Bill Text: FL S0452 | 2023 | Regular Session | Comm Sub

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

---

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-Comm_Sub.html

---

       Florida Senate - 2023                              CS for SB 452
       
       
        
       By the Appropriations Committee on Health and Human Services;
       and Senator Harrell
       
       
       
       
       603-02369-23                                           2023452c1
    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 appropriations and authorizing positions;
   73         providing an effective date.
   74          
   75  Be It Enacted by the Legislature of the State of Florida:
   76  
   77         Section 1. Present subsections (5) through (10), (11),
   78  (12), (13), (14), and (15) through (29) of section 400.462,
   79  Florida Statutes, are redesignated as subsections (6) through
   80  (11), (13), (15), (16), (17), and (19) through (33),
   81  respectively, new subsections (5), (12), (14), and (18) are
   82  added to that section, and subsection (1) and present subsection
   83  (10) of that section are amended, to read:
   84         400.462 Definitions.—As used in this part, the term:
   85         (1) “Administrator” means a direct employee, as defined in
   86  subsection (10) (9), who is a licensed physician, physician
   87  assistant, or registered nurse licensed to practice in this
   88  state or an individual having at least 1 year of supervisory or
   89  administrative experience in home health care or in a facility
   90  licensed under chapter 395, under part II of this chapter, or
   91  under part I of chapter 429.
   92         (5) “Approved training program” means a course of training
   93  approved by the agency, in consultation with the Board of
   94  Nursing, under s. 400.4765 to train family caregivers as home
   95  health aides for medically fragile children.
   96         (11)(10) “Director of nursing” means a registered nurse who
   97  is a direct employee, as defined in subsection (10) (9), of the
   98  agency and who is a graduate of an approved school of nursing
   99  and is licensed in this state; who has at least 1 year of
  100  supervisory experience as a registered nurse; and who is
  101  responsible for overseeing the professional nursing and home
  102  health aid delivery of services of the agency.
  103         (12) “Eligible relative” means, with respect to the home
  104  health aide for medically fragile children program under s.
  105  400.4765, a person 21 years of age or younger who is eligible to
  106  receive continuous skilled nursing or skilled nursing respite
  107  care services under the Medicaid program and is a relative of a
  108  home health aide for medically fragile children.
  109         (14) “Family caregiver” means a person providing or
  110  intending to provide significant personal care and assistance to
  111  an eligible relative 21 years of age or younger who has an
  112  underlying physical or cognitive condition that prevents him or
  113  her from safely living independently.
  114         (18) “Home health aide for medically fragile children”
  115  means a family caregiver who meets the qualifications specified
  116  in s. 400.4765; performs tasks delegated to him or her under
  117  chapter 464 while caring for an eligible relative; and provides
  118  care and assistance to an eligible relative relating to:
  119         (a) Activities of daily living, such as those associated
  120  with personal care, maintaining mobility, nutrition and
  121  hydration, toileting and elimination, assistive devices, and
  122  safety and cleanliness.
  123         (b) Data gathering.
  124         (c) Reporting abnormal signs and symptoms.
  125         (d) Patient socialization and reality orientation.
  126         (e) Cardiopulmonary resuscitation and emergency care.
  127         (f) Residents’ or patients’ rights.
  128         (g) Documentation of services.
  129         (h) End-of-life care.
  130         (i) Postmortem care.
  131         Section 2. Subsection (5) of section 400.464, Florida
  132  Statutes, is amended to read:
  133         400.464 Home health agencies to be licensed; expiration of
  134  license; exemptions; unlawful acts; penalties.—
  135         (5) If a licensed home health agency authorizes a
  136  registered nurse to delegate tasks, including medication
  137  administration, to a certified nursing assistant pursuant to
  138  chapter 464 or to a home health aide or a home health aide for
  139  medically fragile children pursuant to s. 400.490, the licensed
  140  home health agency must ensure that such delegation meets the
  141  requirements of this chapter and chapter 464 and the rules
  142  adopted thereunder.
  143         Section 3. Subsection (3) of section 400.476, Florida
  144  Statutes, is amended to read:
  145         400.476 Staffing requirements; notifications; limitations
  146  on staffing services.—
  147         (3) TRAINING.—A home health agency shall ensure that each
  148  certified nursing assistant employed by or under contract with
  149  the home health agency and each home health aide and home health
  150  aide for medically fragile children employed by or under
  151  contract with the home health agency is adequately trained to
  152  perform the tasks of a home health aide in the home setting. A
  153  parent, guardian, or family member who seeks the training
  154  required under s. 464.4765 to become a home health aide for
  155  medically fragile children may not be required to repay or
  156  reimburse the home health agency for the costs associated with
  157  the training program.
  158         Section 4. Section 400.4765, Florida Statutes, is created
  159  to read:
  160         400.4765 Home health aides for medically fragile children
  161  program.—The home health aides for medically fragile children
  162  program is hereby established in response to the shortage of
  163  health care workers in this state and the impact that the
  164  shortage has on medically fragile children and their caregivers.
  165  The program is designed to decrease hospitalization and
  166  institutionalization of medically fragile children, reduce state
  167  expenditures, and provide an opportunity for affected family
  168  caregivers to receive training and gainful employment.
  169         (1) The agency, in consultation with the Board of Nursing,
  170  shall approve a training program created by a home health agency
  171  in accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
  172  train family caregivers as home health aides for medically
  173  fragile children to increase the health care workforce in this
  174  state and to authorize persons to provide trained nursing
  175  services to eligible relatives. The program must consist of at
  176  least 85 hours of training, including, but not limited to, all
  177  of the following:
  178         (a) A minimum of 40 hours of theoretical instruction in
  179  nursing, including, but not limited to, instruction on all of
  180  the following:
  181         1. Person-centered care.
  182         2. Communication and interpersonal skills.
  183         3. Infection control.
  184         4. Safety and emergency procedures.
  185         5. Assistance with activities of daily living.
  186         6. Mental health and social service needs.
  187         7. Care of cognitively impaired individuals.
  188         8. Basic restorative care and rehabilitation.
  189         9. Patient rights and confidentiality of personal
  190  information and medical records.
  191         10. Relevant legal and ethical issues.
  192  
  193  Such instruction must be offered in various formats, and any
  194  interactive instruction must be provided during various times of
  195  the day.
  196         (b) A minimum of 20 hours of skills training on basic
  197  nursing skills, including, but not limited to:
  198         1. Hygiene, grooming, and toileting.
  199         2. Skin care and pressure sore prevention.
  200         3. Nutrition and hydration.
  201         4. Measuring vital signs, height, and weight.
  202         5. Safe lifting, positioning, and moving of patients.
  203         6. Wound care.
  204         7. Portable oxygen use and safety and other respiratory
  205  procedures.
  206         8. Tracheostomy care.
  207         9. Enteral care and therapy.
  208         10. Peripheral intravenous assistive activities and
  209  alternative feeding methods.
  210         11. Urinary catheterization and ostomy care.
  211         (c) At least 16 hours of clinical training under direct
  212  supervision of a licensed registered nurse.
  213         (2) A home health agency may employ as a home health aide
  214  for medically fragile children any person 18 years of age or
  215  older who meets all of the following criteria:
  216         (a) Is a family caregiver of an eligible relative who is 21
  217  years of age or younger and is eligible to receive continuous
  218  skilled nursing or skilled nursing respite care services under
  219  the Medicaid program.
  220         (b) Demonstrates a minimum competency to read and write.
  221         (c) Completes a training program approved under this
  222  section or has graduated from an accredited school of nursing
  223  and has not yet taken the state exam for licensure in this
  224  state.
  225         (d) Successfully passes the required background screening
  226  pursuant to s. 400.512. If the person has successfully passed
  227  the required background screening pursuant to s. 400.512 or s.
  228  408.809 within 90 days before applying for a certificate to
  229  practice and the person’s background screening results are not
  230  retained in the clearinghouse created under s. 435.12, the
  231  agency must waive the requirement that the applicant
  232  successfully pass an additional background screening pursuant to
  233  s. 400.512.
  234         (3) If a home health aide for medically fragile children
  235  allows 24 consecutive months to pass without performing any
  236  nursing-related services for an eligible relative, the family
  237  caregiver must again complete an approved training program
  238  before serving as a home health aide for medically fragile
  239  children.
  240         (4) All home health aides for medically fragile children
  241  must complete an HIV/AIDS training course and are required to
  242  obtain and maintain a current certificate in cardiopulmonary
  243  resuscitation.
  244         (5) A home health agency that employs a home health aide
  245  for medically fragile children must ensure that the aide
  246  completes 12 hours of inservice training during each 12-month
  247  period as a condition of employment. The HIV/AIDS training and
  248  cardiopulmonary training required under subsection (4) may count
  249  toward meeting the 12 hours of inservice training. The home
  250  health agency shall maintain documentation demonstrating
  251  compliance with this subsection.
  252         (6) If a home health agency terminates or denies employment
  253  to a home health aide for medically fragile children who fails
  254  to maintain the requirements of this section or whose name
  255  appears on a criminal screening report of the Department of Law
  256  Enforcement, the home health agency is not civilly liable for
  257  such termination and a cause of action may not be brought
  258  against the home health agency for damages. There may not be any
  259  monetary liability on the part of, and a cause of action for
  260  damages may not arise against, any licensed facility or its
  261  governing board or members thereof, medical staff, disciplinary
  262  board, agents, investigators, witnesses, employees, or any other
  263  person for any action taken in good faith, without intentional
  264  fraud, to comply with this section.
  265         (7) A home health agency, or an agent thereof, may not use
  266  criminal records or juvenile records relating to vulnerable
  267  adults for any purpose other than determining if the person
  268  meets the requirements of this section. The agency shall
  269  maintain the confidentiality of any such records and information
  270  it obtains which are confidential and exempt from s. 119.07(1)
  271  and s. 24(a), Art. I of the State Constitution.
  272         (8) The agency, in consultation with the Board of Nursing,
  273  may adopt rules to implement this section.
  274         Section 5. Section 400.489, Florida Statutes, is amended to
  275  read:
  276         400.489 Administration of medication by a home health aide
  277  or home health aide for medically fragile children; staff
  278  training requirements.—
  279         (1) A home health aide or home health aide for medically
  280  fragile children may administer oral, transdermal, ophthalmic,
  281  otic, rectal, inhaled, enteral, or topical prescription
  282  medications if the home health aide or home health aide for
  283  medically fragile children has been delegated such task by a
  284  registered nurse licensed under chapter 464, has satisfactorily
  285  completed an initial 6-hour training course approved by the
  286  agency, and has been found competent to administer medication to
  287  a patient in a safe and sanitary manner. The training,
  288  determination of competency, and initial and annual validations
  289  required in this section shall be conducted by a registered
  290  nurse licensed under chapter 464 or a physician licensed under
  291  chapter 458 or chapter 459.
  292         (2) A Home health aides and home health aides for medically
  293  fragile children aide must annually and satisfactorily complete
  294  a 2-hour inservice training course approved by the agency in
  295  medication administration and medication error prevention. The
  296  inservice training course is shall be in addition to the annual
  297  inservice training hours required by agency rules.
  298         (3) The agency, in consultation with the Board of Nursing,
  299  shall establish by rule standards and procedures that a home
  300  health aide and home health aide for medically fragile children
  301  must follow when administering medication to a patient. Such
  302  rules must, at a minimum, address qualification requirements for
  303  trainers, requirements for labeling medication, documentation
  304  and recordkeeping, the storage and disposal of medication,
  305  instructions concerning the safe administration of medication,
  306  informed-consent requirements and records, and the training
  307  curriculum and validation procedures.
  308         Section 6. Section 400.490, Florida Statutes, is amended to
  309  read:
  310         400.490 Nurse-delegated tasks.—A certified nursing
  311  assistant, or home health aide, or home health aide for
  312  medically fragile children may perform any task delegated by a
  313  registered nurse as authorized in this part and in chapter 464,
  314  including, but not limited to, medication administration.
  315         Section 7. Section 400.54, Florida Statutes, is created to
  316  read:
  317         400.54 Annual assessment of home health aides for medically
  318  fragile children program.—The agency shall conduct an annual
  319  assessment of the home health aides for medically fragile
  320  children program established under s. 400.4765. The assessment
  321  must report caregiver satisfaction with the program, identify
  322  additional supports that may be needed by home health aides for
  323  medically fragile children, and assess the rate and extent of
  324  hospitalization of children in home health services who are
  325  attended by a home health aide for medically fragile children
  326  compared to those in home health services without a home health
  327  aide for medically fragile children. By January 1 of each year,
  328  beginning January 1, 2025, the agency shall report its findings
  329  to the Governor, the President of the Senate, and the Speaker of
  330  the House of Representatives.
  331         Section 8. The Agency for Health Care Administration shall
  332  modify any state Medicaid plans and implement any federal
  333  waivers necessary to implement this act. The agency shall
  334  establish a Medicaid fee schedule for home health agencies
  335  employing a home health aide for medically fragile children at
  336  $25 per hour with a utilization cap of no more than 8 hours per
  337  day.
  338         Section 9. Paragraph (e) of subsection (2) of section
  339  768.38, Florida Statutes, is amended to read:
  340         768.38 Liability protections for COVID-19-related claims.—
  341         (2) As used in this section, the term:
  342         (e) “Health care provider” means:
  343         1. A provider as defined in s. 408.803.
  344         2. A clinical laboratory providing services in this state
  345  or services to health care providers in this state, if the
  346  clinical laboratory is certified by the Centers for Medicare and
  347  Medicaid Services under the federal Clinical Laboratory
  348  Improvement Amendments and the federal rules adopted thereunder.
  349         3. A federally qualified health center as defined in 42
  350  U.S.C. s. 1396d(l)(2)(B), as that definition exists on the
  351  effective date of this act.
  352         4. Any site providing health care services which was
  353  established for the purpose of responding to the COVID-19
  354  pandemic pursuant to any federal or state order, declaration, or
  355  waiver.
  356         5. A health care practitioner as defined in s. 456.001.
  357         6. A health care professional licensed under part IV of
  358  chapter 468.
  359         7. A home health aide as defined in s. 400.462 s.
  360  400.462(15).
  361         8. A provider licensed under chapter 394 or chapter 397 and
  362  its clinical and nonclinical staff providing inpatient or
  363  outpatient services.
  364         9. A continuing care facility licensed under chapter 651.
  365         10. A pharmacy permitted under chapter 465.
  366         Section 10. Paragraph (f) of subsection (1) of section
  367  768.381, Florida Statutes, is amended to read:
  368         768.381 COVID-19-related claims against health care
  369  providers.—
  370         (1) DEFINITIONS.—As used in this section, the term:
  371         (f) “Health care provider” means any of the following:
  372         1. A provider as defined in s. 408.803.
  373         2. A clinical laboratory providing services in this state
  374  or services to health care providers in this state, if the
  375  clinical laboratory is certified by the Centers for Medicare and
  376  Medicaid Services under the federal Clinical Laboratory
  377  Improvement Amendments and the federal rules adopted thereunder.
  378         3. A federally qualified health center as defined in 42
  379  U.S.C. s. 1396d(l)(2)(B), as that definition existed on the
  380  effective date of this act.
  381         4. Any site providing health care services which was
  382  established for the purpose of responding to the COVID-19
  383  pandemic pursuant to any federal or state order, declaration, or
  384  waiver.
  385         5. A health care practitioner as defined in s. 456.001.
  386         6. A health care professional licensed under part IV of
  387  chapter 468.
  388         7. A home health aide as defined in s. 400.462 s.
  389  400.462(15).
  390         8. A provider licensed under chapter 394 or chapter 397 and
  391  its clinical and nonclinical staff providing inpatient or
  392  outpatient services.
  393         9. A continuing care facility licensed under chapter 651.
  394         10. A pharmacy permitted under chapter 465.
  395         Section 11. For the 2023-2024 fiscal year, four full-time
  396  equivalent positions with associated salary rate of 186,483 are
  397  authorized, and the sums of $353,589 in recurring funds and
  398  $118,728 in nonrecurring funds are appropriated from the Health
  399  Care Trust Fund to the Agency for Health Care Administration,
  400  for the purpose of implementing this act.
  401         Section 12. This act shall take effect upon becoming a law.