HB 0117A 2003
1	A bill to be entitled
2	An act relating to certified geriatric specialty nursing;
3	providing a popular name; requiring the Agency for
4	Workforce Innovation to establish a pilot program for
5	delivery of certified geriatric specialty nursing
6	education; specifying eligibility requirements for
7	certified nursing assistants to obtain certified geriatric
8	specialty nursing education; specifying requirements for
9	the education of certified nursing assistants to prepare
10	for certification as a certified geriatric specialist;
11	creating a Certified Geriatric Specialty Nursing
12	Initiative Steering Committee; providing for the
13	composition of and manner of appointment to the Certified
14	Geriatric Specialty Nursing Initiative Steering Committee;
15	providing responsibilities of the steering committee;
16	providing for reimbursement for per diem and travel
17	expenses; requiring the Agency for Workforce Innovation to
18	conduct or contract for an evaluation of the pilot program
19	for delivery of certified geriatric specialty nursing
20	education; requiring the evaluation to include
21	recommendations regarding the expansion of the delivery of
22	certified geriatric specialty nursing education in nursing
23	homes; requiring the Agency for Workforce Innovation to
24	report to the Governor and Legislature regarding the
25	status and evaluation of the pilot program; creating s.
26	464.0125, F.S.; providing definitions; providing
27	requirements for persons to become certified geriatric
28	specialists; specifying fees; providing for articulation
29	of geriatric specialty nursing coursework and practical
30	nursing coursework; providing practice standards and
31	grounds for which certified geriatric specialists may be
32	subject to discipline by the Board of Nursing; creating
33	restrictions on the use of professional nursing titles;
34	prohibiting the use of certain professional titles;
35	providing penalties; authorizing approved nursing programs
36	to provide education for the preparation of certified
37	geriatric specialists without further board approval;
38	authorizing certified geriatric specialists to supervise
39	the activities of others in nursing home facilities
40	according to rules by the Board of Nursing; revising
41	terminology relating to nursing to conform to the
42	certification of geriatric specialists; amending s.
43	381.00315, F.S.; revising requirements for the
44	reactivation of the licenses of specified health care
45	practitioners in the event of a public health emergency to
46	include certified geriatric specialists; amending s.
47	400.021, F.S.; including services provided by a certified
48	geriatric specialist within the definition of nursing
49	service; amending s. 400.211, F.S.; revising requirements
50	for persons employed as nursing assistants to conform to
51	the certification of certified geriatric specialists;
52	amending s. 400.23, F.S.; specifying that certified
53	geriatric specialists shall be considered licensed nursing
54	staff; authorizing licensed practical nurses to supervise
55	the activities of certified geriatric specialists in
56	nursing home facilities according to rules adopted by the
57	Board of Nursing; amending s. 409.908, F.S.; revising the
58	methodology for reimbursement of Medicaid program
59	providers to include services of certified geriatric
60	specialists; amending s. 458.303, F.S.; revising
61	exceptions to the practice of medicine to include services
62	delegated to a certified geriatric specialist under
63	specified circumstances; amending s. 1009.65, F.S.;
64	revising eligibility for the Medical Education
65	Reimbursement and Loan Repayment Program to include
66	certified geriatric specialists; amending s. 1009.66,
67	F.S.; revising eligibility requirements for the Nursing
68	Student Loan Forgiveness Program to include certified
69	geriatric specialists; providing an appropriation;
70	amending s. 464.201, F.S.; providing a definition;
71	amending s. 464.202, F.S.; authorizing the Board of
72	Nursing to adopt rules regarding the practice and
73	supervision of certified nursing assistants; providing for
74	construction of the act in pari materia with laws enacted
75	during the 2003 Regular Session of the Legislature;
76	providing an effective date.
77
78	Be It Enacted by the Legislature of the State of Florida:
79
80	Section 1. This act shall be known by the popular name the
81	"Clara Ramsey Care of the Elderly Act."
82	Section 2. Certified Geriatric Specialist Preparation
83	Pilot Program.--
84	(1) The Agency for Workforce Innovation shall establish a
85	pilot program for delivery of geriatric nursing education to
86	certified nursing assistants who wish to become certified
87	geriatric specialists. The agency shall select two pilot sites
88	in nursing homes that have received the Gold Seal designation
89	under s. 400.235, Florida Statutes, have been designated as a
90	teaching nursing home under s. 430.80, Florida Statutes, or have
91	not received a class I or class II deficiency within the 30
92	months preceding application for this program.
93	(2) To be eligible to receive geriatric nursing education,
94	a certified nursing assistant must have been employed by a
95	participating nursing home for at least 1 year and have received
96	a high school diploma or its equivalent.
97	(3) The education shall be provided at the worksite and in
98	coordination with the certified nursing assistant's work
99	schedule.
100	(4) Faculty shall provide the instruction under an
101	approved nursing program pursuant to s. 464.019, Florida
102	Statutes.
103	(5) The education shall prepare the certified nursing
104	assistant to meet the requirements for certification as a
105	geriatric specialist. The didactic and clinical education shall
106	include all portions of the practical nursing curriculum
107	pursuant to s. 464.019, Florida Statutes, except for pediatric
108	and obstetric/maternal-child education, and shall include
109	additional education in the care of ill, injured, or infirm
110	geriatric patients and the maintenance of health, the prevention
111	of injury, and the provision of palliative care for geriatric
112	patients.
113	Section 3. Certified Geriatric Specialty Nursing
114	Initiative Steering Committee.--
115	(1) In order to guide the implementation of the Certified
116	Geriatric Specialist Preparation Pilot Program, there is created
117	a Certified Geriatric Specialty Nursing Initiative Steering
118	Committee. The steering committee shall be composed of the
119	following members:
120	(a) The chair of the Board of Nursing or his or her
121	designee;
122	(b) A representative of the Agency for Workforce
123	Innovation, appointed by the Director of Workforce Innovation;
124	(c) A representative of Workforce Florida, Inc., appointed
125	by the chair of the Board of Directors of Workforce Florida,
126	Inc.;
127	(d) A representative of the Department of Education,
128	appointed by the Secretary of Education;
129	(e) A representative of the Agency for Health Care
130	Administration, appointed by the Secretary of Health Care
131	Administration;
132	(f) The Director of the Florida Center for Nursing; and
133	(g) A representative of a Gold Seal nursing home that is
134	not one of the pilot program sites, appointed by the Secretary
135	of Health Care Administration.
136	(2) The steering committee shall:
137	(a) Provide consultation and guidance to the Agency for
138	Workforce Innovation on matters of policy during the
139	implementation of the pilot program.
140	(b) Provide oversight to the evaluation of the pilot
141	program.
142	(3) Members of the steering committee are entitled to
143	reimbursement for per diem and travel expenses under s. 112.061,
144	Florida Statutes.
145	(4) The steering committee shall complete its activities
146	by June 30, 2006, and the authorization for the steering
147	committee shall end on that date.
148	Section 4. Evaluation of the Certified Geriatric
149	Specialist Preparation Pilot Program.--The Agency for Workforce
150	Innovation, in consultation with the Certified Geriatric
151	Specialty Nursing Initiative Steering Committee, shall conduct
152	or contract for an evaluation of the pilot program. The agency
153	shall ensure that an evaluation report is submitted to the
154	Governor, the President of the Senate, and the Speaker of the
155	House of Representatives by January 1, 2006. The evaluation must
156	address the experience and success of the certified nursing
157	assistants in the pilot program and must contain recommendations
158	regarding the expansion of the delivery of geriatric nursing
159	education in nursing homes.
160	Section 5. Reports.--The Agency for Workforce Innovation
161	shall submit status reports and recommendations regarding
162	legislation necessary to further the implementation of the pilot
163	program to the Governor, the President of the Senate, and the
164	Speaker of the House of Representatives on January 1, 2004,
165	January 1, 2005, and January 1, 2006.
166	Section 6. Section 464.0125, Florida Statutes, is created
167	to read:
168	464.0125 Certified geriatric specialists; certification
169	requirements.--
170	(1) DEFINITIONS; RESPONSIBILITIES.--
171	(a) As used in this section, the term:
172	1. "Certified geriatric specialist" means a person who
173	meets the qualifications specified in this section and who is
174	certified by the board to practice as a certified geriatric
175	specialist.
176	2. "Geriatric patient" means any patient who is 60 years
177	of age or older.
178	3. "Practice of certified geriatric specialty nursing"
179	means the performance of selected acts in facilities licensed
180	under part II or part III of chapter 400, including the
181	administration of treatments and medications, in the care of
182	ill, injured, or infirm geriatric patients and the promotion of
183	wellness, maintenance of health, and prevention of illness of
184	geriatric patients under the direction of a registered nurse, a
185	licensed physician, a licensed osteopathic physician, a licensed
186	podiatric physician, or a licensed dentist. The scope of
187	practice of a certified geriatric specialist includes the
188	practice of practical nursing as defined in s. 464.003 for
189	geriatric patients only, except for any act in which instruction
190	and clinical knowledge of pediatric nursing or
191	obstetric/maternal-child nursing is required. A certified
192	geriatric specialist, while providing nursing services in
193	facilities licensed under part II or part III of chapter 400,
194	may supervise the activities of certified nursing assistants and
195	other unlicensed personnel providing services in such facilities
196	in accordance with rules adopted by the board.
197	(b) The certified geriatric specialist shall be
198	responsible and accountable for making decisions that are based
199	upon the individual's educational preparation and experience in
200	performing certified geriatric specialty nursing.
201	(2) CERTIFICATION.--
202	(a) Any certified nursing assistant desiring to be
203	certified as a certified geriatric specialist shall apply to the
204	department and submit proof that he or she holds a current
205	certificate as a certified nursing assistant under this part and
206	has satisfactorily completed the following requirements:
207	1. Is in good mental and physical health, is a recipient
208	of a high school diploma or its equivalent, and has completed
209	the requirements for graduation from an approved program for
210	nursing or its equivalent, as determined by the board, for the
211	preparation of licensed practical nurses, except for instruction
212	and clinical knowledge of pediatric nursing or
213	obstetric/maternal-child nursing. Any program that is approved
214	on or before July 1, 2003, by the board for the preparation of
215	registered nurses or licensed practical nurses may provide
216	education for the preparation of certified geriatric specialists
217	without further board approval.
218	2. Has the ability to communicate in the English language,
219	which may be determined by an examination given by the
220	department.
221	3. Has provided sufficient information, which must be
222	submitted by the department for a statewide criminal records
223	correspondence check through the Department of Law Enforcement.
224	(b) Each applicant who meets the requirements of this
225	subsection shall, unless denied pursuant to s. 464.018, be
226	entitled to certification as a certified geriatric specialist.
227	The board shall certify, and the department shall issue a
228	certificate to practice as a certified geriatric specialist to,
229	any certified nursing assistant meeting the qualifications in
230	this section. The board shall establish an application fee not
231	to exceed $100 and a biennial renewal fee not to exceed $50. The
232	board may adopt rules to administer this section.
233	(c) A person receiving certification under this section
234	shall:
235	1. Work only within the confines of a facility licensed
236	under part II or part III of chapter 400.
237	2. Care for geriatric patients only.
238	3. Comply with the minimum standards of practice for
239	nurses and be subject to disciplinary action for violations of
240	s. 464.018.
241	(3) ARTICULATION.--Any certified geriatric specialist who
242	completes the additional instruction and coursework in an
243	approved nursing program pursuant to s. 464.019 for the
244	preparation of practical nursing in the areas of pediatric
245	nursing and obstetric/maternal-child nursing shall, unless
246	denied pursuant to s. 464.018, be entitled to licensure as a
247	licensed practical nurse if the applicant otherwise meets the
248	requirements of s. 464.008.
249	(4) TITLES AND ABBREVIATIONS; RESTRICTIONS; PENALTIES.--
250	(a) Only persons who hold certificates to practice as
251	certified geriatric specialists in this state or who are
252	performing services within the practice of certified geriatric
253	specialty nursing pursuant to the exception set forth in s.
254	464.022(8) shall have the right to use the title "Certified
255	Geriatric Specialist" and the abbreviation "C.G.S."
256	(b) No person shall practice or advertise as, or assume
257	the title of, Certified Geriatric Specialist or use the
258	abbreviation "C.G.S." or take any other action that would lead
259	the public to believe that person was certified as such or is
260	performing services within the practice of certified geriatric
261	specialty nursing pursuant to the exception set forth in s.
262	464.022(8), unless that person is certified to practice as such.
263	(c) A violation of this subsection is a misdemeanor of the
264	first degree, punishable as provided in s. 775.082 or s.
265	775.083.
266	(5) VIOLATIONS AND PENALTIES.--Practicing certified
267	geriatric specialty nursing, as defined in this section, without
268	holding an active certificate to do so constitutes a felony of
269	the third degree, punishable as provided in s. 775.082, s.
270	775.083, or s. 775.084.
271	Section 7. Paragraph (b) of subsection (1) of section
272	381.00315, Florida Statutes, is amended to read:
273	381.00315 Public health advisories; public health
274	emergencies.--The State Health Officer is responsible for
275	declaring public health emergencies and issuing public health
276	advisories.
277	(1) As used in this section, the term:
278	(b) "Public health emergency" means any occurrence, or
279	threat thereof, whether natural or man made, which results or
280	may result in substantial injury or harm to the public health
281	from infectious disease, chemical agents, nuclear agents,
282	biological toxins, or situations involving mass casualties or
283	natural disasters. Prior to declaring a public health emergency,
284	the State Health Officer shall, to the extent possible, consult
285	with the Governor and shall notify the Chief of Domestic
286	Security Initiatives as created in s. 943.03. The declaration of
287	a public health emergency shall continue until the State Health
288	Officer finds that the threat or danger has been dealt with to
289	the extent that the emergency conditions no longer exist and he
290	or she terminates the declaration. However, a declaration of a
291	public health emergency may not continue for longer than 60 days
292	unless the Governor concurs in the renewal of the declaration.
293	The State Health Officer, upon declaration of a public health
294	emergency, may take actions that are necessary to protect the
295	public health. Such actions include, but are not limited to:
296	1. Directing manufacturers of prescription drugs or over-
297	the-counter drugs who are permitted under chapter 499 and
298	wholesalers of prescription drugs located in this state who are
299	permitted under chapter 499 to give priority to the shipping of
300	specified drugs to pharmacies and health care providers within
301	geographic areas that have been identified by the State Health
302	Officer. The State Health Officer must identify the drugs to be
303	shipped. Manufacturers and wholesalers located in the state must
304	respond to the State Health Officer's priority shipping
305	directive before shipping the specified drugs.
306	2. Notwithstanding chapters 465 and 499 and rules adopted
307	thereunder, directing pharmacists employed by the department to
308	compound bulk prescription drugs and provide these bulk
309	prescription drugs to physicians and nurses of county health
310	departments or any qualified person authorized by the State
311	Health Officer for administration to persons as part of a
312	prophylactic or treatment regimen.
313	3. Notwithstanding s. 456.036, temporarily reactivating
314	the inactive license of the following health care practitioners,
315	when such practitioners are needed to respond to the public
316	health emergency: physicians licensed under chapter 458 or
317	chapter 459; physician assistants licensed under chapter 458 or
318	chapter 459; certified geriatric specialists certified under
319	part I of chapter 464;licensed practical nurses, registered
320	nurses, and advanced registered nurse practitioners licensed
321	under part I of chapter 464; respiratory therapists licensed
322	under part V of chapter 468; and emergency medical technicians
323	and paramedics certified under part III of chapter 401. Only
324	those health care practitioners specified in this paragraph who
325	possess an unencumbered inactive license and who request that
326	such license be reactivated are eligible for reactivation. An
327	inactive license that is reactivated under this paragraph shall
328	return to inactive status when the public health emergency ends
329	or prior to the end of the public health emergency if the State
330	Health Officer determines that the health care practitioner is
331	no longer needed to provide services during the public health
332	emergency. Such licenses may only be reactivated for a period
333	not to exceed 90 days without meeting the requirements of s.
334	456.036 or chapter 401, as applicable.
335	4. Ordering an individual to be examined, tested,
336	vaccinated, treated, or quarantined for communicable diseases
337	that have significant morbidity or mortality and present a
338	severe danger to public health. Individuals who are unable or
339	unwilling to be examined, tested, vaccinated, or treated for
340	reasons of health, religion, or conscience may be subjected to
341	quarantine.
342	a. Examination, testing, vaccination, or treatment may be
343	performed by any qualified person authorized by the State Health
344	Officer.
345	b. If the individual poses a danger to the public health,
346	the State Health Officer may subject the individual to
347	quarantine. If there is no practical method to quarantine the
348	individual, the State Health Officer may use any means necessary
349	to vaccinate or treat the individual.
350
351	Any order of the State Health Officer given to effectuate this
352	paragraph shall be immediately enforceable by a law enforcement
353	officer under s. 381.0012.
354	Section 8. Subsection (14) of section 400.021, Florida
355	Statutes, is amended to read:
356	400.021 Definitions.--When used in this part, unless the
357	context otherwise requires, the term:
358	(14) "Nursing service" means such services or acts as may
359	be rendered, directly or indirectly, to and in behalf of a
360	person by individuals as defined in ss.s. 464.003 and 464.0125.
361	Section 9. Subsection (1) of section 400.211, Florida
362	Statutes, is amended to read:
363	400.211 Persons employed as nursing assistants;
364	certification requirement.--
365	(1) To serve as a nursing assistant in any nursing home, a
366	person must be certified as a nursing assistant under part II of
367	chapter 464, unless the person is a registered nurse, aor
368	practical nurse, or a certified geriatric specialist certified
369	orlicensed in accordance with part I of chapter 464 or an
370	applicant for such licensure who is permitted to practice
371	nursing in accordance with rules adopted by the Board of Nursing
372	pursuant to part I of chapter 464.
373	Section 10. Paragraphs (a) and (c) of subsection (3) of
374	section 400.23, Florida Statutes, are amended to read:
375	400.23 Rules; evaluation and deficiencies; licensure
376	status.--
377	(3)(a) The agency shall adopt rules providing for the
378	minimum staffing requirements for nursing homes. These
379	requirements shall include, for each nursing home facility, a
380	minimum certified nursing assistant staffing of 2.3 hours of
381	direct care per resident per day beginning January 1, 2002,
382	increasing to 2.6 hours of direct care per resident per day
383	beginning January 1, 2003, and increasing to 2.9 hours of direct
384	care per resident per day beginning January 1, 2004. Beginning
385	January 1, 2002, no facility shall staff below one certified
386	nursing assistant per 20 residents, and a minimum licensed
387	nursing staffing of 1.0 hour of direct resident care per
388	resident per day but never below one licensed nurse per 40
389	residents. For purposes of computing nursing staffing minimums
390	and ratios, certified geriatric specialists shall be considered
391	licensed nursing staff.Nursing assistants employed under s.
392	400.211(2) may be included in computing the staffing ratio for
393	certified nursing assistants only if they provide nursing
394	assistance services to residents on a full-time basis. Each
395	nursing home must document compliance with staffing standards as
396	required under this paragraph and post daily the names of staff
397	on duty for the benefit of facility residents and the public.
398	The agency shall recognize the use of licensed nurses for
399	compliance with minimum staffing requirements for certified
400	nursing assistants, provided that the facility otherwise meets
401	the minimum staffing requirements for licensed nurses and that
402	the licensed nurses so recognized are performing the duties of a
403	certified nursing assistant. Unless otherwise approved by the
404	agency, licensed nurses counted towards the minimum staffing
405	requirements for certified nursing assistants must exclusively
406	perform the duties of a certified nursing assistant for the
407	entire shift and shall not also be counted towards the minimum
408	staffing requirements for licensed nurses. If the agency
409	approved a facility's request to use a licensed nurse to perform
410	both licensed nursing and certified nursing assistant duties,
411	the facility must allocate the amount of staff time specifically
412	spent on certified nursing assistant duties for the purpose of
413	documenting compliance with minimum staffing requirements for
414	certified and licensed nursing staff. In no event may the hours
415	of a licensed nurse with dual job responsibilities be counted
416	twice.
417	(c) Licensed practical nurses licensed under chapter 464
418	who are providing nursing services in nursing home facilities
419	under this part may supervise the activities of other licensed
420	practical nurses, certified geriatric specialists,certified
421	nursing assistants, and other unlicensed personnel providing
422	services in such facilities in accordance with rules adopted by
423	the Board of Nursing.
424	Section 11. Paragraph (b) of subsection (2) of section
425	409.908, Florida Statutes, is amended to read:
426	409.908 Reimbursement of Medicaid providers.--Subject to
427	specific appropriations, the agency shall reimburse Medicaid
428	providers, in accordance with state and federal law, according
429	to methodologies set forth in the rules of the agency and in
430	policy manuals and handbooks incorporated by reference therein.
431	These methodologies may include fee schedules, reimbursement
432	methods based on cost reporting, negotiated fees, competitive
433	bidding pursuant to s. 287.057, and other mechanisms the agency
434	considers efficient and effective for purchasing services or
435	goods on behalf of recipients. If a provider is reimbursed based
436	on cost reporting and submits a cost report late and that cost
437	report would have been used to set a lower reimbursement rate
438	for a rate semester, then the provider's rate for that semester
439	shall be retroactively calculated using the new cost report, and
440	full payment at the recalculated rate shall be affected
441	retroactively. Medicare-granted extensions for filing cost
442	reports, if applicable, shall also apply to Medicaid cost
443	reports. Payment for Medicaid compensable services made on
444	behalf of Medicaid eligible persons is subject to the
445	availability of moneys and any limitations or directions
446	provided for in the General Appropriations Act or chapter 216.
447	Further, nothing in this section shall be construed to prevent
448	or limit the agency from adjusting fees, reimbursement rates,
449	lengths of stay, number of visits, or number of services, or
450	making any other adjustments necessary to comply with the
451	availability of moneys and any limitations or directions
452	provided for in the General Appropriations Act, provided the
453	adjustment is consistent with legislative intent.
454	(2)
455	(b) Subject to any limitations or directions provided for
456	in the General Appropriations Act, the agency shall establish
457	and implement a Florida Title XIX Long-Term Care Reimbursement
458	Plan (Medicaid) for nursing home care in order to provide care
459	and services in conformance with the applicable state and
460	federal laws, rules, regulations, and quality and safety
461	standards and to ensure that individuals eligible for medical
462	assistance have reasonable geographic access to such care.
463	1. Changes of ownership or of licensed operator do not
464	qualify for increases in reimbursement rates associated with the
465	change of ownership or of licensed operator. The agency shall
466	amend the Title XIX Long Term Care Reimbursement Plan to provide
467	that the initial nursing home reimbursement rates, for the
468	operating, patient care, and MAR components, associated with
469	related and unrelated party changes of ownership or licensed
470	operator filed on or after September 1, 2001, are equivalent to
471	the previous owner's reimbursement rate.
472	2. The agency shall amend the long-term care reimbursement
473	plan and cost reporting system to create direct care and
474	indirect care subcomponents of the patient care component of the
475	per diem rate. These two subcomponents together shall equal the
476	patient care component of the per diem rate. Separate cost-based
477	ceilings shall be calculated for each patient care subcomponent.
478	The direct care subcomponent of the per diem rate shall be
479	limited by the cost-based class ceiling, and the indirect care
480	subcomponent shall be limited by the lower of the cost-based
481	class ceiling, by the target rate class ceiling, or by the
482	individual provider target. The agency shall adjust the patient
483	care component effective January 1, 2002. The cost to adjust the
484	direct care subcomponent shall be net of the total funds
485	previously allocated for the case mix add-on. The agency shall
486	make the required changes to the nursing home cost reporting
487	forms to implement this requirement effective January 1, 2002.
488	3. The direct care subcomponent shall include salaries and
489	benefits of direct care staff providing nursing services
490	including registered nurses, licensed practical nurses,
491	certified geriatric specialists certified under part I of
492	chapter 464,and certified nursing assistants who deliver care
493	directly to residents in the nursing home facility. This
494	excludes nursing administration, MDS, and care plan
495	coordinators, staff development, and staffing coordinator.
496	4. All other patient care costs shall be included in the
497	indirect care cost subcomponent of the patient care per diem
498	rate. There shall be no costs directly or indirectly allocated
499	to the direct care subcomponent from a home office or management
500	company.
501	5. On July 1 of each year, the agency shall report to the
502	Legislature direct and indirect care costs, including average
503	direct and indirect care costs per resident per facility and
504	direct care and indirect care salaries and benefits per category
505	of staff member per facility.
506	6. In order to offset the cost of general and professional
507	liability insurance, the agency shall amend the plan to allow
508	for interim rate adjustments to reflect increases in the cost of
509	general or professional liability insurance for nursing homes.
510	This provision shall be implemented to the extent existing
511	appropriations are available.
512
513	It is the intent of the Legislature that the reimbursement plan
514	achieve the goal of providing access to health care for nursing
515	home residents who require large amounts of care while
516	encouraging diversion services as an alternative to nursing home
517	care for residents who can be served within the community. The
518	agency shall base the establishment of any maximum rate of
519	payment, whether overall or component, on the available moneys
520	as provided for in the General Appropriations Act. The agency
521	may base the maximum rate of payment on the results of
522	scientifically valid analysis and conclusions derived from
523	objective statistical data pertinent to the particular maximum
524	rate of payment.
525	Section 12. Subsection (2) of section 458.303, Florida
526	Statutes, is amended to read:
527	458.303 Provisions not applicable to other practitioners;
528	exceptions, etc.--
529	(2) Nothing in s. 458.301, s. 458.303, s. 458.305, s.
530	458.307, s. 458.309, s. 458.311, s. 458.313, s. 458.319, s.
531	458.321, s. 458.327, s. 458.329, s. 458.331, s. 458.337, s.
532	458.339, s. 458.341, s. 458.343, s. 458.345, or s. 458.347 shall
533	be construed to prohibit any service rendered by a registered
534	nurse,or a licensed practical nurse, or a certified geriatric
535	specialist certified under part I of chapter 464,if such
536	service is rendered under the direct supervision and control of
537	a licensed physician who provides specific direction for any
538	service to be performed and gives final approval to all services
539	performed. Further, nothing in this or any other chapter shall
540	be construed to prohibit any service rendered by a medical
541	assistant in accordance with the provisions of s. 458.3485.
542	Section 13. Subsection (1) and paragraph (a) of subsection
543	(2) of section 1009.65, Florida Statutes, are amended to read:
544	1009.65 Medical Education Reimbursement and Loan Repayment
545	Program.--
546	(1) To encourage qualified medical professionals to
547	practice in underserved locations where there are shortages of
548	such personnel, there is established the Medical Education
549	Reimbursement and Loan Repayment Program. The function of the
550	program is to make payments that offset loans and educational
551	expenses incurred by students for studies leading to a medical
552	or nursing degree, medical or nursing licensure, or advanced
553	registered nurse practitioner certification or physician
554	assistant licensure. The following licensed or certified health
555	care professionals are eligible to participate in this program:
556	medical doctors with primary care specialties, doctors of
557	osteopathic medicine with primary care specialties, physician's
558	assistants, certified geriatric specialists certified under part
559	I of chapter 464,licensed practical nurses and registered
560	nurses, and advanced registered nurse practitioners with primary
561	care specialties such as certified nurse midwives. Primary care
562	medical specialties for physicians include obstetrics,
563	gynecology, general and family practice, internal medicine,
564	pediatrics, and other specialties which may be identified by the
565	Department of Health.
566	(2) From the funds available, the Department of Health
567	shall make payments to selected medical professionals as
568	follows:
569	(a) Up to $4,000 per year for certified geriatric
570	specialists certified under part I of chapter 464,licensed
571	practical nurses,and registered nurses, up to $10,000 per year
572	for advanced registered nurse practitioners and physician's
573	assistants, and up to $20,000 per year for physicians.
574	Penalties for noncompliance shall be the same as those in the
575	National Health Services Corps Loan Repayment Program.
576	Educational expenses include costs for tuition, matriculation,
577	registration, books, laboratory and other fees, other
578	educational costs, and reasonable living expenses as determined
579	by the Department of Health.
580	Section 14. Subsection (2) of section 1009.66, Florida
581	Statutes, is amended to read:
582	1009.66 Nursing Student Loan Forgiveness Program.--
583	(2) To be eligible, a candidate must have graduated from
584	an accredited or approved nursing program and have received a
585	Florida license as a licensed practical nurse, a certified
586	geriatric specialist certified under part I of chapter 464,or a
587	registered nurse or a Florida certificate as an advanced
588	registered nurse practitioner.
589	Section 15. The sum of $157,017 is appropriated from the
590	General Revenue Fund to the Agency for Workforce Innovation to
591	support the work of the Certified Geriatric Specialty Nursing
592	Initiative Steering Committee, to administer the pilot sites, to
593	contract for an evaluation, and to provide, if necessary,
594	nursing faculty, substitute certified nursing assistants for
595	those who are in clinical education, and technical support to
596	the pilot sites during the 2003-2004 fiscal year.
597	Section 16. Subsection (5) of section 464.201, Florida
598	Statutes, is renumbered as subsection (6) and a new subsection
599	(5) is added to said section, to read:
600	464.201 Definitions.--As used in this part, the term:
601	(5) "Practice of a certified nursing assistant" means
602	providing care and assisting persons with tasks relating to the
603	activities of daily living. Such tasks are those associated with
604	personal care, maintaining mobility, nutrition and hydration,
605	toileting and elimination, assistive devices, safety and
606	cleanliness, data gathering, reporting abnormal signs and
607	symptoms, post mortem care, patient socialization and reality
608	orientation, end-of-life care, CPR and emergency care,
609	residents' or patients' rights, documentation of nursing
610	assistant services, and other tasks that a certified nursing
611	assistant may perform after training beyond that required for
612	initial certification and upon validation of competence in that
613	skill by a registered nurse. This section does not restrict the
614	ability of any person who is otherwise trained and educated from
615	performing such tasks.
616	Section 17. Section 464.202, Florida Statutes, is amended
617	to read:
618	464.202 Duties and powers of the board.--The board shall
619	maintain, or contract with or approve another entity to
620	maintain, a state registry of certified nursing assistants. The
621	registry must consist of the name of each certified nursing
622	assistant in this state; other identifying information defined
623	by board rule; certification status; the effective date of
624	certification; other information required by state or federal
625	law; information regarding any crime or any abuse, neglect, or
626	exploitation as provided under chapter 435; and any disciplinary
627	action taken against the certified nursing assistant. The
628	registry shall be accessible to the public, the
629	certificateholder, employers, and other state agencies. The
630	board shall adopt by rule testing procedures for use in
631	certifying nursing assistants and shall adopt rules regulating
632	the practice of certified nursing assistants which specify the
633	scope of practice authorized and level of supervision required
634	for the practice of certified nursing assistantsto enforce this
635	part. The board may contract with or approve another entity or
636	organization to provide the examination services, including the
637	development and administration of examinations. The board shall
638	require that the contract provider offer certified nursing
639	assistant applications via the Internet, and may require the
640	contract provider to accept certified nursing assistant
641	applications for processing via the Internet. The board shall
642	require the contract provider to provide the preliminary results
643	of the certified nursing examination on the date the test is
644	administered. The provider shall pay all reasonable costs and
645	expenses incurred by the board in evaluating the provider's
646	application and performance during the delivery of services,
647	including examination services and procedures for maintaining
648	the certified nursing assistant registry.
649	Section 18. If any law amended by this act was also
650	amended by a law enacted at the 2003 Regular Session of the
651	Legislature, such laws shall be construed as if they had been
652	enacted at the same session of the Legislature, and full effect
653	shall be given to each if possible.
654	Section 19. This act shall take effect upon becoming a
655	law.