Florida Senate - 2020 COMMITTEE AMENDMENT
Bill No. CS for SB 1676
Senate . House
Appropriations Subcommittee on Health and Human Services
(Albritton) recommended the following:
1 Senate Amendment (with title amendment)
3 Delete lines 135 - 412
4 and insert:
5 Section 3. Subsection (1) of section 400.461, Florida
6 Statutes, is amended to read:
7 400.461 Short title; purpose.—
8 (1) This part, consisting of ss. 400.461-400.52
9 400.461-400.518, may be cited as the “Home Health Services Act.”
10 Section 4. Subsection (15) of section 400.462, Florida
11 Statutes, is amended to read:
12 400.462 Definitions.—As used in this part, the term:
13 (15) “Home health aide” means a person who is trained or
14 qualified, as provided by rule, and who provides hands-on
15 personal care, performs simple procedures as an extension of
16 therapy or nursing services, assists in ambulation or exercises,
17 or assists in administering medications as permitted in rule and
18 for which the person has received training established by the
19 agency under this part, or performs tasks delegated to him or
20 her under chapter 464 s. 400.497(1).
21 Section 5. Present subsections (5) and (6) of section
22 400.464, Florida Statutes, are redesignated as subsections (6)
23 and (7), respectively, a new subsection (5) is added to that
24 section, and present subsection (6) of that section is amended,
25 to read:
26 400.464 Home health agencies to be licensed; expiration of
27 license; exemptions; unlawful acts; penalties.—
28 (5) If a licensed home health agency authorizes a
29 registered nurse to delegate tasks, including medication
30 administration, to a certified nursing assistant pursuant to
31 chapter 464 or to a home health aide pursuant to s. 400.490, the
32 licensed home health agency must ensure that such delegation
33 meets the requirements of this chapter and chapter 464 and the
34 rules adopted thereunder.
35 (7) (6) Any person, entity, or organization providing home
36 health services which is exempt from licensure under subsection
37 (6) subsection (5) may voluntarily apply for a certificate of
38 exemption from licensure under its exempt status with the agency
39 on a form that specifies its name or names and addresses, a
40 statement of the reasons why it is exempt from licensure as a
41 home health agency, and other information deemed necessary by
42 the agency. A certificate of exemption is valid for a period of
43 not more than 2 years and is not transferable. The agency may
44 charge an applicant $100 for a certificate of exemption or
45 charge the actual cost of processing the certificate.
46 Section 6. Subsections (2) and (3) of section 400.488,
47 Florida Statutes, are amended to read:
48 400.488 Assistance with self-administration of medication.—
49 (2) Patients who are capable of self-administering their
50 own medications without assistance shall be encouraged and
51 allowed to do so. However, an unlicensed person may, consistent
52 with a dispensed prescription’s label or the package directions
53 of an over-the-counter medication, assist a patient whose
54 condition is medically stable with the self-administration of
55 routine, regularly scheduled medications that are intended to be
56 self-administered. Assistance with self-medication by an
57 unlicensed person may occur only upon a documented request by,
58 and the written informed consent of, a patient or the patient’s
59 surrogate, guardian, or attorney in fact. For purposes of this
60 section, self-administered medications include both legend and
61 over-the-counter oral dosage forms, topical dosage forms, and
62 topical ophthalmic, otic, and nasal dosage forms, including
63 solutions, suspensions, sprays, and inhalers, intermittent
64 positive pressure breathing treatments, and nebulizer
66 (3) Assistance with self-administration of medication
68 (a) Taking the medication, in its previously dispensed,
69 properly labeled container, from where it is stored and bringing
70 it to the patient.
71 (b) In the presence of the patient, confirming that the
72 medication is intended for that patient, orally advising the
73 patient of the medication name and purpose reading the label,
74 opening the container, removing a prescribed amount of
75 medication from the container, and closing the container.
76 (c) Placing an oral dosage in the patient’s hand or placing
77 the dosage in another container and helping the patient by
78 lifting the container to his or her mouth.
79 (d) Applying topical medications, including providing
80 routine preventative skin care and basic wound care.
81 (e) Returning the medication container to proper storage.
82 (f) For intermittent positive pressure breathing treatments
83 or for nebulizer treatments, assisting with setting up and
84 cleaning the device in the presence of the patient, confirming
85 that the medication is intended for that patient, orally
86 advising the patient of the medication name and purpose, opening
87 the container, removing the prescribed amount for a single
88 treatment dose from a properly labeled container, and assisting
89 the patient with placing the dose into the medicine receptacle
90 or mouthpiece.
91 (g) (f) Keeping a record of when a patient receives
92 assistance with self-administration under this section.
93 Section 7. Section 400.489, Florida Statutes, is created to
95 400.489 Administration of medication by a home health aide;
96 staff training requirements.—
97 (1) A home health aide may administer oral, transdermal,
98 ophthalmic, otic, rectal, inhaled, enteral, or topical
99 prescription medications if the home health aide has been
100 delegated such task by a registered nurse licensed under chapter
101 464; has satisfactorily completed an initial 6-hour training
102 course approved by the agency; and has been found competent to
103 administer medication to a patient in a safe and sanitary
104 manner. The training, determination of competency, and initial
105 and annual validations required in this section shall be
106 conducted by a registered nurse licensed under chapter 464 or a
107 physician licensed under chapter 458 or chapter 459.
108 (2) A home health aide must annually and satisfactorily
109 complete a 2-hour inservice training course approved by the
110 agency in medication administration and medication error
111 prevention. The inservice training course shall be in addition
112 to the annual inservice training hours required by agency rules.
113 (3) The agency, in consultation with the Board of Nursing,
114 shall establish by rule standards and procedures that a home
115 health aide must follow when administering medication to a
116 patient. Such rules must, at a minimum, address qualification
117 requirements for trainers, requirements for labeling medication,
118 documentation and recordkeeping, the storage and disposal of
119 medication, instructions concerning the safe administration of
120 medication, informed-consent requirements and records, and the
121 training curriculum and validation procedures.
122 Section 8. Section 400.490, Florida Statutes, is created to
124 400.490 Nurse-delegated tasks.—A certified nursing
125 assistant or home health aide may perform any task delegated by
126 a registered nurse as authorized in this part and in chapter
127 464, including, but not limited to, medication administration.
128 Section 9. Section 400.52, Florida Statutes, is created to
130 400.52 Excellence in Home Health Program.—
131 (1) There is created within the agency the Excellence in
132 Home Health Program for the purpose of awarding program
133 designations to home health agencies or nurse registries that
134 meet the criteria specified in this section.
135 (2)(a) The agency shall adopt rules establishing criteria
136 for the program which must include, at a minimum, meeting
137 standards relating to:
138 1. Patient satisfaction.
139 2. Patients requiring emergency care for wound infections.
140 3. Patients admitted or readmitted to an acute care
142 4. Patient improvement in the activities of daily living.
143 5. Employee satisfaction.
144 6. Quality of employee training.
145 7. Employee retention rates.
146 (b) The agency shall annually evaluate home health agencies
147 and nurse registries seeking the program designation which apply
148 on a form and in the manner designated by rule.
149 (3) To receive a program designation, the home health
150 agency or nurse registry must:
151 (a) Be actively licensed and have been operating for at
152 least 24 months before applying for the program designation. A
153 designation awarded under the program is not transferable to
154 another licensee, unless the existing home health agency or
155 nurse registry is being relicensed in the name of an entity
156 related to the current licenseholder by common control or
157 ownership and there will be no change in the management,
158 operation, or programs of the home health agency or nurse
159 registry as a result of the relicensure.
160 (b) Have not had any licensure denials, revocations, or
161 Class I, Class II, or uncorrected Class III deficiencies within
162 the 24 months before the application for the program
164 (4) The program designation expires on the same date as the
165 home health agency’s or nurse registry’s license. A home health
166 agency or nurse registry must reapply and be approved biennially
167 for the program designation to continue using the program
168 designation in the manner authorized under subsection (5).
169 (5) A home health agency or nurse registry that is awarded
170 a designation under the program may use the designation in
171 advertising and marketing. A home health agency or nurse
172 registry may not use the program designation in any advertising
173 or marketing if the home health agency or nurse registry:
174 (a) Has not been awarded the designation;
175 (b) Fails to renew the designation upon expiration of the
176 awarded designation;
177 (c) Has undergone a change in ownership that does not
178 qualify for an exception under paragraph (3)(a); or
179 (d) Has been notified that it no longer meets the criteria
180 for the award upon reapplication after expiration of the awarded
182 (6) An application for an award designation under the
183 program is not an application for licensure. A designation award
184 or denial by the agency under this section does not constitute
185 final agency action subject to chapter 120.
186 Section 10. Section 408.822, Florida Statutes, is created
187 to read:
188 408.822 Direct care workforce survey.—
189 (1) For purposes of this section, the term “direct care
190 worker” means a certified nursing assistant, a home health aide,
191 a personal care assistant, a companion services or homemaker
192 services provider, a paid feeding assistant trained under s.
193 400.141(1)(v), or another individual who provides personal care
194 as defined in s. 400.462 to individuals who are elderly,
195 developmentally disabled, or chronically ill.
196 (2) Beginning January 1, 2021, each licensee that applies
197 for licensure renewal as a nursing home facility licensed under
198 part II of chapter 400, an assisted living facility licensed
199 under part I of chapter 429, or a home health agency or
200 companion services or homemaker services provider licensed under
201 part III of chapter 400 shall furnish the following information
202 to the agency in a survey on the direct care workforce:
203 (a) The number of registered nurses and the number of
204 direct care workers by category employed by the licensee.
205 (b) The turnover and vacancy rates of registered nurses and
206 direct care workers and the contributing factors to these rates.
207 (c) The average employee wage for registered nurses and
208 each category of direct care worker.
209 (d) Employment benefits for registered nurses and direct
210 care workers and the average cost of such benefits to the
211 employer and the employee.
212 (e) Type and availability of training for registered nurses
213 and direct care workers.
214 (3) An administrator or designee shall include the
215 information required in subsection (2) on a survey form
216 developed by the agency by rule which must contain an
217 attestation that the information provided is true and accurate
218 to the best of his or her knowledge.
219 (4) The licensee must submit the completed survey prior to
220 the agency issuing the license renewal.
221 (5) The agency shall continually analyze the results of the
222 surveys and publish the results on its website. The agency shall
223 update the information published on its website monthly.
224 Section 11. Section 464.0156, Florida Statutes, is created
225 to read:
226 464.0156 Delegation of duties.—
227 (1) A registered nurse may delegate a task to a certified
228 nursing assistant certified under part II of this chapter or a
229 home health aide as defined in s. 400.462, if the registered
230 nurse determines that the certified nursing assistant or the
231 home health aide is competent to perform the task, the task is
232 delegable under federal law, and the task:
233 (a) Is within the nurse’s scope of practice.
234 (b) Frequently recurs in the routine care of a patient or
235 group of patients.
236 (c) Is performed according to an established sequence of
238 (d) Involves little or no modification from one patient to
240 (e) May be performed with a predictable outcome.
241 (f) Does not inherently involve ongoing assessment,
242 interpretation, or clinical judgment.
243 (g) Does not endanger a patient’s life or well-being.
244 (2) A registered nurse may delegate to a certified nursing
245 assistant or a home health aide the administration of oral,
246 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
247 topical prescription medications to a patient of a home health
248 agency, if the certified nursing assistant or home health aide
249 meets the requirements of s. 464.2035 or s. 400.489,
250 respectively. A registered nurse may not delegate the
251 administration of any controlled substance listed in Schedule
252 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s.
254 (3) The board, in consultation with the Agency for Health
255 Care Administration, shall adopt rules to implement this
257 Section 12. Paragraph (r) is added to subsection (1) of
258 section 464.018, Florida Statutes, to read:
259 464.018 Disciplinary actions.—
260 (1) The following acts constitute grounds for denial of a
261 license or disciplinary action, as specified in ss. 456.072(2)
262 and 464.0095:
263 (r) Delegating professional responsibilities to a person
264 when the nurse delegating such responsibilities knows or has
265 reason to know that such person is not qualified by training,
266 experience, certification, or licensure to perform them.
267 Section 13. Section 464.2035, Florida Statutes, is created
268 to read:
269 464.2035 Administration of medication.—
270 (1) A certified nursing assistant may administer oral,
271 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
272 topical prescription medication to a patient of a home health
273 agency if the certified nursing assistant has been delegated
274 such task by a registered nurse licensed under part I of this
275 chapter, has satisfactorily completed an initial 6-hour training
276 course approved by the board, and has been found competent to
277 administer medication to a patient in a safe and sanitary
278 manner. The training, determination of competency, and initial
279 and annual validations required under this section must be
280 conducted by a registered nurse licensed under this chapter or a
281 physician licensed under chapter 458 or chapter 459.
282 (2) A certified nursing assistant shall annually and
283 satisfactorily complete 2 hours of inservice training in
284 medication administration and medication error prevention
285 approved by the board, in consultation with the Agency for
286 Health Care Administration. The inservice training is in
287 addition to the other annual inservice training hours required
288 under this part.
289 (3) The board, in consultation with the Agency for Health
290 Care Administration, shall establish by rule standards and
291 procedures that a certified nursing assistant must follow when
292 administering medication to a patient of a home health agency.
293 Such rules must, at a
295 ================= T I T L E A M E N D M E N T ================
296 And the title is amended as follows:
297 Delete lines 10 - 51
298 and insert:
299 with minimum staffing standards; amending s. 400.461,
300 F.S.; revising a short title; amending s. 400.462,
301 F.S.; revising the definition of the term “home health
302 aide”; amending s. 400.464, F.S.; requiring a licensed
303 home health agency that authorizes a registered nurse
304 to delegate tasks to a certified nursing assistant to
305 ensure that certain requirements are met; amending s.
306 400.488, F.S.; authorizing an unlicensed person to
307 assist with self-administration of certain treatments;
308 revising the requirements for such assistance;
309 creating s. 400.489, F.S.; authorizing a home health
310 aide to administer certain prescription medications
311 under certain conditions; requiring the home health
312 aide to meet certain training and competency
313 requirements; requiring the training, determination of
314 competency, and annual validations of home health
315 aides to be conducted by a registered nurse or a
316 physician; requiring a home health aide to complete
317 annual inservice training in medication administration
318 and medication error prevention, in addition to
319 existing annual inservice training requirements;
320 requiring the Agency for Health Care Administration,
321 in consultation with the Board of Nursing, to
322 establish by rule standards and procedures for
323 medication administration by home health aides;
324 creating s. 400.490, F.S.; authorizing a certified
325 nursing assistant or home health aide to perform tasks
326 delegated by a registered nurse; creating s. 400.52,
327 F.S.; creating the Excellence in Home Health Program
328 within the agency; requiring the agency to adopt rules
329 establishing program criteria; requiring the agency to
330 annually evaluate certain home health agencies and
331 nurse registries that apply for a program designation;
332 providing program designation eligibility
333 requirements; providing that a program designation is
334 not transferable, with an exception; providing for the
335 expiration of awarded designations; requiring home
336 health agencies and nurse registries to reapply
337 biennially to renew the awarded program designation;
338 authorizing a program designation award recipient to
339 use the designation in advertising and marketing;
340 prohibiting a home health agency or nurse registry
341 from using a program designation in advertising or
342 marketing under certain circumstances; providing that
343 an application under the program is not an application
344 for licensure; providing that certain actions by the
345 agency are not subject to certain provisions; creating
346 s. 408.822,