Florida Senate - 2020                        COMMITTEE AMENDMENT
       Bill No. CS for SB 1676
                              LEGISLATIVE ACTION                        
                    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 ss.
    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
   65  treatments.
   66         (3) Assistance with self-administration of medication
   67  includes:
   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
   94  read:
   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
  123  read:
  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
  129  read:
  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
  141  hospital.
  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
  163  designation.
  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
  181  designation.
  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
  237  steps.
  238         (d) Involves little or no modification from one patient to
  239  another.
  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.
  253  812.
  254         (3) The board, in consultation with the Agency for Health
  255  Care Administration, shall adopt rules to implement this
  256  section.
  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,