If the home health agency is licensed under
89	this chapter and is part of a retirement community that provides
90	multiple levels of care, an employee of the retirement community
91	may serve as the director of nursing of the home health agency
92	and of up to four entities licensed under this chapter which are
93	owned, operated, or managed by the same corporate entity. A
94	director of nursing shall designate, in writing, for each
95	licensed entity, a qualified alternate registered nurse to serve
96	during the absence of the director of nursing.
97	(11)(8)  "Home health agency" means an organization that
98	provides home health services and staffing services.
99	(12)(9)  "Home health agency personnel" means persons who
100	are employed by or under contract with a home health agency and
101	enter the home or place of residence of patients at any time in
102	the course of their employment or contract.
103	(13)(10)  "Home health services" means health and medical
104	services and medical supplies furnished by an organization to an
105	individual in the individual's home or place of residence. The
106	term includes organizations that provide one or more of the
107	following:
108	(a)  Nursing care.
109	(b)  Physical, occupational, respiratory, or speech
110	therapy.
111	(c)  Home health aide services.
112	(d)  Dietetics and nutrition practice and nutrition
113	counseling.
114	(e)  Medical supplies, restricted to drugs and biologicals
115	prescribed by a physician.
116	(14)(11)  "Home health aide" means a person who is trained
117	or qualified, as provided by rule, and who provides hands-on
118	personal care, performs simple procedures as an extension of
119	therapy or nursing services, assists in ambulation or exercises,
120	or assists in administering medications as permitted in rule and
121	for which the person has received training established by the
122	agency under s. 400.497(1). The licensed home health agency or
123	licensed nurse registry shall ensure that the home health aide
124	employed by or under contract with the home health agency or
125	licensed nurse registry is adequately trained to perform the
126	tasks of a home health aide in the home setting.
127	(15)(12)  "Homemaker" means a person who performs household
128	chores that include housekeeping, meal planning and preparation,
129	shopping assistance, and routine household activities for an
130	elderly, handicapped, or convalescent individual. A homemaker
131	may not provide hands-on personal care to a client.
132	(16)(13)  "Home infusion therapy provider" means an
133	organization that employs, contracts with, or refers a licensed
134	professional who has received advanced training and experience
135	in intravenous infusion therapy and who administers infusion
136	therapy to a patient in the patient's home or place of
137	residence.
138	(17)(14)  "Home infusion therapy" means the administration
139	of intravenous pharmacological or nutritional products to a
140	patient in his or her home.
141	(18)(15)  "Nurse registry" means any person that procures,
142	offers, promises, or attempts to secure health-care-related
143	contracts for registered nurses, licensed practical nurses,
144	certified nursing assistants, home health aides, companions, or
145	homemakers, who are compensated by fees as independent
146	contractors, including, but not limited to, contracts for the
147	provision of services to patients and contracts to provide
148	private duty or staffing services to health care facilities
149	licensed under chapter 395 or this chapter or other business
150	entities.
151	(19)(16)  "Organization" means a corporation, government or
152	governmental subdivision or agency, partnership or association,
153	or any other legal or commercial entity, any of which involve
154	more than one health care professional discipline; or a health
155	care professional and a home health aide or certified nursing
156	assistant; more than one home health aide; more than one
157	certified nursing assistant; or a home health aide and a
158	certified nursing assistant. The term does not include an entity
159	that provides services using only volunteers or only individuals
160	related by blood or marriage to the patient or client.
161	(20)(17)  "Patient" means any person who receives home
162	health services in his or her home or place of residence.
163	(21)(18)  "Personal care" means assistance to a patient in
164	the activities of daily living, such as dressing, bathing,
165	eating, or personal hygiene, and assistance in physical
166	transfer, ambulation, and in administering medications as
167	permitted by rule.
168	(22)(19)  "Physician" means a person licensed under chapter
169	458, chapter 459, chapter 460, or chapter 461.
170	(23)  "Physician assistant" means a person who is a
171	graduate of an approved program or its equivalent, or meets
172	standards approved by the boards, and is licensed to perform
173	medical services delegated by the supervising physician, as
174	defined in s. 458.347 or s. 459.022.
175	(24)(20)  "Skilled care" means nursing services or
176	therapeutic services required by law to be delivered by a health
177	care professional who is licensed under part I of chapter 464;
178	part I, part III, or part V of chapter 468; or chapter 486 and
179	who is employed by or under contract with a licensed home health
180	agency or is referred by a licensed nurse registry.
181	(25)(21)  "Staffing services" means services provided to a
182	health care facility or other business entity on a temporary
183	basis by licensed health care personnel and by, including
184	certified nursing assistants and home heath aides who are
185	employed by, or work under the auspices of, a licensed home
186	health agency or who are registered with a licensed nurse
187	registry. Staffing services may be provided anywhere within the
188	state.
189	Section 3.  Subsections (1) and (4) of section 400.464,
190	Florida Statutes, are amended to read:
191	400.464  Home health agencies to be licensed; expiration of
192	license; exemptions; unlawful acts; penalties.--
193	(1)  Any home health agency must be licensed by the agency
194	to operate in this state. A license issued to a home health
195	agency, unless sooner suspended or revoked, expires 2 years 1
196	year after its date of issuance.
197	(4)(a)  An organization may not provide, offer, or
198	advertise home health services to the public unless the
199	organization has a valid license or is specifically exempted
200	under this part. An organization that offers or advertises to
201	the public any service for which licensure or registration is
202	required under this part must include in the advertisement the
203	license number or registration regulation number issued to the
204	organization by the agency. The agency shall assess a fine of
205	not less than $100 to any licensee or registrant who fails to
206	include the license or registration number when submitting the
207	advertisement for publication, broadcast, or printing. The fine
208	for a second or subsequent offense is $500. The holder of a
209	license issued under this part may not advertise or indicate to
210	the public that it holds a home health agency or nurse registry
211	license other than the one it has been issued.
212	(b)  The operation or maintenance of an unlicensed home
213	health agency or the performance of any home health services in
214	violation of this part is declared a nuisance, inimical to the
215	public health, welfare, and safety. The agency or any state
216	attorney may, in addition to other remedies provided in this
217	part, bring an action for an injunction to restrain such
218	violation, or to enjoin the future operation or maintenance of
219	the home health agency or the provision of home health services
220	in violation of this part, until compliance with this part or
221	the rules adopted under this part has been demonstrated to the
222	satisfaction of the agency.
223	(c)(b)  A person who violates paragraph (a) is subject to
224	an injunctive proceeding under s. 400.515. A violation of
225	paragraph (a) is a deceptive and unfair trade practice and
226	constitutes a violation of the Florida Deceptive and Unfair
227	Trade Practices Act under part II of chapter 501.
228	(d)(c)  A person who violates the provisions of paragraph
229	(a) commits a misdemeanor of the second degree, punishable as
230	provided in s. 775.082 or s. 775.083. Any person who commits a
231	second or subsequent violation commits a misdemeanor of the
232	first degree, punishable as provided in s. 775.082 or s.
233	775.083. Each day of continuing violation constitutes a separate
234	offense.
235	(e)  Any person who owns, operates, or maintains an
236	unlicensed home health agency and who, within 10 working days
237	after receiving notification from the agency, fails to cease
238	operation and apply for a license under this part commits a
239	misdemeanor of the second degree, punishable as provided in s.
240	775.082 or s. 775.083. Each day of continued operation is a
241	separate offense.
242	(f)  Any home health agency that fails to cease operation
243	after agency notification may be fined $500 for each day of
244	noncompliance.
245	Section 4.  Section 400.471, Florida Statutes, is amended
246	to read:
247	400.471  Application for license; fee; provisional license;
248	temporary permit.--
249	(1)  Application for an initial license or for renewal of
250	an existing license must be made under oath to the agency on
251	forms furnished by it and must be accompanied by the appropriate
252	license fee as provided in subsection (10) (8). The agency must
253	take final action on an initial licensure application within 60
254	days after receipt of all required documentation.
255	(2)  The initial applicant must file with the application
256	satisfactory proof that the home health agency is in compliance
257	with this part and applicable rules, including:
258	(a)  A listing of services to be provided, either directly
259	by the applicant or through contractual arrangements with
260	existing providers.;
261	(b)  The number and discipline of professional staff to be
262	employed.; and
263	(c)  Proof of financial ability to operate.
264	(d)  Completion of questions concerning volume data on the
265	renewal application as determined by rule.
266	(3)  An applicant for initial licensure must demonstrate
267	financial ability to operate by submitting a balance sheet and
268	income and expense statement for the first 2 years of operation
269	which provide evidence of having sufficient assets, credit, and
270	projected revenues to cover liabilities and expenses. The
271	applicant shall have demonstrated financial ability to operate
272	if the applicant's assets, credit, and projected revenues meet
273	or exceed projected liabilities and expenses. All documents
274	required under this subsection must be prepared in accordance
275	with generally accepted accounting principles, and must be
276	compiled the financial statement must be signed by a certified
277	public accountant.
278	(4)  Each applicant for licensure must comply with the
279	following requirements:
280	(a)  Upon receipt of a completed, signed, and dated
281	application, the agency shall require background screening of
282	the applicant, in accordance with the level 2 standards for
283	screening set forth in chapter 435. As used in this subsection,
284	the term "applicant" means the administrator, or a similarly
285	titled person who is responsible for the day-to-day operation of
286	the licensed home health agency, and the financial officer, or
287	similarly titled individual who is responsible for the financial
288	operation of the licensed home health agency.
289	(b)  The agency may require background screening for a
290	member of the board of directors of the licensee or an officer
291	or an individual owning 5 percent or more of the licensee if the
292	agency reasonably suspects that such individual has been
293	convicted of an offense prohibited under the level 2 standards
294	for screening set forth in chapter 435.
295	(c)  Proof of compliance with the level 2 background
296	screening requirements of chapter 435 which has been submitted
297	within the previous 5 years in compliance with any other health
298	care or assisted living licensure requirements of this state is
299	acceptable in fulfillment of paragraph (a). Proof of compliance
300	with background screening which has been submitted within the
301	previous 5 years to fulfill the requirements of the Financial
302	Services Commission and the Office of Insurance Regulation
303	pursuant to chapter 651 as part of an application for a
304	certificate of authority to operate a continuing care retirement
305	community is acceptable in fulfillment of the Department of Law
306	Enforcement and Federal Bureau of Investigation background
307	check.
308	(d)  A provisional license may be granted to an applicant
309	when each individual required by this section to undergo
310	background screening has met the standards for the Department of
311	Law Enforcement background check, but the agency has not yet
312	received background screening results from the Federal Bureau of
313	Investigation. A standard license may be granted to the licensee
314	upon the agency's receipt of a report of the results of the
315	Federal Bureau of Investigation background screening for each
316	individual required by this section to undergo background
317	screening which confirms that all standards have been met, or
318	upon the granting of a disqualification exemption by the agency
319	as set forth in chapter 435. Any other person who is required to
320	undergo level 2 background screening may serve in his or her
321	capacity pending the agency's receipt of the report from the
322	Federal Bureau of Investigation. However, the person may not
323	continue to serve if the report indicates any violation of
324	background screening standards and a disqualification exemption
325	has not been requested of and granted by the agency as set forth
326	in chapter 435.
327	(e)  Each applicant must submit to the agency, with its
328	application, a description and explanation of any exclusions,
329	permanent suspensions, or terminations of the licensee or
330	potential licensee from the Medicare or Medicaid programs. Proof
331	of compliance with the requirements for disclosure of ownership
332	and control interest under the Medicaid or Medicare programs may
333	be accepted in lieu of this submission.
334	(f)  Each applicant must submit to the agency a description
335	and explanation of any conviction of an offense prohibited under
336	the level 2 standards of chapter 435 by a member of the board of
337	directors of the applicant, its officers, or any individual
338	owning 5 percent or more of the applicant. This requirement does
339	not apply to a director of a not-for-profit corporation or
340	organization if the director serves solely in a voluntary
341	capacity for the corporation or organization, does not regularly
342	take part in the day-to-day operational decisions of the
343	corporation or organization, receives no remuneration for his or
344	her services on the corporation or organization's board of
345	directors, and has no financial interest and has no family
346	members with a financial interest in the corporation or
347	organization, provided that the director and the not-for-profit
348	corporation or organization include in the application a
349	statement affirming that the director's relationship to the
350	corporation satisfies the requirements of this paragraph.
351	(g)  A license may not be granted to an applicant if the
352	applicant, administrator, or financial officer has been found
353	guilty of, regardless of adjudication, or has entered a plea of
354	nolo contendere or guilty to, any offense prohibited under the
355	level 2 standards for screening set forth in chapter 435, unless
356	an exemption from disqualification has been granted by the
357	agency as set forth in chapter 435.
358	(h)  The agency may deny or revoke licensure if the
359	applicant:
360	1.  Has falsely represented a material fact in the
361	application required by paragraph (e) or paragraph (f), or has
362	omitted any material fact from the application required by
363	paragraph (e) or paragraph (f); or
364	2.  has been or is currently excluded, suspended,
365	terminated from, or has involuntarily withdrawn from
366	participation in this state's Medicaid program, or the Medicaid
367	program of any other state, or from participation in the
368	Medicare program or any other governmental or private health
369	care or health insurance program.
370	(i)  An application for license renewal must contain the
371	information required under paragraphs (e) and (f).
372	(5)  The agency may deny or revoke licensure if the
373	applicant has falsely represented a material fact, or has
374	omitted any material fact, from the application required by this
375	section.
376	(6)(5)  The home health agency must also obtain and
377	maintain the following insurance coverage coverages in an amount
378	of not less than $250,000 per claim, and the home health agency
379	must submit proof of coverage with an initial application for
380	licensure and with each annual application for license renewal:
381	(a)  Malpractice insurance as defined in s. 624.605(1)(k).;
382	(b)  Liability insurance as defined in s. 624.605(1)(b).
383	(7)(6)  Sixty Ninety days before the expiration date, an
384	application for renewal must be submitted to the agency under
385	oath on forms furnished by it, and a license must be renewed if
386	the applicant has met the requirements established under this
387	part and applicable rules. The home health agency must file with
388	the application satisfactory proof that it is in compliance with
389	this part and applicable rules. If there is evidence of
390	financial instability, the home health agency must submit
391	satisfactory proof of its financial ability to comply with the
392	requirements of this part. The agency shall impose an
393	administrative fine of $50 per day for each day the home health
394	agency fails to file an application within the timeframe
395	specified in this subsection. Each day of continuing violation
396	is a separate violation; however, the aggregate of such fines
397	may not exceed $500.
398	(8)(7)  When transferring the ownership of a home health
399	agency, the transferee must submit an application for a license
400	at least 60 days before the effective date of the transfer. If
401	the application is filed late, an administrative fine shall be
402	imposed in the amount of $50 per day. Each day of continuing
403	violation is a separate violation; however, the aggregate of
404	such fines may not exceed $500. If the home health agency is
405	being leased, a copy of the lease agreement must be filed with
406	the application.
407	(9)  The agency shall accept, in lieu of its own periodic
408	licensure survey, submission of the survey of an accrediting
409	organization that is recognized by the agency if the
410	accreditation of the licensed home health agency is not
411	provisional and if the licensed home health agency authorizes
412	release of, and the agency receives the report of, the
413	accrediting organization.
414	(10)(8)  The license fee and annual renewal fee required of
415	a home health agency are nonrefundable. The agency shall set the
416	license fees in an amount that is sufficient to cover its costs
417	in carrying out its responsibilities under this part, but not to
418	exceed $2,000 $1,000. However, state, county, or municipal
419	governments applying for licenses under this part are exempt
420	from the payment of license fees. All fees collected under this
421	part must be deposited in the Health Care Trust Fund for the
422	administration of this part.
423	(11)(9)  The license must be displayed in a conspicuous
424	place in the administrative office of the home health agency and
425	is valid only while in the possession of the person to which it
426	is issued. The license may not be sold, assigned, or otherwise
427	transferred, voluntarily or involuntarily, and is valid only for
428	the home health agency and location for which originally issued.
429	(12)(10)  A home health agency against whom a revocation or
430	suspension proceeding is pending at the time of license renewal
431	may be issued a provisional license effective until final
432	disposition by the agency of such proceedings. If judicial
433	relief is sought from the final disposition, the court that has
434	jurisdiction may issue a temporary permit for the duration of
435	the judicial proceeding.
436	(13)(11)  The agency may not issue a license designated as
437	certified to a home health agency that fails to satisfy the
438	requirements of a Medicare certification survey from the agency.
439	(14)(12)  The agency may not issue a license to a home
440	health agency that has any unpaid fines assessed under this
441	part.
442	Section 5.  Section 400.487, Florida Statutes, is amended
443	to read:
444	400.487  Home health service agreements; physician's,
445	physician assistant's, and advanced registered nurse
446	practitioner's treatment orders; patient assessment;
447	establishment and review of plan of care; provision of services;
448	orders not to resuscitate.--
449	(1)  Services provided by a home health agency must be
450	covered by an agreement between the home health agency and the
451	patient or the patient's legal representative specifying the
452	home health services to be provided, the rates or charges for
453	services paid with private funds, and the sources method of
454	payment, which may include Medicare, Medicaid, private
455	insurance, personal funds, or a combination thereof. A home
456	health agency providing skilled care must make an assessment of
457	the patient's needs within 48 hours after the start of services.
458	(2)  When required by the provisions of chapter 464; part
459	I, part III, or part V of chapter 468; or chapter 486, the
460	attending physician, physician assistant, or advanced registered
461	nurse practitioner, acting within his or her respective scope of
462	practice, shall for a patient who is to receive skilled care
463	must establish treatment orders for a patient who is to receive
464	skilled care. The treatment orders must be signed by the
465	physician, physician assistant, or advanced registered nurse
466	practitioner before a claim for payment for the skilled services
467	is submitted by the home health agency. If the claim is
468	submitted to a managed care organization, the treatment orders
469	must be signed within the time allowed under the provider
470	agreement. The treatment orders shall within 30 days after the
471	start of care and must be reviewed, as frequently as the
472	patient's illness requires, by the physician, physician
473	assistant, or advanced registered nurse practitioner in
474	consultation with the home health agency personnel that provide
475	services to the patient.
476	(3)  A home health agency shall arrange for supervisory
477	visits by a registered nurse to the home of a patient receiving
478	home health aide services in accordance with the patient's
479	direction, and approval, and agreement to pay the charge for the
480	visits.
481	(4)  Each patient has the right to be informed of and to
482	participate in the planning of his or her care. Each patient
483	must be provided, upon request, a copy of the plan of care
484	established and maintained for that patient by the home health
485	agency.
486	(5)  When nursing services are ordered, the home health
487	agency to which a patient has been admitted for care must
488	provide the initial admission visit, all service evaluation
489	visits, and the discharge visit by a direct employee qualified
490	personnel who are on the payroll of, and to whom an IRS payroll
491	form W-2 will be issued by, the home health agency. Services
492	provided by others under contractual arrangements to a home
493	health agency must be monitored and managed by the admitting
494	home health agency. The admitting home health agency is fully
495	responsible for ensuring that all care provided through its
496	employees or contract staff is delivered in accordance with this
497	part and applicable rules.
498	(6)  The skilled care services provided by a home health
499	agency, directly or under contract, must be supervised and
500	coordinated in accordance with the plan of care.
501	(7)  Home health agency personnel may withhold or withdraw
502	cardiopulmonary resuscitation if presented with an order not to
503	resuscitate executed pursuant to s. 401.45. The agency shall
504	adopt rules providing for the implementation of such orders.
505	Home health personnel and agencies shall not be subject to
506	criminal prosecution or civil liability, nor be considered to
507	have engaged in negligent or unprofessional conduct, for
508	withholding or withdrawing cardiopulmonary resuscitation
509	pursuant to such an order and rules adopted by the agency.
510	Section 6.  Subsection (1) of section 400.491, Florida
511	Statutes, is amended to read:
512	400.491  Clinical records.--
513	(1)  The home health agency must maintain for each patient
514	who receives skilled care a clinical record that includes
515	pertinent past and current medical, nursing, social and other
516	therapeutic information, the treatment orders, and other such
517	information as is necessary for the safe and adequate care of
518	the patient. When home health services are terminated, the
519	record must show the date and reason for termination. Such
520	records are considered patient records under s. 400.494 s.
521	456.057, and must be maintained by the home health agency for 6
522	5 years following termination of services. If a patient
523	transfers to another home health agency, a copy of his or her
524	record must be provided to the other home health agency upon
525	request.
526	Section 7.  Section 400.494, Florida Statutes, is amended
527	to read:
528	400.494  Information about patients confidential.--
529	(1)  Information about patients received by persons
530	employed by, or providing services to, a home health agency or
531	received by the licensing agency through reports or inspection
532	shall be confidential and exempt from the provisions of s.
533	119.07(1) and shall only not be disclosed to any person, other
534	than the patient, as permitted under the provisions of 45 C.F.R.
535	ss. 160.102, 160.103, and 164, subpart A, commonly referred to
536	as the HIPAA Privacy Regulation; except that clinical records
537	described in ss. 381.004, 384.29, 385.202, 392.65, 394.4615,
538	395.404, 397.501, and 760.40 shall be disclosed as authorized in
539	those sections without the written consent of that patient or
540	the patient's guardian.
541	(2)  This section does not apply to information lawfully
542	requested by the Medicaid Fraud Control Unit of the Department
543	of Legal Affairs.
544	Section 8.  Subsections (3), (5), (7), (8), (10), (13),
545	(14), and (17) of section 400.506, Florida Statutes, are amended
546	to read:
547	400.506  Licensure of nurse registries; requirements;
548	penalties.--
549	(3)  Application for license must be made to the Agency for
550	Health Care Administration on forms furnished by it and must be
551	accompanied by the appropriate licensure fee, as established by
552	rule and not to exceed the cost of regulation under this part.
553	The licensure fee for nurse registries may not exceed $2,000
554	$1,000 and must be deposited in the Health Care Trust Fund.
555	(5)  A license issued for the operation of a nurse
556	registry, unless sooner suspended or revoked, expires 2 years 1
557	year after its date of issuance. Sixty days before the
558	expiration date, an application for renewal must be submitted to
559	the Agency for Health Care Administration on forms furnished by
560	it. The Agency for Health Care Administration shall renew the
561	license if the applicant has met the requirements of this
562	section and applicable rules. A nurse registry against which a
563	revocation or suspension proceeding is pending at the time of
564	license renewal may be issued a conditional license effective
565	until final disposition by the Agency for Health Care
566	Administration of such proceedings. If judicial relief is sought
567	from the final disposition, the court having jurisdiction may
568	issue a conditional license for the duration of the judicial
569	proceeding.
570	(7)  A person that provides, offers, or advertises to the
571	public that it provides any service for which licensure is
572	required under this section must include in such advertisement
573	the license number issued to it by the Agency for Health Care
574	Administration. The agency shall assess a fine of not less than
575	$100 against any licensee who fails to include the license
576	number when submitting the advertisement for publication,
577	broadcast, or printing. The fine for a second or subsequent
578	offense is $500.
579	(8)(a)  It is unlawful for a person to provide, offer, or
580	advertise to the public services as defined by rule without
581	obtaining a valid license from the Agency for Health Care
582	Administration. It is unlawful for any holder of a license to
583	advertise or hold out to the public that he or she holds a
584	license for other than that for which he or she actually holds a
585	license. A person who violates this subsection is subject to
586	injunctive proceedings under s. 400.515.
587	(b)  A person who violates the provisions of paragraph (a)
588	commits a misdemeanor of the second degree, punishable as
589	provided in s. 775.082 or s. 775.083. Each day of continuing
590	violation is a separate offense.
591	(c)  Any person who owns, operates, or maintains an
592	unlicensed nurse registry and who, within 10 working days after
593	receiving notification from the agency, fails to cease operation
594	and apply for a license under this part commits a misdemeanor of
595	the second degree, punishable as provided in s. 775.082 or s.
596	775.083. Each day of continued operation is a separate offense.
597	(d)  If a nurse registry fails to cease operation after
598	agency notification, the agency may impose a fine of $500 for
599	each day of noncompliance.
600	(10)(a)  A nurse registry may refer for contract in private
601	residences registered nurses and licensed practical nurses
602	registered and licensed under part I of chapter 464, certified
603	nursing assistants certified under part II of chapter 464, home
604	health aides who present documented proof of successful
605	completion of the training required by rule of the agency, and
606	companions or homemakers for the purposes of providing those
607	services authorized under s. 400.509(1). Each person referred by
608	a nurse registry must provide current documentation that he or
609	she is free from communicable diseases.
610	(b)  A certified nursing assistant or home health aide may
611	be referred for a contract to provide care to a patient in his
612	or her home only if that patient is under a physician's care. A
613	certified nursing assistant or home health aide referred for
614	contract in a private residence shall be limited to assisting a
615	patient with bathing, dressing, toileting, grooming, eating,
616	physical transfer, and those normal daily routines the patient
617	could perform for himself or herself were he or she physically
618	capable. A certified nursing assistant or home health aide may
619	not provide medical or other health care services that require
620	specialized training and that may be performed only by licensed
621	health care professionals. The nurse registry shall obtain the
622	name and address of the attending physician and send written
623	notification to the physician within 48 hours after a contract
624	is concluded that a certified nursing assistant or home health
625	aide will be providing care for that patient.
626	(c)  When a certified nursing assistant or home health aide
627	is referred to a patient's home by a nurse registry, the nurse
628	registry shall advise the patient, the patient's family, or any
629	other person acting on behalf of the patient at the time the
630	contract for services is made that registered nurses are
631	available to make visits to the patient's home for an additional
632	cost. A registered nurse shall make monthly visits to the
633	patient's home to assess the patient's condition and quality of
634	care being provided by the certified nursing assistant or home
635	health aide. Any condition which, in the professional judgment
636	of the nurse, requires further medical attention shall be
637	reported to the attending physician and the nurse registry. A
638	record of the nurse's visit The assessment shall become a part
639	of the patient's file with the nurse registry and may be
640	reviewed by the agency during their survey procedure.
641	(13)  Each nurse registry must comply with the procedures
642	set forth in s. 400.512 for maintaining records of the work
643	employment history of all persons referred for contract and is
644	subject to the standards and conditions set forth in that
645	section. However, an initial screening may not be required for
646	persons who have been continuously registered with the nurse
647	registry since October 1, 2000 September 30, 1990.
648	(14)  The nurse registry must maintain the application on
649	file, and that file must be open to the inspection of the Agency
650	for Health Care Administration. The nurse registry must maintain
651	on file the name and address of the patient or client to whom
652	the nurse or other nurse registry personnel are referred is sent
653	for contract and the amount of the fee received by the nurse
654	registry. A nurse registry must maintain the file that includes
655	the application and other applicable documentation for 3 years
656	after the date of the last file entry of patient-related or
657	client-related information.
658	(17)  All persons referred for contract in private
659	residences by a nurse registry must comply with the following
660	requirements for a plan of treatment:
661	(a)  When, in accordance with the privileges and
662	restrictions imposed upon a nurse under part I of chapter 464,
663	the delivery of care to a patient is under the direction or
664	supervision of a physician or when a physician is responsible
665	for the medical care of the patient, a medical plan of treatment
666	must be established for each patient receiving care or treatment
667	provided by a licensed nurse in the home. The original medical
668	plan of treatment must be timely signed by the physician,
669	physician assistant, or advanced registered nurse practitioner,
670	acting within his or her respective scope of practice, and
671	reviewed by him or her in consultation with the licensed nurse
672	at least every 2 months. Any additional order or change in
673	orders must be obtained from the physician, physician assistant,
674	or advanced registered nurse practitioner and reduced to writing
675	and timely signed by the physician, physician assistant, or
676	advanced registered nurse practitioner. The delivery of care
677	under a medical plan of treatment must be substantiated by the
678	appropriate nursing notes or documentation made by the nurse in
679	compliance with nursing practices established under part I of
680	chapter 464.
681	(b)  Whenever a medical plan of treatment is established
682	for a patient, the initial medical plan of treatment, any
683	amendment to the plan, additional order or change in orders, and
684	copy of nursing notes must be filed in the office of the nurse
685	registry.
686	Section 9.  Subsection (2) of section 400.512, Florida
687	Statutes, is amended to read:
688	400.512  Screening of home health agency personnel; nurse
689	registry personnel; and companions and homemakers.--The agency
690	shall require employment or contractor screening as provided in
691	chapter 435, using the level 1 standards for screening set forth
692	in that chapter, for home health agency personnel; persons
693	referred for employment by nurse registries; and persons
694	employed by companion or homemaker services registered under s.
695	400.509.
696	(2)  The administrator of each home health agency, the
697	managing employee of each nurse registry, and the managing
698	employee of each companion or homemaker service registered under
699	s. 400.509 must sign an affidavit annually, under penalty of
700	perjury, stating that all personnel hired or, contracted with,
701	or registered on or after October 1, 2000 October 1, 1994, who
702	enter the home of a patient or client in their service capacity
703	have been screened and that its remaining personnel have worked
704	for the home health agency or registrant continuously since
705	before October 1, 1994.
706	Section 10.  Section 400.515, Florida Statutes, is amended
707	to read:
708	400.515  Injunction proceedings.--In addition to the other
709	powers provided under this chapter, the agency may institute
710	injunction proceedings in a court of competent jurisdiction to
711	restrain or prevent the establishment or operation of a home
712	health agency or nurse registry that does not have a license or
713	that is in violation of any provision of this part or any rule
714	adopted pursuant to this part. The agency for Health Care
715	Administration may also institute injunction proceedings in a
716	court of competent jurisdiction when violation of this part or
717	of applicable rules constitutes an emergency affecting the
718	immediate health and safety of a patient or client.
719	Section 11.  This act shall take effect July 1, 2005.
720
721
722	================= T I T L E  A M E N D M E N T =================
723	Remove the entire title and insert:
724	A bill to be entitled
725	An act relating to health care; amending s. 400.461, F.S.;
726	revising the purpose of part IV of ch. 400, F.S., to
727	include the licensure of nurse registries; amending s.
728	400.462, F.S.; revising definitions; defining the terms
729	"admission," "advanced registered nurse practitioner,"
730	"direct employee," and "physician assistant" for purposes
731	of part IV of ch. 400, F.S.; amending s. 400.464, F.S.,
732	relating to licensure of home health agencies; revising
733	the licensure period; revising and providing additional
734	administrative, civil, and criminal penalties, sanctions,
735	and fines; amending s. 400.471, F.S.; revising
736	requirements for license application by a home health
737	agency; authorizing the Agency for Health Care
738	Administration to revoke a license under certain
739	circumstances; authorizing administrative fines; amending
740	s. 400.487, F.S.; revising requirements for home health
741	agency service agreements and treatment orders; amending
742	s. 400.491, F.S., relating to clinical records; changing
743	the timeframe for a home health agency to retain patient
744	records; changing a reference; amending s. 400.494, F.S.;
745	providing for the continued confidentiality of patient
746	information in compliance with federal law; providing for
747	disclosure in accordance with certain specified state
748	laws; deleting a requirement for written consent of the
749	patient or the patient's guardian for disclosure of
750	confidential patient information; deleting an exemption
751	provided for the Medicaid Fraud Control Unit of the
752	Department of Legal Affairs; amending s. 400.506, F.S.;
753	revising requirements governing nurse registries;
754	increasing license fee; increasing the period of
755	licensure; authorizing administrative penalties; revising
756	criminal penalties and sanctions; revising certain
757	requirements pertaining to health care professionals that
758	provide services on behalf of a nurse registry; amending
759	s. 400.512, F.S., relating to employment screening;
760	revising the date on which an annual affidavit must be
761	signed which verifies that certain personnel of a home
762	health agency, a nurse registry, or homemaker service have
763	been screened; amending s. 400.515, F.S.; providing
764	additional circumstances under which the agency may
765	petition for an injunction; providing an effective date.

CODING: Words stricken are deletions; words underlined are additions.