Bill Text: FL S1676 | 2020 | Regular Session | Comm Sub

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

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Bill Title: Direct Care Workers

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2020-03-10 - Laid on Table, refer to CS/CS/HB 607 [S1676 Detail]

Download: Florida-2020-S1676-Comm_Sub.html

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       Florida Senate - 2020                             CS for SB 1676
       
       
        
       By the Committee on Health Policy; and Senator Albritton
       
       
       
       
       
       588-03099-20                                          20201676c1
    1                        A bill to be entitled                      
    2         An act relating to direct care workers; amending s.
    3         400.141, F.S.; authorizing a nursing home facility to
    4         use paid feeding assistants in accordance with
    5         specified federal law under certain circumstances;
    6         providing training program requirements; authorizing
    7         the Agency for Health Care Administration to adopt
    8         rules; amending s. 400.23, F.S.; prohibiting paid
    9         feeding assistants from counting toward compliance
   10         with minimum staffing standards; amending s. 400.462,
   11         F.S.; revising the definition of the term “home health
   12         aide”; amending s. 400.464, F.S.; requiring a licensed
   13         home health agency that authorizes a registered nurse
   14         to delegate tasks to a certified nursing assistant to
   15         ensure that certain requirements are met; amending s.
   16         400.488, F.S.; authorizing an unlicensed person to
   17         assist with self-administration of certain treatments;
   18         revising the requirements for such assistance;
   19         creating s. 400.489, F.S.; authorizing a home health
   20         aide to administer certain prescription medications
   21         under certain conditions; requiring the home health
   22         aide to meet certain training and competency
   23         requirements; requiring the training, determination of
   24         competency, and annual validations of home health
   25         aides to be conducted by a registered nurse or a
   26         physician; requiring a home health aide to complete
   27         annual inservice training in medication administration
   28         and medication error prevention, in addition to
   29         existing annual inservice training requirements;
   30         requiring the Agency for Health Care Administration,
   31         in consultation with the Board of Nursing, to
   32         establish by rule standards and procedures for
   33         medication administration by home health aides;
   34         creating s. 400.490, F.S.; authorizing a certified
   35         nursing assistant or home health aide to perform tasks
   36         delegated by a registered nurse; creating s. 400.52,
   37         F.S.; creating the Excellence in Home Health Program
   38         within the agency; requiring the agency to adopt rules
   39         establishing program criteria; requiring the agency to
   40         annually evaluate certain home health agencies that
   41         apply for a program designation; providing program
   42         designation eligibility requirements; providing that a
   43         program designation is not transferrable, with an
   44         exception; providing for the expiration of awarded
   45         designations; requiring home health agencies to
   46         reapply biennially to renew the awarded program
   47         designation; authorizing a program designation award
   48         recipient to use the designation in advertising and
   49         marketing; prohibiting a home health agency from using
   50         a program designation in advertising or marketing
   51         under certain circumstances; creating s. 408.822,
   52         F.S.; defining the term “direct care worker”;
   53         requiring certain licensees to provide specified
   54         information about their employees in a survey
   55         beginning on a specified date; requiring that the
   56         survey be completed on a form adopted by the agency by
   57         rule and include a specified attestation; requiring
   58         licensees to submit such survey before the agency
   59         renews their licenses; requiring the agency to
   60         continually analyze the results of such surveys and
   61         publish the results on the agency’s website; requiring
   62         the agency to update such information monthly;
   63         creating s. 464.0156, F.S.; authorizing a registered
   64         nurse to delegate certain tasks to a certified nursing
   65         assistant or home health aide under certain
   66         conditions; providing the criteria that a registered
   67         nurse must consider in determining if a task may be
   68         delegated to a certified nursing assistant or a home
   69         health aide; authorizing a registered nurse to
   70         delegate prescription medication administration to a
   71         certified nursing assistant or home health aide,
   72         subject to certain requirements; providing an
   73         exception for certain controlled substances; requiring
   74         the Board of Nursing, in consultation with the agency,
   75         to adopt rules; amending s. 464.018, F.S.; subjecting
   76         a registered nurse to disciplinary action for
   77         delegating certain tasks to a person the registered
   78         nurse knows or has reason to know is unqualified to
   79         perform such tasks; creating s. 464.2035, F.S.;
   80         authorizing certified nursing assistants to administer
   81         certain prescription medications under certain
   82         conditions; requiring the certified nursing assistants
   83         to meet certain training and competency requirements;
   84         requiring the training, determination of competency,
   85         and annual validations of certified nursing assistants
   86         to be conducted by a registered nurse or a physician;
   87         requiring a certified nursing assistant to complete
   88         annual inservice training in medication administration
   89         and medication error prevention in addition to
   90         existing annual inservice training requirements;
   91         requiring the board, in consultation with the agency,
   92         to adopt rules for medication administration by
   93         certified nursing assistants; providing an effective
   94         date.
   95          
   96  Be It Enacted by the Legislature of the State of Florida:
   97  
   98         Section 1. Paragraph (v) is added to subsection (1) of
   99  section 400.141, Florida Statutes, to read:
  100         400.141 Administration and management of nursing home
  101  facilities.—
  102         (1) Every licensed facility shall comply with all
  103  applicable standards and rules of the agency and shall:
  104         (v) Be allowed to use paid feeding assistants as defined in
  105  42 C.F.R. s. 488.301, and in accordance with 42 C.F.R. s.
  106  483.60, if the paid feeding assistant has successfully completed
  107  a feeding assistant training program developed by the agency.
  108         1. The feeding assistant training program must consist of a
  109  minimum of 12 hours of education and training and must include
  110  all of the topics and lessons specified in the program
  111  curriculum.
  112         2. The program curriculum must include, but need not be
  113  limited to, training in all of the following content areas:
  114         a. Feeding techniques.
  115         b. Assistance with feeding and hydration.
  116         c. Communication and interpersonal skills.
  117         d. Appropriate responses to resident behavior.
  118         e. Safety and emergency procedures, including the first aid
  119  procedure used to treat upper airway obstructions.
  120         f. Infection control.
  121         g. Residents’ rights.
  122         h. Recognizing changes in residents which are inconsistent
  123  with their normal behavior, and the importance of reporting
  124  those changes to the supervisory nurse.
  125  
  126  The agency may adopt rules to implement this paragraph.
  127         Section 2. Paragraph (b) of subsection (3) of section
  128  400.23, Florida Statutes, is amended to read:
  129         400.23 Rules; evaluation and deficiencies; licensure
  130  status.—
  131         (3)
  132         (b) Paid feeding assistants and nonnursing staff providing
  133  eating assistance to residents shall not count toward compliance
  134  with minimum staffing standards.
  135         Section 3. Subsection (15) of section 400.462, Florida
  136  Statutes, is amended to read:
  137         400.462 Definitions.—As used in this part, the term:
  138         (15) “Home health aide” means a person who is trained or
  139  qualified, as provided by rule, and who provides hands-on
  140  personal care, performs simple procedures as an extension of
  141  therapy or nursing services, assists in ambulation or exercises,
  142  or assists in administering medications as permitted in rule and
  143  for which the person has received training established by the
  144  agency under this part, or performs tasks delegated to him or
  145  her under chapter 464 s. 400.497(1).
  146         Section 4. Present subsections (5) and (6) of section
  147  400.464, Florida Statutes, are redesignated as subsections (6)
  148  and (7), respectively, a new subsection (5) is added to that
  149  section, and present subsection (6) of that section is amended,
  150  to read:
  151         400.464 Home health agencies to be licensed; expiration of
  152  license; exemptions; unlawful acts; penalties.—
  153         (5) If a licensed home health agency authorizes a
  154  registered nurse to delegate tasks, including medication
  155  administration, to a certified nursing assistant pursuant to
  156  chapter 464 or to a home health aide pursuant to s. 400.490, the
  157  licensed home health agency must ensure that such delegation
  158  meets the requirements of this chapter and chapter 464 and the
  159  rules adopted thereunder.
  160         (7)(6) Any person, entity, or organization providing home
  161  health services which is exempt from licensure under subsection
  162  (6) subsection (5) may voluntarily apply for a certificate of
  163  exemption from licensure under its exempt status with the agency
  164  on a form that specifies its name or names and addresses, a
  165  statement of the reasons why it is exempt from licensure as a
  166  home health agency, and other information deemed necessary by
  167  the agency. A certificate of exemption is valid for a period of
  168  not more than 2 years and is not transferable. The agency may
  169  charge an applicant $100 for a certificate of exemption or
  170  charge the actual cost of processing the certificate.
  171         Section 5. Subsections (2) and (3) of section 400.488,
  172  Florida Statutes, are amended to read:
  173         400.488 Assistance with self-administration of medication.—
  174         (2) Patients who are capable of self-administering their
  175  own medications without assistance shall be encouraged and
  176  allowed to do so. However, an unlicensed person may, consistent
  177  with a dispensed prescription’s label or the package directions
  178  of an over-the-counter medication, assist a patient whose
  179  condition is medically stable with the self-administration of
  180  routine, regularly scheduled medications that are intended to be
  181  self-administered. Assistance with self-medication by an
  182  unlicensed person may occur only upon a documented request by,
  183  and the written informed consent of, a patient or the patient’s
  184  surrogate, guardian, or attorney in fact. For purposes of this
  185  section, self-administered medications include both legend and
  186  over-the-counter oral dosage forms, topical dosage forms, and
  187  topical ophthalmic, otic, and nasal dosage forms, including
  188  solutions, suspensions, sprays, and inhalers, intermittent
  189  positive pressure breathing treatments, and nebulizer
  190  treatments.
  191         (3) Assistance with self-administration of medication
  192  includes:
  193         (a) Taking the medication, in its previously dispensed,
  194  properly labeled container, from where it is stored and bringing
  195  it to the patient.
  196         (b) In the presence of the patient, confirming that the
  197  medication is intended for that patient, orally advising the
  198  patient of the medication name and purpose reading the label,
  199  opening the container, removing a prescribed amount of
  200  medication from the container, and closing the container.
  201         (c) Placing an oral dosage in the patient’s hand or placing
  202  the dosage in another container and helping the patient by
  203  lifting the container to his or her mouth.
  204         (d) Applying topical medications, including providing
  205  routine preventative skin care and basic wound care.
  206         (e) Returning the medication container to proper storage.
  207         (f) For intermittent positive pressure breathing treatments
  208  or for nebulizer treatments, assisting with setting up and
  209  cleaning the device in the presence of the patient, confirming
  210  that the medication is intended for that patient, orally
  211  advising the patient of the medication name and purpose, opening
  212  the container, removing the prescribed amount for a single
  213  treatment dose from a properly labeled container, and assisting
  214  the patient with placing the dose into the medicine receptacle
  215  or mouthpiece.
  216         (g)(f) Keeping a record of when a patient receives
  217  assistance with self-administration under this section.
  218         Section 6. Section 400.489, Florida Statutes, is created to
  219  read:
  220         400.489 Administration of medication by a home health aide;
  221  staff training requirements.—
  222         (1) A home health aide may administer oral, transdermal,
  223  ophthalmic, otic, rectal, inhaled, enteral, or topical
  224  prescription medications if the home health aide has been
  225  delegated such task by a registered nurse licensed under chapter
  226  464; has satisfactorily completed an initial 6-hour training
  227  course approved by the agency; and has been found competent to
  228  administer medication to a patient in a safe and sanitary
  229  manner. The training, determination of competency, and initial
  230  and annual validations required in this section shall be
  231  conducted by a registered nurse licensed under chapter 464 or a
  232  physician licensed under chapter 458 or chapter 459.
  233         (2) A home health aide must annually and satisfactorily
  234  complete a 2-hour inservice training course approved by the
  235  agency in medication administration and medication error
  236  prevention. The inservice training course shall be in addition
  237  to the annual inservice training hours required by agency rules.
  238         (3) The agency, in consultation with the Board of Nursing,
  239  shall establish by rule standards and procedures that a home
  240  health aide must follow when administering medication to a
  241  patient. Such rules must, at a minimum, address qualification
  242  requirements for trainers, requirements for labeling medication,
  243  documentation and recordkeeping, the storage and disposal of
  244  medication, instructions concerning the safe administration of
  245  medication, informed-consent requirements and records, and the
  246  training curriculum and validation procedures.
  247         Section 7. Section 400.490, Florida Statutes, is created to
  248  read:
  249         400.490 Nurse-delegated tasks.—A certified nursing
  250  assistant or home health aide may perform any task delegated by
  251  a registered nurse as authorized in chapter 464, including, but
  252  not limited to, medication administration.
  253         Section 8. Section 400.52, Florida Statutes, is created to
  254  read:
  255         400.52 Excellence in Home Health Program.—
  256         (1) There is created within the agency the Excellence in
  257  Home Health Program for the purpose of awarding program
  258  designations to home health agencies that meet the criteria
  259  specified in this section.
  260         (2)(a) The agency shall adopt rules establishing criteria
  261  for the program which must include, at a minimum, meeting
  262  standards relating to:
  263         1. Patient satisfaction.
  264         2. Patients requiring emergency care for wound infections.
  265         3. Patients admitted or readmitted to an acute care
  266  hospital.
  267         4. Patient improvement in the activities of daily living.
  268         5. Employee satisfaction.
  269         6. Quality of employee training.
  270         7. Employee retention rates.
  271         (b) The agency shall annually evaluate home health agencies
  272  seeking the program designation which apply on a form and in the
  273  manner designated by rule.
  274         (3) To receive a program designation, the home health
  275  agency must:
  276         (a) Be actively licensed and have been operating for at
  277  least 24 months before applying for the program designation. A
  278  designation awarded under the program is not transferrable to
  279  another licensee, unless the existing home health agency is
  280  being relicensed in the name of an entity related to the current
  281  licenseholder by common control or ownership and there will be
  282  no change in the management, operation, or programs of the home
  283  health agency as a result of the relicensure.
  284         (b) Have not had any licensure denials, revocations, or
  285  Class I, Class II, or uncorrected Class III deficiencies within
  286  the 24 months before the application for the program
  287  designation.
  288         (4) The program designation expires on the same date as the
  289  home health agency’s license. A home health agency must reapply
  290  and be approved biennially for the program designation to
  291  continue using the program designation in the manner authorized
  292  under subsection (5).
  293         (5) A home health agency that is awarded a designation
  294  under the program may use the designation in advertising and
  295  marketing. A home health agency may not use the program
  296  designation in any advertising or marketing if the home health
  297  agency:
  298         (a) Has not been awarded the designation;
  299         (b) Fails to renew the designation upon expiration of the
  300  awarded designation;
  301         (c) Has undergone a change in ownership that does not
  302  qualify for an exception under paragraph (3)(a); or
  303         (d) Has been notified that it no longer meets the criteria
  304  for the award upon reapplication after expiration of the awarded
  305  designation.
  306         Section 9. Section 408.822, Florida Statutes, is created to
  307  read:
  308         408.822 Direct care workforce survey.—
  309         (1) For purposes of this section, the term “direct care
  310  worker” means a certified nursing assistant, a home health aide,
  311  a personal care assistant, a companion services or homemaker
  312  services provider, a paid feeding assistant trained under s.
  313  400.141(1)(v), or another individual who provides personal care
  314  as defined in s. 400.462 to individuals who are elderly,
  315  developmentally disabled, or chronically ill.
  316         (2) Beginning January 1, 2021, each licensee that applies
  317  for licensure renewal as a nursing home facility licensed under
  318  part II of chapter 400; an assisted living facility licensed
  319  under part I of chapter 429; or a home health agency, nurse
  320  registry, or companion services or homemaker services provider
  321  licensed under part III of chapter 400 shall furnish the
  322  following information to the agency in a survey on the direct
  323  care workforce:
  324         (a) The number of registered nurses and the number of
  325  direct care workers by category employed by the licensee.
  326         (b) The turnover and vacancy rates of registered nurses and
  327  direct care workers and the contributing factors to these rates.
  328         (c) The average employee wage for registered nurses and
  329  each category of direct care worker.
  330         (d) Employment benefits for registered nurses and direct
  331  care workers and the average cost of such benefits to the
  332  employer and the employee.
  333         (e) Type and availability of training for registered nurses
  334  and direct care workers.
  335         (3) An administrator or designee shall include the
  336  information required in subsection (2) on a survey form
  337  developed by the agency by rule which must contain an
  338  attestation that the information provided is true and accurate
  339  to the best of his or her knowledge.
  340         (4) The licensee must submit the completed survey prior to
  341  the agency issuing the license renewal.
  342         (5) The agency shall continually analyze the results of the
  343  surveys and publish the results on its website. The agency shall
  344  update the information published on its website monthly.
  345         Section 10. Section 464.0156, Florida Statutes, is created
  346  to read:
  347         464.0156 Delegation of duties.—
  348         (1) A registered nurse may delegate a task to a certified
  349  nursing assistant certified under part II of this chapter or a
  350  home health aide as defined in s. 400.462, if the registered
  351  nurse determines that the certified nursing assistant or the
  352  home health aide is competent to perform the task, the task is
  353  delegable under federal law, and the task:
  354         (a) Is within the nurse’s scope of practice.
  355         (b) Frequently recurs in the routine care of a patient or
  356  group of patients.
  357         (c) Is performed according to an established sequence of
  358  steps.
  359         (d) Involves little or no modification from one patient to
  360  another.
  361         (e) May be performed with a predictable outcome.
  362         (f) Does not inherently involve ongoing assessment,
  363  interpretation, or clinical judgment.
  364         (g) Does not endanger a patient’s life or well-being.
  365         (2) A registered nurse may delegate to a certified nursing
  366  assistant or a home health aide the administration of oral,
  367  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  368  topical prescription medications, if the certified nursing
  369  assistant or home health aide meets the requirements of s.
  370  464.2035 or s. 400.489, respectively. A registered nurse may not
  371  delegate the administration of any controlled substance listed
  372  in Schedule II, Schedule III, or Schedule IV of s. 893.03 or 21
  373  U.S.C. s. 812.
  374         (3) The board, in consultation with the Agency for Health
  375  Care Administration, shall adopt rules to implement this
  376  section.
  377         Section 11. Paragraph (r) is added to subsection (1) of
  378  section 464.018, Florida Statutes, to read:
  379         464.018 Disciplinary actions.—
  380         (1) The following acts constitute grounds for denial of a
  381  license or disciplinary action, as specified in ss. 456.072(2)
  382  and 464.0095:
  383         (r) Delegating professional responsibilities to a person
  384  when the nurse delegating such responsibilities knows or has
  385  reason to know that such person is not qualified by training,
  386  experience, certification, or licensure to perform them.
  387         Section 12. Section 464.2035, Florida Statutes, is created
  388  to read:
  389         464.2035 Administration of medication.—
  390         (1) A certified nursing assistant may administer oral,
  391  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  392  topical prescription medication to a patient of a home health
  393  agency if the certified nursing assistant has been delegated
  394  such task by a registered nurse licensed under part I of this
  395  chapter, has satisfactorily completed an initial 6-hour training
  396  course approved by the board, and has been found competent to
  397  administer medication to a patient in a safe and sanitary
  398  manner. The training, determination of competency, and initial
  399  and annual validations required under this section must be
  400  conducted by a registered nurse licensed under this chapter or a
  401  physician licensed under chapter 458 or chapter 459.
  402         (2) A certified nursing assistant shall annually and
  403  satisfactorily complete 2 hours of inservice training in
  404  medication administration and medication error prevention
  405  approved by the board, in consultation with the Agency for
  406  Health Care Administration. The inservice training is in
  407  addition to the other annual inservice training hours required
  408  under this part.
  409         (3) The board, in consultation with the Agency for Health
  410  Care Administration, shall establish by rule standards and
  411  procedures that a certified nursing assistant must follow when
  412  administering medication to a patient. Such rules must, at a
  413  minimum, address qualification requirements for trainers,
  414  requirements for labeling medication, documentation and
  415  recordkeeping, the storage and disposal of medication,
  416  instructions concerning the safe administration of medication,
  417  informed-consent requirements and records, and the training
  418  curriculum and validation procedures.
  419         Section 13. This act shall take effect upon becoming a law.