Amendment

Bill No. 0653

Amendment No. 094817

CHAMBER ACTION
Senate		House
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1	Representative Zapata offered the following:
2
3	Amendment (with title amendment)
4	Remove everything after the enacting clause, and insert:
5	Section 1.  Subsections (1) and (2) of section 400.487,
6	Florida Statutes, are amended to read:
7	400.487  Home health service agreements; physician's,
8	physician's assistant's, and advanced registered nurse
9	practitioner's treatment orders; patient assessment;
10	establishment and review of plan of care; provision of services;
11	orders not to resuscitate.--
12	(1)  Services provided by a home health agency must be
13	covered by an agreement between the home health agency and the
14	patient or the patient's legal representative specifying the
15	home health services to be provided, the rates or charges for
16	services paid with private funds, and the sources method of
17	payment, which may include Medicare, Medicaid, private
18	insurance, personal funds, or a combination thereof. A home
19	health agency providing skilled care must make an assessment of
20	the patient's needs within 48 hours after the start of services.
21	(2)  When required by the provisions of chapter 464; part
22	I, part III, or part V of chapter 468; or chapter 486, the
23	attending physician, physician's assistant, or advanced
24	registered nurse practitioner, acting within his or her
25	respective scope of practice, shall for a patient who is to
26	receive skilled care must establish treatment orders for a
27	patient who is to receive skilled care. The treatment orders
28	must be signed by the physician, physician's assistant, or
29	advanced registered nurse practitioner before a claim for
30	payment for the skilled services is submitted by the home health
31	agency. If the claim is submitted to a managed care
32	organization, the treatment order must be signed in the time
33	allowed under the provider agreement. The treatment orders shall
34	within 30 days after the start of care and must be reviewed, as
35	frequently as the patient's illness requires, by the physician,
36	physician's assistant, or advanced registered nurse practitioner
37	in consultation with the home health agency personnel that
38	provide services to the patient.
39	Section 2.  Paragraph (c) of subsection (10) and paragraph
40	(a) of subsection (17) of section 400.506, Florida Statutes, are
41	amended to read:
42	400.506  Licensure of nurse registries; requirements;
43	penalties.--
44	(10)
45	(c)  A nurse registry shall advise the patient, the
46	patient's family, or a person acting on behalf of a patient at
47	the time of contracting for services through the nurse registry
48	of the availability of registered nurses to make visits to the
49	patient's home at an additional cost A registered nurse shall
50	make monthly visits to the patient's home to assess the
51	patient's condition and quality of care being provided by the
52	certified nursing assistant or home health aide. Any condition
53	which in the professional judgment of the nurse requires further
54	medical attention shall be reported to the attending physician
55	and the nurse registry. The assessment shall become a part of
56	the patient's file with the nurse registry and may be reviewed
57	by the agency during their survey procedure.
58	(17)  All persons referred for contract in private
59	residences by a nurse registry must comply with the following
60	requirements for a plan of treatment:
61	(a)  When, in accordance with the privileges and
62	restrictions imposed upon a nurse under part I of chapter 464,
63	the delivery of care to a patient is under the direction or
64	supervision of a physician or when a physician is responsible
65	for the medical care of the patient, a medical plan of treatment
66	must be established for each patient receiving care or treatment
67	provided by a licensed nurse in the home. The original medical
68	plan of treatment must be timely signed by the physician,
69	physician's assistant, or advanced registered nurse
70	practitioner, acting within his or her respective scope of
71	practice, and reviewed by him or her in consultation with the
72	licensed nurse at least every 2 months. Any additional order or
73	change in orders must be obtained from the physician,
74	physician's assistant, or advanced registered nurse practitioner
75	and reduced to writing and timely signed by the physician,
76	physician's assistant, or advanced registered nurse
77	practitioner. The delivery of care under a medical plan of
78	treatment must be substantiated by the appropriate nursing notes
79	or documentation made by the nurse in compliance with nursing
80	practices established under part I of chapter 464.
81	Section 3.  Paragraph (c) of subsection (1) of section
82	464.009, Florida Statutes, is amended to read:
83	464.009  Licensure by endorsement.--
84	(1)  The department shall issue the appropriate license by
85	endorsement to practice professional or practical nursing to an
86	applicant who, upon applying to the department and remitting a
87	fee set by the board not to exceed $100, demonstrates to the
88	board that he or she:
89	(c)  Has actively practiced nursing in another state,
90	jurisdiction, or territory of the United States for 2 of the
91	preceding 3 years without having his or her license acted
92	against by the licensing authority of any jurisdiction.
93	Applicants who become licensed pursuant to this paragraph must
94	complete within 6 months after licensure a Florida laws and
95	rules course that is approved by the board. Once the department
96	has received the results of the national criminal history check
97	and has determined that the applicant has no criminal history,
98	the appropriate license by endorsement shall be issued to the
99	applicant. This paragraph is repealed July 1, 2004, unless
100	reenacted by the Legislature.
101	Section 4.  This act shall take effect upon becoming a law.
102
103	================= T I T L E  A M E N D M E N T =================
104	Remove the entire title, and insert:
105	A bill to be entitled
106	An act relating to health care; amending s. 400.487, F.S.;
107	revising home health agency service agreements and
108	treatment orders; amending s. 400.506, F.S.; requiring
109	nurse registries to advise patients, their families, or
110	persons action on behalf of patients of the availability
111	of registered nurses to make visits at an additional cost;
112	removing the requirement for registered nurses to make
113	monthly visits to patients under the care of certified
114	nursing assistants or home health aides; revising
115	requirements for private residence plans of treatment;
116	amending s. 464.009, F.S.; saving a certain requirement
117	for licensure by endorsement from repeal; providing an
118	effective date.

CODING: Words stricken are deletions; words underlined are additions.