ENROLLED
       2023 Legislature                                   CS for SB 558
       
       
       
       
       
       
                                                              2023558er
    1  
    2         An act relating to certified nursing assistants;
    3         amending s. 400.211, F.S.; authorizing nursing home
    4         facilities to allow their registered nurses to
    5         delegate certain tasks to certified nursing assistants
    6         who meet specified criteria; providing for the
    7         designation of such certified nursing assistants as
    8         qualified medication aides; requiring qualified
    9         medication aides to complete annual validation and
   10         inservice training requirements; providing that
   11         qualified medication aides may administer medication
   12         to residents only under the direct supervision of a
   13         licensed nurse; requiring that medication
   14         administration be included in certain performance
   15         improvement activities tracked by nursing homes in
   16         accordance with federal regulations; requiring the
   17         Board of Nursing, in consultation with the Agency for
   18         Health Care Administration, to adopt rules; amending
   19         s. 400.23, F.S.; providing that the time spent by
   20         certified nursing assistants performing the duties of
   21         a qualified medication aide may not be included in the
   22         computing of certain minimum staffing ratio
   23         requirements for direct care provided to residents;
   24         amending s. 464.0156, F.S.; authorizing registered
   25         nurses to delegate to certified nursing assistants the
   26         administration of medication to residents in nursing
   27         home facilities if the certified nursing assistants
   28         meet specified criteria; amending s. 464.2035, F.S.;
   29         authorizing certified nursing assistants to administer
   30         certain medications to residents of nursing home
   31         facilities if they have been delegated such task by a
   32         registered nurse and they meet specified criteria;
   33         requiring the board, in consultation with the agency,
   34         to establish standards and procedures that a certified
   35         nursing assistant must follow when administering
   36         medication to a resident of a nursing home facility;
   37         providing an effective date.
   38          
   39  Be It Enacted by the Legislature of the State of Florida:
   40  
   41         Section 1. Subsection (5) is added to section 400.211,
   42  Florida Statutes, to read:
   43         400.211 Persons employed as nursing assistants;
   44  certification requirement.—
   45         (5)A nursing home, in accordance with chapter 464 and
   46  rules adopted pursuant to this section, may authorize a
   47  registered nurse to delegate tasks, including medication
   48  administration, to a certified nursing assistant who meets the
   49  requirements of this subsection.
   50         (a)In addition to the initial 6-hour training course and
   51  determination of competency required under s. 464.2035, to be
   52  eligible to administer medication to a resident of a nursing
   53  home facility, a certified nursing assistant must:
   54         1.Hold a clear and active certification from the
   55  Department of Health for a minimum of 1 year immediately
   56  preceding the delegation;
   57         2.Complete an additional 34-hour training course approved
   58  by the Board of Nursing in medication administration and
   59  associated tasks, including, but not limited to, blood glucose
   60  level checks, dialing oxygen flow meters to prescribed settings,
   61  and assisting with continuous positive airway pressure devices;
   62  and
   63         3.Demonstrate clinical competency by successfully
   64  completing a supervised clinical practice in medication
   65  administration and associated tasks conducted in the facility.
   66         (b)Upon completion of the training, competency, and
   67  initial validation requirements under s. 464.2035 and this
   68  subsection, a certified nursing assistant whose delegated tasks
   69  include medication administration is designated as a qualified
   70  medication aide.
   71         (c)A qualified medication aide must satisfactorily
   72  complete the annual validation and 2 hours of inservice training
   73  in medication administration and medication error prevention in
   74  accordance with s. 464.2035.
   75         (d)A qualified medication aide may administer medication
   76  only under the direct supervision of a nurse licensed under part
   77  I of chapter 464.
   78         (e)Medication administration must be included in the
   79  performance improvement activities tracked in accordance with 42
   80  C.F.R. s. 483.75(e)(2).
   81         (f)The Board of Nursing, in consultation with the agency,
   82  shall adopt rules to implement this subsection.
   83         Section 2. Paragraph (b) of subsection (3) of section
   84  400.23, Florida Statutes, is amended to read:
   85         400.23 Rules; evaluation and deficiencies; licensure
   86  status.—
   87         (3)
   88         (b)1. Each facility must determine its direct care staffing
   89  needs based on the facility assessment and the individual needs
   90  of a resident based on the resident’s care plan. At a minimum,
   91  staffing must include, for each facility, the following
   92  requirements:
   93         a. A minimum weekly average of 3.6 hours of care by direct
   94  care staff per resident per day. As used in this sub
   95  subparagraph, a week is defined as Sunday through Saturday.
   96         b. A minimum of 2.0 hours of direct care by a certified
   97  nursing assistant per resident per day. A facility may not staff
   98  below one certified nursing assistant per 20 residents.
   99         c. A minimum of 1.0 hour of direct care by a licensed nurse
  100  per resident per day. A facility may not staff below one
  101  licensed nurse per 40 residents.
  102         2. Nursing assistants employed under s. 400.211(2) may be
  103  included in computing the hours of direct care provided by
  104  certified nursing assistants and may be included in computing
  105  the staffing ratio for certified nursing assistants if their job
  106  responsibilities include only nursing-assistant-related duties.
  107         3.Certified nursing assistants performing the duties of a
  108  qualified medication aide under s. 400.211(5) may not be
  109  included in computing the hours of direct care provided by, or
  110  the staffing ratios for, certified nursing assistants or
  111  licensed nurses under sub-subparagraph 1.b. or sub-subparagraph
  112  1.c., respectively.
  113         4.3. Each nursing home facility must document compliance
  114  with staffing standards as required under this paragraph and
  115  post daily the names of licensed nurses and certified nursing
  116  assistants on duty for the benefit of facility residents and the
  117  public. Facilities must maintain the records documenting
  118  compliance with minimum staffing standards for a period of 5
  119  years and must report staffing in accordance with 42 C.F.R. s.
  120  483.70(q).
  121         5.4. The agency must recognize the use of licensed nurses
  122  for compliance with minimum staffing requirements for certified
  123  nursing assistants if the nursing home facility otherwise meets
  124  the minimum staffing requirements for licensed nurses and the
  125  licensed nurses are performing the duties of a certified nursing
  126  assistant. Unless otherwise approved by the agency, licensed
  127  nurses counted toward the minimum staffing requirements for
  128  certified nursing assistants must exclusively perform the duties
  129  of a certified nursing assistant for the entire shift and not
  130  also be counted toward the minimum staffing requirements for
  131  licensed nurses. If the agency approved a facility’s request to
  132  use a licensed nurse to perform both licensed nursing and
  133  certified nursing assistant duties, the facility must allocate
  134  the amount of staff time specifically spent on certified nursing
  135  assistant duties for the purpose of documenting compliance with
  136  minimum staffing requirements for certified and licensed nursing
  137  staff. The hours of a licensed nurse with dual job
  138  responsibilities may not be counted twice.
  139         6.5. Evidence that a facility complied with the minimum
  140  direct care staffing requirements under subparagraph 1. is not
  141  admissible as evidence of compliance with the nursing services
  142  requirements under 42 C.F.R. s. 483.35 or s. 483.70.
  143         Section 3. Subsection (2) of section 464.0156, Florida
  144  Statutes, is amended to read:
  145         464.0156 Delegation of duties.—
  146         (2)(a)A registered nurse may delegate to a certified
  147  nursing assistant the administration of oral, transdermal,
  148  ophthalmic, otic, inhaled, or topical prescription medication to
  149  a resident of a nursing home facility as defined in s. 400.021
  150  if the certified nursing assistant meets the requirements of s.
  151  400.211(5) and s. 464.2035.
  152         (b) A registered nurse may delegate to a certified nursing
  153  assistant or a home health aide the administration of oral,
  154  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  155  topical prescription medications to a patient of a home health
  156  agency licensed under part III of chapter 400 or to a patient in
  157  a local county detention facility as defined in s. 951.23(1), if
  158  the certified nursing assistant or home health aide meets the
  159  requirements of s. 464.2035 or s. 400.489, respectively.
  160         (c) A registered nurse may not delegate the administration
  161  of any controlled substance listed in Schedule II, Schedule III,
  162  or Schedule IV of s. 893.03 or 21 U.S.C. s. 812, except for the
  163  administration of an insulin syringe that is prefilled with the
  164  proper dosage by a pharmacist or an insulin pen that is
  165  prefilled by the manufacturer.
  166         Section 4. Subsections (1) and (3) of section 464.2035,
  167  Florida Statutes, are amended to read:
  168         464.2035 Administration of medication.—
  169         (1) A certified nursing assistant may administer oral,
  170  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  171  topical prescription medication to a resident of a nursing home
  172  facility as defined in s. 400.021 or may administer oral,
  173  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  174  topical prescription medication to a patient of a home health
  175  agency licensed under part III of chapter 400 or to a patient in
  176  a county detention facility as defined in s. 951.23(1) if the
  177  certified nursing assistant has been delegated such task by a
  178  registered nurse licensed under part I of this chapter, has
  179  satisfactorily completed an initial 6-hour training course
  180  approved by the board, and has been found competent to
  181  administer medication to a patient in a safe and sanitary
  182  manner. The training, determination of competency, and initial
  183  and annual validation required under this section must be
  184  conducted by a registered nurse licensed under this chapter or a
  185  physician licensed under chapter 458 or chapter 459.
  186         (3) The board, in consultation with the Agency for Health
  187  Care Administration, shall establish by rule standards and
  188  procedures that a certified nursing assistant must follow when
  189  administering medication to a resident of a nursing home
  190  facility or to a patient of a home health agency. Such rules
  191  must, at a minimum, address qualification requirements for
  192  trainers, requirements for labeling medication, documentation
  193  and recordkeeping, the storage and disposal of medication,
  194  instructions concerning the safe administration of medication,
  195  informed-consent requirements and records, and the training
  196  curriculum and validation procedures.
  197         Section 5. This act shall take effect July 1, 2023.