HB 0189 2004
1	A bill to be entitled
2	An act relating to nursing; providing a popular name;
3	requiring the Agency for Workforce Innovation to establish
4	a pilot program for the delivery of geriatric nursing
5	education; specifying eligibility requirements for
6	certified nursing assistants to receive geriatric nursing
7	education; specifying requirements for geriatric nursing
8	education provided to certified nursing assistants in
9	preparation for certification as certified geriatric
10	specialists; creating a Certified Geriatric Specialty
11	Nursing Initiative Steering Committee; providing for the
12	composition of and manner of appointment to the steering
13	committee; providing responsibilities of the steering
14	committee; providing for reimbursement for per diem and
15	travel expenses; requiring the agency, in consultation
16	with the steering committee, to conduct or contract for an
17	evaluation of the pilot program; requiring the evaluation
18	to include recommendations regarding the expansion of the
19	delivery of geriatric nursing education in nursing homes;
20	requiring the agency to report to the Governor and the
21	Legislature regarding the status and evaluation of the
22	pilot program; creating s. 464.0125, F.S.; providing
23	definitions; providing requirements for persons to become
24	certified geriatric specialists; specifying fees;
25	providing for articulation of geriatric specialty nursing
26	coursework and practical nursing coursework; providing
27	practice standards, restrictions, and grounds for which
28	certified geriatric specialists may be subject to
29	discipline by the board; creating restrictions on the use
30	of professional nursing titles and abbreviations;
31	prohibiting the use of certain professional titles and
32	abbreviations; providing penalties; authorizing approved
33	nursing programs to provide education for the preparation
34	of certified geriatric specialists without further board
35	approval; authorizing certified geriatric specialists to
36	supervise the activities of certain others in nursing home
37	facilities according to rules of the board; amending s.
38	381.00315, F.S.; revising requirements for the
39	reactivation of the licenses of specified health care
40	practitioners in the event of a public health emergency to
41	include certified geriatric specialists; amending s.
42	400.021, F.S.; including services provided by a certified
43	geriatric specialist within the definition of nursing
44	service; amending s. 400.211, F.S.; revising requirements
45	for persons employed as nursing assistants to conform to
46	the certification of certified geriatric specialists;
47	amending s. 400.23, F.S.; specifying that certified
48	geriatric specialists shall be considered licensed nursing
49	staff; authorizing licensed practical nurses to supervise
50	the activities of certified geriatric specialists in
51	nursing home facilities according to rules adopted by the
52	board; amending s. 409.908, F.S.; revising the methodology
53	for reimbursement of Medicaid program providers to include
54	services of certified geriatric specialists; amending s.
55	458.303, F.S.; revising exceptions to the practice of
56	medicine to include services delegated to a certified
57	geriatric specialist under specified circumstances;
58	amending s. 1009.65, F.S.; revising eligibility and
59	funding provisions for the Medical Education Reimbursement
60	and Loan Repayment Program to include certified geriatric
61	specialists; amending s. 1009.66, F.S.; revising
62	eligibility requirements for the Nursing Student Loan
63	Forgiveness Program to include certified geriatric
64	specialists; providing an appropriation; amending s.
65	464.201, F.S.; defining the term "practice of a certified
66	nursing assistant"; amending s. 464.202, F.S.; authorizing
67	the board to adopt rules regarding the practice and
68	supervision of certified nursing assistants; providing an
69	effective date.
70
71	Be It Enacted by the Legislature of the State of Florida:
72
73	Section 1. This act shall be known by the popular name the
74	"Clara Ramsey Care of the Elderly Act."
75	Section 2. Certified Geriatric Specialist Preparation
76	Pilot Program.--
77	(1) The Agency for Workforce Innovation shall establish a
78	pilot program for delivery of geriatric nursing education to
79	certified nursing assistants who wish to become certified
80	geriatric specialists. The agency shall select two pilot sites
81	in nursing homes that have received the Gold Seal designation
82	under s. 400.235, Florida Statutes; have been designated as
83	teaching nursing homes under s. 430.80, Florida Statutes; or
84	have not received a class I or class II deficiency within the 30
85	months preceding application for this program.
86	(2) To be eligible to receive geriatric nursing education,
87	a certified nursing assistant must have been employed by a
88	participating nursing home for at least 1 year and must have
89	received a high school diploma or its equivalent.
90	(3) The education shall be provided at the worksite and in
91	coordination with the certified nursing assistant's work
92	schedule.
93	(4) Faculty shall provide the instruction under an
94	approved nursing program pursuant to s. 464.019, Florida
95	Statutes.
96	(5) The education must be designed to prepare the
97	certified nursing assistant to meet the requirements for
98	certification as a geriatric specialist. The didactic and
99	clinical education must include all portions of the practical
100	nursing curriculum pursuant to s. 464.019, Florida Statutes,
101	except for pediatric and obstetric/maternal-child education, and
102	must include additional education in the care of ill, injured,
103	or infirm geriatric patients and the maintenance of health, the
104	prevention of injury, and the provision of palliative care for
105	geriatric patients.
106	Section 3. Certified Geriatric Specialty Nursing
107	Initiative Steering Committee.--
108	(1) In order to guide the implementation of the Certified
109	Geriatric Specialist Preparation Pilot Program, there is created
110	a Certified Geriatric Specialty Nursing Initiative Steering
111	Committee. The steering committee shall be composed of the
112	following members:
113	(a) The chair of the Board of Nursing or his or her
114	designee.
115	(b) A representative of the Agency for Workforce
116	Innovation, appointed by the director of Workforce Innovation.
117	(c) A representative of Workforce Florida, Inc., appointed
118	by the chair of the board of directors of Workforce Florida,
119	Inc.
120	(d) A representative of the Department of Education,
121	appointed by the Secretary of Education.
122	(e) A representative of the Department of Health,
123	appointed by the Secretary of Health.
124	(f) A representative of the Agency for Health Care
125	Administration, appointed by the Secretary of Health Care
126	Administration.
127	(g) The executive director of the Florida Center for
128	Nursing.
129	(h) A representative of the Department of Elderly Affairs,
130	appointed by the Secretary of Elderly Affairs.
131	(i) A representative of a Gold Seal nursing home that is
132	not one of the pilot program sites, appointed by the Secretary
133	of Health Care Administration.
134	(2) The steering committee shall:
135	(a) Provide consultation and guidance to the Agency for
136	Workforce Innovation on matters of policy during the
137	implementation of the pilot program.
138	(b) Provide oversight to the evaluation of the pilot
139	program.
140	(3) Members of the steering committee are entitled to
141	reimbursement for per diem and travel expenses under s. 112.061,
142	Florida Statutes.
143	(4) The steering committee shall complete its activities
144	by June 30, 2007, and the authorization for the steering
145	committee ends on that date.
146	Section 4. Evaluation of the Certified Geriatric
147	Specialist Preparation Pilot Program.--The Agency for Workforce
148	Innovation, in consultation with the Certified Geriatric
149	Specialty Nursing Initiative Steering Committee, shall conduct
150	or contract for an evaluation of the pilot program. The agency
151	shall ensure that an evaluation report is submitted to the
152	Governor, the President of the Senate, and the Speaker of the
153	House of Representatives by January 1, 2007. The evaluation must
154	address the experience and success of the certified nursing
155	assistants in the pilot program and must contain recommendations
156	regarding the expansion of the delivery of geriatric nursing
157	education in nursing homes.
158	Section 5. Reports.--The Agency for Workforce Innovation
159	shall submit status reports and recommendations regarding
160	legislation necessary to further the implementation of the pilot
161	program to the Governor, the President of the Senate, and the
162	Speaker of the House of Representatives on January 1, 2005,
163	January 1, 2006, and January 1, 2007.
164	Section 6. Section 464.0125, Florida Statutes, is created
165	to read:
166	464.0125 Certified geriatric specialists; certification
167	requirements.--
168	(1) DEFINITIONS; RESPONSIBILITIES.--
169	(a) As used in this section, the term:
170	1. "Certified geriatric specialist" means a person who
171	meets the qualifications specified in this section and who is
172	certified by the board to practice as a certified geriatric
173	specialist.
174	2. "Geriatric patient" means any patient who is 60 years
175	of age or older.
176	3. "Practice of certified geriatric specialty nursing"
177	means the performance of selected acts in facilities licensed
178	under part II or part III of chapter 400, including the
179	administration of treatments and medications, in the care of
180	ill, injured, or infirm geriatric patients and the promotion of
181	wellness, maintenance of health, and prevention of illness of
182	geriatric patients under the direction of a registered nurse, a
183	licensed physician, a licensed osteopathic physician, a licensed
184	podiatric physician, or a licensed dentist. The scope of
185	practice of a certified geriatric specialist includes the
186	practice of practical nursing as defined in s. 464.003 for
187	geriatric patients only, except for any act in which instruction
188	and clinical knowledge of pediatric nursing or
189	obstetric/maternal-child nursing is required. A certified
190	geriatric specialist, while providing nursing services in
191	facilities licensed under part II or part III of chapter 400,
192	may supervise the activities of certified nursing assistants and
193	other unlicensed personnel providing services in such facilities
194	in accordance with rules adopted by the board.
195	(b) The certified geriatric specialist shall be
196	responsible and accountable for making decisions that are based
197	upon the individual's educational preparation and experience in
198	performing certified geriatric specialty nursing.
199	(2) CERTIFICATION.--
200	(a) Any certified nursing assistant desiring to be
201	certified as a certified geriatric specialist must apply to the
202	department and submit proof that he or she holds a current
203	certificate as a certified nursing assistant under part II of
204	this chapter and has satisfactorily completed the following
205	requirements:
206	1. Is in good mental and physical health, is a recipient
207	of a high school diploma or its equivalent, and has completed
208	the requirements for graduation from an approved program for
209	nursing or its equivalent, as determined by the board, for the
210	preparation of licensed practical nurses, except for instruction
211	and clinical knowledge of pediatric nursing or
212	obstetric/maternal-child nursing. Any program that is approved
213	on July 1, 2004, by the board for the preparation of registered
214	nurses or licensed practical nurses may provide education for
215	the preparation of certified geriatric specialists without
216	further board approval.
217	2. Has the ability to communicate in the English language,
218	which may be determined by an examination given by the
219	department.
220	3. Has provided sufficient information, which must be
221	submitted by the department for a statewide criminal records
222	correspondence check through the Department of Law Enforcement.
223	(b) Each applicant who meets the requirements of this
224	subsection is, unless denied pursuant to s. 464.018, entitled to
225	certification as a certified geriatric specialist. The board
226	must certify, and the department must issue a certificate to
227	practice as a certified geriatric specialist to, any certified
228	nursing assistant who meets the qualifications set forth in this
229	section. The board shall establish an application fee not to
230	exceed $100 and a biennial renewal fee not to exceed $50. The
231	board may adopt rules pursuant to ss. 120.536(1) and 120.54 to
232	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 is, unless denied
246	pursuant to s. 464.018, entitled to licensure as a licensed
247	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) may use the title "Certified Geriatric Specialist"
255	and the abbreviation "C.G.S."
256	(b) A person may not practice or advertise as, or assume
257	the title of, a 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 is 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,licensed practical
319	nurses, registered nurses, and advanced registered nurse
320	practitioners certified orlicensed under part I of chapter 464;
321	respiratory therapists licensed under part V of chapter 468; and
322	emergency medical technicians and paramedics certified under
323	part III of chapter 401. Only those health care practitioners
324	specified in this paragraph who possess an unencumbered inactive
325	license and who request that such license be reactivated are
326	eligible for reactivation. An inactive license that is
327	reactivated under this paragraph shall return to inactive status
328	when the public health emergency ends or prior to the end of the
329	public health emergency if the State Health Officer determines
330	that the health care practitioner is no longer needed to provide
331	services during the public health emergency. Such licenses may
332	only be reactivated for a period not to exceed 90 days without
333	meeting the requirements of s. 456.036 or chapter 401, as
334	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, a or
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 certification orlicensure who is permitted
371	to practice nursing in accordance with rules adopted by the
372	Board of Nursing 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 May 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 never below
392	one licensed nurse per 40 residents.Nursing assistants employed
393	under s. 400.211(2) may be included in computing the staffing
394	ratio for certified nursing assistants only if they provide
395	nursing assistance services to residents on a full-time basis.
396	Each nursing home must document compliance with staffing
397	standards as required under this paragraph and post daily the
398	names of staff on duty for the benefit of facility residents and
399	the public. The agency shall recognize the use of licensed
400	nurses for compliance with minimum staffing requirements for
401	certified nursing assistants, provided that the facility
402	otherwise meets the minimum staffing requirements for licensed
403	nurses and that the licensed nurses so recognized are performing
404	the duties of a certified nursing assistant. Unless otherwise
405	approved by the agency, licensed nurses counted towards the
406	minimum staffing requirements for certified nursing assistants
407	must exclusively perform the duties of a certified nursing
408	assistant for the entire shift and shall not also be counted
409	towards the minimum staffing requirements for licensed nurses.
410	If the agency approved a facility's request to use a licensed
411	nurse to perform both licensed nursing and certified nursing
412	assistant duties, the facility must allocate the amount of staff
413	time specifically spent on certified nursing assistant duties
414	for the purpose of documenting compliance with minimum staffing
415	requirements for certified and licensed nursing staff. In no
416	event may the hours of a licensed nurse with dual job
417	responsibilities be counted twice.
418	(c) Licensed practical nurses licensed under chapter 464
419	who are providing nursing services in nursing home facilities
420	under this part may supervise the activities of other licensed
421	practical nurses, certified geriatric specialists,certified
422	nursing assistants, and other unlicensed personnel providing
423	services in such facilities in accordance with rules adopted by
424	the Board of Nursing.
425	Section 11. Paragraph (b) of subsection (2) of section
426	409.908, Florida Statutes, is amended to read:
427	409.908 Reimbursement of Medicaid providers.--Subject to
428	specific appropriations, the agency shall reimburse Medicaid
429	providers, in accordance with state and federal law, according
430	to methodologies set forth in the rules of the agency and in
431	policy manuals and handbooks incorporated by reference therein.
432	These methodologies may include fee schedules, reimbursement
433	methods based on cost reporting, negotiated fees, competitive
434	bidding pursuant to s. 287.057, and other mechanisms the agency
435	considers efficient and effective for purchasing services or
436	goods on behalf of recipients. If a provider is reimbursed based
437	on cost reporting and submits a cost report late and that cost
438	report would have been used to set a lower reimbursement rate
439	for a rate semester, then the provider's rate for that semester
440	shall be retroactively calculated using the new cost report, and
441	full payment at the recalculated rate shall be affected
442	retroactively. Medicare-granted extensions for filing cost
443	reports, if applicable, shall also apply to Medicaid cost
444	reports. Payment for Medicaid compensable services made on
445	behalf of Medicaid eligible persons is subject to the
446	availability of moneys and any limitations or directions
447	provided for in the General Appropriations Act or chapter 216.
448	Further, nothing in this section shall be construed to prevent
449	or limit the agency from adjusting fees, reimbursement rates,
450	lengths of stay, number of visits, or number of services, or
451	making any other adjustments necessary to comply with the
452	availability of moneys and any limitations or directions
453	provided for in the General Appropriations Act, provided the
454	adjustment is consistent with legislative intent.
455	(2)
456	(b) Subject to any limitations or directions provided for
457	in the General Appropriations Act, the agency shall establish
458	and implement a Florida Title XIX Long-Term Care Reimbursement
459	Plan (Medicaid) for nursing home care in order to provide care
460	and services in conformance with the applicable state and
461	federal laws, rules, regulations, and quality and safety
462	standards and to ensure that individuals eligible for medical
463	assistance have reasonable geographic access to such care.
464	1. Changes of ownership or of licensed operator do not
465	qualify for increases in reimbursement rates associated with the
466	change of ownership or of licensed operator. The agency shall
467	amend the Title XIX Long-Term Long TermCare Reimbursement Plan
468	to provide that the initial nursing home reimbursement rates,
469	for the operating, patient care, and MAR components, associated
470	with related and unrelated party changes of ownership or
471	licensed operator filed on or after September 1, 2001, are
472	equivalent to the previous owner's reimbursement rate.
473	2. The agency shall amend the long-term care reimbursement
474	plan and cost reporting system to create direct care and
475	indirect care subcomponents of the patient care component of the
476	per diem rate. These two subcomponents together shall equal the
477	patient care component of the per diem rate. Separate cost-based
478	ceilings shall be calculated for each patient care subcomponent.
479	The direct care subcomponent of the per diem rate shall be
480	limited by the cost-based class ceiling, and the indirect care
481	subcomponent shall be limited by the lower of the cost-based
482	class ceiling, by the target rate class ceiling, or by the
483	individual provider target. The agency shall adjust the patient
484	care component effective January 1, 2002. The cost to adjust the
485	direct care subcomponent shall be net of the total funds
486	previously allocated for the case mix add-on. The agency shall
487	make the required changes to the nursing home cost reporting
488	forms to implement this requirement effective January 1, 2002.
489	3. The direct care subcomponent shall include salaries and
490	benefits of direct care staff providing nursing services
491	including registered nurses, licensed practical nurses,
492	certified geriatric specialists,and certified nursing
493	assistants who deliver care directly to residents in the nursing
494	home facility. This excludes nursing administration, MDS, and
495	care plan coordinators, staff development, and staffing
496	coordinator.
497	4. All other patient care costs shall be included in the
498	indirect care cost subcomponent of the patient care per diem
499	rate. There shall be no costs directly or indirectly allocated
500	to the direct care subcomponent from a home office or management
501	company.
502	5. On July 1 of each year, the agency shall report to the
503	Legislature direct and indirect care costs, including average
504	direct and indirect care costs per resident per facility and
505	direct care and indirect care salaries and benefits per category
506	of staff member per facility.
507	6. In order to offset the cost of general and professional
508	liability insurance, the agency shall amend the plan to allow
509	for interim rate adjustments to reflect increases in the cost of
510	general or professional liability insurance for nursing homes.
511	This provision shall be implemented to the extent existing
512	appropriations are available.
513
514	It is the intent of the Legislature that the reimbursement plan
515	achieve the goal of providing access to health care for nursing
516	home residents who require large amounts of care while
517	encouraging diversion services as an alternative to nursing home
518	care for residents who can be served within the community. The
519	agency shall base the establishment of any maximum rate of
520	payment, whether overall or component, on the available moneys
521	as provided for in the General Appropriations Act. The agency
522	may base the maximum rate of payment on the results of
523	scientifically valid analysis and conclusions derived from
524	objective statistical data pertinent to the particular maximum
525	rate of payment.
526	Section 12. Subsection (2) of section 458.303, Florida
527	Statutes, is amended to read:
528	458.303 Provisions not applicable to other practitioners;
529	exceptions, etc.--
530	(2) Nothing in s. 458.301, s. 458.303, s. 458.305, s.
531	458.307, s. 458.309, s. 458.311, s. 458.313, s. 458.319, s.
532	458.321, s. 458.327, s. 458.329, s. 458.331, s. 458.337, s.
533	458.339, s. 458.341, s. 458.343, s. 458.345, or s. 458.347 shall
534	be construed to prohibit any service rendered by a registered
535	nurse, or a licensed practical nurse, or a certified geriatric
536	specialist,if such service is rendered under the direct
537	supervision and control of a licensed physician who provides
538	specific direction for any service to be performed and gives
539	final approval to all services performed. Further, nothing in
540	this or any other chapter shall be construed to prohibit any
541	service rendered by a medical assistant in accordance with the
542	provisions of s. 458.3485.
543	Section 13. Subsection (1) and paragraph (a) of subsection
544	(2) of section 1009.65, Florida Statutes, are amended to read:
545	1009.65 Medical Education Reimbursement and Loan Repayment
546	Program.--
547	(1) To encourage qualified medical professionals to
548	practice in underserved locations where there are shortages of
549	such personnel, there is established the Medical Education
550	Reimbursement and Loan Repayment Program. The function of the
551	program is to make payments that offset loans and educational
552	expenses incurred by students for studies leading to a medical
553	or nursing degree, medical or nursing licensure, or advanced
554	registered nurse practitioner certification or physician
555	assistant licensure. The following licensed or certified health
556	care professionals are eligible to participate in this program:
557	medical doctors with primary care specialties, doctors of
558	osteopathic medicine with primary care specialties, physician's
559	assistants, certified geriatric specialists,licensed practical
560	nurses,and registered nurses, and advanced registered nurse
561	practitioners with primary care specialties such as certified
562	nurse midwives. Primary care medical specialties for physicians
563	include obstetrics, gynecology, general and family practice,
564	internal medicine, pediatrics, and other specialties which may
565	be identified by the 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, licensed practical nurses,and registered nurses,
571	up to $10,000 per year for advanced registered nurse
572	practitioners and physician's assistants, and up to $20,000 per
573	year for physicians. Penalties for noncompliance shall be the
574	same as those in the National Health Services Corps Loan
575	Repayment Program. Educational expenses include costs for
576	tuition, matriculation, registration, books, laboratory and
577	other fees, other educational costs, and reasonable living
578	expenses as determined by the Department of Health.
579	Section 14. Subsection (2) of section 1009.66, Florida
580	Statutes, is amended to read:
581	1009.66 Nursing Student Loan Forgiveness Program.--
582	(2) To be eligible, a candidate must have graduated from
583	an accredited or approved nursing program and have received a
584	Florida license as a licensed practical nurse or a registered
585	nurse or a Florida certificate as a certified geriatric
586	specialist oran advanced registered nurse practitioner.
587	Section 15. The sum of $157,017 is appropriated from the
588	General Revenue Fund to the Agency for Workforce Innovation to
589	support the work of the Certified Geriatric Specialty Nursing
590	Initiative Steering Committee, to administer the pilot sites, to
591	contract for an evaluation, and to provide, if necessary,
592	nursing faculty, substitute certified nursing assistants for
593	those who are in clinical education, and technical support to
594	the pilot sites during the 2004-2005 fiscal year.
595	Section 16. Subsection (6) is added to section 464.201,
596	Florida Statutes, to read:
597	464.201 Definitions.--As used in this part, the term:
598	(6) "Practice of a certified nursing assistant" means
599	providing care and assisting persons with tasks relating to the
600	activities of daily living. Such tasks are those associated with
601	personal care, maintaining mobility, nutrition and hydration,
602	toileting and elimination, assistive devices, safety and
603	cleanliness, data gathering, reporting abnormal signs and
604	symptoms, postmortem care, patient socialization and reality
605	orientation, end-of-life care, cardiopulmonary resuscitation and
606	emergency care, residents' or patients' rights, documentation of
607	nursing assistant services, and other tasks that a certified
608	nursing assistant may perform after training beyond that
609	required for initial certification and upon validation of
610	competence in that skill by a registered nurse. This section
611	does not restrict the ability of any person who is otherwise
612	trained and educated from performing such tasks.
613	Section 17. Section 464.202, Florida Statutes, is amended
614	to read:
615	464.202 Duties and powers of the board.--The board shall
616	maintain, or contract with or approve another entity to
617	maintain, a state registry of certified nursing assistants. The
618	registry must consist of the name of each certified nursing
619	assistant in this state; other identifying information defined
620	by board rule; certification status; the effective date of
621	certification; other information required by state or federal
622	law; information regarding any crime or any abuse, neglect, or
623	exploitation as provided under chapter 435; and any disciplinary
624	action taken against the certified nursing assistant. The
625	registry shall be accessible to the public, the
626	certificateholder, employers, and other state agencies. The
627	board shall adopt by rule testing procedures for use in
628	certifying nursing assistants and shall adopt rules regulating
629	the practice of certified nursing assistants which specify the
630	scope of practice authorized and the level of supervision
631	required for the practice of certified nursing assistants to
632	enforce this part. The board may contract with or approve
633	another entity or organization to provide the examination
634	services, including the development and administration of
635	examinations. The board shall require that the contract provider
636	offer certified nursing assistant applications via the Internet,
637	and may require the contract provider to accept certified
638	nursing assistant applications for processing via the Internet.
639	The board shall require the contract provider to provide the
640	preliminary results of the certified nursing examination on the
641	date the test is administered. The provider shall pay all
642	reasonable costs and expenses incurred by the board in
643	evaluating the provider's application and performance during the
644	delivery of services, including examination services and
645	procedures for maintaining the certified nursing assistant
646	registry.
647	Section 18. This act shall take effect upon becoming a
648	law.