Bill Text: FL S0452 | 2023 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Home Health Aides for Medically Fragile Children

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2023-05-02 - Laid on Table, companion bill(s) passed, see CS/CS/CS/HB 391 (Ch. 2023-183) [S0452 Detail]

Download: Florida-2023-S0452-Introduced.html

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       Florida Senate - 2023                                     SB 452
       
       
        
       By Senator Harrell
       
       
       
       
       
       31-00381A-23                                           2023452__
    1                        A bill to be entitled                      
    2         An act relating to home health aides for medically
    3         fragile children; amending s. 400.462, F.S.; defining
    4         terms; amending s. 400.464, F.S.; requiring home
    5         health agencies to ensure that any tasks delegated to
    6         home health aides for medically fragile children meet
    7         specified requirements; amending s. 400.476, F.S.;
    8         requiring home health agencies to ensure that home
    9         health aides for medically fragile children employed
   10         by or under contract with them are adequately trained
   11         to perform the tasks they will be delegated; providing
   12         certain individuals an exemption from costs associated
   13         with specified training; creating s. 400.4765, F.S.;
   14         establishing the home health aides for medically
   15         fragile children program for specified purposes;
   16         requiring the Agency for Health Care Administration,
   17         in consultation with the Board of Nursing, to approve
   18         training programs for home health aides for medically
   19         fragile children; specifying minimum requirements for
   20         the training programs; authorizing home health
   21         agencies to employ certain persons as home health
   22         aides for medically fragile children if they meet
   23         specified criteria; requiring home health aides for
   24         medically fragile children to complete an approved
   25         training program again under certain circumstances;
   26         requiring home health aides for medically fragile
   27         children to complete additional training in HIV/AIDS
   28         and maintain a certificate in cardiopulmonary
   29         resuscitation; requiring home health agencies to
   30         ensure that home health aides for medically fragile
   31         children whom they employ complete certain inservice
   32         training during each 12-month period; requiring home
   33         health agencies to maintain documentation
   34         demonstrating compliance with such training
   35         requirements; exempting home health agencies from
   36         civil liability for terminating or denying employment
   37         to a home health aide for medically fragile children
   38         under certain circumstances; extending the exemption
   39         to certain agents of the home health agencies;
   40         prohibiting home health agencies and their agents from
   41         using certain criminal records or juvenile records
   42         other than for a specified purpose; requiring the
   43         agency to maintain confidentiality of certain
   44         confidential and exempt records; authorizing the
   45         agency, in consultation with the board, to adopt
   46         rules; amending s. 400.489, F.S.; authorizing home
   47         health aides for medically fragile children to
   48         administer certain medications under certain
   49         circumstances; requiring such home health aides for
   50         medically fragile children to complete additional
   51         inservice training annually to continue administering
   52         such medications; requiring the agency, in
   53         consultation with the board, to establish certain
   54         standards and procedures by rule for home health aides
   55         for medically fragile children who administer
   56         medications to patients; amending s. 400.490, F.S.;
   57         authorizing home health aides for medically fragile
   58         children to perform certain tasks delegated by a
   59         registered nurse; creating s. 400.54, F.S.; requiring
   60         the agency to conduct an annual assessment related to
   61         the home health aides for medically fragile children
   62         program; specifying requirements for the assessment;
   63         requiring the agency to submit a report to the
   64         Governor and the Legislature by a specified date each
   65         year, beginning on a specified date; directing the
   66         agency to modify any state Medicaid plans and
   67         implement any federal waivers necessary to implement
   68         the act; directing the agency to establish a certain
   69         Medicaid fee schedule at a specified rate and subject
   70         to a specified utilization cap; amending ss. 768.38
   71         and 768.381, F.S.; conforming cross-references;
   72         providing an effective date.
   73          
   74  Be It Enacted by the Legislature of the State of Florida:
   75  
   76         Section 1. Present subsections (5) through (10), (11),
   77  (12), (13), (14), and (15) through (29) of section 400.462,
   78  Florida Statutes, are redesignated as subsections (6) through
   79  (11), (13), (15), (16), (17), and (19) through (33),
   80  respectively, new subsections (5), (12), (14), and (18) are
   81  added to that section, and subsection (1) and present subsection
   82  (10) of that section are amended, to read:
   83         400.462 Definitions.—As used in this part, the term:
   84         (1) “Administrator” means a direct employee, as defined in
   85  subsection (10) (9), who is a licensed physician, physician
   86  assistant, or registered nurse licensed to practice in this
   87  state or an individual having at least 1 year of supervisory or
   88  administrative experience in home health care or in a facility
   89  licensed under chapter 395, under part II of this chapter, or
   90  under part I of chapter 429.
   91         (5) “Approved training program” means a course of training
   92  approved by the agency, in consultation with the Board of
   93  Nursing, under s. 400.4765 to train family caregivers as home
   94  health aides for medically fragile children.
   95         (11)(10) “Director of nursing” means a registered nurse who
   96  is a direct employee, as defined in subsection (10) (9), of the
   97  agency and who is a graduate of an approved school of nursing
   98  and is licensed in this state; who has at least 1 year of
   99  supervisory experience as a registered nurse; and who is
  100  responsible for overseeing the professional nursing and home
  101  health aid delivery of services of the agency.
  102         (12) “Eligible relative” means, with respect to the home
  103  health aide for medically fragile children program under s.
  104  400.4765, a person 21 years of age or younger who is eligible to
  105  receive continuous skilled nursing or skilled nursing respite
  106  care services under the Medicaid program and is a relative of a
  107  home health aide for medically fragile children.
  108         (14) “Family caregiver” means a person providing or
  109  intending to provide significant personal care and assistance to
  110  an eligible relative 21 years of age or younger who has an
  111  underlying physical or cognitive condition that prevents him or
  112  her from safely living independently.
  113         (18) “Home health aide for medically fragile children”
  114  means a family caregiver who meets the qualifications specified
  115  in s. 400.4765; performs tasks delegated to him or her under
  116  chapter 464 while caring for an eligible relative; and provides
  117  care and assistance to an eligible relative relating to:
  118         (a) Activities of daily living, such as those associated
  119  with personal care, maintaining mobility, nutrition and
  120  hydration, toileting and elimination, assistive devices, and
  121  safety and cleanliness.
  122         (b) Data gathering.
  123         (c) Reporting abnormal signs and symptoms.
  124         (d) Patient socialization and reality orientation.
  125         (e) Cardiopulmonary resuscitation and emergency care.
  126         (f) Residents’ or patients’ rights.
  127         (g) Documentation of services.
  128         (h) End-of-life care.
  129         (i) Postmortem care.
  130         Section 2. Subsection (5) of section 400.464, Florida
  131  Statutes, is amended to read:
  132         400.464 Home health agencies to be licensed; expiration of
  133  license; exemptions; unlawful acts; penalties.—
  134         (5) If a licensed home health agency authorizes a
  135  registered nurse to delegate tasks, including medication
  136  administration, to a certified nursing assistant pursuant to
  137  chapter 464 or to a home health aide or a home health aide for
  138  medically fragile children pursuant to s. 400.490, the licensed
  139  home health agency must ensure that such delegation meets the
  140  requirements of this chapter and chapter 464 and the rules
  141  adopted thereunder.
  142         Section 3. Subsection (3) of section 400.476, Florida
  143  Statutes, is amended to read:
  144         400.476 Staffing requirements; notifications; limitations
  145  on staffing services.—
  146         (3) TRAINING.—A home health agency shall ensure that each
  147  certified nursing assistant employed by or under contract with
  148  the home health agency and each home health aide and home health
  149  aide for medically fragile children employed by or under
  150  contract with the home health agency is adequately trained to
  151  perform the tasks of a home health aide in the home setting. A
  152  parent, guardian, or family member who seeks the training
  153  required under s. 464.4765 to become a home health aide for
  154  medically fragile children may not be required to repay or
  155  reimburse the home health agency for the costs associated with
  156  the training program.
  157         Section 4. Section 400.4765, Florida Statutes, is created
  158  to read:
  159         400.4765 Home health aides for medically fragile children
  160  program.—The home health aides for medically fragile children
  161  program is hereby established in response to the shortage of
  162  health care workers in this state and the impact that the
  163  shortage has on medically fragile children and their caregivers.
  164  The program is designed to decrease hospitalization and
  165  institutionalization of medically fragile children, reduce state
  166  expenditures, and provide an opportunity for affected family
  167  caregivers to receive training and gainful employment.
  168         (1) The agency, in consultation with the Board of Nursing,
  169  shall approve a training program created by a home health agency
  170  in accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
  171  train family caregivers as home health aides for medically
  172  fragile children to increase the health care workforce in this
  173  state and to authorize persons to provide trained nursing
  174  services to eligible relatives. The program must consist of at
  175  least 85 hours of training, including, but not limited to, all
  176  of the following:
  177         (a) A minimum of 40 hours of theoretical instruction in
  178  nursing, including, but not limited to, instruction on all of
  179  the following:
  180         1. Person-centered care.
  181         2. Communication and interpersonal skills.
  182         3. Infection control.
  183         4. Safety and emergency procedures.
  184         5. Assistance with activities of daily living.
  185         6. Mental health and social service needs.
  186         7. Care of cognitively impaired individuals.
  187         8. Basic restorative care and rehabilitation.
  188         9. Patient rights and confidentiality of personal
  189  information and medical records.
  190         10. Relevant legal and ethical issues.
  191  
  192  Such instruction must be offered in various formats, and any
  193  interactive instruction must be provided during various times of
  194  the day.
  195         (b) A minimum of 20 hours of skills training on basic
  196  nursing skills, including, but not limited to:
  197         1. Hygiene, grooming, and toileting.
  198         2. Skin care and pressure sore prevention.
  199         3. Nutrition and hydration.
  200         4. Measuring vital signs, height, and weight.
  201         5. Safe lifting, positioning, and moving of patients.
  202         6. Wound care.
  203         7. Portable oxygen use and safety and other respiratory
  204  procedures.
  205         8. Tracheostomy care.
  206         9. Enteral care and therapy.
  207         10. Peripheral intravenous assistive activities and
  208  alternative feeding methods.
  209         11. Urinary catheterization and ostomy care.
  210         (c) At least 16 hours of clinical training under direct
  211  supervision of a licensed registered nurse.
  212         (2) A home health agency may employ as a home health aide
  213  for medically fragile children any person 18 years of age or
  214  older who meets all of the following criteria:
  215         (a) Is a family caregiver of an eligible relative who is 21
  216  years of age or younger and is eligible to receive continuous
  217  skilled nursing or skilled nursing respite care services under
  218  the Medicaid program.
  219         (b) Demonstrates a minimum competency to read and write.
  220         (c) Completes a training program approved under this
  221  section or has graduated from an accredited school of nursing
  222  and has not yet taken the state exam for licensure in this
  223  state.
  224         (d) Successfully passes the required background screening
  225  pursuant to s. 400.215. If the person has successfully passed
  226  the required background screening pursuant to s. 400.215 or s.
  227  408.809 within 90 days before applying for a certificate to
  228  practice and the person’s background screening results are not
  229  retained in the clearinghouse created under s. 435.12, the
  230  agency must waive the requirement that the applicant
  231  successfully pass an additional background screening pursuant to
  232  s. 400.215.
  233         (3) If a home health aide for medically fragile children
  234  allows 24 consecutive months to pass without performing any
  235  nursing-related services for an eligible relative, the family
  236  caregiver must again complete an approved training program
  237  before serving as a home health aide for medically fragile
  238  children.
  239         (4) All home health aides for medically fragile children
  240  must complete an HIV/AIDS training course and are required to
  241  obtain and maintain a current certificate in cardiopulmonary
  242  resuscitation.
  243         (5) A home health agency that employs a home health aide
  244  for medically fragile children must ensure that the aide
  245  completes 12 hours of inservice training during each 12-month
  246  period as a condition of employment. The HIV/AIDS training and
  247  cardiopulmonary training required under subsection (4) may count
  248  toward meeting the 12 hours of inservice training. The home
  249  health agency shall maintain documentation demonstrating
  250  compliance with this subsection.
  251         (6) If a home health agency terminates or denies employment
  252  to a home health aide for medically fragile children who fails
  253  to maintain the requirements of this section or whose name
  254  appears on a criminal screening report of the Department of Law
  255  Enforcement, the home health agency is not civilly liable for
  256  such termination and a cause of action may not be brought
  257  against the home health agency for damages. There may not be any
  258  monetary liability on the part of, and a cause of action for
  259  damages may not arise against, any licensed facility or its
  260  governing board or members thereof, medical staff, disciplinary
  261  board, agents, investigators, witnesses, employees, or any other
  262  person for any action taken in good faith, without intentional
  263  fraud, to comply with this section.
  264         (7) A home health agency, or an agent thereof, may not use
  265  criminal records or juvenile records relating to vulnerable
  266  adults for any purpose other than determining if the person
  267  meets the requirements of this section. The agency shall
  268  maintain the confidentiality of any such records and information
  269  it obtains which are confidential and exempt from s. 119.07(1)
  270  and s. 24(a), Art. I of the State Constitution.
  271         (8) The agency, in consultation with the Board of Nursing,
  272  may adopt rules to implement this section.
  273         Section 5. Section 400.489, Florida Statutes, is amended to
  274  read:
  275         400.489 Administration of medication by a home health aide
  276  or home health aide for medically fragile children; staff
  277  training requirements.—
  278         (1) A home health aide or home health aide for medically
  279  fragile children may administer oral, transdermal, ophthalmic,
  280  otic, rectal, inhaled, enteral, or topical prescription
  281  medications if the home health aide or home health aide for
  282  medically fragile children has been delegated such task by a
  283  registered nurse licensed under chapter 464, has satisfactorily
  284  completed an initial 6-hour training course approved by the
  285  agency, and has been found competent to administer medication to
  286  a patient in a safe and sanitary manner. The training,
  287  determination of competency, and initial and annual validations
  288  required in this section shall be conducted by a registered
  289  nurse licensed under chapter 464 or a physician licensed under
  290  chapter 458 or chapter 459.
  291         (2) A Home health aides and home health aides for medically
  292  fragile children aide must annually and satisfactorily complete
  293  a 2-hour inservice training course approved by the agency in
  294  medication administration and medication error prevention. The
  295  inservice training course is shall be in addition to the annual
  296  inservice training hours required by agency rules.
  297         (3) The agency, in consultation with the Board of Nursing,
  298  shall establish by rule standards and procedures that a home
  299  health aide and home health aide for medically fragile children
  300  must follow when administering medication to a patient. Such
  301  rules must, at a minimum, address qualification requirements for
  302  trainers, requirements for labeling medication, documentation
  303  and recordkeeping, the storage and disposal of medication,
  304  instructions concerning the safe administration of medication,
  305  informed-consent requirements and records, and the training
  306  curriculum and validation procedures.
  307         Section 6. Section 400.490, Florida Statutes, is amended to
  308  read:
  309         400.490 Nurse-delegated tasks.—A certified nursing
  310  assistant, or home health aide, or home health aide for
  311  medically fragile children may perform any task delegated by a
  312  registered nurse as authorized in this part and in chapter 464,
  313  including, but not limited to, medication administration.
  314         Section 7. Section 400.54, Florida Statutes, is created to
  315  read:
  316         400.54 Annual assessment of home health aides for medically
  317  fragile children program.—The agency shall conduct an annual
  318  assessment of the home health aides for medically fragile
  319  children program established under s. 400.4765. The assessment
  320  must report caregiver satisfaction with the program, identify
  321  additional supports that may be needed by home health aides for
  322  medically fragile children, and assess the rate and extent of
  323  hospitalization of children in home health services who are
  324  attended by a home health aide for medically fragile children
  325  compared to those in home health services without a home health
  326  aide for medically fragile children. By January 1 of each year,
  327  beginning January 1, 2025, the agency shall report its findings
  328  to the Governor, the President of the Senate, and the Speaker of
  329  the House of Representatives.
  330         Section 8. The Agency for Health Care Administration shall
  331  modify any state Medicaid plans and implement any federal
  332  waivers necessary to implement this act. The agency shall
  333  establish a Medicaid fee schedule for home health agencies
  334  employing a home health aide for medically fragile children at
  335  $25 per hour with a utilization cap of no more than 8 hours per
  336  day.
  337         Section 9. Paragraph (e) of subsection (2) of section
  338  768.38, Florida Statutes, is amended to read:
  339         768.38 Liability protections for COVID-19-related claims.—
  340         (2) As used in this section, the term:
  341         (e) “Health care provider” means:
  342         1. A provider as defined in s. 408.803.
  343         2. A clinical laboratory providing services in this state
  344  or services to health care providers in this state, if the
  345  clinical laboratory is certified by the Centers for Medicare and
  346  Medicaid Services under the federal Clinical Laboratory
  347  Improvement Amendments and the federal rules adopted thereunder.
  348         3. A federally qualified health center as defined in 42
  349  U.S.C. s. 1396d(l)(2)(B), as that definition exists on the
  350  effective date of this act.
  351         4. Any site providing health care services which was
  352  established for the purpose of responding to the COVID-19
  353  pandemic pursuant to any federal or state order, declaration, or
  354  waiver.
  355         5. A health care practitioner as defined in s. 456.001.
  356         6. A health care professional licensed under part IV of
  357  chapter 468.
  358         7. A home health aide as defined in s. 400.462 s.
  359  400.462(15).
  360         8. A provider licensed under chapter 394 or chapter 397 and
  361  its clinical and nonclinical staff providing inpatient or
  362  outpatient services.
  363         9. A continuing care facility licensed under chapter 651.
  364         10. A pharmacy permitted under chapter 465.
  365         Section 10. Paragraph (f) of subsection (1) of section
  366  768.381, Florida Statutes, is amended to read:
  367         768.381 COVID-19-related claims against health care
  368  providers.—
  369         (1) DEFINITIONS.—As used in this section, the term:
  370         (f) “Health care provider” means any of the following:
  371         1. A provider as defined in s. 408.803.
  372         2. A clinical laboratory providing services in this state
  373  or services to health care providers in this state, if the
  374  clinical laboratory is certified by the Centers for Medicare and
  375  Medicaid Services under the federal Clinical Laboratory
  376  Improvement Amendments and the federal rules adopted thereunder.
  377         3. A federally qualified health center as defined in 42
  378  U.S.C. s. 1396d(l)(2)(B), as that definition existed on the
  379  effective date of this act.
  380         4. Any site providing health care services which was
  381  established for the purpose of responding to the COVID-19
  382  pandemic pursuant to any federal or state order, declaration, or
  383  waiver.
  384         5. A health care practitioner as defined in s. 456.001.
  385         6. A health care professional licensed under part IV of
  386  chapter 468.
  387         7. A home health aide as defined in s. 400.462 s.
  388  400.462(15).
  389         8. A provider licensed under chapter 394 or chapter 397 and
  390  its clinical and nonclinical staff providing inpatient or
  391  outpatient services.
  392         9. A continuing care facility licensed under chapter 651.
  393         10. A pharmacy permitted under chapter 465.
  394         Section 11. This act shall take effect upon becoming a law.