HB 569

1	A bill to be entitled
2	An act relating to staffing requirements for nursing
3	home facilities; amending s. 400.23, F.S.; revising
4	Agency for Health Care Administration rulemaking
5	authority relating to minimum staffing requirements
6	for nursing home facilities; amending s. 400.141,
7	F.S.; conforming a cross-reference; providing an
8	effective date.
9
10	Be It Enacted by the Legislature of the State of Florida:
11
12	Section 1.  Paragraph (a) of subsection (3) of section
13	400.23, Florida Statutes, is amended to read:
14	400.23  Rules; evaluation and deficiencies; licensure
15	status.-
16	(3)(a)1.  The agency shall adopt rules providing minimum
17	staffing requirements for nursing home facilities. These
18	requirements must include, for each facility:
19	a.  A minimum weekly average of certified nursing assistant
20	and licensed nursing staffing combined of 3.6 hours of direct
21	care per resident per day. As used in this sub-subparagraph, a
22	week is defined as Sunday through Saturday.
23	a.b.  A minimum certified nursing assistant staffing of 2.9
24	2.5 hours of direct care per resident per day. A facility may
25	not staff below one certified nursing assistant per 20
26	residents.
27	b.c.  A minimum licensed nursing staffing of 1.0 hour of
28	direct care per resident per day. A facility may not staff below
29	one licensed nurse per 40 residents.
30	2.  Nursing assistants employed under s. 400.211(2) may be
31	included in computing the staffing ratio for certified nursing
32	assistants if their job responsibilities include only nursing-
33	assistant-related duties.
34	3.  Each nursing home facility must document compliance
35	with staffing standards as required under this paragraph and
36	post daily the names of staff on duty for the benefit of
37	facility residents and the public.
38	4.  The agency shall recognize the use of licensed nurses
39	for compliance with minimum staffing requirements for certified
40	nursing assistants if the nursing home facility otherwise meets
41	the minimum staffing requirements for licensed nurses and the
42	licensed nurses are performing the duties of a certified nursing
43	assistant. Unless otherwise approved by the agency, licensed
44	nurses counted toward the minimum staffing requirements for
45	certified nursing assistants must exclusively perform the duties
46	of a certified nursing assistant for the entire shift and not
47	also be counted toward the minimum staffing requirements for
48	licensed nurses. If the agency approved a facility's request to
49	use a licensed nurse to perform both licensed nursing and
50	certified nursing assistant duties, the facility must allocate
51	the amount of staff time specifically spent on certified nursing
52	assistant duties for the purpose of documenting compliance with
53	minimum staffing requirements for certified and licensed nursing
54	staff. The hours of a licensed nurse with dual job
55	responsibilities may not be counted twice.
56	Section 2.  Paragraph (o) of subsection (1) of section
57	400.141, Florida Statutes, is amended to read:
58	400.141  Administration and management of nursing home
59	facilities.-
60	(1)  Every licensed facility shall comply with all
61	applicable standards and rules of the agency and shall:
62	(o)1.  Submit semiannually to the agency, or more
63	frequently if requested by the agency, information regarding
64	facility staff-to-resident ratios, staff turnover, and staff
65	stability, including information regarding certified nursing
66	assistants, licensed nurses, the director of nursing, and the
67	facility administrator. For purposes of this reporting:
68	a.  Staff-to-resident ratios must be reported in the
69	categories specified in s. 400.23(3)(a) and applicable rules.
70	The ratio must be reported as an average for the most recent
71	calendar quarter.
72	b.  Staff turnover must be reported for the most recent 12-
73	month period ending on the last workday of the most recent
74	calendar quarter prior to the date the information is submitted.
75	The turnover rate must be computed quarterly, with the annual
76	rate being the cumulative sum of the quarterly rates. The
77	turnover rate is the total number of terminations or separations
78	experienced during the quarter, excluding any employee
79	terminated during a probationary period of 3 months or less,
80	divided by the total number of staff employed at the end of the
81	period for which the rate is computed, and expressed as a
82	percentage.
83	c.  The formula for determining staff stability is the
84	total number of employees that have been employed for more than
85	12 months, divided by the total number of employees employed at
86	the end of the most recent calendar quarter, and expressed as a
87	percentage.
88	d.  A nursing facility that has failed to comply with state
89	minimum-staffing requirements for 2 consecutive days is
90	prohibited from accepting new admissions until the facility has
91	achieved the minimum-staffing requirements for a period of 6
92	consecutive days. For the purposes of this sub-subparagraph, any
93	person who was a resident of the facility and was absent from
94	the facility for the purpose of receiving medical care at a
95	separate location or was on a leave of absence is not considered
96	a new admission. Failure to impose such an admissions moratorium
97	constitutes a class II deficiency.
98	e.  A nursing facility that which does not have a
99	conditional license may be cited for failure to comply with the
100	standards in s. 400.23(3)(a)1.a. and b. 400.23(3)(a)1.b. and c.
101	only if it has failed to meet those standards on 2 consecutive
102	days or if it has failed to meet at least 97 percent of those
103	standards on any one day.
104	f.  A facility that which has a conditional license must be
105	in compliance with the standards in s. 400.23(3)(a) at all
106	times.
107	2.  This paragraph does not limit the agency's ability to
108	impose a deficiency or take other actions if a facility does not
109	have enough staff to meet the residents' needs.
110	Section 3.  This act shall take effect upon becoming a law.

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