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The Committee on Health Regulation (Atwater) recommended the

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following amendment:

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     Senate Amendment (with title amendment)

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     Delete everything after the enacting clause

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and insert:

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     Section 1.  Section 400.462, Florida Statutes, is amended

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to read:

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

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     (1)  "Administrator" means a direct employee, as defined in

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subsection (9), who is. The administrator must be a licensed

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physician, physician assistant, or registered nurse licensed to

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practice in this state or an individual having at least 1 year

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of supervisory or administrative experience in home health care

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or in a facility licensed under chapter 395, under part II of

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this chapter, or under part I of chapter 429. An administrator

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may manage a maximum of five licensed home health agencies

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located within one agency service district or within an

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immediately contiguous county. If the home health agency is

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licensed under this chapter and is part of a retirement

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community that provides multiple levels of care, an employee of

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the retirement community may administer the home health agency

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and up to a maximum of four entities licensed under this chapter

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or chapter 429 that are owned, operated, or managed by the same

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corporate entity. An administrator shall designate, in writing,

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for each licensed entity, a qualified alternate administrator to

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serve during absences.

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

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

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

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

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

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residence. Admission includes completion of an agreement with

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the patient or the patient's legal representative to provide

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

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     (3)  "Advanced registered nurse practitioner" means a

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person licensed in this state to practice professional nursing

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and certified in advanced or specialized nursing practice, as

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defined in s. 464.003.

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

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Administration.

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     (5)  "Certified nursing assistant" means any person who has

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been issued a certificate under part II of chapter 464. The

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licensed home health agency or licensed nurse registry shall

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ensure that the certified nursing assistant employed by or under

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contract with the home health agency or licensed nurse registry

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is adequately trained to perform the tasks of a home health aide

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in the home setting.

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

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convalescent individual who receives companion services or

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homemaker services in the individual's home or place of

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residence.

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     (7)  "Companion" or "sitter" means a person who spends time

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with or cares for an elderly, handicapped, or convalescent

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individual and accompanies such individual on trips and outings

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and may prepare and serve meals to such individual. A companion

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may not provide hands-on personal care to a client.

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     (8)  "Department" means the Department of Children and

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Family Services.

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

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the following entities pays withholding taxes: a home health

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agency; a management company that has a contract to manage the

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home health agency on a day-to-day basis; or an employee leasing

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company that has a contract with the home health agency to

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handle the payroll and payroll taxes for the home health agency.

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     (10)  "Director of nursing" means a registered nurse who is

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a direct employee, as defined in subsection (9), of the agency

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and who is a graduate of an approved school of nursing and is

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licensed in this state; who has at least 1 year of supervisory

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experience as a registered nurse; and who is responsible for

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overseeing the professional nursing and home health aid delivery

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of services of the agency. A director of nursing may be the

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director of a maximum of five licensed home health agencies

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operated by a related business entity and located within one

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agency service district or within an immediately contiguous

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county. If the home health agency is licensed under this chapter

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and is part of a retirement community that provides multiple

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levels of care, an employee of the retirement community may

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serve as the director of nursing of the home health agency and

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of up to four entities licensed under this chapter or chapter

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429 which are owned, operated, or managed by the same corporate

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entity.

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     (11) "Fair market value" means the value in arms length

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transactions, consistent with the price that an asset would

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bring as the result of bona fide bargaining between well-

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informed buyers and sellers who are not otherwise in a position

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to generate business for the other party, or the compensation

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that would be included in a service agreement as the result of

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bona fide bargaining between well-informed parties to the

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agreement who are not otherwise in a position to generate

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business for the other party, on the date of acquisition of the

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asset or at the time of the service agreement.

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     (12)(11) "Home health agency" means an organization that

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provides home health services and staffing services.

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     (13)(12) "Home health agency personnel" means persons who

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are employed by or under contract with a home health agency and

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enter the home or place of residence of patients at any time in

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the course of their employment or contract.

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     (14)(13) "Home health services" means health and medical

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services and medical supplies furnished by an organization to an

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individual in the individual's home or place of residence. The

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term includes organizations that provide one or more of the

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following:

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     (a)  Nursing care.

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     (b)  Physical, occupational, respiratory, or speech

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therapy.

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     (c)  Home health aide services.

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     (d)  Dietetics and nutrition practice and nutrition

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counseling.

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     (e)  Medical supplies, restricted to drugs and biologicals

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prescribed by a physician.

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     (15)(14) "Home health aide" means a person who is trained

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or qualified, as provided by rule, and who provides hands-on

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personal care, performs simple procedures as an extension of

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therapy or nursing services, assists in ambulation or exercises,

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or assists in administering medications as permitted in rule and

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for which the person has received training established by the

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agency under s. 400.497(1). The licensed home health agency or

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licensed nurse registry shall ensure that the home health aide

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employed by or under contract with the home health agency or

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licensed nurse registry is adequately trained to perform the

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tasks of a home health aide in the home setting.

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     (16)(15) "Homemaker" means a person who performs household

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chores that include housekeeping, meal planning and preparation,

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shopping assistance, and routine household activities for an

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elderly, handicapped, or convalescent individual. A homemaker

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may not provide hands-on personal care to a client.

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     (17)(16) "Home infusion therapy provider" means an

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organization that employs, contracts with, or refers a licensed

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professional who has received advanced training and experience

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in intravenous infusion therapy and who administers infusion

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therapy to a patient in the patient's home or place of

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residence.

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     (18)(17) "Home infusion therapy" means the administration

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of intravenous pharmacological or nutritional products to a

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patient in his or her home.

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     (19) "Immediate family member" means a husband or wife; a

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birth or adoptive parent, child, or sibling; a stepparent,

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stepchild, stepbrother, or stepsister; a father-in-law, mother-

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in-law, son-in-law, daughter-in-law, brother-in-law, or sister-

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in-law; a grandparent or grandchild; or a spouse of a

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grandparent or grandchild.

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     (20) "Medical director" means a physician who is a

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volunteer with, or who receives remuneration from, a home health

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agency.

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     (21)(18) "Nurse registry" means any person that procures,

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offers, promises, or attempts to secure health-care-related

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contracts for registered nurses, licensed practical nurses,

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certified nursing assistants, home health aides, companions, or

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homemakers, who are compensated by fees as independent

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contractors, including, but not limited to, contracts for the

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provision of services to patients and contracts to provide

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private duty or staffing services to health care facilities

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licensed under chapter 395, this chapter, or chapter 429 or

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other business entities.

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     (22)(19) "Organization" means a corporation, government or

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governmental subdivision or agency, partnership or association,

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or any other legal or commercial entity, any of which involve

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more than one health care professional discipline; a health care

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professional and a home health aide or certified nursing

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assistant; more than one home health aide; more than one

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certified nursing assistant; or a home health aide and a

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certified nursing assistant. The term does not include an entity

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that provides services using only volunteers or only individuals

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related by blood or marriage to the patient or client.

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     (23)(20) "Patient" means any person who receives home

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

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     (24)(21) "Personal care" means assistance to a patient in

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

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eating, or personal hygiene, and assistance in physical

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transfer, ambulation, and in administering medications as

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permitted by rule.

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     (25)(22) "Physician" means a person licensed under chapter

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

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

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graduate of an approved program or its equivalent, or meets

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standards approved by the boards, and is licensed to perform

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medical services delegated by the supervising physician, as

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defined in s. 458.347 or s. 459.022.

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     (27) "Remuneration" means any payment or other benefit

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made directly or indirectly, overtly or covertly, in cash or in

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kind.

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     (28)(24) "Skilled care" means nursing services or

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therapeutic services required by law to be delivered by a health

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care professional who is licensed under part I of chapter 464;

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

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who is employed by or under contract with a licensed home health

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agency or is referred by a licensed nurse registry.

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     (29)(25) "Staffing services" means services provided to a

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health care facility, school, or other business entity on a

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temporary or school-year basis pursuant to a written contract by

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licensed health care personnel and by certified nursing

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assistants and home heath aides who are employed by, or work

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under the auspices of, a licensed home health agency or who are

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registered with a licensed nurse registry. Staffing services may

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be provided anywhere within the state.

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     Section 2.  Section 400.471, Florida Statutes, is amended

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to read:

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     400.471 Application for license; fee; bond; limitation on

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applications accepted.--

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     (1)  Each applicant for licensure must comply with all

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provisions of this part and part II of chapter 408.

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     (2)  In addition to the requirements of part II of chapter

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408, the initial applicant must file with the application

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satisfactory proof that the home health agency is in compliance

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with this part and applicable rules, including:

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

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by the applicant or through contractual arrangements with

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existing providers.

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

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employed.

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     (c)  Completion of questions concerning volume data on the

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renewal application as determined by rule.

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     (3)  In addition to the requirements of s. 408.810, the

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home health agency must also obtain and maintain the following

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insurance coverage in an amount of not less than $250,000 per

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claim, and the home health agency must submit proof of coverage

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with an initial application for licensure and with each

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application for license renewal:

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     (a)  Malpractice insurance as defined in s. 624.605(1)(k).

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

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     (4)  The agency shall accept, in lieu of its own periodic

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licensure survey, submission of the survey of an accrediting

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organization that is recognized by the agency if the

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accreditation of the licensed home health agency is not

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provisional and if the licensed home health agency authorizes

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

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accrediting organization.

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     (5)  In accordance with s. 408.805, an applicant or

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licensee shall pay a fee for each license application submitted

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under this part, part II of chapter 408, and applicable rules.

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The amount of the fee shall be established by rule and shall be

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set at an amount that is sufficient to cover the agency's costs

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in carrying out its responsibilities under this part, but not to

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exceed $2,000 per biennium. However, state, county, or municipal

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governments applying for licenses under this part are exempt

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from the payment of license fees.

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     (6)  The agency may not issue a license designated as

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certified to a home health agency that fails to satisfy the

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requirements of a Medicare certification survey from the agency.

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     (7) An applicant for a new home health agency license must

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submit a surety bond of $50,000, or other equivalent means of

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security acceptable to the agency, such as an irrevocable letter

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of credit or a deposit in a trust account or financial

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institution, payable to the Agency for Health Care

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Administration. A surety bond or other equivalent means of

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security must be valid from initial licensure until the end of

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the first license-renewal period. The purpose of this bond is to

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secure payment of any administrative penalties imposed by the

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agency and any fees and costs incurred by the agency regarding

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the home health agency license which are authorized under state

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law and which the licensee fails to pay 30 days after the fine

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or costs become final. The agency may make a claim against the

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surety bond or security until the later of:

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     (a) One year after the license ceases to be valid if the

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license is not renewed for a second biennial period;

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     (b) One year after the license has been renewed a second

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time; or

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     (c) Sixty days after any administrative or legal

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proceeding, including any appeal, is concluded involving an

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administrative penalty, fees, or costs for an act or omission

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that occurred at any time during the first 4 years after the

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license was initially issued.

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     (8)(a) The agency may accept for processing for a new home

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health agency license only the following number of applications

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quarterly:

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     1. Five for each geographic service area in service areas

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1 through 9;

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     2. Four for geographic service area 10; and

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     3. Three for geographic service area 11.

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However, an application for a new home health agency license

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that is part of a retirement community providing multiple levels

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of care and that will provide home health services exclusively

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to residents of that facility is not subject to the quarterly

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limitation and may not be counted as a new application for

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purposes of the quarterly limitation. If the home health agency

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provides home health services to persons outside that facility,

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the agency shall impose a moratorium on the license in

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accordance with s. 408.814 and revoke the home health agency

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license. The home health agency may reapply for a new home

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health agency license and is subject to the limits on the

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agency's acceptance of new applications.

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     (b) The agency shall accept applications for a new home

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health agency license only during the first 5 business days of a

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calendar quarter. Applications for a new home health agency

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license received during this period, except an application for a

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new home health agency license that is part of a retirement

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community providing multiple levels of care and that will

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provide home health services exclusively to residents of that

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facility, must be grouped according to the geographic service

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area in which the home health agency is to be located. During

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the first 6 through 10 business days of the calendar quarter,

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the agency shall use a lottery system to select the number of

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applications authorized in paragraph (a) to be accepted for

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processing for each geographic service area.

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     (c) Notwithstanding ss. 120.60 or 408.806(3), the agency

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shall return to the sender all applications for a new home

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health agency license which were received:

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     1. And not accepted for processing pursuant to the

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lottery-selection process set forth in paragraph (b); or

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     2. Before or after the first 5 business days of a calendar

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quarter.

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     (d) This subsection expires July 1, 2011.

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     Section 3.  Section 400.474, Florida Statutes, is amended

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to read:

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     400.474  Administrative penalties.--

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     (1)  The agency may deny, revoke, and suspend a license and

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impose an administrative fine in the manner provided in chapter

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120.

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     (2)  Any of the following actions by a home health agency

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or its employee is grounds for disciplinary action by the

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agency:

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     (a)  Violation of this part, part II of chapter 408, or of

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applicable rules.

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     (b)  An intentional, reckless, or negligent act that

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materially affects the health or safety of a patient.

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     (c)  Knowingly providing home health services in an

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unlicensed assisted living facility or unlicensed adult family-

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care home, unless the home health agency or employee reports the

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unlicensed facility or home to the agency within 72 hours after

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providing the services.

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     (d) Preparing or maintaining fraudulent patient records,

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such as, but not limited to, charting ahead, recording vital

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signs or symptoms that were not personally obtained or observed

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by the home health agency's staff at the time indicated,

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borrowing patients or patient records from other home health

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agencies to pass a survey or inspection, or falsifying

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signatures.

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     (3) The agency shall impose a fine of $1,000 against a

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home health agency that demonstrates a pattern of falsifying:

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     (a) Documents of training for home health aides or

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certified nursing assistants; or

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     (b) Health statements for staff providing direct care to

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patients.

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A pattern may be demonstrated by a showing of at least three

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fraudulent entries or documents. The fine shall be imposed for

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each fraudulent document or, if multiple staff members are

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included on one document, for each fraudulent entry on the

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document.

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     (4) The agency shall impose a fine of $5,000 against a

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home health agency that demonstrates a pattern of billing any

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payor for services not provided. A pattern may be demonstrated

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by a showing of at least three billings for services not

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provided within a 12-month period. The fine must be imposed for

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each incident that is falsely billed. The agency may also:

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     (a) Require payback of all funds;

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     (b) Revoke the license; or

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     (c) Issue a moratorium in accordance with s. 408.814.

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     (5) The agency shall impose a fine of $5,000 against a

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home health agency that demonstrates a pattern of failing to

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provide a service specified in the home health agency's written

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agreement with a patient or the plan of care for that patient,

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unless a reduction in service is mandated by Medicare, Medicaid,

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or a state program or as provided in s. 400.492(3). A pattern

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may be demonstrated by a showing of at least three incidences,

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regardless of the patient or service, where the home health

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agency did not provide a service specified in a written

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agreement or plan of care during a 3-month period. The agency

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shall impose the fine for each occurrence. The agency may also

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impose additional administrative fines under s. 400.484 for the

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direct or indirect harm to a patient, or deny, revoke, or

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suspend the license of the home health agency for a pattern of

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failing to provide a service specified in the home health

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agency's written agreement with a patient or the plan of care

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for that patient.

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     (6) The agency may deny, revoke, or suspend the license of

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a home health agency and shall impose a fine of $5,000 against a

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home health agency that:

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     (a) Gives remuneration for staffing services to:

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     1. Another home health agency with which it has formal or

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informal patient-referral transactions or arrangements; or

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     2. A health services pool with which it has formal or

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informal patient-referral transactions or arrangements,

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unless the home health agency has activated its comprehensive

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emergency management plan in accordance with s. 400.492.

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     (b) Provides services to residents in an assisted living

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facility for which the home health agency does not receive fair

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market value remuneration.

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     (c) Provides staffing to an assisted living facility for

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which the home health agency does not receive fair market value

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remuneration.

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     (d) Fails to provide the agency, upon request, with copies

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of all contracts with assisted living facilities which were

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executed within 5 years before the request.

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     (e) Gives remuneration to a case manager, discharge

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planner, facility-based staff member, or third-party vendor who

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is involved in the discharge-planning process of a facility

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licensed under chapter 395 or this chapter from whom the home

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health agency receives referrals.

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     (f) Fails to submit to the agency, within 10 days after

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the end of each calendar quarter, a written report that includes

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the following data based on data as it existed on the last day

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of the quarter:

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     1. The number of insulin-dependent diabetic patients

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receiving insulin-injection services from the home health

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agency;

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     2. The number of patients receiving both home health

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services from the home health agency and hospice services;

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     3. The number of patients receiving home health services

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from that home health agency; and

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     4. The names and nursing license numbers of registered

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nurses whose primary job responsibility is to provide home

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health services to patients and who received remuneration from

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the home health agency in excess of $25,000 during the calendar

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quarter.

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     (g) Gives cash, or its equivalent, to a Medicare or

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Medicaid beneficiary.

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     (h) Has more than one medical director contract in effect

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at one time or more than one medical director contract and one

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contract with a physician-specialist whose services are mandated

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for the home health agency in order to qualify to participate in

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a federal or state health care program at one time.

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     (i) Gives remuneration to a physician without a medical

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director contract being in effect. The contract must:

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     1. Be in writing and signed by both parties;

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     2. Provide for remuneration that is at fair market value

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for an hourly rate, which must be supported by invoices

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submitted by the medical director describing the work performed,

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the dates on which that work was performed, and the duration of

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that work; and

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     3. Be for a term of at least 1 year.

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The hourly rate specified in the contract may not be increased

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during the term of the contract. The home health agency may not

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execute a subsequent contract with that physician which has an

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increased hourly rate and covers any portion of the term that

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was in the original contract.

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     (j) Gives remuneration to:

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     1. A physician and the home health agency in violation of

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paragraph (h) or paragraph (i);

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     2. A member of the physician's office staff; or

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     3. An immediate family member of the physician,

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if the home health agency has received a patient referral in the

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preceding 12 months from that physician or physician's office

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staff.

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     (k) Fails to provide to the agency, upon request, copies

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of all contracts with a medical director which were executed

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within 5 years before the request.

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     (7)(3)(a) In addition to the requirements of s. 408.813,

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any person, partnership, or corporation that violates s. 408.812

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or s. 408.813 and that previously operated a licensed home

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health agency or concurrently operates both a licensed home

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health agency and an unlicensed home health agency commits a

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felony of the third degree punishable as provided in s. 775.082,

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s. 775.083, or s. 775.084.

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     (b)  If any home health agency is found to be operating

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without a license and that home health agency has received any

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government reimbursement for services, the agency shall make a

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fraud referral to the appropriate government reimbursement

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program.

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     Section 4.  Section 400.476, Florida Statutes, is created

456

to read:

457

     400.476 Staffing requirements; notifications; limitations

458

on staffing services.--

459

     (1) ADMINISTRATOR.--

460

     (a) An administrator may manage only one home health

461

agency, except that an administrator may manage up to five home

462

health agencies if all five home health agencies have identical

463

controlling interests as defined in s. 408.803 and are located

464

within one agency geographic service area or within an

465

immediately contiguous county. If the home health agency is

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licensed under this chapter and is part of a retirement

467

community that provides multiple levels of care, an employee of

468

the retirement community may administer the home health agency

469

and up to a maximum of four entities licensed under this chapter

470

or chapter 429 which all have identical controlling interests as

471

defined in s. 408.803. An administrator shall designate, in

472

writing, for each licensed entity, a qualified alternate

473

administrator to serve during the administrator's absence.

474

     (b) An administrator of a home health agency who is a

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licensed physician, physician assistant, or registered nurse

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licensed to practice in this state may also be the director of

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nursing for a home health agency. An administrator may serve as

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a director of nursing only for the number of entities authorized

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in subsection (2).

480

     (2) DIRECTOR OF NURSING.--

481

     (a) A director of nursing may be the director of nursing

482

for:

483

     1. Up to two licensed home health agencies if the agencies

484

have identical controlling interests as defined in s. 408.803

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and are located within one agency geographic service area or

486

within an immediately contiguous county; or

487

     2. Up to five licensed home health agencies if:

488

     a. All of the home health agencies have identical

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controlling interests as defined in s. 408.803;

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     b. All of the home health agencies are located within one

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agency geographic service area or within an immediately

492

contiguous county; and

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     c. Each home health agency has a registered nurse who

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meets the qualifications of a director of nursing and who has a

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written delegation from the director of nursing to serve as the

496

director of nursing for that home health agency when the

497

director of nursing is not present.

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499

If a home health agency licensed under this chapter is part of a

500

retirement community that provides multiple levels of care, an

501

employee of the retirement community may serve as the director

502

of nursing of the home health agency and up to a maximum of four

503

entities, other than home health agencies, licensed under this

504

chapter or chapter 429 which all have identical controlling

505

interests as defined in s. 408.803.

506

     (b) A home health agency may not operate for more than 30

507

calendar days without a director of nursing. A home health

508

agency and the director of nursing of a home health agency must

509

notify the agency within 10 business days after termination of

510

the services of the director of nursing for the home health

511

agency. A home health agency must notify the agency of the

512

identity and qualifications of the new director of nursing

513

within 10 days after the new director is hired. A home health

514

agency that operates for more than 30 calendar days without a

515

director of nursing commits a class II deficiency. In addition

516

to the fine for a class II deficiency, the agency may issue a

517

moratorium in accordance with s. 408.814 or revoke the license.

518

The agency shall fine a home health agency that fails to notify

519

the agency as required in this paragraph $1,000 for the first

520

violation and $2,000 for a repeat violation. The agency may not

521

take administrative action against a home health agency if the

522

director of nursing fails to notify the department upon

523

termination of services as the director of nursing for the home

524

health agency.

525

     (3) TRAINING.--A home health agency shall ensure that each

526

certified nursing assistant employed by or under contract with

527

the home health agency and each home health aide employed by or

528

under contract with the home health agency is adequately trained

529

to perform the tasks of a home health aide in the home setting.

530

     (4) STAFFING.--Staffing services may be provided anywhere

531

within the state.

532

     Section 5.  Section 400.484, Florida Statutes, is amended

533

to read:

534

     400.484  Right of inspection; deficiencies; fines.--

535

     (1)  In addition to the requirements of s. 408.811, the

536

agency may make such inspections and investigations as are

537

necessary in order to determine the state of compliance with

538

this part, part II of chapter 408, and applicable rules.

539

     (2)  The agency shall impose fines for various classes of

540

deficiencies in accordance with the following schedule:

541

     (a)  A class I deficiency is any act, omission, or practice

542

that results in a patient's death, disablement, or permanent

543

injury, or places a patient at imminent risk of death,

544

disablement, or permanent injury. Upon finding a class I

545

deficiency, the agency shall may impose an administrative fine

546

in the amount of $15,000 $5,000 for each occurrence and each day

547

that the deficiency exists.

548

     (b)  A class II deficiency is any act, omission, or

549

practice that has a direct adverse effect on the health, safety,

550

or security of a patient. Upon finding a class II deficiency,

551

the agency shall may impose an administrative fine in the amount

552

of $5,000 $1,000 for each occurrence and each day that the

553

deficiency exists.

554

     (c)  A class III deficiency is any act, omission, or

555

practice that has an indirect, adverse effect on the health,

556

safety, or security of a patient. Upon finding an uncorrected or

557

repeated class III deficiency, the agency shall may impose an

558

administrative fine not to exceed $1,000 $500 for each

559

occurrence and each day that the uncorrected or repeated

560

deficiency exists.

561

     (d)  A class IV deficiency is any act, omission, or

562

practice related to required reports, forms, or documents which

563

does not have the potential of negatively affecting patients.

564

These violations are of a type that the agency determines do not

565

threaten the health, safety, or security of patients. Upon

566

finding an uncorrected or repeated class IV deficiency, the

567

agency shall may impose an administrative fine not to exceed

568

$500 $200 for each occurrence and each day that the uncorrected

569

or repeated deficiency exists.

570

     (3)  In addition to any other penalties imposed pursuant to

571

this section or part, the agency may assess costs related to an

572

investigation that results in a successful prosecution,

573

excluding costs associated with an attorney's time.

574

     Section 6.  Subsection (2) of section 400.491, Florida

575

Statutes, is amended to read:

576

     400.491  Clinical records.--

577

     (2)  The home health agency must maintain for each client

578

who receives nonskilled care a service provision plan. Such

579

records must be maintained by the home health agency for 3 years

580

1 year following termination of services.

581

     Section 7.  Present subsections (5), (6), (7), and (8) of

582

section 400.497, Florida Statutes, are renumbered as subsections

583

(6), (7), (8), and (9), respectively, and a new subsection (5)

584

is added to that section, to read:

585

     400.497  Rules establishing minimum standards.--The agency

586

shall adopt, publish, and enforce rules to implement part II of

587

chapter 408 and this part, including, as applicable, ss. 400.506

588

and 400.509, which must provide reasonable and fair minimum

589

standards relating to:

590

     (5) Oversight by the director of nursing. The agency shall

591

develop rules related to:

592

     (a) Standards that address oversight responsibilities by

593

the director of nursing of skilled nursing and personal care

594

services provided by the home health agency's staff;

595

     (b) Requirements for a director of nursing to provide to

596

the agency, upon request, a certified daily report of the home

597

health services provided by a specified direct employee or

598

contracted staff member on behalf of the home health agency. The

599

agency may request a certified daily report only for a period

600

not to exceed 2 years prior to the date of the request; and

601

     (c) A quality assurance program for home health services

602

provided by the home health agency.

603

     Section 8.  Paragraph (a) of subsection (6) of section

604

400.506, Florida Statutes, is amended to read:

605

     400.506  Licensure of nurse registries; requirements;

606

penalties.--

607

     (6)(a)  A nurse registry may refer for contract in private

608

residences registered nurses and licensed practical nurses

609

registered and licensed under part I of chapter 464, certified

610

nursing assistants certified under part II of chapter 464, home

611

health aides who present documented proof of successful

612

completion of the training required by rule of the agency, and

613

companions or homemakers for the purposes of providing those

614

services authorized under s. 400.509(1). A licensed nurse

615

registry shall ensure that each certified nursing assistant

616

referred for contract by the nurse registry and each home health

617

aide referred for contract by the nurse registry is adequately

618

trained to perform the tasks of a home health aide in the home

619

setting. Each person referred by a nurse registry must provide

620

current documentation that he or she is free from communicable

621

diseases.

622

     Section 9.  Subsection (4) is added to section 400.518,

623

Florida Statutes, to read:

624

     400.518  Prohibited referrals to home health agencies.--

625

     (4) The agency shall impose an administrative fine of

626

$15,000 if a home health agency provides nurses, certified

627

nursing assistants, home health aides, or other staff without

628

charge to a facility licensed under chapter 429 in return for

629

patient referrals from the facility. The proceeds of such fines

630

shall be deposited into the Health Care Trust Fund.

631

     Section 10. The Agency for Health Care Administration

632

shall conduct an unannounced survey of each home health agency

633

within 15 months after issuing a new license to the home health

634

agency.

635

     Section 11. The Agency for Health Care Administration

636

shall review the process, procedures, and contractor's

637

performance for the prior authorization of home health agency

638

visits that are in excess of 60 visits over the lifetime of a

639

Medicaid recipient. The agency shall determine whether

640

modifications are necessary in order to reduce Medicaid fraud

641

and abuse related to home health services for a Medicaid

642

recipient which are not medically necessary. If modifications to

643

the prior authorization function are necessary, the agency shall

644

amend the contract to require contractor performance that

645

reduces potential Medicaid fraud and abuse with respect to home

646

health agency visits.

647

     Section 12. The Agency for Health Care Administration

648

shall report to the Legislature by January 1, 2009, on the

649

feasibility and costs of accessing the Medicare system to

650

disallow Medicaid payment for home health services that are paid

651

for under the Medicare prospective payment system for recipients

652

who are dually eligible for Medicaid and Medicare.

653

     Section 13.  This act shall take effect July 1, 2008.

654

655

================ T I T L E  A M E N D M E N T ================

656

And the title is amended as follows:

657

     Delete everything before the enacting clause

658

and insert:

659

A bill to be entitled

660

An act relating to home health care; amending s. 400.462,

661

F.S.; revising and adding definitions; amending s.

662

400.471, F.S.; requiring an applicant for a new home

663

health agency license to submit a surety bond or other

664

security of a specified amount to the Agency for Health

665

Care Administration; providing procedures for the agency

666

with respect to making a claim against a surety bond or

667

security; limiting the timing of receipt and the number of

668

applications for a new home health agency license which

669

the agency may accept each quarter; providing an exception

670

under certain circumstances for a home health agency that

671

is part of a retirement community; specifying a procedure

672

for the agency to follow in selecting applications to

673

process for a new home health agency license; providing

674

for the future expiration of such provisions; amending s.

675

400.474, F.S.; providing additional grounds under which

676

the Agency for Health Care Administration may take  

677

disciplinary action against a home health agency; creating

678

s. 400.476, F.S.; establishing staffing requirements for

679

home health agencies; reducing the number of home health

680

agencies that an administrator or director of nursing may

681

serve; requiring that an alternate administrator be

682

designated in writing; limiting the period that a home

683

health agency may operate without a director of nursing;

684

requiring notification upon the termination and

685

replacement of a director of nursing; requiring the Agency

686

for Health Care Administration to take administrative

687

enforcement action against a home health agency for

688

noncompliance with the notification and staffing

689

requirements for a director of nursing; providing training

690

requirements for certified nursing assistants and home

691

health aides; amending s. 400.484, F.S.; requiring that

692

the agency impose administrative fines for certain

693

deficiencies; increasing the administrative fines imposed

694

for certain deficiencies; amending s. 400.491, F.S.;

695

extending the period that a home health agency must retain

696

records of the nonskilled care it provides; amending s.

697

400.497, F.S.; requiring that the Agency for Health Care

698

Administration adopt rules related to standards for the

699

director of nursing of a home health agency, requirements

700

for a director of nursing to submit certified staff

701

activity logs pursuant to an agency request, and quality

702

assurance programs; amending s. 400.506, F.S.; providing

703

training requirements for certified nursing assistants and

704

home health aides referred for contract by a nurse

705

registry; amending s. 400.518, F.S.; providing for a fine

706

to be imposed against a home health agency that provides

707

complimentary staffing to an assisted care community in

708

exchange for patient referrals; requiring the Agency for

709

Health Care Administration to conduct an unannounced

710

survey of each home health agency within a specified

711

period after issuing a license; requiring the Agency for

712

Health Care Administration to review the process for prior

713

authorization of home health agency visits and determine

714

whether modifications to the process are necessary;

715

requiring the agency to report to the Legislature on the

716

feasibility of accessing the Medicare system to determine

717

recipient eligibility for home health services; providing

718

an effective date.

1/20/2008  10:49:00 AM     588-03159A-08