HB 0739

A bill to be entitled
2An act relating to health care; amending s. 400.461, F.S.;
3revising the purpose of part IV of ch. 400, F.S., to
4include the licensure of nurse registries; amending s.
5400.462, F.S.; revising definitions; defining the terms
6"admission," "advanced registered nurse practitioner,"
7"direct employee," and "physician assistant" for purposes
8of part IV of ch. 400, F.S.; amending s. 400.464, F.S.,
9relating to licensure of home health agencies; revising
10the licensure period; revising and providing additional
11administrative, civil, and criminal penalties, sanctions,
12and fines; amending s. 400.471, F.S.; revising
13requirements for license application by a home health
14agency; authorizing the Agency for Health Care
15Administration to revoke a license under certain
16circumstances; authorizing administrative fines; amending
17s. 400.487, F.S.; revising requirements for home health
18agency service agreements and treatment orders; amending
19s. 400.491, F.S., relating to clinical records; revising
20the ownership of patient records generated by a home
21health agency; changing the timeframe for a home health
22agency to retain patient records; providing for the
23disposition of patient records when a home health agency
24ceases business; deleting a requirement for a service
25provision plan pertaining to nonskilled care; deleting
26requirements for maintaining such records; amending s.
27400.494, F.S.; providing for the continued confidentiality
28of patient information in compliance with federal law;
29providing for disclosure in accordance with certain
30specified state laws; deleting a requirement for written
31consent of the patient or the patient's guardian for
32disclosure of confidential patient information; deleting
33an exemption provided for the Medicaid Fraud Control Unit
34of the Department of Legal Affairs; amending s. 400.506,
35F.S.; revising requirements governing nurse registries;
36increasing license fee; increasing the period of
37licensure; authorizing administrative penalties; revising
38criminal penalties and sanctions; revising certain
39requirements pertaining to health care professionals that
40provide services on behalf of a nurse registry; amending
41s. 400.512, F.S., relating to employment screening;
42revising the date on which an annual affidavit must be
43signed which verifies that certain personnel of a home
44health agency, a nurse registry, or homemaker service have
45been screened; amending s. 400.515, F.S.; providing
46additional circumstances under which the agency may
47petition for an injunction; providing an effective date.
49Be It Enacted by the Legislature of the State of Florida:
51     Section 1.  Subsection (2) of section 400.461, Florida
52Statutes, is amended to read:
53     400.461  Short title; purpose.--
54     (2)  The purpose of this part is to provide for the
55licensure of every home health agency and nurse registry and to
56provide for the development, establishment, and enforcement of
57basic standards that will ensure the safe and adequate care of
58persons receiving health services in their own homes.
59     Section 2.  Section 400.462, Florida Statutes, is amended
60to read:
61     400.462  Definitions.--As used in this part, the term:
62     (1)  "Administrator" means a direct employee, as defined in
63subsection (9) of the home health agency or a related
64organization, or of a management company that has a contract to
65manage the home health agency, to whom the governing body has
66delegated the responsibility for day-to-day administration of
67the home health agency. The administrator must be a licensed
68physician, physician assistant, or registered nurse licensed to
69practice in this state or an individual having at least 1 year
70of supervisory or administrative experience in home health care
71or in a facility licensed under chapter 395 or under part II or
72part III of this chapter. An administrator may manage a maximum
73of five licensed home health agencies located within one agency
74service district or within an immediately contiguous county. If
75the home health agency is licensed under this chapter and is
76part of a retirement community that provides multiple levels of
77care, an employee of the retirement community may administer the
78home health agency and up to a maximum of four entities licensed
79under this chapter that are owned, operated, or managed by the
80same corporate entity. An administrator shall designate, in
81writing, for each licensed entity, a qualified alternate
82administrator to serve during absences.
83     (2)  "Admission" means a decision by the home health
84agency, during or after an evaluation visit to the patient's
85home, that there is reasonable expectation that the patient's
86medical, nursing, and social needs for skilled care can be
87adequately met by the agency in the patient's place of
89     (3)  "Advanced registered nurse practitioner" means a
90person licensed in this state to practice professional nursing
91and certified in advanced or specialized nursing practice, as
92defined in s. 464.003.
93     (4)(2)  "Agency" means the Agency for Health Care
95     (5)(3)  "Certified nursing assistant" means any person who
96has been issued a certificate under part II of chapter 464. The
97licensed home health agency or licensed nurse registry shall
98ensure that the certified nursing assistant or home health aide
99employed by or under contract with the home health agency or
100licensed nurse registry is adequately trained to perform the
101tasks of a home health aide in the home setting.
102     (6)(4)  "Client" means an elderly, handicapped, or
103convalescent individual who receives personal care services,
104companion services, or homemaker services in the individual's
105home or place of residence.
106     (7)(5)  "Companion" or "sitter" means a person who spends
107time with cares for an elderly, handicapped, or convalescent
108individual and accompanies such individual on trips and outings
109and may prepare and serve meals to such individual. A companion
110may not provide hands-on personal care to a client.
111     (8)(6)  "Department" means the Department of Children and
112Family Services.
113     (9)  "Direct employee" means an employee for whom one of
114the following entities pays withholding taxes: a home health
115agency; a management company that has a contract to manage the
116home health agency on a day-to-day basis; or an employee leasing
117company that has a contract with the home health agency to
118handle the payroll and payroll taxes for the home health agency.
119     (10)(7)  "Director of nursing" means a registered nurse who
120is a and direct employee, as defined in subsection (9), of the
121agency and or related business entity who is a graduate of an
122approved school of nursing and is licensed in this state; who
123has at least 1 year of supervisory experience as a registered
124nurse in a licensed home health agency, a facility licensed
125under chapter 395, or a facility licensed under part II or part
126III of this chapter; and who is responsible for overseeing the
127professional nursing and home health aid delivery of services of
128the agency. A director of nursing An employee may be the
129director of nursing of a maximum of five licensed home health
130agencies operated by a related business entity and located
131within one agency service district or within an immediately
132contiguous county. If the home health agency is licensed under
133this chapter and is part of a retirement community that provides
134multiple levels of care, an employee of the retirement community
135may serve as the director of nursing of the home health agency
136and of up to four entities licensed under this chapter which are
137owned, operated, or managed by the same corporate entity. A
138director of nursing shall designate, in writing, for each
139licensed entity, a qualified alternate registered nurse to serve
140during the absence of the director of nursing.
141     (11)(8)  "Home health agency" means an organization that
142provides home health services and staffing services.
143     (12)(9)  "Home health agency personnel" means persons who
144are employed by or under contract with a home health agency and
145enter the home or place of residence of patients at any time in
146the course of their employment or contract.
147     (13)(10)  "Home health services" means health and medical
148services and medical supplies furnished by an organization to an
149individual in the individual's home or place of residence. The
150term includes organizations that provide one or more of the
152     (a)  Nursing care.
153     (b)  Physical, occupational, respiratory, or speech
155     (c)  Home health aide services.
156     (d)  Dietetics and nutrition practice and nutrition
158     (e)  Medical supplies, restricted to drugs and biologicals
159prescribed by a physician.
160     (14)(11)  "Home health aide" means a person who is trained
161or qualified, as provided by rule, and who provides hands-on
162personal care, performs simple procedures as an extension of
163therapy or nursing services, assists in ambulation or exercises,
164or assists in administering medications as permitted in rule and
165for which the person has received training established by the
166agency under s. 400.497(1).
167     (15)(12)  "Homemaker" means a person who performs household
168chores that include housekeeping, meal planning and preparation,
169shopping assistance, and routine household activities for an
170elderly, handicapped, or convalescent individual. A homemaker
171may not provide hands-on personal care to a client.
172     (16)(13)  "Home infusion therapy provider" means an
173organization that employs, contracts with, or refers a licensed
174professional who has received advanced training and experience
175in intravenous infusion therapy and who administers infusion
176therapy to a patient in the patient's home or place of
178     (17)(14)  "Home infusion therapy" means the administration
179of intravenous pharmacological or nutritional products to a
180patient in his or her home.
181     (18)(15)  "Nurse registry" means any person that procures,
182offers, promises, or attempts to secure health-care-related
183contracts for registered nurses, licensed practical nurses,
184certified nursing assistants, home health aides, companions, or
185homemakers, who are compensated by fees as independent
186contractors, including, but not limited to, contracts for the
187provision of services to patients and contracts to provide
188private duty or staffing services to health care facilities
189licensed under chapter 395 or this chapter or other business
191     (19)(16)  "Organization" means a corporation, government or
192governmental subdivision or agency, partnership or association,
193or any other legal or commercial entity, any of which involve
194more than one health care professional discipline; or a health
195care professional and a home health aide or certified nursing
196assistant; more than one home health aide; more than one
197certified nursing assistant; or a home health aide and a
198certified nursing assistant. The term does not include an entity
199that provides services using only volunteers or only individuals
200related by blood or marriage to the patient or client.
201     (20)(17)  "Patient" means any person who receives home
202health services in his or her home or place of residence.
203     (21)(18)  "Personal care" means assistance to a patient in
204the activities of daily living, such as dressing, bathing,
205eating, or personal hygiene, and assistance in physical
206transfer, ambulation, and in administering medications as
207permitted by rule.
208     (22)(19)  "Physician" means a person licensed under chapter
209458, chapter 459, chapter 460, or chapter 461.
210     (23)  "Physician assistant" means a person who is a
211graduate of an approved program or its equivalent, or meets
212standards approved by the boards, and is licensed to perform
213medical services delegated by the supervising physician, as
214defined in s. 458.347 or s. 459.022.
215     (24)(20)  "Skilled care" means nursing services or
216therapeutic services required by law to be delivered by a health
217care professional who is licensed under part I of chapter 464;
218part I, part III, or part V of chapter 468; or chapter 486 and
219who is employed by or under contract with a licensed home health
220agency or is referred by a licensed nurse registry.
221     (25)(21)  "Staffing services" means services provided to a
222health care facility or other business entity on a temporary
223basis by licensed health care personnel and by, including
224certified nursing assistants and home heath aides who are
225employed by, or work under the auspices of, a licensed home
226health agency or who are registered with a licensed nurse
227registry. Staffing services may be provided anywhere within the
229     Section 3.  Subsections (1) and (4) of section 400.464,
230Florida Statutes, are amended to read:
231     400.464  Home health agencies to be licensed; expiration of
232license; exemptions; unlawful acts; penalties.--
233     (1)  Any home health agency must be licensed by the agency
234to operate in this state. A license issued to a home health
235agency, unless sooner suspended or revoked, expires 2 years 1
236year after its date of issuance.
237     (4)(a)  An organization may not provide, offer, or
238advertise home health services to the public unless the
239organization has a valid license or is specifically exempted
240under this part. An organization that offers or advertises to
241the public any service for which licensure or registration is
242required under this part must include in the advertisement the
243license number or registration regulation number issued to the
244organization by the agency. The agency shall assess a fine of
245not less than $100 to any licensee or registrant who fails to
246include the license or registration number when submitting the
247advertisement for publication, broadcast, or printing. The fine
248for a second or subsequent offense is $500. The holder of a
249license issued under this part may not advertise or indicate to
250the public that it holds a home health agency or nurse registry
251license other than the one it has been issued.
252     (b)  The operation or maintenance of an unlicensed home
253health agency or the performance of any home health services in
254violation of this part is declared a nuisance, inimical to the
255public health, welfare, and safety. The agency or any state
256attorney may, in addition to other remedies provided in this
257part, bring an action for an injunction to restrain such
258violation, or to enjoin the future operation or maintenance of
259the home health agency or the provision of home health services
260in violation of this part, until compliance with this part or
261the rules adopted under this part has been demonstrated to the
262satisfaction of the agency.
263     (c)(b)  A person who violates paragraph (a) is subject to
264an injunctive proceeding under s. 400.515. A violation of
265paragraph (a) is a deceptive and unfair trade practice and
266constitutes a violation of the Florida Deceptive and Unfair
267Trade Practices Act under part II of chapter 501.
268     (d)(c)  A person who violates the provisions of paragraph
269(a) commits a felony misdemeanor of the third second degree,
270punishable as provided in s. 775.082, or s. 775.083, or s.
271775.084. Any person who commits a second or subsequent violation
272commits a misdemeanor of the first degree, punishable as
273provided in s. 775.082 or s. 775.083. Each day of continuing
274violation constitutes a separate offense.
275     (e)  Any person who owns, operates, or maintains an
276unlicensed home health agency and who, within 10 working days
277after receiving notification from the agency, fails to cease
278operation and apply for a license under this part commits a
279felony of the third degree, punishable as provided in s.
280775.082, s. 775.083, or s. 775.084. Each day of continued
281operation is a separate offense.
282     (f)  Any home health agency that fails to cease operation
283after agency notification may be fined $500 for each day of
285     Section 4.  Section 400.471, Florida Statutes, is amended
286to read:
287     400.471  Application for license; fee; provisional license;
288temporary permit.--
289     (1)  Application for an initial license or for renewal of
290an existing license must be made under oath to the agency on
291forms furnished by it and must be accompanied by the appropriate
292license fee as provided in subsection (10) (8). The agency must
293take final action on an initial licensure application within 60
294days after receipt of all required documentation.
295     (2)  The initial applicant must file with the application
296satisfactory proof that the home health agency is in compliance
297with this part and applicable rules, including:
298     (a)  A listing of services to be provided., either directly
299by the applicant or through contractual arrangements with
300existing providers;
301     (b)  The number and discipline of professional staff to be
302employed.; and
303     (c)  Proof of financial ability to operate.
304     (d)  Completion of questions concerning volume data on the
305renewal application as determined by rule.
306     (3)  An applicant for initial licensure must demonstrate
307financial ability to operate by submitting a balance sheet and
308income and expense statement for the first 2 years of operation
309which provide evidence of having sufficient assets, credit, and
310projected revenues to cover liabilities and expenses. The
311applicant shall have demonstrated financial ability to operate
312if the applicant's assets, credit, and projected revenues meet
313or exceed projected liabilities and expenses. All documents
314required under this subsection must be prepared in accordance
315with generally accepted accounting principles, and must be
316compiled the financial statement must be signed by a certified
317public accountant.
318     (4)  Each applicant for licensure must comply with the
319following requirements:
320     (a)  Upon receipt of a completed, signed, and dated
321application, the agency shall require background screening of
322the applicant, in accordance with the level 2 standards for
323screening set forth in chapter 435. As used in this subsection,
324the term "applicant" means the administrator, or a similarly
325titled person who is responsible for the day-to-day operation of
326the licensed home health agency, and the financial officer, or
327similarly titled individual who is responsible for the financial
328operation of the licensed home health agency.
329     (b)  The agency may require background screening for a
330member of the board of directors of the licensee or an officer
331or an individual owning 5 percent or more of the licensee if the
332agency reasonably suspects that such individual has been
333convicted of an offense prohibited under the level 2 standards
334for screening set forth in chapter 435.
335     (c)  Proof of compliance with the level 2 background
336screening requirements of chapter 435 which has been submitted
337within the previous 5 years in compliance with any other health
338care or assisted living licensure requirements of this state is
339acceptable in fulfillment of paragraph (a). Proof of compliance
340with background screening which has been submitted within the
341previous 5 years to fulfill the requirements of the Financial
342Services Commission and the Office of Insurance Regulation
343pursuant to chapter 651 as part of an application for a
344certificate of authority to operate a continuing care retirement
345community is acceptable in fulfillment of the Department of Law
346Enforcement and Federal Bureau of Investigation background
348     (d)  A provisional license may be granted to an applicant
349when each individual required by this section to undergo
350background screening has met the standards for the Department of
351Law Enforcement background check, but the agency has not yet
352received background screening results from the Federal Bureau of
353Investigation. A standard license may be granted to the licensee
354upon the agency's receipt of a report of the results of the
355Federal Bureau of Investigation background screening for each
356individual required by this section to undergo background
357screening which confirms that all standards have been met, or
358upon the granting of a disqualification exemption by the agency
359as set forth in chapter 435. Any other person who is required to
360undergo level 2 background screening may serve in his or her
361capacity pending the agency's receipt of the report from the
362Federal Bureau of Investigation. However, the person may not
363continue to serve if the report indicates any violation of
364background screening standards and a disqualification exemption
365has not been requested of and granted by the agency as set forth
366in chapter 435.
367     (e)  Each applicant must submit to the agency, with its
368application, a description and explanation of any exclusions,
369permanent suspensions, or terminations of the licensee or
370potential licensee from the Medicare or Medicaid programs. Proof
371of compliance with the requirements for disclosure of ownership
372and control interest under the Medicaid or Medicare programs may
373be accepted in lieu of this submission.
374     (f)  Each applicant must submit to the agency a description
375and explanation of any conviction of an offense prohibited under
376the level 2 standards of chapter 435 by a member of the board of
377directors of the applicant, its officers, or any individual
378owning 5 percent or more of the applicant. This requirement does
379not apply to a director of a not-for-profit corporation or
380organization if the director serves solely in a voluntary
381capacity for the corporation or organization, does not regularly
382take part in the day-to-day operational decisions of the
383corporation or organization, receives no remuneration for his or
384her services on the corporation or organization's board of
385directors, and has no financial interest and has no family
386members with a financial interest in the corporation or
387organization, provided that the director and the not-for-profit
388corporation or organization include in the application a
389statement affirming that the director's relationship to the
390corporation satisfies the requirements of this paragraph.
391     (g)  A license may not be granted to an applicant if the
392applicant, administrator, or financial officer has been found
393guilty of, regardless of adjudication, or has entered a plea of
394nolo contendere or guilty to, any offense prohibited under the
395level 2 standards for screening set forth in chapter 435, unless
396an exemption from disqualification has been granted by the
397agency as set forth in chapter 435.
398     (h)  The agency may deny or revoke licensure if the
400     1.  Has falsely represented a material fact in the
401application required by paragraph (e) or paragraph (f), or has
402omitted any material fact from the application required by
403paragraph (e) or paragraph (f); or
404     2.  has been or is currently excluded, suspended,
405terminated from, or has involuntarily withdrawn from
406participation in this state's Medicaid program, or the Medicaid
407program of any other state, or from participation in the
408Medicare program or any other governmental or private health
409care or health insurance program.
410     (i)  An application for license renewal must contain the
411information required under paragraphs (e) and (f).
412     (5)  The agency may deny or revoke licensure if the
413applicant has falsely represented a material fact, or has
414omitted any material fact, from the application required by this
416     (6)(5)  The home health agency must also obtain and
417maintain the following insurance coverage coverages in an amount
418of not less than $250,000 per claim, and the home health agency
419must submit proof of coverage with an initial application for
420licensure and with each annual application for license renewal:
421     (a)  Malpractice insurance as defined in s. 624.605(1)(k).;
422     (b)  Liability insurance as defined in s. 624.605(1)(b).
423     (7)(6)  Sixty Ninety days before the expiration date, an
424application for renewal must be submitted to the agency under
425oath on forms furnished by it, and a license must be renewed if
426the applicant has met the requirements established under this
427part and applicable rules. The home health agency must file with
428the application satisfactory proof that it is in compliance with
429this part and applicable rules. If there is evidence of
430financial instability, the home health agency must submit
431satisfactory proof of its financial ability to comply with the
432requirements of this part. The agency shall impose an
433administrative fine of $50 per day for each day the home health
434agency fails to file an application within the timeframe
435specified in this subsection. Each day of continuing violation
436is a separate violation; however, the aggregate of such fines
437may not exceed $500.
438     (8)(7)  When transferring the ownership of a home health
439agency, the transferee must submit an application for a license
440at least 60 days before the effective date of the transfer. If
441the application is filed late, an administrative fine shall be
442imposed in the amount of $50 per day. Each day of continuing
443violation is a separate violation; however, the aggregate of
444such fines may not exceed $500. If the home health agency is
445being leased, a copy of the lease agreement must be filed with
446the application.
447     (9)  The agency shall accept, in lieu of its own periodic
448licensure survey, submission of the survey of an accrediting
449organization that is recognized by the agency if the
450accreditation of the licensed home health agency is not
451provisional and if the licensed home health agency authorizes
452release of, and the agency receives the report of, the
453accrediting organization.
454     (10)(8)  The license fee and annual renewal fee required of
455a home health agency are nonrefundable. The agency shall set the
456license fees in an amount that is sufficient to cover its costs
457in carrying out its responsibilities under this part, but not to
458exceed $2,000 $1,000. However, state, county, or municipal
459governments applying for licenses under this part are exempt
460from the payment of license fees. All fees collected under this
461part must be deposited in the Health Care Trust Fund for the
462administration of this part.
463     (11)(9)  The license must be displayed in a conspicuous
464place in the administrative office of the home health agency and
465is valid only while in the possession of the person to which it
466is issued. The license may not be sold, assigned, or otherwise
467transferred, voluntarily or involuntarily, and is valid only for
468the home health agency and location for which originally issued.
469     (12)(10)  A home health agency against whom a revocation or
470suspension proceeding is pending at the time of license renewal
471may be issued a provisional license effective until final
472disposition by the agency of such proceedings. If judicial
473relief is sought from the final disposition, the court that has
474jurisdiction may issue a temporary permit for the duration of
475the judicial proceeding.
476     (13)(11)  The agency may not issue a license designated as
477certified to a home health agency that fails to satisfy the
478requirements of a Medicare certification survey from the agency.
479     (14)(12)  The agency may not issue a license to a home
480health agency that has any unpaid fines assessed under this
482     Section 5.  Section 400.487, Florida Statutes, is amended
483to read:
484     400.487  Home health service agreements; physician's,
485physician assistant's, and advanced registered nurse
486practitioner's treatment orders; patient assessment;
487establishment and review of plan of care; provision of services;
488orders not to resuscitate.--
489     (1)  Services provided by a home health agency must be
490covered by an agreement between the home health agency and the
491patient or the patient's legal representative specifying the
492home health services to be provided, the rates or charges for
493services paid with private funds, and the sources method of
494payment, which may include Medicare, Medicaid, private
495insurance, personal funds, or a combination thereof. A home
496health agency providing skilled care must make an assessment of
497the patient's needs within 48 hours after the start of services.
498     (2)  When required by the provisions of chapter 464; part
499I, part III, or part V of chapter 468; or chapter 486, the
500attending physician, physician assistant, or advanced registered
501nurse practitioner, acting within his or her respective scope of
502practice, shall for a patient who is to receive skilled care
503must establish treatment orders for a patient who is to receive
504skilled care. The treatment orders must be signed by the
505physician, physician assistant, or advanced registered nurse
506practitioner before a claim for payment for the skilled services
507is submitted by the home health agency. If the claim is
508submitted to a managed care organization, the treatment orders
509must be signed within the time allowed under the provider
510agreement. The treatment orders shall within 30 days after the
511start of care and must be reviewed, as frequently as the
512patient's illness requires, by the physician, physician
513assistant, or advanced registered nurse practitioner in
514consultation with the home health agency personnel that provide
515services to the patient.
516     (3)  A home health agency shall arrange for supervisory
517visits by a registered nurse to the home of a patient receiving
518home health aide services in accordance with the patient's
519direction, and approval, and agreement to pay the charge for the
521     (4)  Each patient has the right to be informed of and to
522participate in the planning of his or her care. Each patient
523must be provided, upon request, a copy of the plan of care
524established and maintained for that patient by the home health
526     (5)  When nursing services are ordered, the home health
527agency to which a patient has been admitted for care must
528provide the initial admission visit, all service evaluation
529visits, and the discharge visit by a direct employee qualified
530personnel who are on the payroll of, and to whom an IRS payroll
531form W-2 will be issued by, the home health agency. Services
532provided by others under contractual arrangements to a home
533health agency must be monitored and managed by the admitting
534home health agency. The admitting home health agency is fully
535responsible for ensuring that all care provided through its
536employees or contract staff is delivered in accordance with this
537part and applicable rules.
538     (6)  The skilled care services provided by a home health
539agency, directly or under contract, must be supervised and
540coordinated in accordance with the plan of care.
541     (7)  Home health agency personnel may withhold or withdraw
542cardiopulmonary resuscitation if presented with an order not to
543resuscitate executed pursuant to s. 401.45. The agency shall
544adopt rules providing for the implementation of such orders.
545Home health personnel and agencies shall not be subject to
546criminal prosecution or civil liability, nor be considered to
547have engaged in negligent or unprofessional conduct, for
548withholding or withdrawing cardiopulmonary resuscitation
549pursuant to such an order and rules adopted by the agency.
550     Section 6.  Section 400.491, Florida Statutes, is amended
551to read:
552     400.491  Clinical records.--
553     (1)  The home health agency must maintain for each patient
554who receives skilled care a clinical record that includes
555pertinent past and current medical, nursing, social and other
556therapeutic information, the treatment orders, and other such
557information as is necessary for the safe and adequate care of
558the patient. When home health services are terminated, the
559record must show the date and reason for termination. Such
560records are considered patient records under s. 400.494 s.
561456.057, and must be maintained by the home health agency for 6
5625 years following termination of services. If a patient
563transfers to another home health agency, a copy of his or her
564record must be provided to the other home health agency upon
566     (2)  If a licensed home health agency ceases to remain in
567business, it shall notify each patient whose clinical records it
568has in its possession of the fact that it is ceasing operations
569and give each patient 15 calendar days to retrieve his or her
570clinical record at a specified location within 2 hours' driving
571time of the patient's residence between, at a minimum, the hours
572of 10 a.m. and 3 p.m. Monday through Friday. The home health
573agency must maintain for each client who receives nonskilled
574care a service provision plan. Such records must be maintained
575by the home health agency for 1 year following termination of
577     Section 7.  Section 400.494, Florida Statutes, is amended
578to read:
579     400.494  Information about patients confidential.--
580     (1)  Information about patients received by persons
581employed by, or providing services to, a home health agency or
582received by the licensing agency through reports or inspection
583shall be confidential and exempt from the provisions of s.
584119.07(1) and shall only not be disclosed to any person, other
585than the patient, as permitted under the provisions of 45 C.F.R.
586ss. 160.102, 160.103, and 164, subpart A, commonly referred to
587as the HIPAA Privacy Regulation; except that clinical records
588described in ss. 381.004, 384.29, 385.202, 392.65, 394.4615,
589395.404, 397.501, and 760.40 shall be disclosed as authorized in
590those sections without the written consent of that patient or
591the patient's guardian.
592     (2)  This section does not apply to information lawfully
593requested by the Medicaid Fraud Control Unit of the Department
594of Legal Affairs.
595     Section 8.  Subsections (3), (5), (7), (8), (10), (13),
596(14), and (17) of section 400.506, Florida Statutes, are amended
597to read:
598     400.506  Licensure of nurse registries; requirements;
600     (3)  Application for license must be made to the Agency for
601Health Care Administration on forms furnished by it and must be
602accompanied by the appropriate licensure fee, as established by
603rule and not to exceed the cost of regulation under this part.
604The licensure fee for nurse registries may not exceed $2,000
605$1,000 and must be deposited in the Health Care Trust Fund.
606     (5)  A license issued for the operation of a nurse
607registry, unless sooner suspended or revoked, expires 2 years 1
608year after its date of issuance. Sixty days before the
609expiration date, an application for renewal must be submitted to
610the Agency for Health Care Administration on forms furnished by
611it. The Agency for Health Care Administration shall renew the
612license if the applicant has met the requirements of this
613section and applicable rules. A nurse registry against which a
614revocation or suspension proceeding is pending at the time of
615license renewal may be issued a conditional license effective
616until final disposition by the Agency for Health Care
617Administration of such proceedings. If judicial relief is sought
618from the final disposition, the court having jurisdiction may
619issue a conditional license for the duration of the judicial
621     (7)  A person that provides, offers, or advertises to the
622public that it provides any service for which licensure is
623required under this section must include in such advertisement
624the license number issued to it by the Agency for Health Care
625Administration. The agency shall assess a fine of not less than
626$100 against any licensee who fails to include the license
627number when submitting the advertisement for publication,
628broadcast, or printing. The fine for a second or subsequent
629offense is $500.
630     (8)(a)  It is unlawful for a person to provide, offer, or
631advertise to the public services as defined by rule without
632obtaining a valid license from the Agency for Health Care
633Administration. It is unlawful for any holder of a license to
634advertise or hold out to the public that he or she holds a
635license for other than that for which he or she actually holds a
636license. A person who violates this subsection is subject to
637injunctive proceedings under s. 400.515.
638     (b)  A person who violates paragraph (a) commits a felony
639of the third degree, punishable as provided in s. 775.082, s.
640775.083, or s. 775.084. Each day of continuing violation is a
641separate offense.
642     (c)  Any person who owns, operates, or maintains an
643unlicensed nurse registry and who, within 10 working days after
644receiving notification from the agency, fails to cease operation
645and apply for a license under this part commits a felony of the
646third degree, punishable as provided in s. 775.082, s. 775.083,
647or s. 775.084. Each day of continued operation is a separate
649     (d)  If a nurse registry fails to cease operation after
650agency notification, the agency may impose a fine of $500 for
651each day of noncompliance.
652     (10)(a)  A nurse registry may refer for contract in private
653residences registered nurses and licensed practical nurses
654registered and licensed under part I of chapter 464, certified
655nursing assistants certified under part II of chapter 464, home
656health aides who present documented proof of successful
657completion of the training required by rule of the agency, and
658companions or homemakers for the purposes of providing those
659services authorized under s. 400.509(1). Each person referred by
660a nurse registry must provide current documentation that he or
661she is free from communicable diseases.
662     (b)  A certified nursing assistant or home health aide may
663be referred for a contract to provide care to a patient in his
664or her home only if that patient is under a physician's care. A
665certified nursing assistant or home health aide referred for
666contract in a private residence shall be limited to assisting a
667patient with bathing, dressing, toileting, grooming, eating,
668physical transfer, and those normal daily routines the patient
669could perform for himself or herself were he or she physically
670capable. A certified nursing assistant or home health aide may
671not provide medical or other health care services that require
672specialized training and that may be performed only by licensed
673health care professionals. The nurse registry shall obtain the
674name and address of the attending physician and send written
675notification to the physician within 48 hours after a contract
676is concluded that a certified nursing assistant or home health
677aide will be providing care for that patient.
678     (c)  At the time of contracting for services, the nurse
679registry shall advise the patient, the patient's family, or a
680person acting on behalf of the patient of the availability of
681registered nurses to make visits to the patient's home at an
682additional cost. A registered nurse shall make monthly visits to
683the patient's home to assess the patient's condition and quality
684of care being provided by the certified nursing assistant or
685home health aide. Any condition which, in the professional
686judgment of the nurse, requires further medical attention shall
687be reported to the attending physician and the nurse registry.
688The assessment shall become a part of the patient's file with
689the nurse registry and may be reviewed by the agency during
690their survey procedure.
691     (13)  Each nurse registry must comply with the procedures
692set forth in s. 400.512 for maintaining records of the work
693employment history of all persons referred for contract and is
694subject to the standards and conditions set forth in that
695section. However, an initial screening may not be required for
696persons who have been continuously registered with the nurse
697registry since October 1, 2000 September 30, 1990.
698     (14)  The nurse registry must maintain the application on
699file, and that file must be open to the inspection of the Agency
700for Health Care Administration. The nurse registry must maintain
701on file the name and address of the patient or client to whom
702the nurse or other nurse registry personnel are referred is sent
703for contract and the amount of the fee received by the nurse
704registry. A nurse registry must maintain the file that includes
705the application and other applicable documentation for 3 years
706after the date of the last file entry of patient-related or
707client-related information.
708     (17)  All persons referred for contract in private
709residences by a nurse registry must comply with the following
710requirements for a plan of treatment:
711     (a)  When, in accordance with the privileges and
712restrictions imposed upon a nurse under part I of chapter 464,
713the delivery of care to a patient is under the direction or
714supervision of a physician or when a physician is responsible
715for the medical care of the patient, a medical plan of treatment
716must be established for each patient receiving care or treatment
717provided by a licensed nurse in the home. The original medical
718plan of treatment must be timely signed by the physician,
719physician assistant, or advanced registered nurse practitioner,
720acting within his or her respective scope of practice, and
721reviewed by him or her in consultation with the licensed nurse
722at least every 2 months. Any additional order or change in
723orders must be obtained from the physician, physician assistant,
724or advanced registered nurse practitioner and reduced to writing
725and timely signed by the physician, physician assistant, or
726advanced registered nurse practitioner. The delivery of care
727under a medical plan of treatment must be substantiated by the
728appropriate nursing notes or documentation made by the nurse in
729compliance with nursing practices established under part I of
730chapter 464.
731     (b)  Whenever a medical plan of treatment is established
732for a patient, the initial medical plan of treatment, any
733amendment to the plan, additional order or change in orders, and
734copy of nursing notes must be filed in the office of the nurse
736     Section 9.  Subsection (2) of section 400.512, Florida
737Statutes, is amended to read:
738     400.512  Screening of home health agency personnel; nurse
739registry personnel; and companions and homemakers.--The agency
740shall require employment or contractor screening as provided in
741chapter 435, using the level 1 standards for screening set forth
742in that chapter, for home health agency personnel; persons
743referred for employment by nurse registries; and persons
744employed by companion or homemaker services registered under s.
746     (2)  The administrator of each home health agency, the
747managing employee of each nurse registry, and the managing
748employee of each companion or homemaker service registered under
749s. 400.509 must sign an affidavit annually, under penalty of
750perjury, stating that all personnel hired or, contracted with,
751or registered on or after October 1, 2000 October 1, 1994, who
752enter the home of a patient or client in their service capacity
753have been screened and that its remaining personnel have worked
754for the home health agency or registrant continuously since
755before October 1, 1994.
756     Section 10.  Section 400.515, Florida Statutes, is amended
757to read:
758     400.515  Injunction proceedings.--In addition to the other
759powers provided under this chapter, the agency may institute
760injunction proceedings in a court of competent jurisdiction to
761restrain or prevent the establishment or operation of a home
762health agency or nurse registry that does not have a license or
763that is in violation of any provision of this part or any rule
764adopted pursuant to this part. The agency for Health Care
765Administration may also institute injunction proceedings in a
766court of competent jurisdiction when violation of this part or
767of applicable rules constitutes an emergency affecting the
768immediate health and safety of a patient or client.
769     Section 11.  This act shall take effect July 1, 2005.

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