HB 0739CS


1The Health Care Regulation Committee recommends the following:
3     Council/Committee Substitute
4     Remove the entire bill and insert:
A bill to be entitled
6An act relating to health care; amending s. 400.461, F.S.;
7revising the purpose of part IV of ch. 400, F.S., to
8include the licensure of nurse registries; amending s.
9400.462, F.S.; revising definitions; defining the terms
10"admission," "advanced registered nurse practitioner,"
11"direct employee," and "physician assistant" for purposes
12of part IV of ch. 400, F.S.; amending s. 400.464, F.S.,
13relating to licensure of home health agencies; revising
14the licensure period; revising and providing additional
15administrative, civil, and criminal penalties, sanctions,
16and fines; amending s. 400.471, F.S.; revising
17requirements for license application by a home health
18agency; authorizing the Agency for Health Care
19Administration to revoke a license under certain
20circumstances; authorizing administrative fines; amending
21s. 400.487, F.S.; revising requirements for home health
22agency service agreements and treatment orders; amending
23s. 400.491, F.S., relating to clinical records; changing
24the timeframe for a home health agency to retain patient
25records; changing a reference; amending s. 400.494, F.S.;
26providing for the continued confidentiality of patient
27information in compliance with federal law; providing for
28disclosure in accordance with certain specified state
29laws; deleting a requirement for written consent of the
30patient or the patient's guardian for disclosure of
31confidential patient information; deleting an exemption
32provided for the Medicaid Fraud Control Unit of the
33Department of Legal Affairs; amending s. 400.506, F.S.;
34revising requirements governing nurse registries;
35increasing license fee; increasing the period of
36licensure; authorizing administrative penalties; revising
37criminal penalties and sanctions; revising certain
38requirements pertaining to health care professionals that
39provide services on behalf of a nurse registry; amending
40s. 400.512, F.S., relating to employment screening;
41revising the date on which an annual affidavit must be
42signed which verifies that certain personnel of a home
43health agency, a nurse registry, or homemaker service have
44been screened; amending s. 400.515, F.S.; providing
45additional circumstances under which the agency may
46petition for an injunction; providing an effective date.
48Be It Enacted by the Legislature of the State of Florida:
50     Section 1.  Subsection (2) of section 400.461, Florida
51Statutes, is amended to read:
52     400.461  Short title; purpose.--
53     (2)  The purpose of this part is to provide for the
54licensure of every home health agency and nurse registry and to
55provide for the development, establishment, and enforcement of
56basic standards that will ensure the safe and adequate care of
57persons receiving health services in their own homes.
58     Section 2.  Section 400.462, Florida Statutes, is amended
59to read:
60     400.462  Definitions.--As used in this part, the term:
61     (1)  "Administrator" means a direct employee, as defined in
62subsection (9) of the home health agency or a related
63organization, or of a management company that has a contract to
64manage the home health agency, to whom the governing body has
65delegated the responsibility for day-to-day administration of
66the home health agency. The administrator must be a licensed
67physician, physician assistant, or registered nurse licensed to
68practice in this state or an individual having at least 1 year
69of supervisory or administrative experience in home health care
70or in a facility licensed under chapter 395 or under part II or
71part III of this chapter. An administrator may manage a maximum
72of five licensed home health agencies located within one agency
73service district or within an immediately contiguous county. If
74the home health agency is licensed under this chapter and is
75part of a retirement community that provides multiple levels of
76care, an employee of the retirement community may administer the
77home health agency and up to a maximum of four entities licensed
78under this chapter that are owned, operated, or managed by the
79same corporate entity. An administrator shall designate, in
80writing, for each licensed entity, a qualified alternate
81administrator to serve during absences.
82     (2)  "Admission" means a decision by the home health
83agency, during or after an evaluation visit to the patient's
84home, that there is reasonable expectation that the patient's
85medical, nursing, and social needs for skilled care can be
86adequately met by the agency in the patient's place of
87residence. Admission includes completion of an agreement with
88the patient or the patient's legal representative to provide
89home health services as required in s. 400.487(1).
90     (3)  "Advanced registered nurse practitioner" means a
91person licensed in this state to practice professional nursing
92and certified in advanced or specialized nursing practice, as
93defined in s. 464.003.
94     (4)(2)  "Agency" means the Agency for Health Care
96     (5)(3)  "Certified nursing assistant" means any person who
97has been issued a certificate under part II of chapter 464. The
98licensed home health agency or licensed nurse registry shall
99ensure that the certified nursing assistant employed by or under
100contract with the home health agency or licensed nurse registry
101is adequately trained to perform the tasks of a home health aide
102in the home setting.
103     (6)(4)  "Client" means an elderly, handicapped, or
104convalescent individual who receives personal care services,
105companion services, or homemaker services in the individual's
106home or place of residence.
107     (7)(5)  "Companion" or "sitter" means a person who spends
108time with or cares for an elderly, handicapped, or convalescent
109individual and accompanies such individual on trips and outings
110and may prepare and serve meals to such individual. A companion
111may not provide hands-on personal care to a client.
112     (8)(6)  "Department" means the Department of Children and
113Family Services.
114     (9)  "Direct employee" means an employee for whom one of
115the following entities pays withholding taxes: a home health
116agency; a management company that has a contract to manage the
117home health agency on a day-to-day basis; or an employee leasing
118company that has a contract with the home health agency to
119handle the payroll and payroll taxes for the home health agency.
120     (10)(7)  "Director of nursing" means a registered nurse who
121is a and direct employee, as defined in subsection (9), of the
122agency and or related business entity who is a graduate of an
123approved school of nursing and is licensed in this state; who
124has at least 1 year of supervisory experience as a registered
125nurse in a licensed home health agency, a facility licensed
126under chapter 395, or a facility licensed under part II or part
127III of this chapter; and who is responsible for overseeing the
128professional nursing and home health aid delivery of services of
129the agency. A director of nursing An employee may be the
130director of nursing of a maximum of five licensed home health
131agencies operated by a related business entity and located
132within one agency service district or within an immediately
133contiguous county. If the home health agency is licensed under
134this chapter and is part of a retirement community that provides
135multiple levels of care, an employee of the retirement community
136may serve as the director of nursing of the home health agency
137and of up to four entities licensed under this chapter which are
138owned, operated, or managed by the same corporate entity. A
139director of nursing shall designate, in writing, for each
140licensed entity, a qualified alternate registered nurse to serve
141during the absence of the director of nursing.
142     (11)(8)  "Home health agency" means an organization that
143provides home health services and staffing services.
144     (12)(9)  "Home health agency personnel" means persons who
145are employed by or under contract with a home health agency and
146enter the home or place of residence of patients at any time in
147the course of their employment or contract.
148     (13)(10)  "Home health services" means health and medical
149services and medical supplies furnished by an organization to an
150individual in the individual's home or place of residence. The
151term includes organizations that provide one or more of the
153     (a)  Nursing care.
154     (b)  Physical, occupational, respiratory, or speech
156     (c)  Home health aide services.
157     (d)  Dietetics and nutrition practice and nutrition
159     (e)  Medical supplies, restricted to drugs and biologicals
160prescribed by a physician.
161     (14)(11)  "Home health aide" means a person who is trained
162or qualified, as provided by rule, and who provides hands-on
163personal care, performs simple procedures as an extension of
164therapy or nursing services, assists in ambulation or exercises,
165or assists in administering medications as permitted in rule and
166for which the person has received training established by the
167agency under s. 400.497(1). The licensed home health agency or
168licensed nurse registry shall ensure that the home health aide
169employed by or under contract with the home health agency or
170licensed nurse registry is adequately trained to perform the
171tasks of a home health aide in the home setting.
172     (15)(12)  "Homemaker" means a person who performs household
173chores that include housekeeping, meal planning and preparation,
174shopping assistance, and routine household activities for an
175elderly, handicapped, or convalescent individual. A homemaker
176may not provide hands-on personal care to a client.
177     (16)(13)  "Home infusion therapy provider" means an
178organization that employs, contracts with, or refers a licensed
179professional who has received advanced training and experience
180in intravenous infusion therapy and who administers infusion
181therapy to a patient in the patient's home or place of
183     (17)(14)  "Home infusion therapy" means the administration
184of intravenous pharmacological or nutritional products to a
185patient in his or her home.
186     (18)(15)  "Nurse registry" means any person that procures,
187offers, promises, or attempts to secure health-care-related
188contracts for registered nurses, licensed practical nurses,
189certified nursing assistants, home health aides, companions, or
190homemakers, who are compensated by fees as independent
191contractors, including, but not limited to, contracts for the
192provision of services to patients and contracts to provide
193private duty or staffing services to health care facilities
194licensed under chapter 395 or this chapter or other business
196     (19)(16)  "Organization" means a corporation, government or
197governmental subdivision or agency, partnership or association,
198or any other legal or commercial entity, any of which involve
199more than one health care professional discipline; or a health
200care professional and a home health aide or certified nursing
201assistant; more than one home health aide; more than one
202certified nursing assistant; or a home health aide and a
203certified nursing assistant. The term does not include an entity
204that provides services using only volunteers or only individuals
205related by blood or marriage to the patient or client.
206     (20)(17)  "Patient" means any person who receives home
207health services in his or her home or place of residence.
208     (21)(18)  "Personal care" means assistance to a patient in
209the activities of daily living, such as dressing, bathing,
210eating, or personal hygiene, and assistance in physical
211transfer, ambulation, and in administering medications as
212permitted by rule.
213     (22)(19)  "Physician" means a person licensed under chapter
214458, chapter 459, chapter 460, or chapter 461.
215     (23)  "Physician assistant" means a person who is a
216graduate of an approved program or its equivalent, or meets
217standards approved by the boards, and is licensed to perform
218medical services delegated by the supervising physician, as
219defined in s. 458.347 or s. 459.022.
220     (24)(20)  "Skilled care" means nursing services or
221therapeutic services required by law to be delivered by a health
222care professional who is licensed under part I of chapter 464;
223part I, part III, or part V of chapter 468; or chapter 486 and
224who is employed by or under contract with a licensed home health
225agency or is referred by a licensed nurse registry.
226     (25)(21)  "Staffing services" means services provided to a
227health care facility or other business entity on a temporary
228basis by licensed health care personnel and by, including
229certified nursing assistants and home heath aides who are
230employed by, or work under the auspices of, a licensed home
231health agency or who are registered with a licensed nurse
232registry. Staffing services may be provided anywhere within the
234     Section 3.  Subsections (1) and (4) of section 400.464,
235Florida Statutes, are amended to read:
236     400.464  Home health agencies to be licensed; expiration of
237license; exemptions; unlawful acts; penalties.--
238     (1)  Any home health agency must be licensed by the agency
239to operate in this state. A license issued to a home health
240agency, unless sooner suspended or revoked, expires 2 years 1
241year after its date of issuance.
242     (4)(a)  An organization may not provide, offer, or
243advertise home health services to the public unless the
244organization has a valid license or is specifically exempted
245under this part. An organization that offers or advertises to
246the public any service for which licensure or registration is
247required under this part must include in the advertisement the
248license number or registration regulation number issued to the
249organization by the agency. The agency shall assess a fine of
250not less than $100 to any licensee or registrant who fails to
251include the license or registration number when submitting the
252advertisement for publication, broadcast, or printing. The fine
253for a second or subsequent offense is $500. The holder of a
254license issued under this part may not advertise or indicate to
255the public that it holds a home health agency or nurse registry
256license other than the one it has been issued.
257     (b)  The operation or maintenance of an unlicensed home
258health agency or the performance of any home health services in
259violation of this part is declared a nuisance, inimical to the
260public health, welfare, and safety. The agency or any state
261attorney may, in addition to other remedies provided in this
262part, bring an action for an injunction to restrain such
263violation, or to enjoin the future operation or maintenance of
264the home health agency or the provision of home health services
265in violation of this part, until compliance with this part or
266the rules adopted under this part has been demonstrated to the
267satisfaction of the agency.
268     (c)(b)  A person who violates paragraph (a) is subject to
269an injunctive proceeding under s. 400.515. A violation of
270paragraph (a) is a deceptive and unfair trade practice and
271constitutes a violation of the Florida Deceptive and Unfair
272Trade Practices Act under part II of chapter 501.
273     (d)(c)  A person who violates the provisions of paragraph
274(a) commits a misdemeanor of the second degree, punishable as
275provided in s. 775.082 or s. 775.083. Any person who commits a
276second or subsequent violation commits a misdemeanor of the
277first degree, punishable as provided in s. 775.082 or s.
278775.083. Each day of continuing violation constitutes a separate
280     (e)  Any person who owns, operates, or maintains an
281unlicensed home health agency and who, within 10 working days
282after receiving notification from the agency, fails to cease
283operation and apply for a license under this part commits a
284misdemeanor of the first degree, punishable as provided in s.
285775.082 or s. 775.083. Each day of continued operation is a
286separate offense.
287     (f)  Any home health agency that fails to cease operation
288after agency notification may be fined $500 for each day of
290     Section 4.  Section 400.471, Florida Statutes, is amended
291to read:
292     400.471  Application for license; fee; provisional license;
293temporary permit.--
294     (1)  Application for an initial license or for renewal of
295an existing license must be made under oath to the agency on
296forms furnished by it and must be accompanied by the appropriate
297license fee as provided in subsection (10) (8). The agency must
298take final action on an initial licensure application within 60
299days after receipt of all required documentation.
300     (2)  The initial applicant must file with the application
301satisfactory proof that the home health agency is in compliance
302with this part and applicable rules, including:
303     (a)  A listing of services to be provided, either directly
304by the applicant or through contractual arrangements with
305existing providers.;
306     (b)  The number and discipline of professional staff to be
307employed.; and
308     (c)  Proof of financial ability to operate.
309     (d)  Completion of questions concerning volume data on the
310renewal application as determined by rule.
311     (3)  An applicant for initial licensure must demonstrate
312financial ability to operate by submitting a balance sheet and
313income and expense statement for the first 2 years of operation
314which provide evidence of having sufficient assets, credit, and
315projected revenues to cover liabilities and expenses. The
316applicant shall have demonstrated financial ability to operate
317if the applicant's assets, credit, and projected revenues meet
318or exceed projected liabilities and expenses. All documents
319required under this subsection must be prepared in accordance
320with generally accepted accounting principles, and must be
321compiled the financial statement must be signed by a certified
322public accountant.
323     (4)  Each applicant for licensure must comply with the
324following requirements:
325     (a)  Upon receipt of a completed, signed, and dated
326application, the agency shall require background screening of
327the applicant, in accordance with the level 2 standards for
328screening set forth in chapter 435. As used in this subsection,
329the term "applicant" means the administrator, or a similarly
330titled person who is responsible for the day-to-day operation of
331the licensed home health agency, and the financial officer, or
332similarly titled individual who is responsible for the financial
333operation of the licensed home health agency.
334     (b)  The agency may require background screening for a
335member of the board of directors of the licensee or an officer
336or an individual owning 5 percent or more of the licensee if the
337agency reasonably suspects that such individual has been
338convicted of an offense prohibited under the level 2 standards
339for screening set forth in chapter 435.
340     (c)  Proof of compliance with the level 2 background
341screening requirements of chapter 435 which has been submitted
342within the previous 5 years in compliance with any other health
343care or assisted living licensure requirements of this state is
344acceptable in fulfillment of paragraph (a). Proof of compliance
345with background screening which has been submitted within the
346previous 5 years to fulfill the requirements of the Financial
347Services Commission and the Office of Insurance Regulation
348pursuant to chapter 651 as part of an application for a
349certificate of authority to operate a continuing care retirement
350community is acceptable in fulfillment of the Department of Law
351Enforcement and Federal Bureau of Investigation background
353     (d)  A provisional license may be granted to an applicant
354when each individual required by this section to undergo
355background screening has met the standards for the Department of
356Law Enforcement background check, but the agency has not yet
357received background screening results from the Federal Bureau of
358Investigation. A standard license may be granted to the licensee
359upon the agency's receipt of a report of the results of the
360Federal Bureau of Investigation background screening for each
361individual required by this section to undergo background
362screening which confirms that all standards have been met, or
363upon the granting of a disqualification exemption by the agency
364as set forth in chapter 435. Any other person who is required to
365undergo level 2 background screening may serve in his or her
366capacity pending the agency's receipt of the report from the
367Federal Bureau of Investigation. However, the person may not
368continue to serve if the report indicates any violation of
369background screening standards and a disqualification exemption
370has not been requested of and granted by the agency as set forth
371in chapter 435.
372     (e)  Each applicant must submit to the agency, with its
373application, a description and explanation of any exclusions,
374permanent suspensions, or terminations of the licensee or
375potential licensee from the Medicare or Medicaid programs. Proof
376of compliance with the requirements for disclosure of ownership
377and control interest under the Medicaid or Medicare programs may
378be accepted in lieu of this submission.
379     (f)  Each applicant must submit to the agency a description
380and explanation of any conviction of an offense prohibited under
381the level 2 standards of chapter 435 by a member of the board of
382directors of the applicant, its officers, or any individual
383owning 5 percent or more of the applicant. This requirement does
384not apply to a director of a not-for-profit corporation or
385organization if the director serves solely in a voluntary
386capacity for the corporation or organization, does not regularly
387take part in the day-to-day operational decisions of the
388corporation or organization, receives no remuneration for his or
389her services on the corporation or organization's board of
390directors, and has no financial interest and has no family
391members with a financial interest in the corporation or
392organization, provided that the director and the not-for-profit
393corporation or organization include in the application a
394statement affirming that the director's relationship to the
395corporation satisfies the requirements of this paragraph.
396     (g)  A license may not be granted to an applicant if the
397applicant, administrator, or financial officer has been found
398guilty of, regardless of adjudication, or has entered a plea of
399nolo contendere or guilty to, any offense prohibited under the
400level 2 standards for screening set forth in chapter 435, unless
401an exemption from disqualification has been granted by the
402agency as set forth in chapter 435.
403     (h)  The agency may deny or revoke licensure if the
405     1.  Has falsely represented a material fact in the
406application required by paragraph (e) or paragraph (f), or has
407omitted any material fact from the application required by
408paragraph (e) or paragraph (f); or
409     2.  has been or is currently excluded, suspended,
410terminated from, or has involuntarily withdrawn from
411participation in this state's Medicaid program, or the Medicaid
412program of any other state, or from participation in the
413Medicare program or any other governmental or private health
414care or health insurance program.
415     (i)  An application for license renewal must contain the
416information required under paragraphs (e) and (f).
417     (5)  The agency may deny or revoke licensure if the
418applicant has falsely represented a material fact, or has
419omitted any material fact, from the application required by this
421     (6)(5)  The home health agency must also obtain and
422maintain the following insurance coverage coverages in an amount
423of not less than $250,000 per claim, and the home health agency
424must submit proof of coverage with an initial application for
425licensure and with each annual application for license renewal:
426     (a)  Malpractice insurance as defined in s. 624.605(1)(k).;
427     (b)  Liability insurance as defined in s. 624.605(1)(b).
428     (7)(6)  Sixty Ninety days before the expiration date, an
429application for renewal must be submitted to the agency under
430oath on forms furnished by it, and a license must be renewed if
431the applicant has met the requirements established under this
432part and applicable rules. The home health agency must file with
433the application satisfactory proof that it is in compliance with
434this part and applicable rules. If there is evidence of
435financial instability, the home health agency must submit
436satisfactory proof of its financial ability to comply with the
437requirements of this part. The agency shall impose an
438administrative fine of $50 per day for each day the home health
439agency fails to file an application within the timeframe
440specified in this subsection. Each day of continuing violation
441is a separate violation; however, the aggregate of such fines
442may not exceed $500.
443     (8)(7)  When transferring the ownership of a home health
444agency, the transferee must submit an application for a license
445at least 60 days before the effective date of the transfer. If
446the application is filed late, an administrative fine shall be
447imposed in the amount of $50 per day. Each day of continuing
448violation is a separate violation; however, the aggregate of
449such fines may not exceed $500. If the home health agency is
450being leased, a copy of the lease agreement must be filed with
451the application.
452     (9)  The agency shall accept, in lieu of its own periodic
453licensure survey, submission of the survey of an accrediting
454organization that is recognized by the agency if the
455accreditation of the licensed home health agency is not
456provisional and if the licensed home health agency authorizes
457release of, and the agency receives the report of, the
458accrediting organization.
459     (10)(8)  The license fee and annual renewal fee required of
460a home health agency are nonrefundable. The agency shall set the
461license fees in an amount that is sufficient to cover its costs
462in carrying out its responsibilities under this part, but not to
463exceed $2,000 $1,000. However, state, county, or municipal
464governments applying for licenses under this part are exempt
465from the payment of license fees. All fees collected under this
466part must be deposited in the Health Care Trust Fund for the
467administration of this part.
468     (11)(9)  The license must be displayed in a conspicuous
469place in the administrative office of the home health agency and
470is valid only while in the possession of the person to which it
471is issued. The license may not be sold, assigned, or otherwise
472transferred, voluntarily or involuntarily, and is valid only for
473the home health agency and location for which originally issued.
474     (12)(10)  A home health agency against whom a revocation or
475suspension proceeding is pending at the time of license renewal
476may be issued a provisional license effective until final
477disposition by the agency of such proceedings. If judicial
478relief is sought from the final disposition, the court that has
479jurisdiction may issue a temporary permit for the duration of
480the judicial proceeding.
481     (13)(11)  The agency may not issue a license designated as
482certified to a home health agency that fails to satisfy the
483requirements of a Medicare certification survey from the agency.
484     (14)(12)  The agency may not issue a license to a home
485health agency that has any unpaid fines assessed under this
487     Section 5.  Section 400.487, Florida Statutes, is amended
488to read:
489     400.487  Home health service agreements; physician's,
490physician assistant's, and advanced registered nurse
491practitioner's treatment orders; patient assessment;
492establishment and review of plan of care; provision of services;
493orders not to resuscitate.--
494     (1)  Services provided by a home health agency must be
495covered by an agreement between the home health agency and the
496patient or the patient's legal representative specifying the
497home health services to be provided, the rates or charges for
498services paid with private funds, and the sources method of
499payment, which may include Medicare, Medicaid, private
500insurance, personal funds, or a combination thereof. A home
501health agency providing skilled care must make an assessment of
502the patient's needs within 48 hours after the start of services.
503     (2)  When required by the provisions of chapter 464; part
504I, part III, or part V of chapter 468; or chapter 486, the
505attending physician, physician assistant, or advanced registered
506nurse practitioner, acting within his or her respective scope of
507practice, shall for a patient who is to receive skilled care
508must establish treatment orders for a patient who is to receive
509skilled care. The treatment orders must be signed by the
510physician, physician assistant, or advanced registered nurse
511practitioner before a claim for payment for the skilled services
512is submitted by the home health agency. If the claim is
513submitted to a managed care organization, the treatment orders
514must be signed within the time allowed under the provider
515agreement. The treatment orders shall within 30 days after the
516start of care and must be reviewed, as frequently as the
517patient's illness requires, by the physician, physician
518assistant, or advanced registered nurse practitioner in
519consultation with the home health agency personnel that provide
520services to the patient.
521     (3)  A home health agency shall arrange for supervisory
522visits by a registered nurse to the home of a patient receiving
523home health aide services in accordance with the patient's
524direction, and approval, and agreement to pay the charge for the
526     (4)  Each patient has the right to be informed of and to
527participate in the planning of his or her care. Each patient
528must be provided, upon request, a copy of the plan of care
529established and maintained for that patient by the home health
531     (5)  When nursing services are ordered, the home health
532agency to which a patient has been admitted for care must
533provide the initial admission visit, all service evaluation
534visits, and the discharge visit by a direct employee qualified
535personnel who are on the payroll of, and to whom an IRS payroll
536form W-2 will be issued by, the home health agency. Services
537provided by others under contractual arrangements to a home
538health agency must be monitored and managed by the admitting
539home health agency. The admitting home health agency is fully
540responsible for ensuring that all care provided through its
541employees or contract staff is delivered in accordance with this
542part and applicable rules.
543     (6)  The skilled care services provided by a home health
544agency, directly or under contract, must be supervised and
545coordinated in accordance with the plan of care.
546     (7)  Home health agency personnel may withhold or withdraw
547cardiopulmonary resuscitation if presented with an order not to
548resuscitate executed pursuant to s. 401.45. The agency shall
549adopt rules providing for the implementation of such orders.
550Home health personnel and agencies shall not be subject to
551criminal prosecution or civil liability, nor be considered to
552have engaged in negligent or unprofessional conduct, for
553withholding or withdrawing cardiopulmonary resuscitation
554pursuant to such an order and rules adopted by the agency.
555     Section 6.  Subsection (1) of section 400.491, Florida
556Statutes, is amended to read:
557     400.491  Clinical records.--
558     (1)  The home health agency must maintain for each patient
559who receives skilled care a clinical record that includes
560pertinent past and current medical, nursing, social and other
561therapeutic information, the treatment orders, and other such
562information as is necessary for the safe and adequate care of
563the patient. When home health services are terminated, the
564record must show the date and reason for termination. Such
565records are considered patient records under s. 400.494 s.
566456.057, and must be maintained by the home health agency for 6
5675 years following termination of services. If a patient
568transfers to another home health agency, a copy of his or her
569record must be provided to the other home health agency upon
571     Section 7.  Section 400.494, Florida Statutes, is amended
572to read:
573     400.494  Information about patients confidential.--
574     (1)  Information about patients received by persons
575employed by, or providing services to, a home health agency or
576received by the licensing agency through reports or inspection
577shall be confidential and exempt from the provisions of s.
578119.07(1) and shall only not be disclosed to any person, other
579than the patient, as permitted under the provisions of 45 C.F.R.
580ss. 160.102, 160.103, and 164, subpart A, commonly referred to
581as the HIPAA Privacy Regulation; except that clinical records
582described in ss. 381.004, 384.29, 385.202, 392.65, 394.4615,
583395.404, 397.501, and 760.40 shall be disclosed as authorized in
584those sections without the written consent of that patient or
585the patient's guardian.
586     (2)  This section does not apply to information lawfully
587requested by the Medicaid Fraud Control Unit of the Department
588of Legal Affairs.
589     Section 8.  Subsections (3), (5), (7), (8), (10), (13),
590(14), and (17) of section 400.506, Florida Statutes, are amended
591to read:
592     400.506  Licensure of nurse registries; requirements;
594     (3)  Application for license must be made to the Agency for
595Health Care Administration on forms furnished by it and must be
596accompanied by the appropriate licensure fee, as established by
597rule and not to exceed the cost of regulation under this part.
598The licensure fee for nurse registries may not exceed $2,000
599$1,000 and must be deposited in the Health Care Trust Fund.
600     (5)  A license issued for the operation of a nurse
601registry, unless sooner suspended or revoked, expires 2 years 1
602year after its date of issuance. Sixty days before the
603expiration date, an application for renewal must be submitted to
604the Agency for Health Care Administration on forms furnished by
605it. The Agency for Health Care Administration shall renew the
606license if the applicant has met the requirements of this
607section and applicable rules. A nurse registry against which a
608revocation or suspension proceeding is pending at the time of
609license renewal may be issued a conditional license effective
610until final disposition by the Agency for Health Care
611Administration of such proceedings. If judicial relief is sought
612from the final disposition, the court having jurisdiction may
613issue a conditional license for the duration of the judicial
615     (7)  A person that provides, offers, or advertises to the
616public that it provides any service for which licensure is
617required under this section must include in such advertisement
618the license number issued to it by the Agency for Health Care
619Administration. The agency shall assess a fine of not less than
620$100 against any licensee who fails to include the license
621number when submitting the advertisement for publication,
622broadcast, or printing. The fine for a second or subsequent
623offense is $500.
624     (8)(a)  It is unlawful for a person to provide, offer, or
625advertise to the public services as defined by rule without
626obtaining a valid license from the Agency for Health Care
627Administration. It is unlawful for any holder of a license to
628advertise or hold out to the public that he or she holds a
629license for other than that for which he or she actually holds a
630license. A person who violates this subsection is subject to
631injunctive proceedings under s. 400.515.
632     (b)  A person who violates the provisions of paragraph (a)
633commits a misdemeanor of the second degree, punishable as
634provided in s. 775.082 or s. 775.083. Each day of continuing
635violation is a separate offense.
636     (c)  Any person who owns, operates, or maintains an
637unlicensed nurse registry and who, within 10 working days after
638receiving notification from the agency, fails to cease operation
639and apply for a license under this part commits a misdemeanor of
640the second degree, punishable as provided in s. 775.082 or s.
641775.083. Each day of continued operation is a separate offense.
642     (d)  If a nurse registry fails to cease operation after
643agency notification, the agency may impose a fine of $500 for
644each day of noncompliance.
645     (10)(a)  A nurse registry may refer for contract in private
646residences registered nurses and licensed practical nurses
647registered and licensed under part I of chapter 464, certified
648nursing assistants certified under part II of chapter 464, home
649health aides who present documented proof of successful
650completion of the training required by rule of the agency, and
651companions or homemakers for the purposes of providing those
652services authorized under s. 400.509(1). Each person referred by
653a nurse registry must provide current documentation that he or
654she is free from communicable diseases.
655     (b)  A certified nursing assistant or home health aide may
656be referred for a contract to provide care to a patient in his
657or her home only if that patient is under a physician's care. A
658certified nursing assistant or home health aide referred for
659contract in a private residence shall be limited to assisting a
660patient with bathing, dressing, toileting, grooming, eating,
661physical transfer, and those normal daily routines the patient
662could perform for himself or herself were he or she physically
663capable. A certified nursing assistant or home health aide may
664not provide medical or other health care services that require
665specialized training and that may be performed only by licensed
666health care professionals. The nurse registry shall obtain the
667name and address of the attending physician and send written
668notification to the physician within 48 hours after a contract
669is concluded that a certified nursing assistant or home health
670aide will be providing care for that patient.
671     (c)  When a certified nursing assistant or home health aide
672is referred to a patient's home by a nurse registry, the nurse
673registry shall advise the patient, the patient's family, or any
674other person acting on behalf of the patient at the time the
675contract for services is made that registered nurses are
676available to make visits to the patient's home for an additional
677cost. A registered nurse shall make monthly visits to the
678patient's home to assess the patient's condition and quality of
679care being provided by the certified nursing assistant or home
680health aide. Any condition which, in the professional judgment
681of the nurse, requires further medical attention shall be
682reported to the attending physician and the nurse registry. A
683record of the nurse's visit The assessment shall become a part
684of the patient's file with the nurse registry and may be
685reviewed by the agency during their survey procedure.
686     (13)  Each nurse registry must comply with the procedures
687set forth in s. 400.512 for maintaining records of the work
688employment history of all persons referred for contract and is
689subject to the standards and conditions set forth in that
690section. However, an initial screening may not be required for
691persons who have been continuously registered with the nurse
692registry since October 1, 2000 September 30, 1990.
693     (14)  The nurse registry must maintain the application on
694file, and that file must be open to the inspection of the Agency
695for Health Care Administration. The nurse registry must maintain
696on file the name and address of the patient or client to whom
697the nurse or other nurse registry personnel are referred is sent
698for contract and the amount of the fee received by the nurse
699registry. A nurse registry must maintain the file that includes
700the application and other applicable documentation for 3 years
701after the date of the last file entry of patient-related or
702client-related information.
703     (17)  All persons referred for contract in private
704residences by a nurse registry must comply with the following
705requirements for a plan of treatment:
706     (a)  When, in accordance with the privileges and
707restrictions imposed upon a nurse under part I of chapter 464,
708the delivery of care to a patient is under the direction or
709supervision of a physician or when a physician is responsible
710for the medical care of the patient, a medical plan of treatment
711must be established for each patient receiving care or treatment
712provided by a licensed nurse in the home. The original medical
713plan of treatment must be timely signed by the physician,
714physician assistant, or advanced registered nurse practitioner,
715acting within his or her respective scope of practice, and
716reviewed by him or her in consultation with the licensed nurse
717at least every 2 months. Any additional order or change in
718orders must be obtained from the physician, physician assistant,
719or advanced registered nurse practitioner and reduced to writing
720and timely signed by the physician, physician assistant, or
721advanced registered nurse practitioner. The delivery of care
722under a medical plan of treatment must be substantiated by the
723appropriate nursing notes or documentation made by the nurse in
724compliance with nursing practices established under part I of
725chapter 464.
726     (b)  Whenever a medical plan of treatment is established
727for a patient, the initial medical plan of treatment, any
728amendment to the plan, additional order or change in orders, and
729copy of nursing notes must be filed in the office of the nurse
731     Section 9.  Subsection (2) of section 400.512, Florida
732Statutes, is amended to read:
733     400.512  Screening of home health agency personnel; nurse
734registry personnel; and companions and homemakers.--The agency
735shall require employment or contractor screening as provided in
736chapter 435, using the level 1 standards for screening set forth
737in that chapter, for home health agency personnel; persons
738referred for employment by nurse registries; and persons
739employed by companion or homemaker services registered under s.
741     (2)  The administrator of each home health agency, the
742managing employee of each nurse registry, and the managing
743employee of each companion or homemaker service registered under
744s. 400.509 must sign an affidavit annually, under penalty of
745perjury, stating that all personnel hired or, contracted with,
746or registered on or after October 1, 2000 October 1, 1994, who
747enter the home of a patient or client in their service capacity
748have been screened and that its remaining personnel have worked
749for the home health agency or registrant continuously since
750before October 1, 1994.
751     Section 10.  Section 400.515, Florida Statutes, is amended
752to read:
753     400.515  Injunction proceedings.--In addition to the other
754powers provided under this chapter, the agency may institute
755injunction proceedings in a court of competent jurisdiction to
756restrain or prevent the establishment or operation of a home
757health agency or nurse registry that does not have a license or
758that is in violation of any provision of this part or any rule
759adopted pursuant to this part. The agency for Health Care
760Administration may also institute injunction proceedings in a
761court of competent jurisdiction when violation of this part or
762of applicable rules constitutes an emergency affecting the
763immediate health and safety of a patient or client.
764     Section 11.  This act shall take effect July 1, 2005.

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