Senate Bill sb0484e3

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    CS for SB 484                                  Third Engrossed



  1                      A bill to be entitled

  2         An act relating to health care; amending s.

  3         400.461, F.S.; revising the purpose of part IV

  4         of ch. 400, F.S., to include the licensure of

  5         nurse registries; amending s. 400.462, F.S.;

  6         revising definitions; defining the terms

  7         "admission," "advanced registered nurse

  8         practitioner," "direct employee," and

  9         "physician assistant" for purposes of part IV

10         of ch. 400, F.S.; amending s. 400.464, F.S.,

11         relating to licensure of home health agencies;

12         revising the licensure period; revising and

13         providing additional administrative, civil, and

14         criminal penalties, sanctions, and fines;

15         amending s. 400.471, F.S.; revising

16         requirements for license application by a home

17         health agency; authorizing the Agency for

18         Health Care Administration to revoke a license

19         under certain circumstances; authorizing

20         administrative fines; amending s. 400.487,

21         F.S.; revising requirements for home health

22         agency service agreements and treatment orders;

23         amending s. 400.491, F.S., relating to clinical

24         records; changing the timeframe for a home

25         health agency to retain patient records;

26         changing a reference; amending s. 400.494,

27         F.S.; providing for the continued

28         confidentiality of patient information in

29         compliance with federal law; providing for

30         disclosure in accordance with certain specified

31         state laws; deleting a requirement for written


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    CS for SB 484                                  Third Engrossed



 1         consent of the patient or the patient's

 2         guardian for disclosure of confidential patient

 3         information; amending s. 400.506, F.S.;

 4         revising requirements governing nurse

 5         registries; increasing license fee; increasing

 6         the period of licensure; authorizing

 7         administrative penalties; revising criminal

 8         penalties and sanctions; revising certain

 9         requirements pertaining to health care

10         professionals that provide services on behalf

11         of a nurse registry; amending s. 400.512, F.S.,

12         relating to employment screening; revising the

13         date on which an annual affidavit must be

14         signed which verifies that certain personnel of

15         a home health agency, a nurse registry, or

16         homemaker service have been screened; amending

17         s. 400.515, F.S.; providing additional

18         circumstances under which the agency may

19         petition for an injunction; providing an

20         effective date.

21  

22  Be It Enacted by the Legislature of the State of Florida:

23  

24         Section 1.  Subsection (2) of section 400.461, Florida

25  Statutes, is amended to read:

26         400.461  Short title; purpose.--

27         (2)  The purpose of this part is to provide for the

28  licensure of every home health agency and nurse registry and

29  to provide for the development, establishment, and enforcement

30  of basic standards that will ensure the safe and adequate care

31  of persons receiving health services in their own homes.


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    CS for SB 484                                  Third Engrossed



 1         Section 2.  Section 400.462, Florida Statutes, is

 2  amended to read:

 3         400.462  Definitions.--As used in this part, the term:

 4         (1)  "Administrator" means a direct employee, as

 5  defined in subsection (9) of the home health agency or a

 6  related organization, or of a management company that has a

 7  contract to manage the home health agency, to whom the

 8  governing body has delegated the responsibility for day-to-day

 9  administration of the home health agency. The administrator

10  must be a licensed physician, physician assistant, or

11  registered nurse licensed to practice in this state or an

12  individual having at least 1 year of supervisory or

13  administrative experience in home health care or in a facility

14  licensed under chapter 395 or under part II or part III of

15  this chapter. An administrator may manage a maximum of five

16  licensed home health agencies located within one agency

17  service district or within an immediately contiguous county.

18  If the home health agency is licensed under this chapter and

19  is part of a retirement community that provides multiple

20  levels of care, an employee of the retirement community may

21  administer the home health agency and up to a maximum of four

22  entities licensed under this chapter that are owned, operated,

23  or managed by the same corporate entity. An administrator

24  shall designate, in writing, for each licensed entity, a

25  qualified alternate administrator to serve during absences.

26         (2)  "Admission" means a decision by the home health

27  agency, during or after an evaluation visit to the patient's

28  home, that there is reasonable expectation that the patient's

29  medical, nursing, and social needs for skilled care can be

30  adequately met by the agency in the patient's place of

31  residence. Admission includes completion of an agreement with


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    CS for SB 484                                  Third Engrossed



 1  the patient or the patient's legal representative to provide

 2  home health services as required in s. 400.487(1).

 3         (3)  "Advanced registered nurse practitioner" means a

 4  person licensed in this state to practice professional nursing

 5  and certified in advanced or specialized nursing practice, as

 6  defined in s. 464.003.

 7         (4)(2)  "Agency" means the Agency for Health Care

 8  Administration.

 9         (5)(3)  "Certified nursing assistant" means any person

10  who has been issued a certificate under part II of chapter

11  464. The licensed home health agency or licensed nurse

12  registry shall ensure that the certified nursing assistant

13  employed by or under contract with the home health agency or

14  licensed nurse registry is adequately trained to perform the

15  tasks of a home health aide in the home setting.

16         (6)(4)  "Client" means an elderly, handicapped, or

17  convalescent individual who receives personal care services,

18  companion services, or homemaker services in the individual's

19  home or place of residence.

20         (7)(5)  "Companion" or "sitter" means a person who

21  spends time with or cares for an elderly, handicapped, or

22  convalescent individual and accompanies such individual on

23  trips and outings and may prepare and serve meals to such

24  individual. A companion may not provide hands-on personal care

25  to a client.

26         (8)(6)  "Department" means the Department of Children

27  and Family Services.

28         (9)  "Direct employee" means an employee for whom one

29  of the following entities pays withholding taxes: a home

30  health agency; a management company that has a contract to

31  manage the home health agency on a day-to-day basis; or an


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    CS for SB 484                                  Third Engrossed



 1  employee leasing company that has a contract with the home

 2  health agency to handle the payroll and payroll taxes for the

 3  home health agency.

 4         (10)(7)  "Director of nursing" means a registered nurse

 5  who is a and direct employee, as defined in subsection (9), of

 6  the agency and or related business entity who is a graduate of

 7  an approved school of nursing and is licensed in this state;

 8  who has at least 1 year of supervisory experience as a

 9  registered nurse in a licensed home health agency, a facility

10  licensed under chapter 395, or a facility licensed under part

11  II or part III of this chapter; and who is responsible for

12  overseeing the professional nursing and home health aid

13  delivery of services of the agency. A director of nursing An

14  employee may be the director  of nursing of a maximum of five

15  licensed home health agencies operated by a related business

16  entity and located within one agency service district or

17  within an immediately contiguous county. If the home health

18  agency is licensed under this chapter and is part of a

19  retirement community that provides multiple levels of care, an

20  employee of the retirement community may serve as the director

21  of nursing of the home health agency and of up to four

22  entities licensed under this chapter which are owned,

23  operated, or managed by the same corporate entity. A director

24  of nursing shall designate, in writing, for each licensed

25  entity, a qualified alternate registered nurse to serve during

26  the absence of the director of nursing.

27         (11)(8)  "Home health agency" means an organization

28  that provides home health services and staffing services.

29         (12)(9)  "Home health agency personnel" means persons

30  who are employed by or under contract with a home health

31  


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    CS for SB 484                                  Third Engrossed



 1  agency and enter the home or place of residence of patients at

 2  any time in the course of their employment or contract.

 3         (13)(10)  "Home health services" means health and

 4  medical services and medical supplies furnished by an

 5  organization to an individual in the individual's home or

 6  place of residence. The term includes organizations that

 7  provide one or more of the following:

 8         (a)  Nursing care.

 9         (b)  Physical, occupational, respiratory, or speech

10  therapy.

11         (c)  Home health aide services.

12         (d)  Dietetics and nutrition practice and nutrition

13  counseling.

14         (e)  Medical supplies, restricted to drugs and

15  biologicals prescribed by a physician.

16         (14)(11)  "Home health aide" means a person who is

17  trained or qualified, as provided by rule, and who provides

18  hands-on personal care, performs simple procedures as an

19  extension of therapy or nursing services, assists in

20  ambulation or exercises, or assists in administering

21  medications as permitted in rule and for which the person has

22  received training established by the agency under s.

23  400.497(1). The licensed home health agency or licensed nurse

24  registry shall ensure that the home health aide employed by or

25  under contract with the home health agency or licensed nurse

26  registry is adequately trained to perform the tasks of a home

27  health aide in the home setting.

28         (15)(12)  "Homemaker" means a person who performs

29  household chores that include housekeeping, meal planning and

30  preparation, shopping assistance, and routine household

31  activities for an elderly, handicapped, or convalescent


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    CS for SB 484                                  Third Engrossed



 1  individual. A homemaker may not provide hands-on personal care

 2  to a client.

 3         (16)(13)  "Home infusion therapy provider" means an

 4  organization that employs, contracts with, or refers a

 5  licensed professional who has received advanced training and

 6  experience in intravenous infusion therapy and who administers

 7  infusion therapy to a patient in the patient's home or place

 8  of residence.

 9         (17)(14)  "Home infusion therapy" means the

10  administration of intravenous pharmacological or nutritional

11  products to a patient in his or her home.

12         (18)(15)  "Nurse registry" means any person that

13  procures, offers, promises, or attempts to secure

14  health-care-related contracts for registered nurses, licensed

15  practical nurses, certified nursing assistants, home health

16  aides, companions, or homemakers, who are compensated by fees

17  as independent contractors, including, but not limited to,

18  contracts for the provision of services to patients and

19  contracts to provide private duty or staffing services to

20  health care facilities licensed under chapter 395 or this

21  chapter or other business entities.

22         (19)(16)  "Organization" means a corporation,

23  government or governmental subdivision or agency, partnership

24  or association, or any other legal or commercial entity, any

25  of which involve more than one health care professional

26  discipline; or a health care professional and a home health

27  aide or certified nursing assistant; more than one home health

28  aide; more than one certified nursing assistant; or a home

29  health aide and a certified nursing assistant. The term does

30  not include an entity that provides services using only

31  


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 1  volunteers or only individuals related by blood or marriage to

 2  the patient or client.

 3         (20)(17)  "Patient" means any person who receives home

 4  health services in his or her home or place of residence.

 5         (21)(18)  "Personal care" means assistance to a patient

 6  in the activities of daily living, such as dressing, bathing,

 7  eating, or personal hygiene, and assistance in physical

 8  transfer, ambulation, and in administering medications as

 9  permitted by rule.

10         (22)(19)  "Physician" means a person licensed under

11  chapter 458, chapter 459, chapter 460, or chapter 461.

12         (23)  "Physician assistant" means a person who is a

13  graduate of an approved program or its equivalent, or meets

14  standards approved by the boards, and is licensed to perform

15  medical services delegated by the supervising physician, as

16  defined in s. 458.347 or s. 459.022.

17         (24)(20)  "Skilled care" means nursing services or

18  therapeutic services required by law to be delivered by a

19  health care professional who is licensed under part I of

20  chapter 464; part I, part III, or part V of chapter 468; or

21  chapter 486 and who is employed by or under contract with a

22  licensed home health agency or is referred by a licensed nurse

23  registry.

24         (25)(21)  "Staffing services" means services provided

25  to a health care facility or other business entity on a

26  temporary basis by licensed health care personnel and by,

27  including certified nursing assistants and home heath aides

28  who are employed by, or work under the auspices of, a licensed

29  home health agency or who are registered with a licensed nurse

30  registry. Staffing services may be provided anywhere within

31  the state.


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    CS for SB 484                                  Third Engrossed



 1         Section 3.  Subsections (1) and (4) of section 400.464,

 2  Florida Statutes, are amended to read:

 3         400.464  Home health agencies to be licensed;

 4  expiration of license; exemptions; unlawful acts; penalties.--

 5         (1)  Any home health agency must be licensed by the

 6  agency to operate in this state. A license issued to a home

 7  health agency, unless sooner suspended or revoked, expires 2

 8  years 1 year after its date of issuance.

 9         (4)(a)  An organization may not provide, offer, or

10  advertise home health services to the public unless the

11  organization has a valid license or is specifically exempted

12  under this part. An organization that offers or advertises to

13  the public any service for which licensure or registration is

14  required under this part must include in the advertisement the

15  license number or registration regulation number issued to the

16  organization by the agency. The agency shall assess a fine of

17  not less than $100 to any licensee or registrant who fails to

18  include the license or registration number when submitting the

19  advertisement for publication, broadcast, or printing. The

20  fine for a second or subsequent offense is $500. The holder of

21  a license issued under this part may not advertise or indicate

22  to the public that it holds a home health agency or nurse

23  registry license other than the one it has been issued.

24         (b)  The operation or maintenance of an unlicensed home

25  health agency or the performance of any home health services

26  in violation of this part is declared a nuisance, inimical to

27  the public health, welfare, and safety. The agency or any

28  state attorney may, in addition to other remedies provided in

29  this part, bring an action for an injunction to restrain such

30  violation, or to enjoin the future operation or maintenance of

31  the home health agency or the provision of home health


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    CS for SB 484                                  Third Engrossed



 1  services in violation of this part, until compliance with this

 2  part or the rules adopted under this part has been

 3  demonstrated to the satisfaction of the agency.

 4         (c)(b)  A person who violates paragraph (a) is subject

 5  to an injunctive proceeding under s. 400.515. A violation of

 6  paragraph (a) is a deceptive and unfair trade practice and

 7  constitutes a violation of the Florida Deceptive and Unfair

 8  Trade Practices Act under part II of chapter 501.

 9         (d)(c)  A person who violates the provisions of

10  paragraph (a) commits a misdemeanor of the second degree,

11  punishable as provided in s. 775.082 or s. 775.083. Any person

12  who commits a second or subsequent violation commits a

13  misdemeanor of the first degree, punishable as provided in s.

14  775.082 or s. 775.083. Each day of continuing violation

15  constitutes a separate offense.

16         (e)  Any person who owns, operates, or maintains an

17  unlicensed home health agency and who, within 10 working days

18  after receiving notification from the agency, fails to cease

19  operation and apply for a license under this part commits a

20  misdemeanor of the second degree, punishable as provided in s.

21  775.082 or s. 775.083. Each day of continued operation is a

22  separate offense.

23         (f)  Any home health agency that fails to cease

24  operation after agency notification may be fined $500 for each

25  day of noncompliance.

26         Section 4.  Section 400.471, Florida Statutes, is

27  amended to read:

28         400.471  Application for license; fee; provisional

29  license; temporary permit.--

30         (1)  Application for an initial license or for renewal

31  of an existing license must be made under oath to the agency


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    CS for SB 484                                  Third Engrossed



 1  on forms furnished by it and must be accompanied by the

 2  appropriate license fee as provided in subsection (10) (8).

 3  The agency must take final action on an initial licensure

 4  application within 60 days after receipt of all required

 5  documentation.

 6         (2)  The initial applicant must file with the

 7  application satisfactory proof that the home health agency is

 8  in compliance with this part and applicable rules, including:

 9         (a)  A listing of services to be provided, either

10  directly by the applicant or through contractual arrangements

11  with existing providers.;

12         (b)  The number and discipline of professional staff to

13  be employed.; and

14         (c)  Proof of financial ability to operate.

15         (d)  Completion of questions concerning volume data on

16  the renewal application as determined by rule.

17         (3)  An applicant for initial licensure must

18  demonstrate financial ability to operate by submitting a

19  balance sheet and income and expense statement for the first 2

20  years of operation which provide evidence of having sufficient

21  assets, credit, and projected revenues to cover liabilities

22  and expenses. The applicant shall have demonstrated financial

23  ability to operate if the applicant's assets, credit, and

24  projected revenues meet or exceed projected liabilities and

25  expenses. All documents required under this subsection must be

26  prepared in accordance with generally accepted accounting

27  principles, and must be compiled the financial statement must

28  be signed by a certified public accountant.

29         (4)  Each applicant for licensure must comply with the

30  following requirements:

31  


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    CS for SB 484                                  Third Engrossed



 1         (a)  Upon receipt of a completed, signed, and dated

 2  application, the agency shall require background screening of

 3  the applicant, in accordance with the level 2 standards for

 4  screening set forth in chapter 435. As used in this

 5  subsection, the term "applicant" means the administrator, or a

 6  similarly titled person who is responsible for the day-to-day

 7  operation of the licensed home health agency, and the

 8  financial officer, or similarly titled individual who is

 9  responsible for the financial operation of the licensed home

10  health agency.

11         (b)  The agency may require background screening for a

12  member of the board of directors of the licensee or an officer

13  or an individual owning 5 percent or more of the licensee if

14  the agency reasonably suspects that such individual has been

15  convicted of an offense prohibited under the level 2 standards

16  for screening set forth in chapter 435.

17         (c)  Proof of compliance with the level 2 background

18  screening requirements of chapter 435 which has been submitted

19  within the previous 5 years in compliance with any other

20  health care or assisted living licensure requirements of this

21  state is acceptable in fulfillment of paragraph (a). Proof of

22  compliance with background screening which has been submitted

23  within the previous 5 years to fulfill the requirements of the

24  Financial Services Commission and the Office of Insurance

25  Regulation pursuant to chapter 651 as part of an application

26  for a certificate of authority to operate a continuing care

27  retirement community is acceptable in fulfillment of the

28  Department of Law Enforcement and Federal Bureau of

29  Investigation background check.

30         (d)  A provisional license may be granted to an

31  applicant when each individual required by this section to


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    CS for SB 484                                  Third Engrossed



 1  undergo background screening has met the standards for the

 2  Department of Law Enforcement background check, but the agency

 3  has not yet received background screening results from the

 4  Federal Bureau of Investigation. A standard license may be

 5  granted to the licensee upon the agency's receipt of a report

 6  of the results of the Federal Bureau of Investigation

 7  background screening for each individual required by this

 8  section to undergo background screening which confirms that

 9  all standards have been met, or upon the granting of a

10  disqualification exemption by the agency as set forth in

11  chapter 435. Any other person who is required to undergo level

12  2 background screening may serve in his or her capacity

13  pending the agency's receipt of the report from the Federal

14  Bureau of Investigation. However, the person may not continue

15  to serve if the report indicates any violation of background

16  screening standards and a disqualification exemption has not

17  been requested of and granted by the agency as set forth in

18  chapter 435.

19         (e)  Each applicant must submit to the agency, with its

20  application, a description and explanation of any exclusions,

21  permanent suspensions, or terminations of the licensee or

22  potential licensee from the Medicare or Medicaid programs.

23  Proof of compliance with the requirements for disclosure of

24  ownership and control interest under the Medicaid or Medicare

25  programs may be accepted in lieu of this submission.

26         (f)  Each applicant must submit to the agency a

27  description and explanation of any conviction of an offense

28  prohibited under the level 2 standards of chapter 435 by a

29  member of the board of directors of the applicant, its

30  officers, or any individual owning 5 percent or more of the

31  applicant. This requirement does not apply to a director of a


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    CS for SB 484                                  Third Engrossed



 1  not-for-profit corporation or organization if the director

 2  serves solely in a voluntary capacity for the corporation or

 3  organization, does not regularly take part in the day-to-day

 4  operational decisions of the corporation or organization,

 5  receives no remuneration for his or her services on the

 6  corporation or organization's board of directors, and has no

 7  financial interest and has no family members with a financial

 8  interest in the corporation or organization, provided that the

 9  director and the not-for-profit corporation or organization

10  include in the application a statement affirming that the

11  director's relationship to the corporation satisfies the

12  requirements of this paragraph.

13         (g)  A license may not be granted to an applicant if

14  the applicant, administrator, or financial officer has been

15  found guilty of, regardless of adjudication, or has entered a

16  plea of nolo contendere or guilty to, any offense prohibited

17  under the level 2 standards for screening set forth in chapter

18  435, unless an exemption from disqualification has been

19  granted by the agency as set forth in chapter 435.

20         (h)  The agency may deny or revoke licensure if the

21  applicant:

22         1.  Has falsely represented a material fact in the

23  application required by paragraph (e) or paragraph (f), or has

24  omitted any material fact from the application required by

25  paragraph (e) or paragraph (f); or

26         2.  has been or is currently excluded, suspended,

27  terminated from, or has involuntarily withdrawn from

28  participation in this state's Medicaid program, or the

29  Medicaid program of any other state, or from participation in

30  the Medicare program or any other governmental or private

31  health care or health insurance program.


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    CS for SB 484                                  Third Engrossed



 1         (i)  An application for license renewal must contain

 2  the information required under paragraphs (e) and (f).

 3         (5)  The agency may deny or revoke licensure if the

 4  applicant has falsely represented a material fact, or has

 5  omitted any material fact, from the application required by

 6  this section.

 7         (6)(5)  The home health agency must also obtain and

 8  maintain the following insurance coverage coverages in an

 9  amount of not less than $250,000 per claim, and the home

10  health agency must submit proof of coverage with an initial

11  application for licensure and with each annual application for

12  license renewal:

13         (a)  Malpractice insurance as defined in s.

14  624.605(1)(k).;(b)  Liability insurance as defined in s.

15  624.605(1)(b).

16         (7)(6)  Sixty Ninety days before the expiration date,

17  an application for renewal must be submitted to the agency

18  under oath on forms furnished by it, and a license must be

19  renewed if the applicant has met the requirements established

20  under this part and applicable rules. The home health agency

21  must file with the application satisfactory proof that it is

22  in compliance with this part and applicable rules. If there is

23  evidence of financial instability, the home health agency must

24  submit satisfactory proof of its financial ability to comply

25  with the requirements of this part. The agency shall impose an

26  administrative fine of $50 per day for each day the home

27  health agency fails to file an application within the

28  timeframe specified in this subsection. Each day of continuing

29  violation is a separate violation; however, the aggregate of

30  such fines may not exceed $500.

31  


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    CS for SB 484                                  Third Engrossed



 1         (8)(7)  When transferring the ownership of a home

 2  health agency, the transferee must submit an application for a

 3  license at least 60 days before the effective date of the

 4  transfer. If the application is filed late, an administrative

 5  fine shall be imposed in the amount of $50 per day. Each day

 6  of continuing violation is a separate violation; however, the

 7  aggregate of such fines may not exceed $500. If the home

 8  health agency is being leased, a copy of the lease agreement

 9  must be filed with the application.

10         (9)  The agency shall accept, in lieu of its own

11  periodic licensure survey, submission of the survey of an

12  accrediting organization that is recognized by the agency if

13  the accreditation of the licensed home health agency is not

14  provisional and if the licensed home health agency authorizes

15  release of, and the agency receives the report of, the

16  accrediting organization.

17         (10)(8)  The license fee and annual renewal fee

18  required of a home health agency are nonrefundable. The agency

19  shall set the license fees in an amount that is sufficient to

20  cover its costs in carrying out its responsibilities under

21  this part, but not to exceed $2,000 $1,000. However, state,

22  county, or municipal governments applying for licenses under

23  this part are exempt from the payment of license fees. All

24  fees collected under this part must be deposited in the Health

25  Care Trust Fund for the administration of this part.

26         (11)(9)  The license must be displayed in a conspicuous

27  place in the administrative office of the home health agency

28  and is valid only while in the possession of the person to

29  which it is issued. The license may not be sold, assigned, or

30  otherwise transferred, voluntarily or involuntarily, and is

31  


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    CS for SB 484                                  Third Engrossed



 1  valid only for the home health agency and location for which

 2  originally issued.

 3         (12)(10)  A home health agency against whom a

 4  revocation or suspension proceeding is pending at the time of

 5  license renewal may be issued a provisional license effective

 6  until final disposition by the agency of such proceedings. If

 7  judicial relief is sought from the final disposition, the

 8  court that has jurisdiction may issue a temporary permit for

 9  the duration of the judicial proceeding.

10         (13)(11)  The agency may not issue a license designated

11  as certified to a home health agency that fails to satisfy the

12  requirements of a Medicare certification survey from the

13  agency.

14         (14)(12)  The agency may not issue a license to a home

15  health agency that has any unpaid fines assessed under this

16  part.

17         Section 5.  Section 400.487, Florida Statutes, is

18  amended to read:

19         400.487  Home health service agreements; physician's,

20  physician assistant's, and advanced registered nurse

21  practitioner's treatment orders; patient assessment;

22  establishment and review of plan of care; provision of

23  services; orders not to resuscitate.--

24         (1)  Services provided by a home health agency must be

25  covered by an agreement between the home health agency and the

26  patient or the patient's legal representative specifying the

27  home health services to be provided, the rates or charges for

28  services paid with private funds, and the sources method of

29  payment, which may include Medicare, Medicaid, private

30  insurance, personal funds, or a combination thereof. A home

31  health agency providing skilled care must make an assessment


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    CS for SB 484                                  Third Engrossed



 1  of the patient's needs within 48 hours after the start of

 2  services.

 3         (2)  When required by the provisions of chapter 464;

 4  part I, part III, or part V of chapter 468; or chapter 486,

 5  the attending physician, physician assistant, or advanced

 6  registered nurse practitioner, acting within his or her

 7  respective scope of practice, shall for a patient who is to

 8  receive skilled care must establish treatment orders for a

 9  patient who is to receive skilled care. The treatment orders

10  must be signed by the physician, physician assistant, or

11  advanced registered nurse practitioner before a claim for

12  payment for the skilled services is submitted by the home

13  health agency. If the claim is submitted to a managed care

14  organization, the treatment orders must be signed within the

15  time allowed under the provider agreement. The treatment

16  orders shall within 30 days after the start of care and must

17  be reviewed, as frequently as the patient's illness requires,

18  by the physician, physician assistant, or advanced registered

19  nurse practitioner in consultation with the home health agency

20  personnel that provide services to the patient.

21         (3)  A home health agency shall arrange for supervisory

22  visits by a registered nurse to the home of a patient

23  receiving home health aide services in accordance with the

24  patient's direction, and approval, and agreement to pay the

25  charge for the visits.

26         (4)  Each patient has the right to be informed of and

27  to participate in the planning of his or her care. Each

28  patient must be provided, upon request, a copy of the plan of

29  care established and maintained for that patient by the home

30  health agency.

31  


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    CS for SB 484                                  Third Engrossed



 1         (5)  When nursing services are ordered, the home health

 2  agency to which a patient has been admitted for care must

 3  provide the initial admission visit, all service evaluation

 4  visits, and the discharge visit by a direct employee qualified

 5  personnel who are on the payroll of, and to whom an IRS

 6  payroll form W-2 will be issued by, the home health agency.

 7  Services provided by others under contractual arrangements to

 8  a home health agency must be monitored and managed by the

 9  admitting home health agency. The admitting home health agency

10  is fully responsible for ensuring that all care provided

11  through its employees or contract staff is delivered in

12  accordance with this part and applicable rules.

13         (6)  The skilled care services provided by a home

14  health agency, directly or under contract, must be supervised

15  and coordinated in accordance with the plan of care.

16         (7)  Home health agency personnel may withhold or

17  withdraw cardiopulmonary resuscitation if presented with an

18  order not to resuscitate executed pursuant to s. 401.45. The

19  agency shall adopt rules providing for the implementation of

20  such orders. Home health personnel and agencies shall not be

21  subject to criminal prosecution or civil liability, nor be

22  considered to have engaged in negligent or unprofessional

23  conduct, for withholding or withdrawing cardiopulmonary

24  resuscitation pursuant to such an order and rules adopted by

25  the agency.

26         Section 6.  Subsection (1) of section 400.491, Florida

27  Statutes, is amended to read:

28         400.491  Clinical records.--

29         (1)  The home health agency must maintain for each

30  patient who receives skilled care a clinical record that

31  includes pertinent past and current medical, nursing, social


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    CS for SB 484                                  Third Engrossed



 1  and other therapeutic information, the treatment orders, and

 2  other such information as is necessary for the safe and

 3  adequate care of the patient. When home health services are

 4  terminated, the record must show the date and reason for

 5  termination. Such records are considered patient records under

 6  s. 400.494 s. 456.057, and must be maintained by the home

 7  health agency for 6 5 years following termination of services.

 8  If a patient transfers to another home health agency, a copy

 9  of his or her record must be provided to the other home health

10  agency upon request.

11         Section 7.  Section 400.494, Florida Statutes, is

12  amended to read:

13         400.494  Information about patients confidential.--

14         (1)  Information about patients received by persons

15  employed by, or providing services to, a home health agency or

16  received by the licensing agency through reports or inspection

17  shall be confidential and exempt from the provisions of s.

18  119.07(1) and shall only not be disclosed to any person, other

19  than the patient, as permitted under the provisions of 45

20  C.F.R. ss. 160.102, 160.103, and 164, subpart A, commonly

21  referred to as the HIPAA Privacy Regulation; except that

22  clinical records described in ss. 381.004, 384.29, 385.202,

23  392.65, 394.4615, 395.404, 397.501, and 760.40 shall be

24  disclosed as authorized in those sections without the written

25  consent of that patient or the patient's guardian.

26         (2)  This section does not apply to information

27  lawfully requested by the Medicaid Fraud Control Unit of the

28  Department of Legal Affairs.

29         Section 8.  Subsections (3), (5), (7), (8), (10), (13),

30  (14), and (17) of section 400.506, Florida Statutes, are

31  amended to read:


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    CS for SB 484                                  Third Engrossed



 1         400.506  Licensure of nurse registries; requirements;

 2  penalties.--

 3         (3)  Application for license must be made to the Agency

 4  for Health Care Administration on forms furnished by it and

 5  must be accompanied by the appropriate licensure fee, as

 6  established by rule and not to exceed the cost of regulation

 7  under this part. The licensure fee for nurse registries may

 8  not exceed $2,000 $1,000 and must be deposited in the Health

 9  Care Trust Fund.

10         (5)  A license issued for the operation of a nurse

11  registry, unless sooner suspended or revoked, expires 2 years

12  1 year after its date of issuance. Sixty days before the

13  expiration date, an application for renewal must be submitted

14  to the Agency for Health Care Administration on forms

15  furnished by it. The Agency for Health Care Administration

16  shall renew the license if the applicant has met the

17  requirements of this section and applicable rules. A nurse

18  registry against which a revocation or suspension proceeding

19  is pending at the time of license renewal may be issued a

20  conditional license effective until final disposition by the

21  Agency for Health Care Administration of such proceedings. If

22  judicial relief is sought from the final disposition, the

23  court having jurisdiction may issue a conditional license for

24  the duration of the judicial proceeding.

25         (7)  A person that provides, offers,  or advertises to

26  the public that it provides any service for which licensure is

27  required under this section must include in such advertisement

28  the license number issued to it by the Agency for Health Care

29  Administration. The agency shall assess a fine of not less

30  than $100 against any licensee who fails to include the

31  license number when submitting the advertisement for


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    CS for SB 484                                  Third Engrossed



 1  publication, broadcast, or printing. The fine for a second or

 2  subsequent offense is $500.

 3         (8)(a)  It is unlawful for a person to provide, offer,

 4  or advertise to the public services as defined by rule without

 5  obtaining a valid license from the Agency for Health Care

 6  Administration. It is unlawful for any holder of a license to

 7  advertise or hold out to the public that he or she holds a

 8  license for other than that for which he or she actually holds

 9  a license. A person who violates this subsection is subject to

10  injunctive proceedings under s. 400.515.

11         (b)  A person who violates the provisions of paragraph

12  (a) commits a misdemeanor of the second degree, punishable as

13  provided in s. 775.082 or s. 775.083. Each day of continuing

14  violation is a separate offense.

15         (c)  Any person who owns, operates, or maintains an

16  unlicensed nurse registry and who, within 10 working days

17  after receiving notification from the agency, fails to cease

18  operation and apply for a license under this part commits a

19  misdemeanor of the second degree, punishable as provided in s.

20  775.082 or s. 775.083. Each day of continued operation is a

21  separate offense.

22         (d)  If a nurse registry fails to cease operation after

23  agency notification, the agency may impose a fine of $500 for

24  each day of noncompliance.

25         (10)(a)  A nurse registry may refer for contract in

26  private residences registered nurses and licensed practical

27  nurses registered and licensed under part I of chapter 464,

28  certified nursing assistants certified under part II of

29  chapter 464, home health aides who present documented proof of

30  successful completion of the training required by rule of the

31  agency, and companions or homemakers for the purposes of


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    CS for SB 484                                  Third Engrossed



 1  providing those services authorized under s. 400.509(1). Each

 2  person referred by a nurse registry must provide current

 3  documentation that he or she is free from communicable

 4  diseases.

 5         (b)  A certified nursing assistant or home health aide

 6  may be referred for a contract to provide care to a patient in

 7  his or her home only if that patient is under a physician's

 8  care. A certified nursing assistant or home health aide

 9  referred for contract in a private residence shall be limited

10  to assisting a patient with bathing, dressing, toileting,

11  grooming, eating, physical transfer, and those normal daily

12  routines the patient could perform for himself or herself were

13  he or she physically capable. A certified nursing assistant or

14  home health aide may not provide medical or other health care

15  services that require specialized training and that may be

16  performed only by licensed health care professionals. The

17  nurse registry shall obtain the name and address of the

18  attending physician and send written notification to the

19  physician within 48 hours after a contract is concluded that a

20  certified nursing assistant or home health aide will be

21  providing care for that patient.

22         (c)  When a certified nursing assistant or home health

23  aide is referred to a patient's home by a nurse registry, the

24  nurse registry shall advise the patient, the patient's family,

25  or any other person acting on behalf of the patient at the

26  time the contract for services is made that registered nurses

27  are available to make visits to the patient's home for an

28  additional cost. A registered nurse shall make monthly visits

29  to the patient's home to assess the patient's condition and

30  quality of care being provided by the certified nursing

31  assistant or home health aide. Any condition which, in the


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    CS for SB 484                                  Third Engrossed



 1  professional judgment of the nurse requires further medical

 2  attention shall be reported to the attending physician and the

 3  nurse registry. A record of the nurse's visit The assessment

 4  shall become a part of the patient's file with the nurse

 5  registry and may be reviewed by the agency during their survey

 6  procedure.

 7         (13)  Each nurse registry must comply with the

 8  procedures set forth in s. 400.512 for maintaining records of

 9  the work employment history of all persons referred for

10  contract and is subject to the standards and conditions set

11  forth in that section. However, an initial screening may not

12  be required for persons who have been continuously registered

13  with the nurse registry since October 1, 2000 September 30,

14  1990.

15         (14)  The nurse registry must maintain the application

16  on file, and that file must be open to the inspection of the

17  Agency for Health Care Administration. The nurse registry must

18  maintain on file the name and address of the patient or client

19  to whom the nurse or other nurse registry personnel are

20  referred is sent for contract and the amount of the fee

21  received by the nurse registry. A nurse registry must maintain

22  the file that includes the application and other applicable

23  documentation for 3 years after the date of the last file

24  entry of patient-related or client-related information.

25         (17)  All persons referred for contract in private

26  residences by a nurse registry must comply with the following

27  requirements for a plan of treatment:

28         (a)  When, in accordance with the privileges and

29  restrictions imposed upon a nurse under part I of chapter 464,

30  the delivery of care to a patient is under the direction or

31  supervision of a physician or when a physician is responsible


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    CS for SB 484                                  Third Engrossed



 1  for the medical care of the patient, a medical plan of

 2  treatment must be established for each patient receiving care

 3  or treatment provided by a licensed nurse in the home. The

 4  original medical plan of treatment must be timely signed by

 5  the physician, physician assistant, or advanced registered

 6  nurse practitioner, acting within his or her respective scope

 7  of practice, and reviewed by him or her in consultation with

 8  the licensed nurse at least every 2 months. Any additional

 9  order or change in orders must be obtained from the physician,

10  physician assistant, or advanced registered nurse practitioner

11  and reduced to writing and timely signed by the physician,

12  physician assistant, or advanced registered nurse

13  practitioner. The delivery of care under a medical plan of

14  treatment must be substantiated by the appropriate nursing

15  notes or documentation made by the nurse in compliance with

16  nursing practices established under part I of chapter 464.

17         (b)  Whenever a medical plan of treatment is

18  established for a patient, the initial medical plan of

19  treatment, any amendment to the plan, additional order or

20  change in orders, and copy of nursing notes must be filed in

21  the office of the nurse registry.

22         Section 9.  Subsection (2) of section 400.512, Florida

23  Statutes, is amended to read:

24         400.512  Screening of home health agency personnel;

25  nurse registry personnel; and companions and homemakers.--The

26  agency shall require employment or contractor screening as

27  provided in chapter 435, using the level 1 standards for

28  screening set forth in that chapter, for home health agency

29  personnel; persons referred for employment by nurse

30  registries; and persons employed by companion or homemaker

31  services registered under s. 400.509.


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    CS for SB 484                                  Third Engrossed



 1         (2)  The administrator of each home health agency, the

 2  managing employee of each nurse registry, and the managing

 3  employee of each companion or homemaker service registered

 4  under s. 400.509 must sign an affidavit annually, under

 5  penalty of perjury, stating that all personnel hired or,

 6  contracted with, or registered on or after October 1, 2000

 7  October 1, 1994, who enter the home of a patient or client in

 8  their service capacity have been screened and that its

 9  remaining personnel have worked for the home health agency or

10  registrant continuously since before October 1, 1994.

11         Section 10.  Section 400.515, Florida Statutes, is

12  amended to read:

13         400.515  Injunction proceedings.--In addition to the

14  other powers provided under this chapter, the agency may

15  institute injunction proceedings in a court of competent

16  jurisdiction to restrain or prevent the establishment or

17  operation of a home health agency or nurse registry that does

18  not have a license or that is in violation of any provision of

19  this part or any rule adopted pursuant to this part. The

20  agency for Health Care Administration may also institute

21  injunction proceedings in a court of competent jurisdiction

22  when violation of this part or of applicable rules constitutes

23  an emergency affecting the immediate health and safety of a

24  patient or client.

25         Section 11.  This act shall take effect July 1, 2005.

26  

27  

28  

29  

30  

31  


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