| 1 | Representative Farkas offered the following: |
| 2 |
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| 3 | Amendment to Amendment (954111) (with directory and title |
| 4 | amendments) |
| 5 | Between lines 3939 and 3940 insert: |
| 6 | Section 113. Sections 113 through 129 of this act may be |
| 7 | referred to by the popular name the "Clara Ramsey Care of the |
| 8 | Elderly Act." |
| 9 | Section 114. Certified Geriatric Specialist Preparation |
| 10 | Pilot Program.-- |
| 11 | (1) The Agency for Workforce Innovation shall establish a |
| 12 | pilot program for delivery of geriatric nursing education to |
| 13 | certified nursing assistants who wish to become certified |
| 14 | geriatric specialists. The agency shall select two pilot sites |
| 15 | in nursing homes that have received the Gold Seal designation |
| 16 | under s. 400.235, Florida Statutes; have been designated as |
| 17 | teaching nursing homes under s. 430.80, Florida Statutes; or |
| 18 | have not received a class I or class II deficiency within the 30 |
| 19 | months preceding application for this program. |
| 20 | (2) To be eligible to receive geriatric nursing education, |
| 21 | a certified nursing assistant must have been employed by a |
| 22 | participating nursing home for at least 1 year and must have |
| 23 | received a high school diploma or its equivalent. |
| 24 | (3) The education shall be provided at the worksite and in |
| 25 | coordination with the certified nursing assistant's work |
| 26 | schedule. |
| 27 | (4) Faculty shall provide the instruction under an |
| 28 | approved nursing program pursuant to s. 464.019, Florida |
| 29 | Statutes. |
| 30 | (5) The education must be designed to prepare the |
| 31 | certified nursing assistant to meet the requirements for |
| 32 | certification as a geriatric specialist. The didactic and |
| 33 | clinical education must include all portions of the practical |
| 34 | nursing curriculum pursuant to s. 464.019, Florida Statutes, |
| 35 | except for pediatric and obstetric/maternal-child education, and |
| 36 | must include additional education in the care of ill, injured, |
| 37 | or infirm geriatric patients and the maintenance of health, the |
| 38 | prevention of injury, and the provision of palliative care for |
| 39 | geriatric patients. |
| 40 | Section 115. Certified Geriatric Specialty Nursing |
| 41 | Initiative Steering Committee.-- |
| 42 | (1) In order to guide the implementation of the Certified |
| 43 | Geriatric Specialist Preparation Pilot Program, there is created |
| 44 | a Certified Geriatric Specialty Nursing Initiative Steering |
| 45 | Committee. The steering committee shall be composed of the |
| 46 | following members: |
| 47 | (a) The chair of the Board of Nursing or his or her |
| 48 | designee. |
| 49 | (b) A representative of the Agency for Workforce |
| 50 | Innovation, appointed by the director of Workforce Innovation. |
| 51 | (c) A representative of Workforce Florida, Inc., appointed |
| 52 | by the chair of the board of directors of Workforce Florida, |
| 53 | Inc. |
| 54 | (d) A representative of the Department of Education, |
| 55 | appointed by the Secretary of Education. |
| 56 | (e) A representative of the Department of Health, |
| 57 | appointed by the Secretary of Health. |
| 58 | (f) A representative of the Agency for Health Care |
| 59 | Administration, appointed by the Secretary of Health Care |
| 60 | Administration. |
| 61 | (g) The executive director of the Florida Center for |
| 62 | Nursing. |
| 63 | (h) A representative of the Department of Elderly Affairs, |
| 64 | appointed by the Secretary of Elderly Affairs. |
| 65 | (i) A representative of a Gold Seal nursing home that is |
| 66 | not one of the pilot program sites, appointed by the Secretary |
| 67 | of Health Care Administration. |
| 68 | (2) The steering committee shall: |
| 69 | (a) Provide consultation and guidance to the Agency for |
| 70 | Workforce Innovation on matters of policy during the |
| 71 | implementation of the pilot program. |
| 72 | (b) Provide oversight to the evaluation of the pilot |
| 73 | program. |
| 74 | (3) Members of the steering committee are entitled to |
| 75 | reimbursement for per diem and travel expenses under s. 112.061, |
| 76 | Florida Statutes. |
| 77 | (4) The steering committee shall complete its activities |
| 78 | by June 30, 2007, and the authorization for the steering |
| 79 | committee ends on that date. |
| 80 | Section 116. Evaluation of the Certified Geriatric |
| 81 | Specialist Preparation Pilot Program.--The Agency for Workforce |
| 82 | Innovation, in consultation with the Certified Geriatric |
| 83 | Specialty Nursing Initiative Steering Committee, shall conduct |
| 84 | or contract for an evaluation of the pilot program. The agency |
| 85 | shall ensure that an evaluation report is submitted to the |
| 86 | Governor, the President of the Senate, and the Speaker of the |
| 87 | House of Representatives by January 1, 2007. The evaluation must |
| 88 | address the experience and success of the certified nursing |
| 89 | assistants in the pilot program and must contain recommendations |
| 90 | regarding the expansion of the delivery of geriatric nursing |
| 91 | education in nursing homes. |
| 92 | Section 117. Reports.--The Agency for Workforce Innovation |
| 93 | shall submit status reports and recommendations regarding |
| 94 | legislation necessary to further the implementation of the pilot |
| 95 | program to the Governor, the President of the Senate, and the |
| 96 | Speaker of the House of Representatives on January 1, 2005, |
| 97 | January 1, 2006, and January 1, 2007. |
| 98 | Section 118. Section 464.0125, Florida Statutes, is |
| 99 | created to read: |
| 100 | 464.0125 Certified geriatric specialists; certification |
| 101 | requirements.-- |
| 102 | (1) DEFINITIONS; RESPONSIBILITIES.-- |
| 103 | (a) As used in this section, the term: |
| 104 | 1. "Certified geriatric specialist" means a person who |
| 105 | meets the qualifications specified in this section and who is |
| 106 | certified by the board to practice as a certified geriatric |
| 107 | specialist. |
| 108 | 2. "Geriatric patient" means any patient who is 60 years |
| 109 | of age or older. |
| 110 | 3. "Practice of certified geriatric specialty nursing" |
| 111 | means the performance of selected acts in facilities licensed |
| 112 | under part II or part III of chapter 400, including the |
| 113 | administration of treatments and medications, in the care of |
| 114 | ill, injured, or infirm geriatric patients and the promotion of |
| 115 | wellness, maintenance of health, and prevention of illness of |
| 116 | geriatric patients under the direction of a registered nurse, a |
| 117 | licensed physician, a licensed osteopathic physician, a licensed |
| 118 | podiatric physician, or a licensed dentist. The scope of |
| 119 | practice of a certified geriatric specialist includes the |
| 120 | practice of practical nursing as defined in s. 464.003 for |
| 121 | geriatric patients only, except for any act in which instruction |
| 122 | and clinical knowledge of pediatric nursing or |
| 123 | obstetric/maternal-child nursing is required. A certified |
| 124 | geriatric specialist, while providing nursing services in |
| 125 | facilities licensed under part II or part III of chapter 400, |
| 126 | may supervise the activities of certified nursing assistants and |
| 127 | other unlicensed personnel providing services in such facilities |
| 128 | in accordance with rules adopted by the board. |
| 129 | (b) The certified geriatric specialist shall be |
| 130 | responsible and accountable for making decisions that are based |
| 131 | upon the individual's educational preparation and experience in |
| 132 | performing certified geriatric specialty nursing. |
| 133 | (2) CERTIFICATION.-- |
| 134 | (a) Any certified nursing assistant desiring to be |
| 135 | certified as a certified geriatric specialist must apply to the |
| 136 | department and submit proof that he or she holds a current |
| 137 | certificate as a certified nursing assistant under part II of |
| 138 | this chapter and has satisfactorily completed the following |
| 139 | requirements: |
| 140 | 1. Is in good mental and physical health, is a recipient |
| 141 | of a high school diploma or its equivalent, and has completed |
| 142 | the requirements for graduation from an approved program for |
| 143 | nursing or its equivalent, as determined by the board, for the |
| 144 | preparation of licensed practical nurses, except for instruction |
| 145 | and clinical knowledge of pediatric nursing or |
| 146 | obstetric/maternal-child nursing. Any program that is approved |
| 147 | on July 1, 2004, by the board for the preparation of registered |
| 148 | nurses or licensed practical nurses may provide education for |
| 149 | the preparation of certified geriatric specialists without |
| 150 | further board approval. |
| 151 | 2. Has the ability to communicate in the English language, |
| 152 | which may be determined by an examination given by the |
| 153 | department. |
| 154 | 3. Has provided sufficient information, which must be |
| 155 | submitted by the department for a statewide criminal records |
| 156 | correspondence check through the Department of Law Enforcement. |
| 157 | (b) Each applicant who meets the requirements of this |
| 158 | subsection is, unless denied pursuant to s. 464.018, entitled to |
| 159 | certification as a certified geriatric specialist. The board |
| 160 | must certify, and the department must issue a certificate to |
| 161 | practice as a certified geriatric specialist to, any certified |
| 162 | nursing assistant who meets the qualifications set forth in this |
| 163 | section. The board shall establish an application fee not to |
| 164 | exceed $100 and a biennial renewal fee not to exceed $50. The |
| 165 | board may adopt rules pursuant to ss. 120.536(1) and 120.54 to |
| 166 | administer this section. |
| 167 | (c) A person receiving certification under this section |
| 168 | shall: |
| 169 | 1. Work only within the confines of a facility licensed |
| 170 | under part II or part III of chapter 400. |
| 171 | 2. Care for geriatric patients only. |
| 172 | 3. Comply with the minimum standards of practice for |
| 173 | nurses and be subject to disciplinary action for violations of |
| 174 | s. 464.018. |
| 175 | (3) ARTICULATION.--Any certified geriatric specialist who |
| 176 | completes the additional instruction and coursework in an |
| 177 | approved nursing program pursuant to s. 464.019 for the |
| 178 | preparation of practical nursing in the areas of pediatric |
| 179 | nursing and obstetric/maternal-child nursing is, unless denied |
| 180 | pursuant to s. 464.018, entitled to licensure as a licensed |
| 181 | practical nurse if the applicant otherwise meets the |
| 182 | requirements of s. 464.008. |
| 183 | (4) TITLES AND ABBREVIATIONS; RESTRICTIONS; PENALTIES.-- |
| 184 | (a) Only persons who hold certificates to practice as |
| 185 | certified geriatric specialists in this state or who are |
| 186 | performing services within the practice of certified geriatric |
| 187 | specialty nursing pursuant to the exception set forth in s. |
| 188 | 464.022(8) may use the title "Certified Geriatric Specialist" |
| 189 | and the abbreviation "C.G.S." |
| 190 | (b) A person may not practice or advertise as, or assume |
| 191 | the title of, a certified geriatric specialist or use the |
| 192 | abbreviation "C.G.S." or take any other action that would lead |
| 193 | the public to believe that person is certified as such or is |
| 194 | performing services within the practice of certified geriatric |
| 195 | specialty nursing pursuant to the exception set forth in s. |
| 196 | 464.022(8), unless that person is certified to practice as such. |
| 197 | (c) A violation of this subsection is a misdemeanor of the |
| 198 | first degree, punishable as provided in s. 775.082 or s. |
| 199 | 775.083. |
| 200 | (5) VIOLATIONS AND PENALTIES.--Practicing certified |
| 201 | geriatric specialty nursing, as defined in this section, without |
| 202 | holding an active certificate to do so constitutes a felony of |
| 203 | the third degree, punishable as provided in s. 775.082, s. |
| 204 | 775.083, or s. 775.084. |
| 205 | Section 119. Paragraph (b) of subsection (1) of section |
| 206 | 381.00315, Florida Statutes, is amended to read: |
| 207 | 381.00315 Public health advisories; public health |
| 208 | emergencies.--The State Health Officer is responsible for |
| 209 | declaring public health emergencies and issuing public health |
| 210 | advisories. |
| 211 | (1) As used in this section, the term: |
| 212 | (b) "Public health emergency" means any occurrence, or |
| 213 | threat thereof, whether natural or man made, which results or |
| 214 | may result in substantial injury or harm to the public health |
| 215 | from infectious disease, chemical agents, nuclear agents, |
| 216 | biological toxins, or situations involving mass casualties or |
| 217 | natural disasters. Prior to declaring a public health emergency, |
| 218 | the State Health Officer shall, to the extent possible, consult |
| 219 | with the Governor and shall notify the Chief of Domestic |
| 220 | Security Initiatives as created in s. 943.03. The declaration of |
| 221 | a public health emergency shall continue until the State Health |
| 222 | Officer finds that the threat or danger has been dealt with to |
| 223 | the extent that the emergency conditions no longer exist and he |
| 224 | or she terminates the declaration. However, a declaration of a |
| 225 | public health emergency may not continue for longer than 60 days |
| 226 | unless the Governor concurs in the renewal of the declaration. |
| 227 | The State Health Officer, upon declaration of a public health |
| 228 | emergency, may take actions that are necessary to protect the |
| 229 | public health. Such actions include, but are not limited to: |
| 230 | 1. Directing manufacturers of prescription drugs or over- |
| 231 | the-counter drugs who are permitted under chapter 499 and |
| 232 | wholesalers of prescription drugs located in this state who are |
| 233 | permitted under chapter 499 to give priority to the shipping of |
| 234 | specified drugs to pharmacies and health care providers within |
| 235 | geographic areas that have been identified by the State Health |
| 236 | Officer. The State Health Officer must identify the drugs to be |
| 237 | shipped. Manufacturers and wholesalers located in the state must |
| 238 | respond to the State Health Officer's priority shipping |
| 239 | directive before shipping the specified drugs. |
| 240 | 2. Notwithstanding chapters 465 and 499 and rules adopted |
| 241 | thereunder, directing pharmacists employed by the department to |
| 242 | compound bulk prescription drugs and provide these bulk |
| 243 | prescription drugs to physicians and nurses of county health |
| 244 | departments or any qualified person authorized by the State |
| 245 | Health Officer for administration to persons as part of a |
| 246 | prophylactic or treatment regimen. |
| 247 | 3. Notwithstanding s. 456.036, temporarily reactivating |
| 248 | the inactive license of the following health care practitioners, |
| 249 | when such practitioners are needed to respond to the public |
| 250 | health emergency: physicians licensed under chapter 458 or |
| 251 | chapter 459; physician assistants licensed under chapter 458 or |
| 252 | chapter 459; certified geriatric specialists, licensed practical |
| 253 | nurses, registered nurses, and advanced registered nurse |
| 254 | practitioners certified or licensed under part I of chapter 464; |
| 255 | respiratory therapists licensed under part V of chapter 468; and |
| 256 | emergency medical technicians and paramedics certified under |
| 257 | part III of chapter 401. Only those health care practitioners |
| 258 | specified in this paragraph who possess an unencumbered inactive |
| 259 | license and who request that such license be reactivated are |
| 260 | eligible for reactivation. An inactive license that is |
| 261 | reactivated under this paragraph shall return to inactive status |
| 262 | when the public health emergency ends or prior to the end of the |
| 263 | public health emergency if the State Health Officer determines |
| 264 | that the health care practitioner is no longer needed to provide |
| 265 | services during the public health emergency. Such licenses may |
| 266 | only be reactivated for a period not to exceed 90 days without |
| 267 | meeting the requirements of s. 456.036 or chapter 401, as |
| 268 | applicable. |
| 269 | 4. Ordering an individual to be examined, tested, |
| 270 | vaccinated, treated, or quarantined for communicable diseases |
| 271 | that have significant morbidity or mortality and present a |
| 272 | severe danger to public health. Individuals who are unable or |
| 273 | unwilling to be examined, tested, vaccinated, or treated for |
| 274 | reasons of health, religion, or conscience may be subjected to |
| 275 | quarantine. |
| 276 | a. Examination, testing, vaccination, or treatment may be |
| 277 | performed by any qualified person authorized by the State Health |
| 278 | Officer. |
| 279 | b. If the individual poses a danger to the public health, |
| 280 | the State Health Officer may subject the individual to |
| 281 | quarantine. If there is no practical method to quarantine the |
| 282 | individual, the State Health Officer may use any means necessary |
| 283 | to vaccinate or treat the individual. |
| 284 |
|
| 285 | Any order of the State Health Officer given to effectuate this |
| 286 | paragraph shall be immediately enforceable by a law enforcement |
| 287 | officer under s. 381.0012. |
| 288 | Section 120. Subsection (14) of section 400.021, Florida |
| 289 | Statutes, is amended to read: |
| 290 | 400.021 Definitions.--When used in this part, unless the |
| 291 | context otherwise requires, the term: |
| 292 | (14) "Nursing service" means such services or acts as may |
| 293 | be rendered, directly or indirectly, to and in behalf of a |
| 294 | person by individuals as defined in ss. s. 464.003 and 464.0125. |
| 295 | Section 121. Subsection (1) of section 400.211, Florida |
| 296 | Statutes, is amended to read: |
| 297 | 400.211 Persons employed as nursing assistants; |
| 298 | certification requirement.-- |
| 299 | (1) To serve as a nursing assistant in any nursing home, a |
| 300 | person must be certified as a nursing assistant under part II of |
| 301 | chapter 464, unless the person is a registered nurse, a or |
| 302 | practical nurse, or a certified geriatric specialist certified |
| 303 | or licensed in accordance with part I of chapter 464 or an |
| 304 | applicant for such certification or licensure who is permitted |
| 305 | to practice nursing in accordance with rules adopted by the |
| 306 | Board of Nursing pursuant to part I of chapter 464. |
| 307 | Section 122. Paragraphs (a) and (c) of subsection (3) of |
| 308 | section 400.23, Florida Statutes, are amended to read: |
| 309 | 400.23 Rules; evaluation and deficiencies; licensure |
| 310 | status.-- |
| 311 | (3)(a) The agency shall adopt rules providing for the |
| 312 | minimum staffing requirements for nursing homes. These |
| 313 | requirements shall include, for each nursing home facility, a |
| 314 | minimum certified nursing assistant staffing of 2.3 hours of |
| 315 | direct care per resident per day beginning January 1, 2002, |
| 316 | increasing to 2.6 hours of direct care per resident per day |
| 317 | beginning January 1, 2003, and increasing to 2.9 hours of direct |
| 318 | care per resident per day beginning May 1, 2004. Beginning |
| 319 | January 1, 2002, no facility shall staff below one certified |
| 320 | nursing assistant per 20 residents, and a minimum licensed |
| 321 | nursing staffing of 1.0 hour of direct resident care per |
| 322 | resident per day but never below one licensed nurse per 40 |
| 323 | residents. For purposes of computing nursing staffing minimums |
| 324 | and ratios, certified geriatric specialists shall be considered |
| 325 | licensed nursing staff. Nursing assistants employed never below |
| 326 | one licensed nurse per 40 residents. Nursing assistants employed |
| 327 | under s. 400.211(2) may be included in computing the staffing |
| 328 | ratio for certified nursing assistants only if they provide |
| 329 | nursing assistance services to residents on a full-time basis. |
| 330 | Each nursing home must document compliance with staffing |
| 331 | standards as required under this paragraph and post daily the |
| 332 | names of staff on duty for the benefit of facility residents and |
| 333 | the public. The agency shall recognize the use of licensed |
| 334 | nurses for compliance with minimum staffing requirements for |
| 335 | certified nursing assistants, provided that the facility |
| 336 | otherwise meets the minimum staffing requirements for licensed |
| 337 | nurses and that the licensed nurses so recognized are performing |
| 338 | the duties of a certified nursing assistant. Unless otherwise |
| 339 | approved by the agency, licensed nurses counted towards the |
| 340 | minimum staffing requirements for certified nursing assistants |
| 341 | must exclusively perform the duties of a certified nursing |
| 342 | assistant for the entire shift and shall not also be counted |
| 343 | towards the minimum staffing requirements for licensed nurses. |
| 344 | If the agency approved a facility's request to use a licensed |
| 345 | nurse to perform both licensed nursing and certified nursing |
| 346 | assistant duties, the facility must allocate the amount of staff |
| 347 | time specifically spent on certified nursing assistant duties |
| 348 | for the purpose of documenting compliance with minimum staffing |
| 349 | requirements for certified and licensed nursing staff. In no |
| 350 | event may the hours of a licensed nurse with dual job |
| 351 | responsibilities be counted twice. |
| 352 | (c) Licensed practical nurses licensed under chapter 464 |
| 353 | who are providing nursing services in nursing home facilities |
| 354 | under this part may supervise the activities of other licensed |
| 355 | practical nurses, certified geriatric specialists, certified |
| 356 | nursing assistants, and other unlicensed personnel providing |
| 357 | services in such facilities in accordance with rules adopted by |
| 358 | the Board of Nursing. |
| 359 | Section 123. Paragraph (b) of subsection (2) of section |
| 360 | 409.908, Florida Statutes, is amended to read: |
| 361 | 409.908 Reimbursement of Medicaid providers.--Subject to |
| 362 | specific appropriations, the agency shall reimburse Medicaid |
| 363 | providers, in accordance with state and federal law, according |
| 364 | to methodologies set forth in the rules of the agency and in |
| 365 | policy manuals and handbooks incorporated by reference therein. |
| 366 | These methodologies may include fee schedules, reimbursement |
| 367 | methods based on cost reporting, negotiated fees, competitive |
| 368 | bidding pursuant to s. 287.057, and other mechanisms the agency |
| 369 | considers efficient and effective for purchasing services or |
| 370 | goods on behalf of recipients. If a provider is reimbursed based |
| 371 | on cost reporting and submits a cost report late and that cost |
| 372 | report would have been used to set a lower reimbursement rate |
| 373 | for a rate semester, then the provider's rate for that semester |
| 374 | shall be retroactively calculated using the new cost report, and |
| 375 | full payment at the recalculated rate shall be affected |
| 376 | retroactively. Medicare-granted extensions for filing cost |
| 377 | reports, if applicable, shall also apply to Medicaid cost |
| 378 | reports. Payment for Medicaid compensable services made on |
| 379 | behalf of Medicaid eligible persons is subject to the |
| 380 | availability of moneys and any limitations or directions |
| 381 | provided for in the General Appropriations Act or chapter 216. |
| 382 | Further, nothing in this section shall be construed to prevent |
| 383 | or limit the agency from adjusting fees, reimbursement rates, |
| 384 | lengths of stay, number of visits, or number of services, or |
| 385 | making any other adjustments necessary to comply with the |
| 386 | availability of moneys and any limitations or directions |
| 387 | provided for in the General Appropriations Act, provided the |
| 388 | adjustment is consistent with legislative intent. |
| 389 | (2) |
| 390 | (b) Subject to any limitations or directions provided for |
| 391 | in the General Appropriations Act, the agency shall establish |
| 392 | and implement a Florida Title XIX Long-Term Care Reimbursement |
| 393 | Plan (Medicaid) for nursing home care in order to provide care |
| 394 | and services in conformance with the applicable state and |
| 395 | federal laws, rules, regulations, and quality and safety |
| 396 | standards and to ensure that individuals eligible for medical |
| 397 | assistance have reasonable geographic access to such care. |
| 398 | 1. Changes of ownership or of licensed operator do not |
| 399 | qualify for increases in reimbursement rates associated with the |
| 400 | change of ownership or of licensed operator. The agency shall |
| 401 | amend the Title XIX Long-Term Long Term Care Reimbursement Plan |
| 402 | to provide that the initial nursing home reimbursement rates, |
| 403 | for the operating, patient care, and MAR components, associated |
| 404 | with related and unrelated party changes of ownership or |
| 405 | licensed operator filed on or after September 1, 2001, are |
| 406 | equivalent to the previous owner's reimbursement rate. |
| 407 | 2. The agency shall amend the long-term care reimbursement |
| 408 | plan and cost reporting system to create direct care and |
| 409 | indirect care subcomponents of the patient care component of the |
| 410 | per diem rate. These two subcomponents together shall equal the |
| 411 | patient care component of the per diem rate. Separate cost-based |
| 412 | ceilings shall be calculated for each patient care subcomponent. |
| 413 | The direct care subcomponent of the per diem rate shall be |
| 414 | limited by the cost-based class ceiling, and the indirect care |
| 415 | subcomponent shall be limited by the lower of the cost-based |
| 416 | class ceiling, by the target rate class ceiling, or by the |
| 417 | individual provider target. The agency shall adjust the patient |
| 418 | care component effective January 1, 2002. The cost to adjust the |
| 419 | direct care subcomponent shall be net of the total funds |
| 420 | previously allocated for the case mix add-on. The agency shall |
| 421 | make the required changes to the nursing home cost reporting |
| 422 | forms to implement this requirement effective January 1, 2002. |
| 423 | 3. The direct care subcomponent shall include salaries and |
| 424 | benefits of direct care staff providing nursing services |
| 425 | including registered nurses, licensed practical nurses, |
| 426 | certified geriatric specialists, and certified nursing |
| 427 | assistants who deliver care directly to residents in the nursing |
| 428 | home facility. This excludes nursing administration, MDS, and |
| 429 | care plan coordinators, staff development, and staffing |
| 430 | coordinator. |
| 431 | 4. All other patient care costs shall be included in the |
| 432 | indirect care cost subcomponent of the patient care per diem |
| 433 | rate. There shall be no costs directly or indirectly allocated |
| 434 | to the direct care subcomponent from a home office or management |
| 435 | company. |
| 436 | 5. On July 1 of each year, the agency shall report to the |
| 437 | Legislature direct and indirect care costs, including average |
| 438 | direct and indirect care costs per resident per facility and |
| 439 | direct care and indirect care salaries and benefits per category |
| 440 | of staff member per facility. |
| 441 | 6. In order to offset the cost of general and professional |
| 442 | liability insurance, the agency shall amend the plan to allow |
| 443 | for interim rate adjustments to reflect increases in the cost of |
| 444 | general or professional liability insurance for nursing homes. |
| 445 | This provision shall be implemented to the extent existing |
| 446 | appropriations are available. |
| 447 |
|
| 448 | It is the intent of the Legislature that the reimbursement plan |
| 449 | achieve the goal of providing access to health care for nursing |
| 450 | home residents who require large amounts of care while |
| 451 | encouraging diversion services as an alternative to nursing home |
| 452 | care for residents who can be served within the community. The |
| 453 | agency shall base the establishment of any maximum rate of |
| 454 | payment, whether overall or component, on the available moneys |
| 455 | as provided for in the General Appropriations Act. The agency |
| 456 | may base the maximum rate of payment on the results of |
| 457 | scientifically valid analysis and conclusions derived from |
| 458 | objective statistical data pertinent to the particular maximum |
| 459 | rate of payment. |
| 460 | Section 124. Subsection (2) of section 458.303, Florida |
| 461 | Statutes, is amended to read: |
| 462 | 458.303 Provisions not applicable to other practitioners; |
| 463 | exceptions, etc.-- |
| 464 | (2) Nothing in s. 458.301, s. 458.303, s. 458.305, s. |
| 465 | 458.307, s. 458.309, s. 458.311, s. 458.313, s. 458.319, s. |
| 466 | 458.321, s. 458.327, s. 458.329, s. 458.331, s. 458.337, s. |
| 467 | 458.339, s. 458.341, s. 458.343, s. 458.345, or s. 458.347 shall |
| 468 | be construed to prohibit any service rendered by a registered |
| 469 | nurse, or a licensed practical nurse, or a certified geriatric |
| 470 | specialist, if such service is rendered under the direct |
| 471 | supervision and control of a licensed physician who provides |
| 472 | specific direction for any service to be performed and gives |
| 473 | final approval to all services performed. Further, nothing in |
| 474 | this or any other chapter shall be construed to prohibit any |
| 475 | service rendered by a medical assistant in accordance with the |
| 476 | provisions of s. 458.3485. |
| 477 | Section 125. Subsection (1) and paragraph (a) of |
| 478 | subsection (2) of section 1009.65, Florida Statutes, are amended |
| 479 | to read: |
| 480 | 1009.65 Medical Education Reimbursement and Loan Repayment |
| 481 | Program.-- |
| 482 | (1) To encourage qualified medical professionals to |
| 483 | practice in underserved locations where there are shortages of |
| 484 | such personnel, there is established the Medical Education |
| 485 | Reimbursement and Loan Repayment Program. The function of the |
| 486 | program is to make payments that offset loans and educational |
| 487 | expenses incurred by students for studies leading to a medical |
| 488 | or nursing degree, medical or nursing licensure, or advanced |
| 489 | registered nurse practitioner certification or physician |
| 490 | assistant licensure. The following licensed or certified health |
| 491 | care professionals are eligible to participate in this program: |
| 492 | medical doctors with primary care specialties, doctors of |
| 493 | osteopathic medicine with primary care specialties, physician's |
| 494 | assistants, certified geriatric specialists, licensed practical |
| 495 | nurses, and registered nurses, and advanced registered nurse |
| 496 | practitioners with primary care specialties such as certified |
| 497 | nurse midwives. Primary care medical specialties for physicians |
| 498 | include obstetrics, gynecology, general and family practice, |
| 499 | internal medicine, pediatrics, and other specialties which may |
| 500 | be identified by the Department of Health. |
| 501 | (2) From the funds available, the Department of Health |
| 502 | shall make payments to selected medical professionals as |
| 503 | follows: |
| 504 | (a) Up to $4,000 per year for certified geriatric |
| 505 | specialists, licensed practical nurses, and registered nurses, |
| 506 | up to $10,000 per year for advanced registered nurse |
| 507 | practitioners and physician's assistants, and up to $20,000 per |
| 508 | year for physicians. Penalties for noncompliance shall be the |
| 509 | same as those in the National Health Services Corps Loan |
| 510 | Repayment Program. Educational expenses include costs for |
| 511 | tuition, matriculation, registration, books, laboratory and |
| 512 | other fees, other educational costs, and reasonable living |
| 513 | expenses as determined by the Department of Health. |
| 514 | Section 126. Subsection (2) of section 1009.66, Florida |
| 515 | Statutes, is amended to read: |
| 516 | 1009.66 Nursing Student Loan Forgiveness Program.-- |
| 517 | (2) To be eligible, a candidate must have graduated from |
| 518 | an accredited or approved nursing program and have received a |
| 519 | Florida license as a licensed practical nurse or a registered |
| 520 | nurse or a Florida certificate as a certified geriatric |
| 521 | specialist or an advanced registered nurse practitioner. |
| 522 | Section 127. The sum of $157,017 is appropriated from the |
| 523 | General Revenue Fund to the Agency for Workforce Innovation to |
| 524 | support the work of the Certified Geriatric Specialty Nursing |
| 525 | Initiative Steering Committee, to administer the pilot sites, to |
| 526 | contract for an evaluation, and to provide, if necessary, |
| 527 | nursing faculty, substitute certified nursing assistants for |
| 528 | those who are in clinical education, and technical support to |
| 529 | the pilot sites during the 2004-2005 fiscal year. |
| 530 | Section 128. Subsection (6) is added to section 464.201, |
| 531 | Florida Statutes, to read: |
| 532 | 464.201 Definitions.--As used in this part, the term: |
| 533 | (6) "Practice of a certified nursing assistant" means |
| 534 | providing care and assisting persons with tasks relating to the |
| 535 | activities of daily living. Such tasks are those associated with |
| 536 | personal care, maintaining mobility, nutrition and hydration, |
| 537 | toileting and elimination, assistive devices, safety and |
| 538 | cleanliness, data gathering, reporting abnormal signs and |
| 539 | symptoms, postmortem care, patient socialization and reality |
| 540 | orientation, end-of-life care, cardiopulmonary resuscitation and |
| 541 | emergency care, residents' or patients' rights, documentation of |
| 542 | nursing assistant services, and other tasks that a certified |
| 543 | nursing assistant may perform after training beyond that |
| 544 | required for initial certification and upon validation of |
| 545 | competence in that skill by a registered nurse. This section |
| 546 | does not restrict the ability of any person who is otherwise |
| 547 | trained and educated from performing such tasks. |
| 548 | Section 129. Section 464.202, Florida Statutes, is amended |
| 549 | to read: |
| 550 | 464.202 Duties and powers of the board.--The board shall |
| 551 | maintain, or contract with or approve another entity to |
| 552 | maintain, a state registry of certified nursing assistants. The |
| 553 | registry must consist of the name of each certified nursing |
| 554 | assistant in this state; other identifying information defined |
| 555 | by board rule; certification status; the effective date of |
| 556 | certification; other information required by state or federal |
| 557 | law; information regarding any crime or any abuse, neglect, or |
| 558 | exploitation as provided under chapter 435; and any disciplinary |
| 559 | action taken against the certified nursing assistant. The |
| 560 | registry shall be accessible to the public, the |
| 561 | certificateholder, employers, and other state agencies. The |
| 562 | board shall adopt by rule testing procedures for use in |
| 563 | certifying nursing assistants and shall adopt rules regulating |
| 564 | the practice of certified nursing assistants which specify the |
| 565 | scope of practice authorized and the level of supervision |
| 566 | required for the practice of certified nursing assistants to |
| 567 | enforce this part. The board may contract with or approve |
| 568 | another entity or organization to provide the examination |
| 569 | services, including the development and administration of |
| 570 | examinations. The board shall require that the contract provider |
| 571 | offer certified nursing assistant applications via the Internet, |
| 572 | and may require the contract provider to accept certified |
| 573 | nursing assistant applications for processing via the Internet. |
| 574 | The board shall require the contract provider to provide the |
| 575 | preliminary results of the certified nursing examination on the |
| 576 | date the test is administered. The provider shall pay all |
| 577 | reasonable costs and expenses incurred by the board in |
| 578 | evaluating the provider's application and performance during the |
| 579 | delivery of services, including examination services and |
| 580 | procedures for maintaining the certified nursing assistant |
| 581 | registry. |
| 582 |
|
| 583 | ================ T I T L E A M E N D M E N T ============= |
| 584 | Remove line 4160 and insert: |
| 585 | trainers; allowing for certain relicensure; providing a |
| 586 | popular name; requiring the Agency for Workforce |
| 587 | Innovation to establish a pilot program for the delivery |
| 588 | of geriatric nursing education; specifying eligibility |
| 589 | requirements for certified nursing assistants to receive |
| 590 | geriatric nursing education; specifying requirements for |
| 591 | geriatric nursing education provided to certified nursing |
| 592 | assistants in preparation for certification as certified |
| 593 | geriatric specialists; creating a Certified Geriatric |
| 594 | Specialty Nursing Initiative Steering Committee; providing |
| 595 | for the composition of and manner of appointment to the |
| 596 | steering committee; providing responsibilities of the |
| 597 | steering committee; providing for reimbursement for per |
| 598 | diem and travel expenses; requiring the agency, in |
| 599 | consultation with the steering committee, to conduct or |
| 600 | contract for an evaluation of the pilot program; requiring |
| 601 | the evaluation to include recommendations regarding the |
| 602 | expansion of the delivery of geriatric nursing education |
| 603 | in nursing homes; requiring the agency to report to the |
| 604 | Governor and the Legislature regarding the status and |
| 605 | evaluation of the pilot program; creating s. 464.0125, |
| 606 | F.S.; providing definitions; providing requirements for |
| 607 | persons to become certified geriatric specialists; |
| 608 | specifying fees; providing for articulation of geriatric |
| 609 | specialty nursing coursework and practical nursing |
| 610 | coursework; providing practice standards, restrictions, |
| 611 | and grounds for which certified geriatric specialists may |
| 612 | be subject to discipline by the board; creating |
| 613 | restrictions on the use of professional nursing titles and |
| 614 | abbreviations; prohibiting the use of certain professional |
| 615 | titles and abbreviations; providing penalties; authorizing |
| 616 | approved nursing programs to provide education for the |
| 617 | preparation of certified geriatric specialists without |
| 618 | further board approval; authorizing certified geriatric |
| 619 | specialists to supervise the activities of certain others |
| 620 | in nursing home facilities according to rules of the |
| 621 | board; amending s. 381.00315, F.S.; revising requirements |
| 622 | for the reactivation of the licenses of specified health |
| 623 | care practitioners in the event of a public health |
| 624 | emergency to include certified geriatric specialists; |
| 625 | amending s. 400.021, F.S.; including services provided by |
| 626 | a certified geriatric specialist within the definition of |
| 627 | nursing service; amending s. 400.211, F.S.; revising |
| 628 | requirements for persons employed as nursing assistants to |
| 629 | conform to the certification of certified geriatric |
| 630 | specialists; amending s. 400.23, F.S.; specifying that |
| 631 | certified geriatric specialists shall be considered |
| 632 | licensed nursing staff; authorizing licensed practical |
| 633 | nurses to supervise the activities of certified geriatric |
| 634 | specialists in nursing home facilities according to rules |
| 635 | adopted by the board; amending s. 409.908, F.S.; revising |
| 636 | the methodology for reimbursement of Medicaid program |
| 637 | providers to include services of certified geriatric |
| 638 | specialists; amending s. 458.303, F.S.; revising |
| 639 | exceptions to the practice of medicine to include services |
| 640 | delegated to a certified geriatric specialist under |
| 641 | specified circumstances; amending s. 1009.65, F.S.; |
| 642 | revising eligibility and funding provisions for the |
| 643 | Medical Education Reimbursement and Loan Repayment Program |
| 644 | to include certified geriatric specialists; amending s. |
| 645 | 1009.66, F.S.; revising eligibility requirements for the |
| 646 | Nursing Student Loan Forgiveness Program to include |
| 647 | certified geriatric specialists; providing an |
| 648 | appropriation; amending s. 464.201, F.S.; defining the |
| 649 | term "practice of a certified nursing assistant"; amending |
| 650 | s. 464.202, F.S.; authorizing the board to adopt rules |
| 651 | regarding the practice and supervision of certified |
| 652 | nursing assistants; repealing ss. |