Senate Bill sb0430
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Florida Senate - 2005 SB 430
By Senator King
8-286-05
1 A bill to be entitled
2 An act relating to nursing; providing a short
3 title; requiring the Agency for Workforce
4 Innovation to establish a pilot program for the
5 delivery of certified geriatric specialty
6 nursing education; specifying eligibility
7 requirements for a certified nursing assistant
8 to obtain certification as a geriatric
9 specialist; specifying requirements for the
10 education of a certified nursing assistant to
11 prepare for certification as a certified
12 geriatric specialist; creating a Certified
13 Geriatric Specialty Nursing Initiative Steering
14 Committee; providing for the composition of and
15 manner of appointment to the Certified
16 Geriatric Specialty Nursing Initiative Steering
17 Committee; providing responsibilities of the
18 steering committee; providing for reimbursement
19 for per diem and travel expenses; requiring the
20 Agency for Workforce Innovation to conduct or
21 contract for an evaluation of the pilot program
22 for the delivery of certified geriatric
23 specialty nursing education; requiring the
24 evaluation to include recommendations regarding
25 the expansion of the delivery of certified
26 geriatric specialty nursing education in
27 nursing homes; requiring the Agency for
28 Workforce Innovation to report to the Governor
29 and the Legislature regarding the evaluation of
30 the pilot program; requiring the agency to
31 submit periodic status reports and recommended
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1 legislation to the Governor and the
2 Legislature; creating s. 464.0125, F.S.;
3 providing definitions; providing requirements
4 for persons to become certified geriatric
5 specialists; requiring the Board of Nursing to
6 establish core competencies by rule; specifying
7 fees; providing practice standards and grounds
8 for which certified geriatric specialists may
9 be subject to discipline by the Board of
10 Nursing; providing for articulation of
11 geriatric specialty nursing coursework and
12 practical nursing coursework; creating
13 restrictions on the use of professional nursing
14 titles; prohibiting the use of certain
15 professional titles; providing penalties;
16 authorizing approved nursing programs to
17 provide education for the preparation of
18 certified geriatric specialists without further
19 board approval; authorizing certified geriatric
20 specialists to supervise the activities of
21 others in nursing home facilities according to
22 rules by the Board of Nursing; amending s.
23 381.00315, F.S.; revising requirements for the
24 reactivation of the licenses of specified
25 health care practitioners in the event of a
26 public health emergency to include certified
27 geriatric specialists; amending s. 400.021,
28 F.S.; including services provided by a
29 certified geriatric specialist within the
30 definition of nursing service; amending s.
31 400.211, F.S.; revising requirements for
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1 persons employed as nursing assistants to
2 conform to the certification of certified
3 geriatric specialists; amending s. 400.23,
4 F.S.; specifying that certified geriatric
5 specialists shall be considered licensed
6 nursing staff; authorizing licensed practical
7 nurses to supervise the activities of certified
8 geriatric specialists in nursing home
9 facilities according to rules adopted by the
10 Board of Nursing; amending s. 409.908, F.S.;
11 revising the methodology for reimbursement of
12 Medicaid program providers to include services
13 of certified geriatric specialists; amending s.
14 458.303, F.S.; revising exceptions to the
15 practice of medicine to include services
16 delegated to a certified geriatric specialist
17 under specified circumstances; amending s.
18 1009.65, F.S.; revising eligibility for the
19 Medical Education Reimbursement and Loan
20 Repayment Program to include certified
21 geriatric specialists; amending s. 1009.66,
22 F.S.; revising eligibility requirements for the
23 Nursing Student Loan Forgiveness Program to
24 include certified geriatric specialists;
25 providing an appropriation; amending s.
26 464.201, F.S.; defining terms; amending s.
27 464.202, F.S.; authorizing the Board of Nursing
28 to adopt rules regarding the practice and
29 supervision of certified nursing assistants;
30 providing an effective date.
31
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1 Be It Enacted by the Legislature of the State of Florida:
2
3 Section 1. This act may be cited as the "Clara Ramsey
4 Care of the Elderly Act."
5 Section 2. Certified Geriatric Specialist Preparation
6 Pilot Program.--
7 (1) The Agency for Workforce Innovation shall
8 establish a pilot program for the delivery of geriatric
9 nursing education to certified nursing assistants who wish to
10 become certified geriatric specialists. The agency shall
11 select two pilot sites in nursing homes that have received the
12 Gold Seal designation under section 400.235, Florida Statutes;
13 have been designated as a teaching nursing home under section
14 430.80, Florida Statutes; or have not received a class I or
15 class II deficiency within the 30 months preceding application
16 for this program.
17 (2) To be eligible to receive geriatric nursing
18 education, a certified nursing assistant must have been
19 employed by a participating nursing home for at least 1 year
20 and must have received a high school diploma or its
21 equivalent.
22 (3) The education shall be provided at the worksite
23 and in coordination with the certified nursing assistant's
24 work schedule.
25 (4) Faculty shall provide the instruction under an
26 approved nursing program pursuant to section 464.019, Florida
27 Statutes.
28 (5) The education must be designed to prepare the
29 certified nursing assistant to meet the requirements for
30 certification as a geriatric specialist. The didactic and
31 clinical education must include all portions of the practical
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1 nursing curriculum pursuant to section 464.019, Florida
2 Statutes, except for pediatric and obstetric/maternal-child
3 education, and must include additional education in the care
4 of ill, injured, or infirm geriatric patients and the
5 maintenance of health, the prevention of injury, and the
6 provision of palliative care for geriatric patients.
7 Section 3. Certified Geriatric Specialty Nursing
8 Initiative Steering Committee.--
9 (1) In order to guide the implementation of the
10 Certified Geriatric Specialist Preparation Pilot Program,
11 there is created a Certified Geriatric Specialty Nursing
12 Initiative Steering Committee. The steering committee shall be
13 composed of the following members:
14 (a) The chair of the Board of Nursing or his or her
15 designee;
16 (b) A representative of the Agency for Workforce
17 Innovation, appointed by the director of Workforce Innovation;
18 (c) A representative of Workforce Florida, Inc.,
19 appointed by the chair of the Board of Directors of Workforce
20 Florida, Inc.;
21 (d) A representative of the Department of Education,
22 appointed by the Commissioner of Education;
23 (e) A representative of the Department of Health,
24 appointed by the Secretary of Health;
25 (f) A representative of the Agency for Health Care
26 Administration, appointed by the Secretary of Health Care
27 Administration;
28 (g) The executive director of the Florida Center for
29 Nursing;
30 (h) A representative of the Department of Elderly
31 Affairs, appointed by the Secretary of Elderly Affairs; and
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1 (i) A representative of a Gold Seal nursing home that
2 is not one of the pilot program sites, appointed by the
3 Secretary of Health Care Administration.
4 (2) The steering committee shall:
5 (a) Provide consultation and guidance to the Agency
6 for Workforce Innovation on matters of policy during the
7 implementation of the pilot program; and
8 (b) Provide oversight to the evaluation of the pilot
9 program.
10 (3) Members of the steering committee are entitled to
11 reimbursement for per diem and travel expenses under section
12 112.061, Florida Statutes.
13 (4) The steering committee shall complete its
14 activities by June 30, 2008, and the authorization for the
15 steering committee ends on that date.
16 Section 4. Evaluation of the Certified Geriatric
17 Specialist Preparation Pilot Program.--The Agency for
18 Workforce Innovation, in consultation with the Certified
19 Geriatric Specialty Nursing Initiative Steering Committee,
20 shall conduct or contract for an evaluation of the pilot
21 program. The agency shall ensure that an evaluation report is
22 submitted to the Governor, the President of the Senate, and
23 the Speaker of the House of Representatives by January 1,
24 2008. The evaluation must address the experience and success
25 of the certified nursing assistants in the pilot program and
26 must contain recommendations regarding the expansion of the
27 delivery of geriatric nursing education in nursing homes.
28 Section 5. Reports.--The Agency for Workforce
29 Innovation shall submit status reports and recommendations
30 regarding legislation necessary to further the implementation
31 of the pilot program to the Governor, the President of the
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1 Senate, and the Speaker of the House of Representatives on
2 January 1, 2006, January 1, 2007, and January 1, 2008.
3 Section 6. Section 464.0125, Florida Statutes, is
4 created to read:
5 464.0125 Certified geriatric specialists;
6 certification requirements.--
7 (1) DEFINITIONS; RESPONSIBILITIES.--
8 (a) As used in this section, the term:
9 1. "Certified geriatric specialist" means a person who
10 meets the qualifications specified in this section and who is
11 certified by the board to practice as a certified geriatric
12 specialist.
13 2. "Geriatric patient" means any patient who is 60
14 years of age or older.
15 3. "Practice of certified geriatric specialty nursing"
16 means the performance of selected acts in facilities licensed
17 under part II or part III of chapter 400, including the
18 administration of treatments and medications, in the care of
19 ill, injured, or infirm geriatric patients and the promotion
20 of wellness, maintenance of health, and prevention of illness
21 of geriatric patients under the direction of a registered
22 nurse, a licensed physician, a licensed osteopathic physician,
23 a licensed podiatric physician, or a licensed dentist. The
24 scope of practice of a certified geriatric specialist includes
25 the practice of practical nursing as defined in s. 464.003 for
26 geriatric patients only, except for any act in which
27 instruction and clinical knowledge of pediatric nursing or
28 obstetric/maternal-child nursing is required. A certified
29 geriatric specialist, while providing nursing services in
30 facilities licensed under part II or part III of chapter 400,
31 may supervise the activities of certified nursing assistants
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1 and other unlicensed personnel providing services in such
2 facilities in accordance with rules adopted by the board.
3 (b) The certified geriatric specialist shall be
4 responsible and accountable for making decisions that are
5 based upon the individual's educational preparation and
6 experience in performing certified geriatric specialty
7 nursing.
8 (2) CERTIFICATION.--
9 (a) Any certified nursing assistant desiring to be
10 certified as a certified geriatric specialist must apply to
11 the department and submit proof that he or she holds a current
12 certificate as a certified nursing assistant under part II of
13 this chapter and has satisfactorily completed the following
14 requirements:
15 1. Is in good mental and physical health; is a
16 recipient of a high school diploma or its equivalent; has
17 completed the requirements for graduation from an approved
18 program for nursing or its equivalent, as determined by the
19 board, for the preparation of licensed practical nurses,
20 except for instruction and clinical knowledge of pediatric
21 nursing or obstetric/maternal-child nursing; and has completed
22 additional education in the care of ill, injured, or infirm
23 geriatric patients, the maintenance of health, the prevention
24 of injury, and the provision of palliative care for geriatric
25 patients. By September 1, 2005, the Board of Nursing shall
26 adopt rules establishing the core competencies for the
27 additional education in geriatric care. Any program that is
28 approved on July 1, 2005, by the board for the preparation of
29 registered nurses or licensed practical nurses may provide
30 education for the preparation of certified geriatric
31 specialists without further board approval.
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1 2. Has the ability to communicate in the English
2 language, which may be determined by an examination given by
3 the department.
4 3. Has provided sufficient information, which must be
5 submitted by the department for a statewide criminal records
6 correspondence check through the Department of Law
7 Enforcement.
8 (b) Each applicant who meets the requirements of this
9 subsection is, unless denied pursuant to s. 464.018, entitled
10 to certification as a certified geriatric specialist. The
11 board must certify, and the department must issue a
12 certificate to practice as a certified geriatric specialist
13 to, any certified nursing assistant who meets the
14 qualifications set forth in this section. The board shall
15 establish an application fee not to exceed $100 and a biennial
16 renewal fee not to exceed $50. The board may adopt rules to
17 administer this section.
18 (c) A person receiving certification under this
19 section shall:
20 1. Work only within the confines of a facility
21 licensed under part II or part III of chapter 400.
22 2. Care for geriatric patients only.
23 3. Comply with the minimum standards of practice for
24 nurses and be subject to disciplinary action for violations of
25 s. 464.018.
26 (3) ARTICULATION.--Any certified geriatric specialist
27 who completes the additional instruction and coursework in an
28 approved nursing program pursuant to s. 464.019 for the
29 preparation of practical nursing in the areas of pediatric
30 nursing and obstetric/maternal-child nursing is, unless denied
31 pursuant to s. 464.018, entitled to licensure as a licensed
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1 practical nurse if the applicant otherwise meets the
2 requirements of s. 464.008.
3 (4) TITLES AND ABBREVIATIONS; RESTRICTIONS;
4 PENALTIES.--
5 (a) Only persons who hold certificates to practice as
6 certified geriatric specialists in this state or who are
7 performing services within the practice of certified geriatric
8 specialty nursing pursuant to the exception set forth in s.
9 464.022(8) may use the title "Certified Geriatric Specialist"
10 and the abbreviation "C.G.S."
11 (b) A person may not practice or advertise as, or
12 assume the title of, certified geriatric specialist or use the
13 abbreviation "C.G.S." or take any other action that would lead
14 the public to believe that person is certified as such or is
15 performing services within the practice of certified geriatric
16 specialty nursing pursuant to the exception set forth in s.
17 464.022(8), unless that person is certified to practice as
18 such.
19 (c) A violation of this subsection is a misdemeanor of
20 the first degree, punishable as provided in s. 775.082 or s.
21 775.083.
22 (5) VIOLATIONS AND PENALTIES.--Practicing certified
23 geriatric specialty nursing, as defined in this section,
24 without holding an active certificate to do so constitutes a
25 felony of the third degree, punishable as provided in s.
26 775.082, s. 775.083, or s. 775.084.
27 Section 7. Paragraph (b) of subsection (1) of section
28 381.00315, Florida Statutes, is amended to read:
29 381.00315 Public health advisories; public health
30 emergencies.--The State Health Officer is responsible for
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1 declaring public health emergencies and issuing public health
2 advisories.
3 (1) As used in this section, the term:
4 (b) "Public health emergency" means any occurrence, or
5 threat thereof, whether natural or man made, which results or
6 may result in substantial injury or harm to the public health
7 from infectious disease, chemical agents, nuclear agents,
8 biological toxins, or situations involving mass casualties or
9 natural disasters. Prior to declaring a public health
10 emergency, the State Health Officer shall, to the extent
11 possible, consult with the Governor and shall notify the Chief
12 of Domestic Security Initiatives as created in s. 943.03. The
13 declaration of a public health emergency shall continue until
14 the State Health Officer finds that the threat or danger has
15 been dealt with to the extent that the emergency conditions no
16 longer exist and he or she terminates the declaration.
17 However, a declaration of a public health emergency may not
18 continue for longer than 60 days unless the Governor concurs
19 in the renewal of the declaration. The State Health Officer,
20 upon declaration of a public health emergency, may take
21 actions that are necessary to protect the public health. Such
22 actions include, but are not limited to:
23 1. Directing manufacturers of prescription drugs or
24 over-the-counter drugs who are permitted under chapter 499 and
25 wholesalers of prescription drugs located in this state who
26 are permitted under chapter 499 to give priority to the
27 shipping of specified drugs to pharmacies and health care
28 providers within geographic areas that have been identified by
29 the State Health Officer. The State Health Officer must
30 identify the drugs to be shipped. Manufacturers and
31 wholesalers located in the state must respond to the State
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1 Health Officer's priority shipping directive before shipping
2 the specified drugs.
3 2. Notwithstanding chapters 465 and 499 and rules
4 adopted thereunder, directing pharmacists employed by the
5 department to compound bulk prescription drugs and provide
6 these bulk prescription drugs to physicians and nurses of
7 county health departments or any qualified person authorized
8 by the State Health Officer for administration to persons as
9 part of a prophylactic or treatment regimen.
10 3. Notwithstanding s. 456.036, temporarily
11 reactivating the inactive license of the following health care
12 practitioners, when such practitioners are needed to respond
13 to the public health emergency: physicians licensed under
14 chapter 458 or chapter 459; physician assistants licensed
15 under chapter 458 or chapter 459; certified geriatric
16 specialists certified under part I of chapter 464; licensed
17 practical nurses, registered nurses, and advanced registered
18 nurse practitioners licensed under part I of chapter 464;
19 respiratory therapists licensed under part V of chapter 468;
20 and emergency medical technicians and paramedics certified
21 under part III of chapter 401. Only those health care
22 practitioners specified in this paragraph who possess an
23 unencumbered inactive license and who request that such
24 license be reactivated are eligible for reactivation. An
25 inactive license that is reactivated under this paragraph
26 shall return to inactive status when the public health
27 emergency ends or prior to the end of the public health
28 emergency if the State Health Officer determines that the
29 health care practitioner is no longer needed to provide
30 services during the public health emergency. Such licenses may
31 only be reactivated for a period not to exceed 90 days without
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1 meeting the requirements of s. 456.036 or chapter 401, as
2 applicable.
3 4. Ordering an individual to be examined, tested,
4 vaccinated, treated, or quarantined for communicable diseases
5 that have significant morbidity or mortality and present a
6 severe danger to public health. Individuals who are unable or
7 unwilling to be examined, tested, vaccinated, or treated for
8 reasons of health, religion, or conscience may be subjected to
9 quarantine.
10 a. Examination, testing, vaccination, or treatment may
11 be performed by any qualified person authorized by the State
12 Health Officer.
13 b. If the individual poses a danger to the public
14 health, the State Health Officer may subject the individual to
15 quarantine. If there is no practical method to quarantine the
16 individual, the State Health Officer may use any means
17 necessary to vaccinate or treat the individual.
18
19 Any order of the State Health Officer given to effectuate this
20 paragraph shall be immediately enforceable by a law
21 enforcement officer under s. 381.0012.
22 Section 8. Subsection (14) of section 400.021, Florida
23 Statutes, is amended to read:
24 400.021 Definitions.--When used in this part, unless
25 the context otherwise requires, the term:
26 (14) "Nursing service" means such services or acts as
27 may be rendered, directly or indirectly, to and in behalf of a
28 person by individuals as defined in ss. s. 464.003 and
29 464.0125.
30 Section 9. Subsection (1) of section 400.211, Florida
31 Statutes, is amended to read:
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1 400.211 Persons employed as nursing assistants;
2 certification requirement.--
3 (1) To serve as a nursing assistant in any nursing
4 home, a person must be certified as a nursing assistant under
5 part II of chapter 464, unless the person is a registered
6 nurse, a or practical nurse, or a certified geriatric
7 specialist certified or licensed in accordance with part I of
8 chapter 464 or an applicant for such licensure who is
9 permitted to practice nursing in accordance with rules adopted
10 by the Board of Nursing pursuant to part I of chapter 464.
11 Section 10. Paragraphs (a) and (c) of subsection (3)
12 of section 400.23, Florida Statutes, are amended to read:
13 400.23 Rules; evaluation and deficiencies; licensure
14 status.--
15 (3)
16 (a) The agency shall adopt rules providing for the
17 minimum staffing requirements for nursing homes. These
18 requirements shall include, for each nursing home facility, a
19 minimum certified nursing assistant staffing of 2.3 hours of
20 direct care per resident per day beginning January 1, 2002,
21 increasing to 2.6 hours of direct care per resident per day
22 beginning January 1, 2003, and increasing to 2.9 hours of
23 direct care per resident per day beginning July 1, 2005.
24 Beginning January 1, 2002, no facility shall staff below one
25 certified nursing assistant per 20 residents, and a minimum
26 licensed nursing staffing of 1.0 hour of direct resident care
27 per resident per day but never below one licensed nurse per 40
28 residents. For purposes of computing nursing staffing minimums
29 and ratios, certified geriatric specialists shall be
30 considered licensed nursing staff. Nursing assistants employed
31 under s. 400.211(2) may be included in computing the staffing
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1 ratio for certified nursing assistants only if they provide
2 nursing assistance services to residents on a full-time basis.
3 Each nursing home must document compliance with staffing
4 standards as required under this paragraph and post daily the
5 names of staff on duty for the benefit of facility residents
6 and the public. The agency shall recognize the use of licensed
7 nurses for compliance with minimum staffing requirements for
8 certified nursing assistants, provided that the facility
9 otherwise meets the minimum staffing requirements for licensed
10 nurses and that the licensed nurses so recognized are
11 performing the duties of a certified nursing assistant. Unless
12 otherwise approved by the agency, licensed nurses counted
13 toward the minimum staffing requirements for certified nursing
14 assistants must exclusively perform the duties of a certified
15 nursing assistant for the entire shift and shall not also be
16 counted toward the minimum staffing requirements for licensed
17 nurses. If the agency approved a facility's request to use a
18 licensed nurse to perform both licensed nursing and certified
19 nursing assistant duties, the facility must allocate the
20 amount of staff time specifically spent on certified nursing
21 assistant duties for the purpose of documenting compliance
22 with minimum staffing requirements for certified and licensed
23 nursing staff. In no event may the hours of a licensed nurse
24 with dual job responsibilities be counted twice.
25 (c) Licensed practical nurses licensed under chapter
26 464 who are providing nursing services in nursing home
27 facilities under this part may supervise the activities of
28 other licensed practical nurses, certified geriatric
29 specialists, certified nursing assistants, and other
30 unlicensed personnel providing services in such facilities in
31 accordance with rules adopted by the Board of Nursing.
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1 Section 11. Paragraph (b) of subsection (2) of section
2 409.908, Florida Statutes, is amended to read:
3 409.908 Reimbursement of Medicaid providers.--Subject
4 to specific appropriations, the agency shall reimburse
5 Medicaid providers, in accordance with state and federal law,
6 according to methodologies set forth in the rules of the
7 agency and in policy manuals and handbooks incorporated by
8 reference therein. These methodologies may include fee
9 schedules, reimbursement methods based on cost reporting,
10 negotiated fees, competitive bidding pursuant to s. 287.057,
11 and other mechanisms the agency considers efficient and
12 effective for purchasing services or goods on behalf of
13 recipients. If a provider is reimbursed based on cost
14 reporting and submits a cost report late and that cost report
15 would have been used to set a lower reimbursement rate for a
16 rate semester, then the provider's rate for that semester
17 shall be retroactively calculated using the new cost report,
18 and full payment at the recalculated rate shall be effected
19 retroactively. Medicare-granted extensions for filing cost
20 reports, if applicable, shall also apply to Medicaid cost
21 reports. Payment for Medicaid compensable services made on
22 behalf of Medicaid eligible persons is subject to the
23 availability of moneys and any limitations or directions
24 provided for in the General Appropriations Act or chapter 216.
25 Further, nothing in this section shall be construed to prevent
26 or limit the agency from adjusting fees, reimbursement rates,
27 lengths of stay, number of visits, or number of services, or
28 making any other adjustments necessary to comply with the
29 availability of moneys and any limitations or directions
30 provided for in the General Appropriations Act, provided the
31 adjustment is consistent with legislative intent.
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1 (2)
2 (b) Subject to any limitations or directions provided
3 for in the General Appropriations Act, the agency shall
4 establish and implement a Florida Title XIX Long-Term Care
5 Reimbursement Plan (Medicaid) for nursing home care in order
6 to provide care and services in conformance with the
7 applicable state and federal laws, rules, regulations, and
8 quality and safety standards and to ensure that individuals
9 eligible for medical assistance have reasonable geographic
10 access to such care.
11 1. Changes of ownership or of licensed operator do not
12 qualify for increases in reimbursement rates associated with
13 the change of ownership or of licensed operator. The agency
14 shall amend the Title XIX Long Term Care Reimbursement Plan to
15 provide that the initial nursing home reimbursement rates, for
16 the operating, patient care, and MAR components, associated
17 with related and unrelated party changes of ownership or
18 licensed operator filed on or after September 1, 2001, are
19 equivalent to the previous owner's reimbursement rate.
20 2. The agency shall amend the long-term care
21 reimbursement plan and cost reporting system to create direct
22 care and indirect care subcomponents of the patient care
23 component of the per diem rate. These two subcomponents
24 together shall equal the patient care component of the per
25 diem rate. Separate cost-based ceilings shall be calculated
26 for each patient care subcomponent. The direct care
27 subcomponent of the per diem rate shall be limited by the
28 cost-based class ceiling, and the indirect care subcomponent
29 shall be limited by the lower of the cost-based class ceiling,
30 by the target rate class ceiling, or by the individual
31 provider target. The agency shall adjust the patient care
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1 component effective January 1, 2002. The cost to adjust the
2 direct care subcomponent shall be net of the total funds
3 previously allocated for the case mix add-on. The agency shall
4 make the required changes to the nursing home cost reporting
5 forms to implement this requirement effective January 1, 2002.
6 3. The direct care subcomponent shall include salaries
7 and benefits of direct care staff providing nursing services
8 including registered nurses, licensed practical nurses,
9 certified geriatric specialists certified under part I of
10 chapter 464, and certified nursing assistants who deliver care
11 directly to residents in the nursing home facility. This
12 excludes nursing administration, MDS, and care plan
13 coordinators, staff development, and staffing coordinator.
14 4. All other patient care costs shall be included in
15 the indirect care cost subcomponent of the patient care per
16 diem rate. There shall be no costs directly or indirectly
17 allocated to the direct care subcomponent from a home office
18 or management company.
19 5. On July 1 of each year, the agency shall report to
20 the Legislature direct and indirect care costs, including
21 average direct and indirect care costs per resident per
22 facility and direct care and indirect care salaries and
23 benefits per category of staff member per facility.
24 6. In order to offset the cost of general and
25 professional liability insurance, the agency shall amend the
26 plan to allow for interim rate adjustments to reflect
27 increases in the cost of general or professional liability
28 insurance for nursing homes. This provision shall be
29 implemented to the extent existing appropriations are
30 available.
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1 It is the intent of the Legislature that the reimbursement
2 plan achieve the goal of providing access to health care for
3 nursing home residents who require large amounts of care while
4 encouraging diversion services as an alternative to nursing
5 home care for residents who can be served within the
6 community. The agency shall base the establishment of any
7 maximum rate of payment, whether overall or component, on the
8 available moneys as provided for in the General Appropriations
9 Act. The agency may base the maximum rate of payment on the
10 results of scientifically valid analysis and conclusions
11 derived from objective statistical data pertinent to the
12 particular maximum rate of payment.
13 Section 12. Subsection (2) of section 458.303, Florida
14 Statutes, is amended to read:
15 458.303 Provisions not applicable to other
16 practitioners; exceptions, etc.--
17 (2) Nothing in s. 458.301, s. 458.303, s. 458.305, s.
18 458.307, s. 458.309, s. 458.311, s. 458.313, s. 458.319, s.
19 458.321, s. 458.327, s. 458.329, s. 458.331, s. 458.337, s.
20 458.339, s. 458.341, s. 458.343, s. 458.345, or s. 458.347
21 shall be construed to prohibit any service rendered by a
22 registered nurse, or a licensed practical nurse, or a
23 certified geriatric specialist certified under part I of
24 chapter 464, if such service is rendered under the direct
25 supervision and control of a licensed physician who provides
26 specific direction for any service to be performed and gives
27 final approval to all services performed. Further, nothing in
28 this or any other chapter shall be construed to prohibit any
29 service rendered by a medical assistant in accordance with the
30 provisions of s. 458.3485.
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1 Section 13. Subsection (1) and paragraph (a) of
2 subsection (2) of section 1009.65, Florida Statutes, are
3 amended to read:
4 1009.65 Medical Education Reimbursement and Loan
5 Repayment Program.--
6 (1) To encourage qualified medical professionals to
7 practice in underserved locations where there are shortages of
8 such personnel, there is established the Medical Education
9 Reimbursement and Loan Repayment Program. The function of the
10 program is to make payments that offset loans and educational
11 expenses incurred by students for studies leading to a medical
12 or nursing degree, medical or nursing licensure, or advanced
13 registered nurse practitioner certification or physician
14 assistant licensure. The following licensed or certified
15 health care professionals are eligible to participate in this
16 program: medical doctors with primary care specialties,
17 doctors of osteopathic medicine with primary care specialties,
18 physician's assistants, certified geriatric specialists
19 certified under part I of chapter 464, licensed practical
20 nurses and registered nurses, and advanced registered nurse
21 practitioners with primary care specialties such as certified
22 nurse midwives. Primary care medical specialties for
23 physicians include obstetrics, gynecology, general and family
24 practice, internal medicine, pediatrics, and other specialties
25 which may be identified by the Department of Health.
26 (2) From the funds available, the Department of Health
27 shall make payments to selected medical professionals as
28 follows:
29 (a) Up to $4,000 per year for certified geriatric
30 specialists certified under part I of chapter 464, licensed
31 practical nurses, and registered nurses, up to $10,000 per
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1 year for advanced registered nurse practitioners and
2 physician's assistants, and up to $20,000 per year for
3 physicians. Penalties for noncompliance shall be the same as
4 those in the National Health Services Corps Loan Repayment
5 Program. Educational expenses include costs for tuition,
6 matriculation, registration, books, laboratory and other fees,
7 other educational costs, and reasonable living expenses as
8 determined by the Department of Health.
9 Section 14. Subsection (2) of section 1009.66, Florida
10 Statutes, is amended to read:
11 1009.66 Nursing Student Loan Forgiveness Program.--
12 (2) To be eligible, a candidate must have graduated
13 from an accredited or approved nursing program and have
14 received a Florida license as a licensed practical nurse, a
15 certified geriatric specialist certified under part I of
16 chapter 464, or a registered nurse or a Florida certificate as
17 an advanced registered nurse practitioner.
18 Section 15. The sum of $157,017 is appropriated from
19 the General Revenue Fund to the Agency for Workforce
20 Innovation to support the work of the Certified Geriatric
21 Specialty Nursing Initiative Steering Committee, to administer
22 the pilot sites, contract for an evaluation, and to provide,
23 if necessary, nursing faculty, substitute certified nursing
24 assistants for those who are in clinical education, and
25 technical support to the pilot sites during the 2005-2006
26 fiscal year.
27 Section 16. Subsection (6) is added to section
28 464.201, Florida Statutes, to read:
29 464.201 Definitions.--As used in this part, the term:
30 (6) "Practice of a certified nursing assistant" means
31 providing care and assisting persons with tasks relating to
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1 the activities of daily living. Such tasks are those
2 associated with personal care, maintaining mobility, nutrition
3 and hydration, toileting and elimination, assistive devices,
4 safety and cleanliness, data gathering, reporting abnormal
5 signs and symptoms, postmortem care, patient socialization and
6 reality orientation, end-of-life care, cardiopulmonary
7 resuscitation and emergency care, residents' or patients'
8 rights, documentation of nursing assistant services, and other
9 tasks that a certified nurse assistant may perform after
10 training beyond that required for initial certification and
11 upon validation of competence in that skill by a registered
12 nurse. This subsection does not restrict the ability of any
13 person who is otherwise trained and educated from performing
14 such tasks.
15 Section 17. Section 464.202, Florida Statutes, is
16 amended to read:
17 464.202 Duties and powers of the board.--The board
18 shall maintain, or contract with or approve another entity to
19 maintain, a state registry of certified nursing assistants.
20 The registry must consist of the name of each certified
21 nursing assistant in this state; other identifying information
22 defined by board rule; certification status; the effective
23 date of certification; other information required by state or
24 federal law; information regarding any crime or any abuse,
25 neglect, or exploitation as provided under chapter 435; and
26 any disciplinary action taken against the certified nursing
27 assistant. The registry shall be accessible to the public, the
28 certificateholder, employers, and other state agencies. The
29 board shall adopt by rule testing procedures for use in
30 certifying nursing assistants and shall adopt rules regulating
31 the practice of certified nursing assistants which specify the
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1 scope of practice authorized and the level of supervision
2 required for the practice of certified nursing assistants to
3 enforce this part. The board may contract with or approve
4 another entity or organization to provide the examination
5 services, including the development and administration of
6 examinations. The board shall require that the contract
7 provider offer certified nursing assistant applications via
8 the Internet, and may require the contract provider to accept
9 certified nursing assistant applications for processing via
10 the Internet. The board shall require the contract provider
11 to provide the preliminary results of the certified nursing
12 examination on the date the test is administered. The provider
13 shall pay all reasonable costs and expenses incurred by the
14 board in evaluating the provider's application and performance
15 during the delivery of services, including examination
16 services and procedures for maintaining the certified nursing
17 assistant registry.
18 Section 18. This act shall take effect upon becoming a
19 law.
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22 SENATE SUMMARY
23 Creates the "Clara Ramsey Care of the Elderly Act."
Requires the Agency for Workforce Innovation to establish
24 a pilot program for the delivery of certified geriatric
specialty nursing education. Creates a steering
25 committee. Requires the agency to conduct or contract for
an evaluation of the pilot program and to report to the
26 Governor and the Legislature. Includes the services
provided by a certified geriatric specialist within the
27 definition of nursing service. Provides guidelines for
the practice and supervision of certified geriatric
28 specialists. Provides a penalty for unlicensed practice.
Requires the Board of Nursing to adopt rules. (See bill
29 for details.)
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