Florida Senate - 2008 SB 1374
By the Committee on Health Regulation
588-03491-08 20081374__
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A bill to be entitled
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An act relating to home health care; amending s. 400.462,
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F.S.; revising and adding definitions; amending s.
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400.471, F.S.; requiring an applicant for a new home
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health agency license to submit a surety bond or other
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security of a specified amount to the Agency for Health
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Care Administration; providing procedures for the agency
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with respect to making a claim against a surety bond or
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security; limiting the timing of receipt and the number of
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applications for a new home health agency license which
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the agency may accept each quarter; providing an exception
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under certain circumstances for a home health agency that
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is part of a retirement community; specifying a procedure
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for the agency to follow in selecting applications to
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process for a new home health agency license; providing
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for the future expiration of such provisions; amending s.
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400.474, F.S.; providing additional grounds under which
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the Agency for Health Care Administration may take
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disciplinary action against a home health agency; creating
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s. 400.476, F.S.; establishing staffing requirements for
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home health agencies; reducing the number of home health
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agencies that an administrator or director of nursing may
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serve; requiring that an alternate administrator be
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designated in writing; limiting the period that a home
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health agency may operate without a director of nursing;
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requiring notification upon the termination and
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replacement of a director of nursing; requiring the Agency
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for Health Care Administration to take administrative
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enforcement action against a home health agency for
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noncompliance with the notification and staffing
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requirements for a director of nursing; providing training
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requirements for certified nursing assistants and home
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health aides; amending s. 400.484, F.S.; requiring that
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the agency impose administrative fines for certain
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deficiencies; increasing the administrative fines imposed
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for certain deficiencies; amending s. 400.491, F.S.;
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extending the period that a home health agency must retain
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records of the nonskilled care it provides; amending s.
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400.497, F.S.; requiring that the Agency for Health Care
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Administration adopt rules related to standards for the
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director of nursing of a home health agency, requirements
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for a director of nursing to submit certified staff
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activity logs pursuant to an agency request, and quality
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assurance programs; amending s. 400.506, F.S.; providing
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training requirements for certified nursing assistants and
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home health aides referred for contract by a nurse
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registry; amending s. 400.518, F.S.; providing for a fine
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to be imposed against a home health agency that provides
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complimentary staffing to an assisted care community in
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exchange for patient referrals; requiring the Agency for
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Health Care Administration to conduct an unannounced
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survey of each home health agency within a specified
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period after issuing a license; requiring the Agency for
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Health Care Administration to review the process for prior
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authorization of home health agency visits and determine
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whether modifications to the process are necessary;
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requiring the agency to report to the Legislature on the
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feasibility of accessing the Medicare system to determine
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recipient eligibility for home health services; providing
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an effective date.
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Be It Enacted by the Legislature of the State of Florida:
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Section 1. Section 400.462, Florida Statutes, is amended to
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read:
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400.462 Definitions.--As used in this part, the term:
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(1) "Administrator" means a direct employee, as defined in
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subsection (9), who is. The administrator must be a licensed
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physician, physician assistant, or registered nurse licensed to
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practice in this state or an individual having at least 1 year of
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supervisory or administrative experience in home health care or
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in a facility licensed under chapter 395, under part II of this
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chapter, or under part I of chapter 429. An administrator may
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manage a maximum of five licensed home health agencies located
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within one agency service district or within an immediately
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contiguous county. If the home health agency is licensed under
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this chapter and is part of a retirement community that provides
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multiple levels of care, an employee of the retirement community
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may administer the home health agency and up to a maximum of four
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entities licensed under this chapter or chapter 429 that are
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owned, operated, or managed by the same corporate entity. An
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administrator shall designate, in writing, for each licensed
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entity, a qualified alternate administrator to serve during
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absences.
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(2) "Admission" means a decision by the home health agency,
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during or after an evaluation visit to the patient's home, that
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there is reasonable expectation that the patient's medical,
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nursing, and social needs for skilled care can be adequately met
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by the agency in the patient's place of residence. Admission
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includes completion of an agreement with the patient or the
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patient's legal representative to provide home health services as
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required in s. 400.487(1).
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(3) "Advanced registered nurse practitioner" means a person
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licensed in this state to practice professional nursing and
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certified in advanced or specialized nursing practice, as defined
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in s. 464.003.
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(4) "Agency" means the Agency for Health Care
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Administration.
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(5) "Certified nursing assistant" means any person who has
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been issued a certificate under part II of chapter 464. The
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licensed home health agency or licensed nurse registry shall
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ensure that the certified nursing assistant employed by or under
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contract with the home health agency or licensed nurse registry
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is adequately trained to perform the tasks of a home health aide
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in the home setting.
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(6) "Client" means an elderly, handicapped, or convalescent
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individual who receives companion services or homemaker services
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in the individual's home or place of residence.
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(7) "Companion" or "sitter" means a person who spends time
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with or cares for an elderly, handicapped, or convalescent
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individual and accompanies such individual on trips and outings
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and may prepare and serve meals to such individual. A companion
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may not provide hands-on personal care to a client.
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(8) "Department" means the Department of Children and
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Family Services.
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(9) "Direct employee" means an employee for whom one of the
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following entities pays withholding taxes: a home health agency;
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a management company that has a contract to manage the home
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health agency on a day-to-day basis; or an employee leasing
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company that has a contract with the home health agency to handle
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the payroll and payroll taxes for the home health agency.
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(10) "Director of nursing" means a registered nurse who is
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a direct employee, as defined in subsection (9), of the agency
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and who is a graduate of an approved school of nursing and is
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licensed in this state; who has at least 1 year of supervisory
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experience as a registered nurse; and who is responsible for
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overseeing the professional nursing and home health aid delivery
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of services of the agency. A director of nursing may be the
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director of a maximum of five licensed home health agencies
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operated by a related business entity and located within one
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agency service district or within an immediately contiguous
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county. If the home health agency is licensed under this chapter
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and is part of a retirement community that provides multiple
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levels of care, an employee of the retirement community may serve
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as the director of nursing of the home health agency and of up to
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four entities licensed under this chapter or chapter 429 which
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are owned, operated, or managed by the same corporate entity.
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(11) "Fair market value" means the value in arms length
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transactions, consistent with the price that an asset would bring
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as the result of bona fide bargaining between well-informed
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buyers and sellers who are not otherwise in a position to
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generate business for the other party, or the compensation that
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would be included in a service agreement as the result of bona
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fide bargaining between well-informed parties to the agreement
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who are not otherwise in a position to generate business for the
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other party, on the date of acquisition of the asset or at the
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time of the service agreement.
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(12)(11) "Home health agency" means an organization that
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provides home health services and staffing services.
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(13)(12) "Home health agency personnel" means persons who
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are employed by or under contract with a home health agency and
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enter the home or place of residence of patients at any time in
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the course of their employment or contract.
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(14)(13) "Home health services" means health and medical
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services and medical supplies furnished by an organization to an
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individual in the individual's home or place of residence. The
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term includes organizations that provide one or more of the
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following:
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(a) Nursing care.
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(b) Physical, occupational, respiratory, or speech therapy.
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(c) Home health aide services.
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(d) Dietetics and nutrition practice and nutrition
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counseling.
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(e) Medical supplies, restricted to drugs and biologicals
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prescribed by a physician.
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(15)(14) "Home health aide" means a person who is trained
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or qualified, as provided by rule, and who provides hands-on
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personal care, performs simple procedures as an extension of
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therapy or nursing services, assists in ambulation or exercises,
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or assists in administering medications as permitted in rule and
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for which the person has received training established by the
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agency under s. 400.497(1). The licensed home health agency or
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licensed nurse registry shall ensure that the home health aide
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employed by or under contract with the home health agency or
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licensed nurse registry is adequately trained to perform the
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tasks of a home health aide in the home setting.
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(16)(15) "Homemaker" means a person who performs household
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chores that include housekeeping, meal planning and preparation,
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shopping assistance, and routine household activities for an
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elderly, handicapped, or convalescent individual. A homemaker may
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not provide hands-on personal care to a client.
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(17)(16) "Home infusion therapy provider" means an
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organization that employs, contracts with, or refers a licensed
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professional who has received advanced training and experience in
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intravenous infusion therapy and who administers infusion therapy
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to a patient in the patient's home or place of residence.
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(18)(17) "Home infusion therapy" means the administration
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of intravenous pharmacological or nutritional products to a
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patient in his or her home.
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(19) "Immediate family member" means a husband or wife; a
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birth or adoptive parent, child, or sibling; a stepparent,
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stepchild, stepbrother, or stepsister; a father-in-law, mother-
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in-law, son-in-law, daughter-in-law, brother-in-law, or sister-
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in-law; a grandparent or grandchild; or a spouse of a grandparent
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or grandchild.
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(20) "Medical director" means a physician who is a
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volunteer with, or who receives remuneration from, a home health
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agency.
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(21)(18) "Nurse registry" means any person that procures,
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offers, promises, or attempts to secure health-care-related
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contracts for registered nurses, licensed practical nurses,
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certified nursing assistants, home health aides, companions, or
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homemakers, who are compensated by fees as independent
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contractors, including, but not limited to, contracts for the
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provision of services to patients and contracts to provide
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private duty or staffing services to health care facilities
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licensed under chapter 395, this chapter, or chapter 429 or other
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business entities.
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(22)(19) "Organization" means a corporation, government or
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governmental subdivision or agency, partnership or association,
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or any other legal or commercial entity, any of which involve
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more than one health care professional discipline; a health care
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professional and a home health aide or certified nursing
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assistant; more than one home health aide; more than one
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certified nursing assistant; or a home health aide and a
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certified nursing assistant. The term does not include an entity
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that provides services using only volunteers or only individuals
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related by blood or marriage to the patient or client.
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(23)(20) "Patient" means any person who receives home
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health services in his or her home or place of residence.
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(24)(21) "Personal care" means assistance to a patient in
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the activities of daily living, such as dressing, bathing,
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eating, or personal hygiene, and assistance in physical transfer,
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ambulation, and in administering medications as permitted by
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rule.
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(25)(22) "Physician" means a person licensed under chapter
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458, chapter 459, chapter 460, or chapter 461.
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(26)(23) "Physician assistant" means a person who is a
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graduate of an approved program or its equivalent, or meets
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standards approved by the boards, and is licensed to perform
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medical services delegated by the supervising physician, as
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(27) "Remuneration" means any payment or other benefit made
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directly or indirectly, overtly or covertly, in cash or in kind.
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(28)(24) "Skilled care" means nursing services or
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therapeutic services required by law to be delivered by a health
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care professional who is licensed under part I of chapter 464;
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part I, part III, or part V of chapter 468; or chapter 486 and
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who is employed by or under contract with a licensed home health
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agency or is referred by a licensed nurse registry.
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(29)(25) "Staffing services" means services provided to a
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health care facility, school, or other business entity on a
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temporary or school-year basis pursuant to a written contract by
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licensed health care personnel and by certified nursing
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assistants and home heath aides who are employed by, or work
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under the auspices of, a licensed home health agency or who are
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registered with a licensed nurse registry. Staffing services may
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be provided anywhere within the state.
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Section 2. Section 400.471, Florida Statutes, is amended to
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read:
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400.471 Application for license; fee; bond; limitation on
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applications accepted.--
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(1) Each applicant for licensure must comply with all
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provisions of this part and part II of chapter 408.
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(2) In addition to the requirements of part II of chapter
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408, the initial applicant must file with the application
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satisfactory proof that the home health agency is in compliance
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with this part and applicable rules, including:
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(a) A listing of services to be provided, either directly
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by the applicant or through contractual arrangements with
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existing providers.
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(b) The number and discipline of professional staff to be
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employed.
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(c) Completion of questions concerning volume data on the
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renewal application as determined by rule.
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(3) In addition to the requirements of s. 408.810, the home
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health agency must also obtain and maintain the following
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insurance coverage in an amount of not less than $250,000 per
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claim, and the home health agency must submit proof of coverage
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with an initial application for licensure and with each
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application for license renewal:
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(a) Malpractice insurance as defined in s. 624.605(1)(k).
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(b) Liability insurance as defined in s. 624.605(1)(b).
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(4) The agency shall accept, in lieu of its own periodic
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licensure survey, submission of the survey of an accrediting
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organization that is recognized by the agency if the
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accreditation of the licensed home health agency is not
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provisional and if the licensed home health agency authorizes
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release of, and the agency receives the report of, the
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accrediting organization.
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(5) In accordance with s. 408.805, an applicant or licensee
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shall pay a fee for each license application submitted under this
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part, part II of chapter 408, and applicable rules. The amount of
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the fee shall be established by rule and shall be set at an
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amount that is sufficient to cover the agency's costs in carrying
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out its responsibilities under this part, but not to exceed
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$2,000 per biennium. However, state, county, or municipal
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governments applying for licenses under this part are exempt from
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the payment of license fees.
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(6) The agency may not issue a license designated as
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certified to a home health agency that fails to satisfy the
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requirements of a Medicare certification survey from the agency.
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(7) An applicant for a new home health agency license must
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submit a surety bond of $50,000, or other equivalent means of
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security acceptable to the agency, such as an irrevocable letter
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of credit or a deposit in a trust account or financial
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institution, payable to the Agency for Health Care
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Administration. A surety bond or other equivalent means of
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security must be valid from initial licensure until the end of
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the first license-renewal period. The purpose of this bond is to
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secure payment of any administrative penalties imposed by the
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agency and any fees and costs incurred by the agency regarding
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the home health agency license which are authorized under state
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law and which the licensee fails to pay 30 days after the fine or
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costs become final. The agency may make a claim against the
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surety bond or security until the later of:
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(a) One year after the license ceases to be valid if the
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license is not renewed for a second biennial period;
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(b) One year after the license has been renewed a second
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time; or
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(c) Sixty days after any administrative or legal
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proceeding, including any appeal, is concluded involving an
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administrative penalty, fees, or costs for an act or omission
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that occurred at any time during the first 4 years after the
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license was initially issued.
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(8)(a) The agency may accept for processing for a new home
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health agency license only the following number of applications
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quarterly:
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1. Five for each geographic service area in service areas 1
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through 9;
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2. Four for geographic service area 10; and
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3. Three for geographic service area 11.
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However, an application for a new home health agency license that
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is part of a retirement community providing multiple levels of
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care and that will provide home health services exclusively to
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residents of that facility is not subject to the quarterly
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limitation and may not be counted as a new application for
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purposes of the quarterly limitation. If the home health agency
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provides home health services to persons outside that facility,
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the agency shall impose a moratorium on the license in accordance
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with s. 408.814 and revoke the home health agency license. The
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home health agency may reapply for a new home health agency
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license and is subject to the limits on the agency's acceptance
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of new applications.
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(b) The agency shall accept applications for a new home
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health agency license only during the first 5 business days of a
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calendar quarter. Applications for a new home health agency
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license received during this period, except an application for a
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new home health agency license that is part of a retirement
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community providing multiple levels of care and that will provide
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home health services exclusively to residents of that facility,
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must be grouped according to the geographic service area in which
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the home health agency is to be located. During the first 6
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through 10 business days of the calendar quarter, the agency
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shall use a lottery system to select the number of applications
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authorized in paragraph (a) to be accepted for processing for
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each geographic service area.
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shall return to the sender all applications for a new home health
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agency license which were received:
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1. And not accepted for processing pursuant to the lottery-
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selection process set forth in paragraph (b); or
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2. Before or after the first 5 business days of a calendar
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quarter.
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(d) This subsection expires July 1, 2011.
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Section 3. Section 400.474, Florida Statutes, is amended to
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read:
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400.474 Administrative penalties.--
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(1) The agency may deny, revoke, and suspend a license and
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impose an administrative fine in the manner provided in chapter
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120.
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(2) Any of the following actions by a home health agency or
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its employee is grounds for disciplinary action by the agency:
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(a) Violation of this part, part II of chapter 408, or of
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applicable rules.
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(b) An intentional, reckless, or negligent act that
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materially affects the health or safety of a patient.
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(c) Knowingly providing home health services in an
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unlicensed assisted living facility or unlicensed adult family-
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care home, unless the home health agency or employee reports the
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unlicensed facility or home to the agency within 72 hours after
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providing the services.
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(d) Preparing or maintaining fraudulent patient records,
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such as, but not limited to, charting ahead, recording vital
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signs or symptoms that were not personally obtained or observed
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by the home health agency's staff at the time indicated,
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borrowing patients or patient records from other home health
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agencies to pass a survey or inspection, or falsifying
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signatures.
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(3) The agency shall impose a fine of $1,000 against a home
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health agency that demonstrates a pattern of falsifying:
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(a) Documents of training for home health aides or
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certified nursing assistants; or
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(b) Health statements for staff providing direct care to
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patients.
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A pattern may be demonstrated by a showing of at least three
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fraudulent entries or documents. The fine shall be imposed for
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each fraudulent document or, if multiple staff members are
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included on one document, for each fraudulent entry on the
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document.
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(4) The agency shall impose a fine of $5,000 against a home
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health agency that demonstrates a pattern of billing any payor
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for services not provided. A pattern may be demonstrated by a
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showing of at least three billings for services not provided
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within a 12-month period. The fine must be imposed for each
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incident that is falsely billed. The agency may also:
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(a) Require payback of all funds;
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(b) Revoke the license; or
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(c) Issue a moratorium in accordance with s. 408.814.
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(5) The agency shall impose a fine of $5,000 against a home
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health agency that demonstrates a pattern of failing to provide a
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service specified in the home health agency's written agreement
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with a patient or the plan of care for that patient, unless a
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reduction in service is mandated by Medicare, Medicaid, or a
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state program or as provided in s. 400.492(3). A pattern may be
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demonstrated by a showing of at least three incidences,
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regardless of the patient or service, where the home health
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agency did not provide a service specified in a written agreement
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or plan of care during a 3-month period. The agency shall impose
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the fine for each occurrence. The agency may also impose
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additional administrative fines under s. 400.484 for the direct
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or indirect harm to a patient, or deny, revoke, or suspend the
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license of the home health agency for a pattern of failing to
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provide a service specified in the home health agency's written
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agreement with a patient or the plan of care for that patient.
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(6) The agency may deny, revoke, or suspend the license of
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a home health agency and shall impose a fine of $5,000 against a
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home health agency that:
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(a) Gives remuneration for staffing services to:
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1. Another home health agency with which it has formal or
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informal patient-referral transactions or arrangements; or
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2. A health services pool with which it has formal or
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informal patient-referral transactions or arrangements,
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unless the home health agency has activated its comprehensive
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emergency management plan in accordance with s. 400.492.
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(b) Provides services to residents in an assisted living
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facility for which the home health agency does not receive fair
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market value remuneration.
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(c) Provides staffing to an assisted living facility for
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which the home health agency does not receive fair market value
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remuneration.
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(d) Fails to provide the agency, upon request, with copies
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of all contracts with assisted living facilities which were
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executed within 5 years before the request.
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(e) Gives remuneration to a case manager, discharge
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planner, facility-based staff member, or third-party vendor who
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is involved in the discharge-planning process of a facility
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licensed under chapter 395 or this chapter from whom the home
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health agency receives referrals.
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(f) Fails to submit to the agency, within 10 days after the
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end of each calendar quarter, a written report that includes the
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following data based on data as it existed on the last day of the
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quarter:
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1. The number of insulin-dependent diabetic patients
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receiving insulin-injection services from the home health agency;
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2. The number of patients receiving both home health
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services from the home health agency and hospice services;
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3. The number of patients receiving home health services
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from that home health agency; and
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4. The names and nursing license numbers of registered
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nurses whose primary job responsibility is to provide home health
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services to patients and who received remuneration from the home
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health agency in excess of $25,000 during the calendar quarter.
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(g) Gives cash, or its equivalent, to a Medicare or
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Medicaid beneficiary.
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(h) Has more than one medical director contract in effect
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at one time or more than one medical director contract and one
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contract with a physician-specialist whose services are mandated
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for the home health agency in order to qualify to participate in
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a federal or state health care program at one time.
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(i) Gives remuneration to a physician without a medical
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director contract being in effect. The contract must:
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1. Be in writing and signed by both parties;
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2. Provide for remuneration that is at fair market value
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for an hourly rate, which must be supported by invoices submitted
469
by the medical director describing the work performed, the dates
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on which that work was performed, and the duration of that work;
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and
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3. Be for a term of at least 1 year.
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The hourly rate specified in the contract may not be increased
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during the term of the contract. The home health agency may not
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execute a subsequent contract with that physician which has an
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increased hourly rate and covers any portion of the term that was
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in the original contract.
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(j) Gives remuneration to:
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1. A physician, and the home health agency is in violation
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of paragraph (h) or paragraph (i);
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2. A member of the physician's office staff; or
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3. An immediate family member of the physician,
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if the home health agency has received a patient referral in the
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preceding 12 months from that physician or physician's office
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staff.
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(k) Fails to provide to the agency, upon request, copies of
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all contracts with a medical director which were executed within
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5 years before the request.
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(7)(3)(a) In addition to the requirements of s. 408.813,
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any person, partnership, or corporation that violates s. 408.812
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or s. 408.813 and that previously operated a licensed home health
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agency or concurrently operates both a licensed home health
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agency and an unlicensed home health agency commits a felony of
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the third degree punishable as provided in s. 775.082, s.
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(b) If any home health agency is found to be operating
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without a license and that home health agency has received any
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government reimbursement for services, the agency shall make a
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fraud referral to the appropriate government reimbursement
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program.
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Section 4. Section 400.476, Florida Statutes, is created to
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read:
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400.476 Staffing requirements; notifications; limitations
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on staffing services.--
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(1) ADMINISTRATOR.--
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(a) An administrator may manage only one home health
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agency, except that an administrator may manage up to five home
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health agencies if all five home health agencies have identical
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controlling interests as defined in s. 408.803 and are located
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within one agency geographic service area or within an
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immediately contiguous county. If the home health agency is
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licensed under this chapter and is part of a retirement community
515
that provides multiple levels of care, an employee of the
516
retirement community may administer the home health agency and up
517
to a maximum of four entities licensed under this chapter or
518
chapter 429 which all have identical controlling interests as
519
defined in s. 408.803. An administrator shall designate, in
520
writing, for each licensed entity, a qualified alternate
521
administrator to serve during the administrator's absence.
522
(b) An administrator of a home health agency who is a
523
licensed physician, physician assistant, or registered nurse
524
licensed to practice in this state may also be the director of
525
nursing for a home health agency. An administrator may serve as a
526
director of nursing only for the number of entities authorized in
527
subsection (2).
528
(2) DIRECTOR OF NURSING.--
529
(a) A director of nursing may be the director of nursing
530
for:
531
1. Up to two licensed home health agencies if the agencies
532
have identical controlling interests as defined in s. 408.803 and
533
are located within one agency geographic service area or within
534
an immediately contiguous county; or
535
2. Up to five licensed home health agencies if:
536
a. All of the home health agencies have identical
537
controlling interests as defined in s. 408.803;
538
b. All of the home health agencies are located within one
539
agency geographic service area or within an immediately
540
contiguous county; and
541
c. Each home health agency has a registered nurse who meets
542
the qualifications of a director of nursing and who has a written
543
delegation from the director of nursing to serve as the director
544
of nursing for that home health agency when the director of
545
nursing is not present.
546
547
If a home health agency licensed under this chapter is part of a
548
retirement community that provides multiple levels of care, an
549
employee of the retirement community may serve as the director of
550
nursing of the home health agency and up to a maximum of four
551
entities, other than home health agencies, licensed under this
552
chapter or chapter 429 which all have identical controlling
553
interests as defined in s. 408.803.
554
(b) A home health agency may not operate for more than 30
555
calendar days without a director of nursing. A home health agency
556
and the director of nursing of a home health agency must notify
557
the agency within 10 business days after termination of the
558
services of the director of nursing for the home health agency. A
559
home health agency must notify the agency of the identity and
560
qualifications of the new director of nursing within 10 days
561
after the new director is hired. A home health agency that
562
operates for more than 30 calendar days without a director of
563
nursing commits a class II deficiency. In addition to the fine
564
for a class II deficiency, the agency may issue a moratorium in
565
accordance with s. 408.814 or revoke the license. The agency
566
shall fine a home health agency that fails to notify the agency
567
as required in this paragraph $1,000 for the first violation and
568
$2,000 for a repeat violation. The agency may not take
569
administrative action against a home health agency if the
570
director of nursing fails to notify the department upon
571
termination of services as the director of nursing for the home
572
health agency.
573
(3) TRAINING.--A home health agency shall ensure that each
574
certified nursing assistant employed by or under contract with
575
the home health agency and each home health aide employed by or
576
under contract with the home health agency is adequately trained
577
to perform the tasks of a home health aide in the home setting.
578
(4) STAFFING.--Staffing services may be provided anywhere
579
within the state.
580
Section 5. Section 400.484, Florida Statutes, is amended to
581
read:
582
400.484 Right of inspection; deficiencies; fines.--
583
(1) In addition to the requirements of s. 408.811, the
584
agency may make such inspections and investigations as are
585
necessary in order to determine the state of compliance with this
586
part, part II of chapter 408, and applicable rules.
587
(2) The agency shall impose fines for various classes of
588
deficiencies in accordance with the following schedule:
589
(a) A class I deficiency is any act, omission, or practice
590
that results in a patient's death, disablement, or permanent
591
injury, or places a patient at imminent risk of death,
592
disablement, or permanent injury. Upon finding a class I
593
deficiency, the agency shall may impose an administrative fine in
594
the amount of $15,000 $5,000 for each occurrence and each day
595
that the deficiency exists.
596
(b) A class II deficiency is any act, omission, or practice
597
that has a direct adverse effect on the health, safety, or
598
security of a patient. Upon finding a class II deficiency, the
599
agency shall may impose an administrative fine in the amount of
600
$5,000 $1,000 for each occurrence and each day that the
601
deficiency exists.
602
(c) A class III deficiency is any act, omission, or
603
practice that has an indirect, adverse effect on the health,
604
safety, or security of a patient. Upon finding an uncorrected or
605
repeated class III deficiency, the agency shall may impose an
606
administrative fine not to exceed $1,000 $500 for each occurrence
607
and each day that the uncorrected or repeated deficiency exists.
608
(d) A class IV deficiency is any act, omission, or practice
609
related to required reports, forms, or documents which does not
610
have the potential of negatively affecting patients. These
611
violations are of a type that the agency determines do not
612
threaten the health, safety, or security of patients. Upon
613
finding an uncorrected or repeated class IV deficiency, the
614
agency shall may impose an administrative fine not to exceed $500
615
$200 for each occurrence and each day that the uncorrected or
616
repeated deficiency exists.
617
(3) In addition to any other penalties imposed pursuant to
618
this section or part, the agency may assess costs related to an
619
investigation that results in a successful prosecution, excluding
620
costs associated with an attorney's time.
621
Section 6. Subsection (2) of section 400.491, Florida
622
Statutes, is amended to read:
623
400.491 Clinical records.--
624
(2) The home health agency must maintain for each client
625
who receives nonskilled care a service provision plan. Such
626
records must be maintained by the home health agency for 3 years
627
1 year following termination of services.
628
Section 7. Present subsections (5), (6), (7), and (8) of
629
section 400.497, Florida Statutes, are renumbered as subsections
630
(6), (7), (8), and (9), respectively, and a new subsection (5) is
631
added to that section, to read:
632
400.497 Rules establishing minimum standards.--The agency
633
shall adopt, publish, and enforce rules to implement part II of
634
chapter 408 and this part, including, as applicable, ss. 400.506
635
and 400.509, which must provide reasonable and fair minimum
636
standards relating to:
637
(5) Oversight by the director of nursing. The agency shall
638
develop rules related to:
639
(a) Standards that address oversight responsibilities by
640
the director of nursing of skilled nursing and personal care
641
services provided by the home health agency's staff;
642
(b) Requirements for a director of nursing to provide to
643
the agency, upon request, a certified daily report of the home
644
health services provided by a specified direct employee or
645
contracted staff member on behalf of the home health agency. The
646
agency may request a certified daily report only for a period not
647
to exceed 2 years prior to the date of the request; and
648
(c) A quality assurance program for home health services
649
provided by the home health agency.
650
Section 8. Paragraph (a) of subsection (6) of section
651
400.506, Florida Statutes, is amended to read:
652
400.506 Licensure of nurse registries; requirements;
653
penalties.--
654
(6)(a) A nurse registry may refer for contract in private
655
residences registered nurses and licensed practical nurses
656
registered and licensed under part I of chapter 464, certified
657
nursing assistants certified under part II of chapter 464, home
658
health aides who present documented proof of successful
659
completion of the training required by rule of the agency, and
660
companions or homemakers for the purposes of providing those
661
services authorized under s. 400.509(1). A licensed nurse
662
registry shall ensure that each certified nursing assistant
663
referred for contract by the nurse registry and each home health
664
aide referred for contract by the nurse registry is adequately
665
trained to perform the tasks of a home health aide in the home
666
setting. Each person referred by a nurse registry must provide
667
current documentation that he or she is free from communicable
668
diseases.
669
Section 9. Subsection (4) is added to section 400.518,
670
Florida Statutes, to read:
671
400.518 Prohibited referrals to home health agencies.--
672
(4) The agency shall impose an administrative fine of
673
$15,000 if a home health agency provides nurses, certified
674
nursing assistants, home health aides, or other staff without
675
charge to a facility licensed under chapter 429 in return for
676
patient referrals from the facility. The proceeds of such fines
677
shall be deposited into the Health Care Trust Fund.
678
Section 10. The Agency for Health Care Administration shall
679
conduct an unannounced survey of each home health agency within
680
15 months after issuing a new license to the home health agency.
681
Section 11. The Agency for Health Care Administration shall
682
review the process, procedures, and contractor's performance for
683
the prior authorization of home health agency visits that are in
684
excess of 60 visits over the lifetime of a Medicaid recipient.
685
The agency shall determine whether modifications are necessary in
686
order to reduce Medicaid fraud and abuse related to home health
687
services for a Medicaid recipient which are not medically
688
necessary. If modifications to the prior authorization function
689
are necessary, the agency shall amend the contract to require
690
contractor performance that reduces potential Medicaid fraud and
691
abuse with respect to home health agency visits.
692
Section 12. The Agency for Health Care Administration shall
693
report to the Legislature by January 1, 2009, on the feasibility
694
and costs of accessing the Medicare system to disallow Medicaid
695
payment for home health services that are paid for under the
696
Medicare prospective payment system for recipients who are dually
697
eligible for Medicaid and Medicare.
698
Section 13. This act shall take effect July 1, 2008.
CODING: Words stricken are deletions; words underlined are additions.