Florida Senate - 2023 COMMITTEE AMENDMENT
Bill No. CS for SB 1182
Ì1943929Î194392
LEGISLATIVE ACTION
Senate . House
Comm: RCS .
04/12/2023 .
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
The Appropriations Committee on Health and Human Services
(Simon) recommended the following:
1 Senate Amendment (with title amendment)
2
3 Delete lines 77 - 494
4 and insert:
5 provider, a health care services pool, an assisted living
6 facility, an adult family-care home, or an adult day care center
7 licensed or registered under chapter 400 or chapter 429.
8 (b) “Department” means the Department of Elderly Affairs.
9 (c) “Employee” means a person, contracted staff, or an
10 independent contractor employed or referred by a covered
11 provider who is required to undergo a level 2 background
12 screening under s. 408.809 and chapter 435.
13 (d) “Personal care” means providing, through in-person
14 contact, assistance with activities of daily living, assistance
15 with self-administration of medication, homemaker or companion
16 services, nursing services, or other services that promote the
17 physical, mental, and psychosocial well-being of participants,
18 patients, and residents of covered providers. The term does not
19 include duties involving administrative functions or maintaining
20 the physical environment of a licensed facility, including
21 grounds maintenance, building maintenance, housekeeping,
22 laundry, or food preparation.
23 (e) “Regular contact” means the performance of duties other
24 than personal care which may require employees to interact in
25 person on a daily basis with participants, patients, or
26 residents.
27 (3) The department shall offer to the general public
28 education about Alzheimer’s disease and related forms of
29 dementia. Such education must provide basic information about
30 the most common forms of dementia, how to identify the signs and
31 symptoms of dementia, coping skills, how to respond to changes,
32 planning for the future, and how to access additional resources
33 about dementia.
34 (4) Employees of covered providers must complete the
35 following training for Alzheimer’s disease and related forms of
36 dementia:
37 (a) Upon beginning employment, each employee must receive
38 basic written information about interacting with persons who
39 have Alzheimer’s disease or related forms of dementia.
40 (b) Within 30 days after beginning employment, each
41 employee who provides personal care to or has regular contact
42 with participants, patients, or residents must complete a 1-hour
43 training program provided by the department.
44 1. The department shall provide the training in an online
45 format at no cost. The 1-hour training program must contain
46 information on understanding the basics about the most common
47 forms of dementia, how to identify the signs and symptoms of
48 dementia, and skills for communicating and interacting with
49 persons with Alzheimer’s disease or related forms of dementia. A
50 record of the completion of the training program must be made
51 available to the covered provider which identifies the training
52 course, the name of the employee, and the date of completion.
53 2. A covered provider must maintain a record of the
54 employee’s completion of the training and, upon written request
55 of the employee, must provide the employee with a copy of the
56 record of completion consistent with the employer’s written
57 policies.
58 3. An employee who has completed the training required in
59 this subsection is not required to repeat the program upon
60 changing employment to a different covered provider.
61 (c) Within 7 months after beginning employment for a home
62 health agency, nurse registry, or companion or homemaker service
63 provider, each employee who provides personal care must complete
64 2 hours of training in addition to the training required in
65 paragraphs (a) and (b). The additional training must include,
66 but is not limited to, behavior management, promoting the
67 person’s independence in activities of daily living, and skills
68 in working with families and caregivers.
69 (d) Within 7 months after beginning employment for a
70 nursing home, an assisted living facility, an adult family-care
71 home, or an adult day care center, each employee who provides
72 personal care must complete 3 hours of training in addition to
73 the training required in paragraphs (a) and (b). The additional
74 training must include, but is not limited to, behavior
75 management, promoting the person’s independence in activities of
76 daily living, skills in working with families and caregivers,
77 group and individual activities, maintaining an appropriate
78 environment, and ethical issues.
79 (e) For an assisted living facility, adult family-care
80 home, or adult day care center that advertises and provides, or
81 is designated to provide, specialized care for persons with
82 Alzheimer’s disease or related forms of dementia, in addition to
83 the training specified in paragraphs (a) and (b), employees must
84 receive the following training:
85 1. Within 3 months after beginning employment, each
86 employee who provides personal care to or has regular contact
87 with the residents or participants must complete the additional
88 3 hours of training as provided in paragraph (d).
89 2. Within 6 months after beginning employment, each
90 employee who provides personal care must complete an additional
91 4 hours of dementia-specific training. Such training must
92 include, but is not limited to, understanding Alzheimer’s
93 disease and related forms of dementia, the stages of Alzheimer’s
94 disease, communication strategies, medical information, and
95 stress management.
96 3. Thereafter, each employee who provides personal care
97 must participate in at least 4 hours of continuing education
98 each calendar year through contact hours, on-the-job training,
99 or electronic learning technology. For this subparagraph, the
100 term “on-the-job training” means a form of direct coaching in
101 which a facility administrator or his or her designee instructs
102 an employee who provides personal care with guidance, support,
103 or hands-on experience to help develop and refine the employee’s
104 skills for caring for a person with Alzheimer’s disease or a
105 related form of dementia. The continuing education must cover at
106 least one of the topics included in the dementia-specific
107 training in which the employee has not received previous
108 training in the previous calendar year. The continuing education
109 may be fulfilled and documented in a minimum of one quarter-hour
110 increments through on-the-job training of the employee by a
111 facility administrator or his or her designee or by an
112 electronic learning technology chosen by the facility
113 administrator. On-the-job training may not account for more than
114 2 hours of continuing education each calendar year.
115 (f)1. An employee provided, assigned, or referred by a
116 health care services pool must complete the training required in
117 paragraph (c), paragraph (d), or paragraph (e) as applicable to
118 the covered provider and the position in which the employee will
119 be working. The documentation verifying the completed training
120 and continuing education of the employee must, if applicable, be
121 provided to the covered provider upon request.
122 2. A health care services pool must verify and maintain
123 documentation as required under s. 400.980(5) before providing,
124 assigning, or referring an employee to a covered provider.
125 (5) The department may establish training curricula
126 guidelines for the training required in paragraphs (4)(c), (d),
127 and (e). The department may approve training providers and
128 training curricula and maintain a list of approved providers.
129 Approved training may be offered in a variety of formats,
130 including, but not limited to, in person, electronically, or on
131 the-job by a facility administrator or his or her designee.
132 Continuing education under this section does not require the
133 adoption of training curricula guidelines by the department or
134 approval of the training provider and curricula by the
135 department. The department may develop or provide continuing
136 education training or curricula as an option for covered
137 providers and employees.
138 (a) A training provider meeting one of the following
139 qualifications may offer training in compliance with the
140 training curricula guidelines without prior approval of the
141 department:
142 1. A person approved by an applicable board or the
143 Department of Health to provide training who is registered with
144 the electronic continuing education tracking system under s.
145 456.025; or
146 2. A training provider approved by the department or its
147 designee before July 1, 2023.
148 (b) Training providers qualified under subparagraph (a)1.
149 must also have:
150 1. At least 1 year of teaching experience as an educator
151 for caregivers of persons with Alzheimer’s disease or related
152 forms of dementia;
153 2. At least 1 year of practical experience in a program
154 providing care to persons with Alzheimer’s disease or related
155 forms of dementia; or
156 3. Completed a specialized training program in the subject
157 matter of Alzheimer’s disease and related forms of dementia from
158 an accredited health care, human services, or gerontology
159 education provider.
160 (c) Upon an employee’s completion of the training specified
161 in paragraphs (4)(c), (d), and (e), the training provider must
162 provide a record of the completion of the training which
163 includes the name of the employee, the name of the training
164 provider, the topics covered, and the date of completion. The
165 training record is evidence of completion of training in the
166 identified topic and the employee is not required to repeat
167 training in that topic if the employee changes employment to a
168 different covered provider.
169 (d) Any Alzheimer’s disease and related forms of dementia
170 training curriculum approved by the department or its designee
171 before July 1, 2023, remains in effect until the curriculum’s
172 expiration date.
173 (6) The department may adopt rules to establish training
174 curriculum guidelines, requirements for the approval of other
175 qualified training providers, and a process for conducting a
176 sampling of training or training curricula as necessary to
177 monitor for compliance with curricula guidelines.
178 (7) For a certified nursing assistant as defined in s.
179 464.201, training hours completed as required under this section
180 may count toward the total hours of training required to
181 maintain certification as a nursing assistant.
182 (8) For a health care practitioner as defined in s.
183 456.001, training hours completed as required under this section
184 may count toward the total hours of continuing education
185 required by that practitioner’s licensing board.
186 (9) Each person employed, contracted, or referred to
187 provide services before July 1, 2023, must complete the training
188 required in this section before July 1, 2026. Proof of
189 completion of equivalent training completed before July 1, 2023,
190 shall substitute for the training required in subsection (4).
191 Each person employed, contracted, or referred to provide
192 services on or after July 1, 2023, may satisfy the training
193 requirements by completing training using approved curricula as
194 specified in paragraph (5)(d) until the effective date of the
195 rules adopted by the department under subsection (6).
196 Section 2. Paragraph (b) of subsection (2) of section
197 400.0239, Florida Statutes, is amended to read:
198 400.0239 Quality of Long-Term Care Facility Improvement
199 Trust Fund.—
200 (2) Expenditures from the trust fund shall be allowable for
201 direct support of the following:
202 (b) Development and implementation of specialized training
203 programs for long-term care facility personnel who provide
204 direct care for residents with Alzheimer’s disease and other
205 dementias, including training provided under s. 430.5025,
206 residents at risk of developing pressure sores, and residents
207 with special nutrition and hydration needs.
208 Section 3. Section 400.1755, Florida Statutes, is amended
209 to read:
210 400.1755 Care for persons with Alzheimer’s disease or
211 related disorders; staff training requirements.—
212 (1) As a condition of licensure, the employees of
213 facilities licensed under this part must complete the training
214 required under s. 430.5025 provide to each of their employees,
215 upon beginning employment, basic written information about
216 interacting with persons with Alzheimer’s disease or a related
217 disorder.
218 (2) All employees who are expected to, or whose
219 responsibilities require them to, have direct contact with
220 residents with Alzheimer’s disease or a related disorder must,
221 in addition to being provided the information required in
222 subsection (1), also have an initial training of at least 1 hour
223 completed in the first 3 months after beginning employment. This
224 training must include, but is not limited to, an overview of
225 dementias and must provide basic skills in communicating with
226 persons with dementia.
227 (3) An individual who provides direct care shall be
228 considered a direct caregiver and must complete the required
229 initial training and an additional 3 hours of training within 9
230 months after beginning employment. This training shall include,
231 but is not limited to, managing problem behaviors, promoting the
232 resident’s independence in activities of daily living, and
233 skills in working with families and caregivers.
234 (a) The required 4 hours of training for certified nursing
235 assistants are part of the total hours of training required
236 annually.
237 (b) For a health care practitioner as defined in s.
238 456.001, continuing education hours taken as required by that
239 practitioner’s licensing board shall be counted toward this
240 total of 4 hours.
241 (4) For an employee who is a licensed health care
242 practitioner as defined in s. 456.001, training that is
243 sanctioned by that practitioner’s licensing board shall be
244 considered to be approved by the Department of Elderly Affairs.
245 (5) The Department of Elderly Affairs or its designee must
246 approve the initial and continuing training provided in the
247 facilities. The department must approve training offered in a
248 variety of formats, including, but not limited to, Internet
249 based training, videos, teleconferencing, and classroom
250 instruction. The department shall keep a list of current
251 providers who are approved to provide initial and continuing
252 training. The department shall adopt rules to establish
253 standards for the trainers and the training required in this
254 section.
255 (6) Upon completing any training listed in this section,
256 the employee or direct caregiver shall be issued a certificate
257 that includes the name of the training provider, the topic
258 covered, and the date and signature of the training provider.
259 The certificate is evidence of completion of training in the
260 identified topic, and the employee or direct caregiver is not
261 required to repeat training in that topic if the employee or
262 direct caregiver changes employment to a different facility or
263 to an assisted living facility, home health agency, adult day
264 care center, or adult family-care home. The direct caregiver
265 must comply with other applicable continuing education
266 requirements.
267 Section 4. Section 400.4785, Florida Statutes, is amended
268 to read:
269 400.4785 Patients with Alzheimer’s disease or other related
270 disorders; staff training requirements; certain disclosures.—
271 (1) The employees of a home health agency must complete the
272 training required under s. 430.5025 A home health agency must
273 provide the following staff training:
274 (a) Upon beginning employment with the agency, each
275 employee must receive basic written information about
276 interacting with participants who have Alzheimer’s disease or
277 dementia-related disorders.
278 (b) In addition to the information provided under paragraph
279 (a), newly hired home health agency personnel who will be
280 providing direct care to patients must complete 2 hours of
281 training in Alzheimer’s disease and dementia-related disorders
282 within 9 months after beginning employment with the agency. This
283 training must include, but is not limited to, an overview of
284 dementia, a demonstration of basic skills in communicating with
285 persons who have dementia, the management of problem behaviors,
286 information about promoting the client’s independence in
287 activities of daily living, and instruction in skills for
288 working with families and caregivers.
289 (c) For certified nursing assistants, the required 2 hours
290 of training shall be part of the total hours of training
291 required annually.
292 (d) For a health care practitioner as defined in s.
293 456.001, continuing education hours taken as required by that
294 practitioner’s licensing board shall be counted toward the total
295 of 2 hours.
296 (e) For an employee who is a licensed health care
297 practitioner as defined in s. 456.001, training that is
298 sanctioned by that practitioner’s licensing board shall be
299 considered to be approved by the Department of Elderly Affairs.
300 (f) The Department of Elderly Affairs, or its designee,
301 must approve the required training. The department must consider
302 for approval training offered in a variety of formats. The
303 department shall keep a list of current providers who are
304 approved to provide the 2-hour training. The department shall
305 adopt rules to establish standards for the employees who are
306 subject to this training, for the trainers, and for the training
307 required in this section.
308 (g) Upon completing the training listed in this section,
309 the employee shall be issued a certificate that states that the
310 training mandated under this section has been received. The
311 certificate shall be dated and signed by the training provider.
312 The certificate is evidence of completion of this training, and
313 the employee is not required to repeat this training if the
314 employee changes employment to a different home health agency.
315 (2)(h) A licensed home health agency whose unduplicated
316 census during the most recent calendar year was composed
317 comprised of at least 90 percent of individuals aged 21 years or
318 younger at the date of admission is exempt from the training
319 requirements in this section.
320 (3)(2) An agency licensed under this part which claims that
321 it provides special care for persons who have Alzheimer’s
322 disease or other related disorders must disclose in its
323 advertisements or in a separate document those services that
324 distinguish the care as being especially applicable to, or
325 suitable for, such persons. The agency must give a copy of all
326 such advertisements or a copy of the document to each person who
327 requests information about the agency and must maintain a copy
328 of all such advertisements and documents in its records. The
329 Agency for Health Care Administration shall examine all such
330 advertisements and documents in the agency’s records as part of
331 the license renewal procedure.
332 Section 5. Section 400.51, Florida Statutes, is created to
333 read:
334 400.51 Patients with Alzheimer’s disease or other related
335 disorders; staff training requirements.—A person employed,
336 contracted, or referred by a nurse registry or a person
337 registered with the agency to provide companion or homemaker
338 services must complete the training required under s. 430.5025.
339 Section 6. Subsection (5) of section 400.980, Florida
340 Statutes, is amended to read:
341 400.980 Health care services pools.—
342 (5) A health care services pool shall verify and maintain
343 documentation document that each temporary employee or
344 independent contractor provided, assigned, or referred to a
345 health care facility has met the licensing, certification,
346 training, or continuing education requirements, as established
347 by the appropriate regulatory agency, for the position in which
348 he or she will be working. The requirements of this subsection
349 may not be delegated to another provider as defined in s.
350 408.803.
351 Section 7. Section 429.178, Florida Statutes, is amended to
352 read:
353 429.178 Special care for persons with Alzheimer’s disease
354 or other related disorders.—
355 (1) A facility that which advertises that it provides
356 special care for persons with Alzheimer’s disease or other
357 related disorders must meet the following standards of
358 operation:
359 (1)(a)1. If the facility has 17 or more residents, have an
360 awake staff member on duty at all hours of the day and night; or
361 (b)2. If the facility has fewer than 17 residents, have an
362 awake staff member on duty at all hours of the day and night or
363 have mechanisms in place to monitor and ensure the safety of the
364 facility’s residents.
365 (2)(b) Offer activities specifically designed for persons
366 who are cognitively impaired.
367 (3)(c) Have a physical environment that provides for the
368 safety and welfare of the facility’s residents.
369 (4)(d) Require employed Employ staff to complete who have
370 completed the training and continuing education required under
371 s. 430.5025 in subsection (2).
372 (2)(a) An individual who is employed by a facility that
373 provides special care for residents who have Alzheimer’s disease
374 or other related disorders, and who has regular contact with
375 such residents, must complete up to 4 hours of initial dementia
376 specific training developed or approved by the department. The
377 training must be completed within 3 months after beginning
378 employment and satisfy the core training requirements of s.
379 429.52(3)(g).
380 (b) A direct caregiver who is employed by a facility that
381 provides special care for residents who have Alzheimer’s disease
382 or other related disorders and provides direct care to such
383 residents must complete the required initial training and 4
384 additional hours of training developed or approved by the
385 department. The training must be completed within 9 months after
386 beginning employment and satisfy the core training requirements
387 of s. 429.52(3)(g).
388 (c) An individual who is employed by a facility that
389 provides special care for residents with Alzheimer’s disease or
390 other related disorders, but who only has incidental contact
391 with such residents, must be given, at a minimum, general
392 information on interacting with individuals with Alzheimer’s
393 disease or other related disorders, within 3 months after
394 beginning employment.
395 (3) In addition to the training required under subsection
396 (2), a direct caregiver must participate in a minimum of 4
397 contact hours of continuing education each calendar year. The
398 continuing education must include one or more topics included in
399 the dementia-specific training developed or approved by the
400 department, in which the caregiver has not received previous
401 training.
402 (4) Upon completing any training listed in subsection (2),
403 the employee or direct caregiver shall be issued a certificate
404 that includes the name of the training provider, the topic
405 covered, and the date and signature of the training provider.
406 The certificate is evidence of completion of training in the
407 identified topic, and the employee or direct caregiver is not
408 required to repeat training in that topic if the employee or
409 direct caregiver changes employment to a different facility. The
410 employee or direct caregiver must comply with other applicable
411 continuing education requirements.
412 (5) The department, or its designee, shall approve the
413 initial and continuing education courses and providers.
414 (6) The department shall keep a current list of providers
415 who are approved to provide initial and continuing education for
416 staff of facilities that provide special care for persons with
417 Alzheimer’s disease or other related disorders.
418 (7) Any facility more than 90 percent of whose residents
419 receive monthly optional supplementation payments is not
420 required to pay for the training and education programs required
421 under this section. A facility that has one or more such
422 residents shall pay a reduced fee that is proportional to the
423 percentage of such residents in the facility. A facility that
424 does not have any residents who receive monthly optional
425 supplementation payments must pay a reasonable fee, as
426 established by the department, for such training and education
427 programs.
428 (8) The department shall adopt rules to establish standards
429 for trainers and training and to implement this section.
430 Section 8. Subsection (1) of section 429.52, Florida
431 Statutes, is amended to read:
432 429.52 Staff training and educational requirements.—
433 (1)(a) Each new assisted living facility employee who has
434 not previously completed core training must attend a preservice
435 orientation provided by the facility before interacting with
436 residents. The preservice orientation must be at least 2 hours
437 in duration and cover topics that help the employee provide
438 responsible care and respond to the needs of facility residents.
439 Upon completion, the employee and the administrator of the
440 facility must sign a statement that the employee completed the
441 required preservice orientation. The facility must keep the
442 signed statement in the employee’s personnel record.
443 (b) Each assisted living facility employee must complete
444 the training required under s. 430.5025. However, an employee of
445 an assisted living facility licensed as a limited mental health
446 facility under s. 429.075 is exempt from the training
447 requirements under s. 430.5025(4)(d).
448
449 ================= T I T L E A M E N D M E N T ================
450 And the title is amended as follows:
451 Delete lines 57 - 62
452 and insert:
453 made by the act; creating s. 400.51, F.S.; requiring a
454 person employed, contracted, or referred by a nurse
455 registry or a person registered with the Agency for
456 Health Care Administration to provide companion or
457 homemaker services to complete specified training;
458 amending s. 400.980, F.S.; requiring health care
459 services pools to verify and maintain documentation
460 that certain employees or independent contractors have
461 met specified licensing, certification, training, and
462 continuing education requirements; prohibiting
463 delegation of specified responsibilities; amending s.
464 429.178, F.S.; conforming provisions to changes made
465 by the act; amending s. 429.52, F.S.; conforming
466 provisions to changes made by the act; exempting
467 certain employees of assisted living facilities from
468 specified training requirements; amending ss. 429.83,
469 429.917, and