Florida Senate - 2025 COMMITTEE AMENDMENT
Bill No. CS for SB 1156
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LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/23/2025 .
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The Committee on Fiscal Policy (Harrell) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Section 400.54, Florida Statutes, is amended to
6 read:
7 400.54 Annual assessment of the home health aide for
8 medically fragile children program.—
9 (1) The agency shall conduct an annual assessment of the
10 home health aide for medically fragile children program. The
11 assessment must report caregiver satisfaction with the program,
12 report data on adverse incidents, and identify additional
13 support that may be needed by the home health aide for medically
14 fragile children, and assess the rate and extent of
15 hospitalization of children in home health services who are
16 attended by a home health aide for medically fragile children
17 compared to those in home health services provided by a
18 registered nurse or a licensed practical nurse without a home
19 health aide for medically fragile children. Medicaid managed
20 care plans shall provide to the agency data necessary to perform
21 this assessment.
22 (2) The home health agency must report all adverse
23 incidents occurring under the care of a home health aide for
24 medically fragile children to the agency and managed care plan
25 within 48 hours of the incident. For purposes of reporting to
26 the agency under this section, the term “adverse incident”
27 means:
28 (a) Death.
29 (b) Brain or spinal damage.
30 (c) Permanent disfigurement.
31 (d) Fracture or dislocation of bones or joints.
32 (e) A limitation of neurological, physical, or sensory
33 function.
34 (f) An event that is reported to law enforcement or its
35 personnel for investigation.
36
37 By January 1 of each year, beginning January 1, 2025, the agency
38 shall report its findings to the Governor, the President of the
39 Senate, and the Speaker of the House of Representatives.
40 Section 2. Paragraph (a) of subsection (3) and subsection
41 (9) of section 400.4765, Florida Statutes, are amended, and
42 subsection (10) is added to that section, to read:
43 400.4765 Home health aide for medically fragile children
44 program.—
45 (3) TRAINING.—
46 (a) Before providing services to an eligible relative, a
47 home health aide for medically fragile children must complete an
48 agency-approved training program. The employing home health
49 agency must provide validation of competency by a registered
50 nurse, and maintain documentation of training completion and
51 competency validation. The employing home health agency must
52 provide additional training and competency validation as the
53 medically fragile child’s care needs change, consistent with any
54 changes to the plan of care. The employing home health agency
55 must provide training on HIV infections and AIDS and must ensure
56 that each home health aide for medically fragile children holds
57 and maintains a certification in cardiopulmonary resuscitation.
58 (b)(a) The agency, in consultation with the Board of
59 Nursing, shall approve home health aide for medically fragile
60 children training programs developed by home health agencies in
61 accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
62 train family caregivers as home health aides for medically
63 fragile children to increase the health care provider workforce
64 and to authorize persons to provide trained nursing services as
65 delegated by a registered nurse to eligible relatives. The
66 training programs program must include supervised practical
67 training under the direct supervision of a licensed registered
68 nurse which must be tailored to the needs of an eligible
69 relative. consist of at least 85 hours of training, including,
70 but not limited to, all of the following:
71 1. A minimum of 40 hours of theoretical instruction in
72 nursing, including, but not limited to, instruction on all of
73 the following:
74 a. Person-centered care.
75 b. Communication and interpersonal skills.
76 c. Infection control.
77 d. Safety and emergency procedures.
78 e. Assistance with activities of daily living.
79 f. Mental health and social service needs.
80 g. Care of cognitively impaired individuals.
81 h. Basic restorative care and rehabilitation.
82 i. Patient rights and confidentiality of personal
83 information and medical records.
84 j. Relevant legal and ethical issues.
85
86 Such instruction must be offered in various formats, and any
87 interactive instruction must be provided during various times of
88 the day.
89 2. A minimum of 20 hours of skills training on basic
90 nursing skills, including, but not limited to:
91 a. Hygiene, grooming, and toileting.
92 b. Skin care and pressure sore prevention.
93 c. Nutrition and hydration.
94 d. Measuring vital signs, height, and weight.
95 e. Safe lifting, positioning, and moving of patients.
96 f. Wound care.
97 g. Portable Oxygen use and safety and other respiratory
98 procedures.
99 h. Tracheostomy care.
100 i. Enteral care and therapy.
101 j. Peripheral Intravenous assistive activities and
102 alternative feeding methods.
103 k. Urinary catheterization and ostomy care.
104 3. At least 16 hours of clinical training under direct
105 supervision of a licensed registered nurse.
106 4. Training concerning HIV infections and AIDS and is
107 required to obtain and maintain a current certificate in
108 cardiopulmonary resuscitation.
109 (9) FEE SCHEDULE.—The agency shall modify any state
110 Medicaid plans and implement any federal waivers necessary to
111 implement this section and shall establish a Medicaid fee
112 schedule for home health agencies employing a home health aide
113 for medically fragile children at minimum rate of $25 per hour
114 with a utilization cap of no more than 12 8 hours per day and 40
115 hours per week, per medically fragile child. The utilization cap
116 of 40 hours per week, per recipient may be exceeded; however,
117 justification must be provided as to why there is no other
118 qualified provider available, and the request must be approved
119 by the home health agency and the managed care plan.
120 (10) FEDERAL APPROVAL.—The agency shall seek necessary
121 federal approval, including seeking the appropriate federal
122 waiver, to:
123 (a) Allow Medicaid private duty nursing specialty providers
124 and home health services providers to participate in and receive
125 reimbursement for services rendered under this program.
126 (b) Provide that the income earned under this program by a
127 home health aide for medically fragile children is disregarded
128 in Medicaid eligibility determinations.
129 Section 3. Subsection (18) of section 400.462, Florida
130 Statutes, is amended to read:
131 400.462 Definitions.—As used in this part, the term:
132 (18) “Home health aide for medically fragile children”
133 means a family caregiver who meets the qualifications specified
134 in this part and who performs tasks delegated to him or her
135 under chapter 464 while caring for an eligible relative, and
136 provides care relating to activities of daily living, including
137 those associated with personal care; maintaining mobility;
138 nutrition and hydration; toileting and elimination; assistive
139 devices; safety and cleanliness; data gathering; reporting
140 abnormal signs and symptoms; postmortem care; patient
141 socialization and reality orientation; end-of-life care;
142 cardiopulmonary resuscitation and emergency care; residents’ or
143 patients’ rights; documentation of services performed; infection
144 control; safety and emergency procedures; hygiene, grooming,
145 skin care, and pressure sore prevention; wound care; portable
146 oxygen use and safety and other respiratory procedures;
147 tracheostomy care; enteral care and therapy; peripheral
148 intravenous assistive activities and alternative feeding
149 methods; and any other tasks delegated to the family caregiver
150 under chapter 464.
151 Section 4. Paragraph (c) of subsection (1) of section
152 409.903, Florida Statutes, is amended to read:
153 409.903 Mandatory payments for eligible persons.—The agency
154 shall make payments for medical assistance and related services
155 on behalf of the following persons who the department, or the
156 Social Security Administration by contract with the Department
157 of Children and Families, determines to be eligible, subject to
158 the income, assets, and categorical eligibility tests set forth
159 in federal and state law. Payment on behalf of these Medicaid
160 eligible persons is subject to the availability of moneys and
161 any limitations established by the General Appropriations Act or
162 chapter 216.
163 (1) Low-income families with children are eligible for
164 Medicaid provided they meet the following requirements:
165 (c) The family’s countable income and resources do not
166 exceed the applicable Aid to Families with Dependent Children
167 (AFDC) income and resource standards under the AFDC state plan
168 in effect in July 1996, except as amended in the Medicaid state
169 plan to conform as closely as possible to the requirements of
170 the welfare transition program, to the extent permitted by
171 federal law. The agency shall seek federal approval, including
172 seeking the appropriate federal waiver or state plan amendment,
173 to exclude from the family’s countable income any income earned
174 through employment as a home health aide for medically fragile
175 children under s. 400.4765.
176 Section 5. Within 60 days after this act becomes law, the
177 Agency for Health Care Administration shall make all necessary
178 requests and submissions to obtain federal approval to implement
179 this act amending s. 409.903, Florida Statutes, and initiate any
180 necessary rulemaking to implement the provisions of this act
181 amending s. 400.4765, Florida Statutes.
182 Section 6. This act shall take effect upon becoming a law.
183
184 ================= T I T L E A M E N D M E N T ================
185 And the title is amended as follows:
186 Delete everything before the enacting clause
187 and insert:
188 A bill to be entitled
189 An act relating to the home health aide for medically
190 fragile children program; amending s. 400.54, F.S.;
191 providing requirements for the annual assessment of
192 the home health aide for medically fragile children
193 program; amending s. 400.4765, F.S.; revising program
194 training requirements; requiring an employing home
195 health agency to provide specified training and ensure
196 that each home health aide for medically fragile
197 children holds and maintains specified certification;
198 revising the utilization cap of a Medicaid fee
199 schedule; requiring a home health aide for medically
200 fragile children who works more than 40 hours per week
201 to provide specified justification; providing
202 requirements for the Agency for Health Care
203 Administration to seek federal approval and a federal
204 waiver for specified purposes; amending s. 400.462,
205 F.S.; conforming provisions to changes made by the
206 act; amending s. 409.903, F.S.; requiring the agency
207 to seek federal approval and implement federal waivers
208 and state plan amendments for specified purposes;
209 providing an effective date.