Senate Bill sb0484e1

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    CS for SB 484                            First Engrossed (ntc)



  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         400.461, F.S.; revising the purpose of part IV

  4         of ch. 400, F.S., to include the licensure of

  5         nurse registries; amending s. 400.462, F.S.;

  6         revising definitions; defining the terms

  7         "admission," "advanced registered nurse

  8         practitioner," "direct employee," and

  9         "physician assistant" for purposes of part IV

10         of ch. 400, F.S.; amending s. 400.464, F.S.,

11         relating to licensure of home health agencies;

12         revising the licensure period; revising and

13         providing additional administrative fines;

14         increasing penalties; amending s. 400.471,

15         F.S.; revising requirements for license

16         application by a home health agency;

17         authorizing the Agency for Health Care

18         Administration to revoke a license under

19         certain circumstances; authorizing

20         administrative fines; amending s. 400.487,

21         F.S.; revising requirements for home health

22         agency service agreements and treatment orders;

23         amending s. 400.491, F.S., relating to clinical

24         records; revising the ownership of patient

25         records generated by a home health agency;

26         changing the timeframe for a home health agency

27         to retain patient records; providing for the

28         disposition of patient records when a home

29         health agency ceases business; deleting a

30         requirement for a service provision plan

31         pertaining to nonskilled care; deleting


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    CS for SB 484                            First Engrossed (ntc)



 1         requirements for maintaining such records;

 2         amending s. 400.494, F.S.; providing for the

 3         continued confidentiality of patient

 4         information in compliance with federal law;

 5         providing for disclosure in accordance with

 6         certain specified state laws; deleting a

 7         requirement for written consent of the patient

 8         or the patient's guardian for disclosure of

 9         confidential patient information; amending s.

10         400.506, F.S.; revising requirements governing

11         nurse registries; increasing license fee;

12         increasing the period of licensure; authorizing

13         administrative penalties; providing criminal

14         penalties and sanctions; revising certain

15         requirements pertaining to health care

16         professionals that provide services on behalf

17         of a nurse registry; amending s. 400.512, F.S.,

18         relating to employment screening; revising the

19         date in which an annual affidavit must be

20         signed which verifies that certain personnel of

21         a home health agency, a nurse registry, or

22         homemaker service have been screened; amending

23         s. 400.515, F.S.; providing additional

24         circumstances under which the agency may

25         petition for an injunction; providing an

26         effective date.

27  

28  Be It Enacted by the Legislature of the State of Florida:

29  

30         Section 1.  Subsection (2) of section 400.461, Florida

31  Statutes, is amended to read:


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    CS for SB 484                            First Engrossed (ntc)



 1         400.461  Short title; purpose.--

 2         (2)  The purpose of this part is to provide for the

 3  licensure of every home health agency and nurse registry and

 4  to provide for the development, establishment, and enforcement

 5  of basic standards that will ensure the safe and adequate care

 6  of persons receiving health services in their own homes.

 7         Section 2.  Section 400.462, Florida Statutes, is

 8  amended to read:

 9         400.462  Definitions.--As used in this part, the term:

10         (1)  "Administrator" means a direct employee, as

11  defined in subsection (9) of the home health agency or a

12  related organization, or of a management company that has a

13  contract to manage the home health agency, to whom the

14  governing body has delegated the responsibility for day-to-day

15  administration of the home health agency. The administrator

16  must be a licensed physician, physician assistant, or

17  registered nurse licensed to practice in this state or an

18  individual having at least 1 year of supervisory or

19  administrative experience in home health care or in a facility

20  licensed under chapter 395 or under part II or part III of

21  this chapter.  An administrator may manage a maximum of five

22  licensed home health agencies located within one agency

23  service district or within an immediately contiguous county.

24  If the home health agency is licensed under this chapter and

25  is part of a retirement community that provides multiple

26  levels of care, an employee of the retirement community may

27  administer the home health agency and up to a maximum of four

28  entities licensed under this chapter that are owned, operated,

29  or managed by the same corporate entity.  An administrator

30  shall designate, in writing, for each licensed entity, a

31  qualified alternate administrator to serve during absences.


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    CS for SB 484                            First Engrossed (ntc)



 1         (2)  "Admission" means a decision by the home health

 2  agency, during or after an evaluation visit to the patient's

 3  home, that there is reasonable expectation that the patient's

 4  medical, nursing, and social needs for skilled care can be

 5  adequately met by the agency in the patient's place of

 6  residence. Admission includes completion of an agreement with

 7  the patient or the patient's legal representative to provide

 8  home health services as required in s. 400.487(1).

 9         (3)  "Advanced registered nurse practitioner" means a

10  person licensed in this state to practice professional nursing

11  and certified in advanced or specialized nursing practice, as

12  defined in s. 464.003.

13         (4)(2)  "Agency" means the Agency for Health Care

14  Administration.

15         (5)(3)  "Certified nursing assistant" means any person

16  who has been issued a certificate under part II of chapter

17  464. The licensed home health agency or licensed nurse

18  registry shall ensure that the certified nursing assistant

19  employed by or under contract with the home health agency or

20  licensed nurse registry is adequately trained to perform the

21  tasks of a home health aide in the home setting.

22         (6)(4)  "Client" means an elderly, handicapped, or

23  convalescent individual who receives personal care services,

24  companion services, or homemaker services in the individual's

25  home or place of residence.

26         (7)(5)  "Companion" or "sitter" means a person who

27  spends time with cares for an elderly, handicapped, or

28  convalescent individual and accompanies such individual on

29  trips and outings and may prepare and serve meals to such

30  individual. A companion may not provide hands-on personal care

31  to a client.


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    CS for SB 484                            First Engrossed (ntc)



 1         (8)(6)  "Department" means the Department of Children

 2  and Family Services.

 3         (9)  "Direct employee" means an employee for whom one

 4  of the following entities pays withholding taxes: a home

 5  health agency; a management company that has a contract to

 6  manage the home health agency on a day-to-day basis; or an

 7  employee leasing company that has a contract with the home

 8  health agency to handle the payroll and payroll taxes for the

 9  home health agency.

10         (10)(7)  "Director of nursing" means a registered nurse

11  who is a and direct employee, as defined in subsection (9), of

12  the agency and or related business entity who is a graduate of

13  an approved school of nursing and is licensed in this state;

14  who has at least 1 year of supervisory experience as a

15  registered nurse in a licensed home health agency, a facility

16  licensed under chapter 395, or a facility licensed under part

17  II or part III of this chapter; and who is responsible for

18  overseeing the professional nursing and home health aid

19  delivery of services of the agency. A director of nursing An

20  employee may be the director of nursing of a maximum of five

21  licensed home health agencies operated by a related business

22  entity and located within one agency service district or

23  within an immediately contiguous county.  If the home health

24  agency is licensed under this chapter and is part of a

25  retirement community that provides multiple levels of care, an

26  employee of the retirement community may serve as the director

27  of nursing of the home health agency and of up to four

28  entities licensed under this chapter which are owned,

29  operated, or managed by the same corporate entity.  A director

30  of nursing shall designate, in writing, for each licensed

31  


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    CS for SB 484                            First Engrossed (ntc)



 1  entity, a qualified alternate registered nurse to serve during

 2  the absence of the director of nursing.

 3         (11)(8)  "Home health agency" means an organization

 4  that provides home health services and staffing services.

 5         (12)(9)  "Home health agency personnel" means persons

 6  who are employed by or under contract with a home health

 7  agency and enter the home or place of residence of patients at

 8  any time in the course of their employment or contract.

 9         (13)(10)  "Home health services" means health and

10  medical services and medical supplies furnished by an

11  organization to an individual in the individual's home or

12  place of residence.  The term includes organizations that

13  provide one or more of the following:

14         (a)  Nursing care.

15         (b)  Physical, occupational, respiratory, or speech

16  therapy.

17         (c)  Home health aide services.

18         (d)  Dietetics and nutrition practice and nutrition

19  counseling.

20         (e)  Medical supplies, restricted to drugs and

21  biologicals prescribed by a physician.

22         (14)(11)  "Home health aide" means a person who is

23  trained or qualified, as provided by rule, and who provides

24  hands-on personal care, performs simple procedures as an

25  extension of therapy or nursing services, assists in

26  ambulation or exercises, or assists in administering

27  medications as permitted in rule and for which the person has

28  received training established by the agency under s.

29  400.497(1). The licensed home health agency or licensed nurse

30  registry shall ensure that the home health aide employed by,

31  or under contract with, the home health agency or licensed


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    CS for SB 484                            First Engrossed (ntc)



 1  nurse registry is adequately trained to perform the tasks of a

 2  home health aide in the home setting.

 3         (15)(12)  "Homemaker" means a person who performs

 4  household chores that include housekeeping, meal planning and

 5  preparation, shopping assistance, and routine household

 6  activities for an elderly, handicapped, or convalescent

 7  individual. A homemaker may not provide hands-on personal care

 8  to a client.

 9         (16)(13)  "Home infusion therapy provider" means an

10  organization that employs, contracts with, or refers a

11  licensed professional who has received advanced training and

12  experience in intravenous infusion therapy and who administers

13  infusion therapy to a patient in the patient's home or place

14  of residence.

15         (17)(14)  "Home infusion therapy" means the

16  administration of intravenous pharmacological or nutritional

17  products to a patient in his or her home.

18         (18)(15)  "Nurse registry" means any person that

19  procures, offers, promises, or attempts to secure

20  health-care-related contracts for registered nurses, licensed

21  practical nurses, certified nursing assistants, home health

22  aides, companions, or homemakers, who are compensated by fees

23  as independent contractors, including, but not limited to,

24  contracts for the provision of services to patients and

25  contracts to provide private duty or staffing services to

26  health care facilities licensed under chapter 395 or this

27  chapter or other business entities.

28         (19)(16)  "Organization" means a corporation,

29  government or governmental subdivision or agency, partnership

30  or association, or any other legal or commercial entity, any

31  of which involve more than one health care professional


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    CS for SB 484                            First Engrossed (ntc)



 1  discipline; or a health care professional and a home health

 2  aide or certified nursing assistant; more than one home health

 3  aide; more than one certified nursing assistant; or a home

 4  health aide and a certified nursing assistant.  The term does

 5  not include an entity that provides services using only

 6  volunteers or only individuals related by blood or marriage to

 7  the patient or client.

 8         (20)(17)  "Patient" means any person who receives home

 9  health services in his or her home or place of residence.

10         (21)(18)  "Personal care" means assistance to a patient

11  in the activities of daily living, such as dressing, bathing,

12  eating, or personal hygiene, and assistance in physical

13  transfer, ambulation, and in administering medications as

14  permitted by rule.

15         (22)(19)  "Physician" means a person licensed under

16  chapter 458, chapter 459, chapter 460, or chapter 461.

17         (23)  "Physician assistant" means a person who is a

18  graduate of an approved program or its equivalent, or meets

19  standards approved by the boards, and is licensed to perform

20  medical services delegated by the supervising physician, as

21  defined in s. 458.347 or s. 459.022.

22         (24)(20)  "Skilled care" means nursing services or

23  therapeutic services required by law to be delivered by a

24  health care professional who is licensed under part I of

25  chapter 464; part I, part III, or part V of chapter 468; or

26  chapter 486 and who is employed by or under contract with a

27  licensed home health agency or is referred by a licensed nurse

28  registry.

29         (25)(21)  "Staffing services" means services provided

30  to a health care facility or other business entity on a

31  temporary basis by licensed health care personnel and by,


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    CS for SB 484                            First Engrossed (ntc)



 1  including certified nursing assistants and home heath aides

 2  who are employed by, or work under the auspices of, a licensed

 3  home health agency or who are registered with a licensed nurse

 4  registry. Staffing services may be provided anywhere within

 5  the state.

 6         Section 3.  Subsections (1) and (4) of section 400.464,

 7  Florida Statutes, are amended to read:

 8         400.464  Home health agencies to be licensed;

 9  expiration of license; exemptions; unlawful acts; penalties.--

10         (1)  Any home health agency must be licensed by the

11  agency to operate in this state.  A license issued to a home

12  health agency, unless sooner suspended or revoked, expires 2

13  years 1 year after its date of issuance.

14         (4)(a)  An organization may not provide, offer, or

15  advertise home health services to the public unless the

16  organization has a valid license or is specifically exempted

17  under this part. An organization that offers or advertises to

18  the public any service for which licensure or registration is

19  required under this part must include in the advertisement the

20  license number or registration regulation number issued to the

21  organization by the agency. The agency shall assess a fine of

22  not less than $100 to any licensee or registrant who fails to

23  include the license or registration number when submitting the

24  advertisement for publication, broadcast, or printing. The

25  fine for a second or subsequent offense is $500. The holder of

26  a license issued under this part may not advertise or indicate

27  to the public that it holds a home health agency or nurse

28  registry license other than the one it has been issued.

29         (b)  The operation or maintenance of an unlicensed home

30  health agency or the performance of any home health services

31  in violation of this part is declared a nuisance, inimical to


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    CS for SB 484                            First Engrossed (ntc)



 1  the public health, welfare, and safety. The agency, or any

 2  state attorney may, in addition to other remedies provided in

 3  this part, bring an action for an injunction to restrain such

 4  violation, or to enjoin the future operation or maintenance of

 5  the home health agency or the provision of home health

 6  services in violation of this part, until compliance with this

 7  part or the rules adopted under this part has been

 8  demonstrated to the satisfaction of the agency.

 9         (c)(b)  A person who violates paragraph (a) is subject

10  to an injunctive proceeding under s. 400.515.  A violation of

11  paragraph (a) is a deceptive and unfair trade practice and

12  constitutes a violation of the Florida Deceptive and Unfair

13  Trade Practices Act under part II of chapter 501.

14         (d)(c)  A person who violates the provisions of

15  paragraph (a) commits a misdemeanor of the second degree,

16  punishable as provided in s. 775.082 or s. 775.083.  Any

17  person who commits a second or subsequent violation commits a

18  misdemeanor of the first degree, punishable as provided in s.

19  775.082 or s. 775.083. Each day of continuing violation

20  constitutes a separate offense.

21         (e)  Any person who owns, operates, or maintains an

22  unlicensed home health agency and who, after receiving

23  notification from the agency, fails to cease operation may be

24  fined $500 for each day of noncompliance.

25         Section 4.  Section 400.471, Florida Statutes, is

26  amended to read:

27         400.471  Application for license; fee; provisional

28  license; temporary permit.--

29         (1)  Application for an initial license or for renewal

30  of an existing license must be made under oath to the agency

31  on forms furnished by it and must be accompanied by the


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    CS for SB 484                            First Engrossed (ntc)



 1  appropriate license fee as provided in subsection (8).  The

 2  agency must take final action on an initial licensure

 3  application within 60 days after receipt of all required

 4  documentation.

 5         (2)  The initial applicant must file with the

 6  application satisfactory proof that the home health agency is

 7  in compliance with this part and applicable rules, including:

 8         (a)  A listing of services to be provided, either

 9  directly by the applicant or through contractual arrangements

10  with existing providers;

11         (b)  The number and discipline of professional staff to

12  be employed; and

13         (c)  Proof of financial ability to operate; and.

14         (d)  Completion of questions concerning volume data on

15  the renewal application as determined by rule.

16         (3)  An applicant for initial licensure must

17  demonstrate financial ability to operate by submitting a

18  balance sheet and income and expense statement for the first 2

19  years of operation which provide evidence of having sufficient

20  assets, credit, and projected revenues to cover liabilities

21  and expenses. The applicant shall have demonstrated financial

22  ability to operate if the applicant's assets, credit, and

23  projected revenues meet or exceed projected liabilities and

24  expenses.  All documents required under this subsection must

25  be prepared in accordance with generally accepted accounting

26  principles, and must be compiled the financial statement must

27  be signed by a certified public accountant.

28         (4)  Each applicant for licensure must comply with the

29  following requirements:

30         (a)  Upon receipt of a completed, signed, and dated

31  application, the agency shall require background screening of


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    CS for SB 484                            First Engrossed (ntc)



 1  the applicant, in accordance with the level 2 standards for

 2  screening set forth in chapter 435. As used in this

 3  subsection, the term "applicant" means the administrator, or a

 4  similarly titled person who is responsible for the day-to-day

 5  operation of the licensed home health agency, and the

 6  financial officer, or similarly titled individual who is

 7  responsible for the financial operation of the licensed home

 8  health agency.

 9         (b)  The agency may require background screening for a

10  member of the board of directors of the licensee or an officer

11  or an individual owning 5 percent or more of the licensee if

12  the agency reasonably suspects that such individual has been

13  convicted of an offense prohibited under the level 2 standards

14  for screening set forth in chapter 435.

15         (c)  Proof of compliance with the level 2 background

16  screening requirements of chapter 435 which has been submitted

17  within the previous 5 years in compliance with any other

18  health care or assisted living licensure requirements of this

19  state is acceptable in fulfillment of paragraph (a). Proof of

20  compliance with background screening which has been submitted

21  within the previous 5 years to fulfill the requirements of the

22  Financial Services Commission and the Office of Insurance

23  Regulation pursuant to chapter 651 as part of an application

24  for a certificate of authority to operate a continuing care

25  retirement community is acceptable in fulfillment of the

26  Department of Law Enforcement and Federal Bureau of

27  Investigation background check.

28         (d)  A provisional license may be granted to an

29  applicant when each individual required by this section to

30  undergo background screening has met the standards for the

31  Department of Law Enforcement background check, but the agency


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    CS for SB 484                            First Engrossed (ntc)



 1  has not yet received background screening results from the

 2  Federal Bureau of Investigation. A standard license may be

 3  granted to the licensee upon the agency's receipt of a report

 4  of the results of the Federal Bureau of Investigation

 5  background screening for each individual required by this

 6  section to undergo background screening which confirms that

 7  all standards have been met, or upon the granting of a

 8  disqualification exemption by the agency as set forth in

 9  chapter 435. Any other person who is required to undergo level

10  2 background screening may serve in his or her capacity

11  pending the agency's receipt of the report from the Federal

12  Bureau of Investigation. However, the person may not continue

13  to serve if the report indicates any violation of background

14  screening standards and a disqualification exemption has not

15  been requested of and granted by the agency as set forth in

16  chapter 435.

17         (e)  Each applicant must submit to the agency, with its

18  application, a description and explanation of any exclusions,

19  permanent suspensions, or terminations of the licensee or

20  potential licensee from the Medicare or Medicaid programs.

21  Proof of compliance with the requirements for disclosure of

22  ownership and control interest under the Medicaid or Medicare

23  programs may be accepted in lieu of this submission.

24         (f)  Each applicant must submit to the agency a

25  description and explanation of any conviction of an offense

26  prohibited under the level 2 standards of chapter 435 by a

27  member of the board of directors of the applicant, its

28  officers, or any individual owning 5 percent or more of the

29  applicant. This requirement does not apply to a director of a

30  not-for-profit corporation or organization if the director

31  serves solely in a voluntary capacity for the corporation or


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    CS for SB 484                            First Engrossed (ntc)



 1  organization, does not regularly take part in the day-to-day

 2  operational decisions of the corporation or organization,

 3  receives no remuneration for his or her services on the

 4  corporation or organization's board of directors, and has no

 5  financial interest and has no family members with a financial

 6  interest in the corporation or organization, provided that the

 7  director and the not-for-profit corporation or organization

 8  include in the application a statement affirming that the

 9  director's relationship to the corporation satisfies the

10  requirements of this paragraph.

11         (g)  A license may not be granted to an applicant if

12  the applicant, administrator, or financial officer has been

13  found guilty of, regardless of adjudication, or has entered a

14  plea of nolo contendere or guilty to, any offense prohibited

15  under the level 2 standards for screening set forth in chapter

16  435, unless an exemption from disqualification has been

17  granted by the agency as set forth in chapter 435.

18         (h)  The agency may deny or revoke licensure if the

19  applicant: 

20         1.  Has falsely represented a material fact in the

21  application required by paragraph (e) or paragraph (f), or has

22  omitted any material fact from the application required by

23  paragraph (e) or paragraph (f); or

24         2.  has been or is currently excluded, suspended,

25  terminated from, or has involuntarily withdrawn from

26  participation in this state's Medicaid program, or the

27  Medicaid program of any other state, or from participation in

28  the Medicare program or any other governmental or private

29  health care or health insurance program.

30         (i)  An application for license renewal must contain

31  the information required under paragraphs (e) and (f).


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 1         (5)  The agency may deny or revoke licensure if the

 2  applicant has falsely represented a material fact, or has

 3  omitted any material fact, from the application required by

 4  this section.

 5         (6)(5)  The home health agency must also obtain and

 6  maintain the following insurance coverage coverages in an

 7  amount of not less than $250,000 per claim, and the home

 8  health agency must submit proof of coverage with an initial

 9  application for licensure and with each annual application for

10  license renewal:

11         (a)  Malpractice insurance as defined in s.

12  624.605(1)(k); and

13         (b)  Liability insurance as defined in s.

14  624.605(1)(b).

15         (7)(6)  Sixty Ninety days before the expiration date,

16  an application for renewal must be submitted to the agency

17  under oath on forms furnished by it, and a license must be

18  renewed if the applicant has met the requirements established

19  under this part and applicable rules. The home health agency

20  must file with the application satisfactory proof that it is

21  in compliance with this part and applicable rules.  If there

22  is evidence of financial instability, the home health agency

23  must submit satisfactory proof of its financial ability to

24  comply with the requirements of this part. The agency shall

25  impose an administrative fine of $50 per day for each day the

26  home health agency fails to file an application within the

27  timeframe specified in this subsection. Each day of continuing

28  violation is a separate violation; however, the aggregate of

29  such fines may not exceed $500.

30         (8)(7)  When transferring the ownership of a home

31  health agency, the transferee must submit an application for a


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 1  license at least 60 days before the effective date of the

 2  transfer. If the application is filed late, an administrative

 3  fine shall be imposed in the amount of $50 per day. Each day

 4  of continuing violation is a separate violation; however, the

 5  aggregate of such fines may not exceed $500.  If the home

 6  health agency is being leased, a copy of the lease agreement

 7  must be filed with the application.

 8         (9)  The agency shall accept, in lieu of its own

 9  periodic licensure survey, submission of the survey of an

10  accrediting organization that is recognized by the agency if

11  the accreditation of the licensed home health agency is not

12  provisional and if the licensed home health agency authorizes

13  release of, and the agency receives the report of, the

14  accrediting organization.

15         (10)(8)  The license fee and annual renewal fee

16  required of a home health agency are nonrefundable. The agency

17  shall set the license fees in an amount that is sufficient to

18  cover its costs in carrying out its responsibilities under

19  this part, but not to exceed $2000 $1,000. However, state,

20  county, or municipal governments applying for licenses under

21  this part are exempt from the payment of license fees.  All

22  fees collected under this part must be deposited in the Health

23  Care Trust Fund for the administration of this part.

24         (11)(9)  The license must be displayed in a conspicuous

25  place in the administrative office of the home health agency

26  and is valid only while in the possession of the person to

27  which it is issued.  The license may not be sold, assigned, or

28  otherwise transferred, voluntarily or involuntarily, and is

29  valid only for the home health agency and location for which

30  originally issued.

31  


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 1         (12)(10)  A home health agency against whom a

 2  revocation or suspension proceeding is pending at the time of

 3  license renewal may be issued a provisional license effective

 4  until final disposition by the agency of such proceedings. If

 5  judicial relief is sought from the final disposition, the

 6  court that has jurisdiction may issue a temporary permit for

 7  the duration of the judicial proceeding.

 8         (13)(11)  The agency may not issue a license designated

 9  as certified to a home health agency that fails to satisfy the

10  requirements of a Medicare certification survey from the

11  agency.

12         (14)(12)  The agency may not issue a license to a home

13  health agency that has any unpaid fines assessed under this

14  part.

15         Section 5.  Section 400.487, Florida Statutes, is

16  amended to read:

17         400.487  Home health service agreements; physician's,

18  physician's assistant's, and advanced registered nurse

19  practitioner's treatment orders; patient assessment;

20  establishment and review of plan of care; provision of

21  services; orders not to resuscitate.--

22         (1)  Services provided by a home health agency must be

23  covered by an agreement between the home health agency and the

24  patient or the patient's legal representative specifying the

25  home health services to be provided, the rates or charges for

26  services paid with private funds, and the sources method of

27  payment, which may include Medicare, Medicaid, private

28  insurance, personal funds, or a combination thereof. A home

29  health agency providing skilled care must make an assessment

30  of the patient's needs within 48 hours after the start of

31  services.


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    CS for SB 484                            First Engrossed (ntc)



 1         (2)  When required by the provisions of chapter 464;

 2  part I, part III, or part V of chapter 468; or chapter 486,

 3  the attending physician, physician's assistant, or advanced

 4  registered nurse practitioner, acting within his or her

 5  respective scope of practice, shall for a patient who is to

 6  receive skilled care must establish treatment orders for a

 7  patient who is to receive skilled care. The treatment orders

 8  must be signed by the physician, physician's assistant, or

 9  advanced registered nurse practitioner before a claim for

10  payment for the skilled services is submitted by the home

11  health agency. If the claim is submitted to a managed care

12  organization, the treatment orders must be signed in the time

13  allowed under the provider agreement. The treatment orders

14  shall within 30 days after the start of care and must be

15  reviewed, as frequently as the patient's illness requires, by

16  the physician, physician's assistant, or advanced registered

17  nurse practitioner in consultation with the home health agency

18  personnel that provide services to the patient.

19         (3)  A home health agency shall arrange for supervisory

20  visits by a registered nurse to the home of a patient

21  receiving home health aide services in accordance with the

22  patient's direction, and approval, and agreement to pay the

23  charge for the visits.

24         (4)  Each patient has the right to be informed of and

25  to participate in the planning of his or her care. Each

26  patient must be provided, upon request, a copy of the plan of

27  care established and maintained for that patient by the home

28  health agency.

29         (5)  When nursing services are ordered, the home health

30  agency to which a patient has been admitted for care must

31  provide the initial admission visit, all service evaluation


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    CS for SB 484                            First Engrossed (ntc)



 1  visits, and the discharge visit by a direct employee qualified

 2  personnel who are on the payroll of, and to whom an IRS

 3  payroll form W-2 will be issued by, the home health agency.

 4  Services provided by others under contractual arrangements to

 5  a home health agency must be monitored and managed by the

 6  admitting home health agency. The admitting home health agency

 7  is fully responsible for ensuring that all care provided

 8  through its employees or contract staff is delivered in

 9  accordance with this part and applicable rules.

10         (6)  The skilled care services provided by a home

11  health agency, directly or under contract, must be supervised

12  and coordinated in accordance with the plan of care.

13         (7)  Home health agency personnel may withhold or

14  withdraw cardiopulmonary resuscitation if presented with an

15  order not to resuscitate executed pursuant to s. 401.45. The

16  agency shall adopt rules providing for the implementation of

17  such orders. Home health personnel and agencies shall not be

18  subject to criminal prosecution or civil liability, nor be

19  considered to have engaged in negligent or unprofessional

20  conduct, for withholding or withdrawing cardiopulmonary

21  resuscitation pursuant to such an order and rules adopted by

22  the agency.

23         Section 6.  Section 400.491, Florida Statutes, is

24  amended to read:

25         400.491  Clinical records.--

26         (1)  The home health agency must maintain for each

27  patient who receives skilled care a clinical record that

28  includes pertinent past and current medical, nursing, social

29  and other therapeutic information, the treatment orders, and

30  other such information as is necessary for the safe and

31  adequate care of the patient.  When home health services are


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    CS for SB 484                            First Engrossed (ntc)



 1  terminated, the record must show the date and reason for

 2  termination.  Such records are considered patient records

 3  under s. 400.494 s. 456.057, and must be maintained by the

 4  home health agency for 6 5 years following termination of

 5  services.  If a patient transfers to another home health

 6  agency, a copy of his or her record must be provided to the

 7  other home health agency upon request.

 8         (2)  If a licensed home health agency ceases to remain

 9  in business, it shall notify each patient, whose clinical

10  records it has in its possession, of the fact that it is

11  ceasing operations and give each patient 15 calendar days to

12  retrieve his or her clinical record at a specified location

13  within 2 hours' driving time of the patient's residence and,

14  at a minimum, between the hours of 10 a.m. and 3 p.m. Monday

15  through Friday. The home health agency must maintain for each

16  client who receives nonskilled care a service provision plan.

17  Such records must be maintained by the home health agency for

18  1 year following termination of services.

19         Section 7.  Section 400.494, Florida Statutes, is

20  amended to read:

21         400.494  Information about patients confidential.--

22         (1)  Information about patients received by persons

23  employed by, or providing services to, a home health agency or

24  received by the licensing agency through reports or inspection

25  shall be confidential and exempt from the provisions of s.

26  119.07(1) and shall only not be disclosed to any person, other

27  than the patient, as permitted under the provisions of 45

28  C.F.R. ss. 160.102, 160.103, and 164, subpart A, commonly

29  referred to as the HIPAA Privacy Regulation; except that

30  clinical records described in ss. 381.004, 384.29, 385.202,

31  392.65, 394.4615, 395.404, 397.501, and 760.40 shall be


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    CS for SB 484                            First Engrossed (ntc)



 1  disclosed as authorized in those sections without the written

 2  consent of that patient or the patient's guardian.

 3         (2)  This section does not apply to information

 4  lawfully requested by the Medicaid Fraud Control Unit of the

 5  Department of Legal Affairs.

 6         Section 8.  Subsections (3), (5), (7), (8), (10), (13),

 7  (14), and (17) of section 400.506, Florida Statutes, are

 8  amended to read:

 9         400.506  Licensure of nurse registries; requirements;

10  penalties.--

11         (3)  Application for license must be made to the Agency

12  for Health Care Administration on forms furnished by it and

13  must be accompanied by the appropriate licensure fee, as

14  established by rule and not to exceed the cost of regulation

15  under this part.  The licensure fee for nurse registries may

16  not exceed $2,000 $1,000 and must be deposited in the Health

17  Care Trust Fund.

18         (5)  A license issued for the operation of a nurse

19  registry, unless sooner suspended or revoked, expires 2 years

20  1 year after its date of issuance. Sixty days before the

21  expiration date, an application for renewal must be submitted

22  to the Agency for Health Care Administration on forms

23  furnished by it.  The Agency for Health Care Administration

24  shall renew the license if the applicant has met the

25  requirements of this section and applicable rules.  A nurse

26  registry against which a revocation or suspension proceeding

27  is pending at the time of license renewal may be issued a

28  conditional license effective until final disposition by the

29  Agency for Health Care Administration of such proceedings.  If

30  judicial relief is sought from the final disposition, the

31  


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    CS for SB 484                            First Engrossed (ntc)



 1  court having jurisdiction may issue a conditional license for

 2  the duration of the judicial proceeding.

 3         (7)  A person that provides, offers, or advertises to

 4  the public that it provides any service for which licensure is

 5  required under this section must include in such advertisement

 6  the license number issued to it by the Agency for Health Care

 7  Administration. The agency shall assess a fine of not less

 8  than $100 against any licensee who fails to include the

 9  license number when submitting the advertisement for

10  publication, broadcast, or printing. The fine for a second or

11  subsequent offense is $500.

12         (8)(a)  It is unlawful for a person to provide, offer,

13  or advertise to the public services as defined by rule without

14  obtaining a valid license from the Agency for Health Care

15  Administration.  It is unlawful for any holder of a license to

16  advertise or hold out to the public that he or she holds a

17  license for other than that for which he or she actually holds

18  a license.  A person who violates this subsection is subject

19  to injunctive proceedings under s. 400.515.

20         (b)  A person who violates paragraph (a) commits a

21  misdemeanor of the second degree, punishable as provided in s.

22  775.082 or s. 775.083. Any person who commits a second or

23  subsequent violation commits a misdemeanor of the first

24  degree, punishable as provided in s. 775.082 or s. 775.083.

25  Each day of continuing violation is a separate offense.

26         (c)  Any person who owns, operates, or maintains an

27  unlicensed nurse registry and who, after receiving

28  notification from the agency, fails to cease operation is

29  subject to a fine of $500 for each day of noncompliance.

30         (10)(a)  A nurse registry may refer for contract in

31  private residences registered nurses and licensed practical


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    CS for SB 484                            First Engrossed (ntc)



 1  nurses registered and licensed under part I of chapter 464,

 2  certified nursing assistants certified under part II of

 3  chapter 464, home health aides who present documented proof of

 4  successful completion of the training required by rule of the

 5  agency, and companions or homemakers for the purposes of

 6  providing those services authorized under s. 400.509(1). Each

 7  person referred by a nurse registry must provide current

 8  documentation that he or she is free from communicable

 9  diseases.

10         (b)  A certified nursing assistant or home health aide

11  may be referred for a contract to provide care to a patient in

12  his or her home only if that patient is under a physician's

13  care.  A certified nursing assistant or home health aide

14  referred for contract in a private residence shall be limited

15  to assisting a patient with bathing, dressing, toileting,

16  grooming, eating, physical transfer, and those normal daily

17  routines the patient could perform for himself or herself were

18  he or she physically capable.  A certified nursing assistant

19  or home health aide may not provide medical or other health

20  care services that require specialized training and that may

21  be performed only by licensed health care professionals. The

22  nurse registry shall obtain the name and address of the

23  attending physician and send written notification to the

24  physician within 48 hours after a contract is concluded that a

25  certified nursing assistant or home health aide will be

26  providing care for that patient.

27         (c)  When a certified nursing assistant or home health

28  aide is referred to a patient's home by a nurse registry, the

29  nurse registry shall advise the patient, the patient's family,

30  or a person acting on behalf of the patient at the time of

31  contracting for services through the nurse registry of the


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    CS for SB 484                            First Engrossed (ntc)



 1  availability of registered nurses to visit the patient's home

 2  to assess the patient's condition at an additional cost. A

 3  registered nurse shall make monthly visits to the patient's

 4  home to assess the patient's condition and quality of care

 5  being provided by the certified nursing assistant or home

 6  health aide. Any condition which, in the professional judgment

 7  of the nurse, requires further medical attention shall be

 8  reported to the attending physician and the nurse registry.

 9  The assessment shall become a part of the patient's file with

10  the nurse registry and may be reviewed by the agency during

11  their survey procedure.

12         (13)  Each nurse registry must comply with the

13  procedures set forth in s. 400.512 for maintaining records of

14  the work employment history of all persons referred for

15  contract and is subject to the standards and conditions set

16  forth in that section. However, an initial screening may not

17  be required for persons who have been continuously registered

18  with the nurse registry since October 1, 2000 September 30,

19  1990.

20         (14)  The nurse registry must maintain the application

21  on file, and that file must be open to the inspection of the

22  Agency for Health Care Administration.  The nurse registry

23  must maintain on file the name and address of the patient or

24  client to whom the nurse or other nurse registry personnel are

25  referred is sent for contract and the amount of the fee

26  received by the nurse registry. A nurse registry must maintain

27  the file that includes the application and other applicable

28  documentation for 3 years after the date of the last file

29  entry of client-related information.

30  

31  


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    CS for SB 484                            First Engrossed (ntc)



 1         (17)  All persons referred for contract in private

 2  residences by a nurse registry must comply with the following

 3  requirements for a plan of treatment:

 4         (a)  When, in accordance with the privileges and

 5  restrictions imposed upon a nurse under part I of chapter 464,

 6  the delivery of care to a patient is under the direction or

 7  supervision of a physician or when a physician is responsible

 8  for the medical care of the patient, a medical plan of

 9  treatment must be established for each patient receiving care

10  or treatment provided by a licensed nurse in the home.  The

11  original medical plan of treatment must be timely signed by

12  the physician, physician's assistant, or advanced registered

13  nurse practitioner, acting within his or her respective scope

14  of practice, and reviewed by him or her in consultation with

15  the licensed nurse at least every 2 months.  Any additional

16  order or change in orders must be obtained from the physician,

17  physician's assistant, or advanced registered nurse

18  practitioner and reduced to writing and timely signed by the

19  physician, physician's assistant, or advanced registered nurse

20  practitioner.  The delivery of care under a medical plan of

21  treatment must be substantiated by the appropriate nursing

22  notes or documentation made by the nurse in compliance with

23  nursing practices established under part I of chapter 464.

24         (b)  Whenever a medical plan of treatment is

25  established for a patient, the initial medical plan of

26  treatment, any amendment to the plan, additional order or

27  change in orders, and copy of nursing notes must be filed in

28  the office of the nurse registry.

29         Section 9.  Subsection (2) of section 400.512, Florida

30  Statutes, is amended to read:

31  


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    CS for SB 484                            First Engrossed (ntc)



 1         400.512  Screening of home health agency personnel;

 2  nurse registry personnel; and companions and homemakers.--The

 3  agency shall require employment or contractor screening as

 4  provided in chapter 435, using the level 1 standards for

 5  screening set forth in that chapter, for home health agency

 6  personnel; persons referred for employment by nurse

 7  registries; and persons employed by companion or homemaker

 8  services registered under s. 400.509.

 9         (2)  The administrator of each home health agency, the

10  managing employee of each nurse registry, and the managing

11  employee of each companion or homemaker service registered

12  under s. 400.509 must sign an affidavit annually, under

13  penalty of perjury, stating that all personnel hired, or

14  contracted with, or registered on or after October 1, 2000

15  October 1, 1994, who enter the home of a patient or client in

16  their service capacity have been screened and that its

17  remaining personnel have worked for the home health agency or

18  registrant continuously since before October 1, 1994.

19         Section 10.  Section 400.515, Florida Statutes, is

20  amended to read:

21         400.515  Injunction proceedings.--In addition to the

22  other powers provided under this chapter, the Agency for

23  Health Care Administration may institute injunction

24  proceedings in a court of competent jurisdiction to restrain

25  or prevent the establishment or operation of a home health

26  agency or nurse registry that does not have a license or that

27  is in violation of any provision of this part or any rule

28  adopted pursuant to this part. The Agency for Health Care

29  Administration may also institute injunction proceedings in a

30  court of competent jurisdiction when violation of this part or

31  


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    CS for SB 484                            First Engrossed (ntc)



 1  of applicable rules constitutes an emergency affecting the

 2  immediate health and safety of a patient or client.

 3         Section 11.  This act shall take effect July 1, 2005.

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