Florida Senate - 2025                        COMMITTEE AMENDMENT
       Bill No. SB 1156
       
       
       
       
       
       
                                Ì735504ÈÎ735504                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  04/01/2025           .                                
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       The Committee on Health Policy (Harrell) recommended the
       following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Section 400.54, Florida Statutes, is amended to
    6  read:
    7         400.54 Annual assessment of the home health aide for
    8  medically fragile children program.—
    9         (1) The agency shall conduct an annual assessment of the
   10  home health aide for medically fragile children program. The
   11  assessment must report caregiver satisfaction with the program,
   12  report data on adverse incidents, identify additional support
   13  that may be needed by the home health aide for medically fragile
   14  children, and assess the rate and extent of hospitalization of
   15  children in home health services who are attended by a home
   16  health aide for medically fragile children compared to those in
   17  home health services provided by a registered nurse or a
   18  licensed practical nurse without a home health aide for
   19  medically fragile children. Medicaid managed care plans shall
   20  provide to the agency data necessary to perform this assessment.
   21         (2) The home health agency shall report all adverse
   22  incidents occurring under the care of a home health aide for
   23  medically fragile children to the agency and managed care plan
   24  within 48 hours after the incident. For purposes of reporting to
   25  the agency under this subsection, the term “adverse incident”
   26  means any of the following:
   27         (a) Death.
   28         (b) Brain or spinal damage.
   29         (c) Permanent disfigurement.
   30         (d) Fracture or dislocation of bones or joints.
   31         (e) A limitation of neurological, physical, or sensory
   32  function.
   33         (f) An event that is reported to law enforcement personnel
   34  for investigation.
   35  
   36  By January 1 of each year, beginning January 1, 2025, the agency
   37  shall report its findings to the Governor, the President of the
   38  Senate, and the Speaker of the House of Representatives.
   39         Section 2. Present paragraphs (a) and (b) of subsection (3)
   40  of section 400.4765, Florida Statutes, are redesignated as
   41  paragraphs (b) and (c), respectively, a new paragraph (a) is
   42  added to that subsection, subsection (10) is added to that
   43  section, and present paragraph (a) of subsection (3) and
   44  subsection (9) of that section are amended, to read:
   45         400.4765 Home health aide for medically fragile children
   46  program.—
   47         (3) TRAINING.—
   48         (a) Before providing services to an eligible relative, a
   49  home health aide for medically fragile children must complete an
   50  approved training program. The employing home health agency must
   51  provide validation of competency by a registered nurse and
   52  maintain documentation of training completion and competency
   53  validation. The employing home health agency must provide
   54  additional training and competency validation as the medically
   55  fragile child’s care needs change and consistent with any
   56  changes to the plan of care.
   57         (b)(a) The agency, in consultation with the Board of
   58  Nursing, shall approve home health aide for medically fragile
   59  children training programs developed by home health agencies in
   60  accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
   61  train family caregivers as home health aides for medically
   62  fragile children to increase the health care provider workforce
   63  and to authorize persons to provide trained nursing services as
   64  delegated by a registered nurse to eligible relatives. The
   65  program shall include must consist of at least 85 hours of
   66  training, including, but not be limited to, all of the
   67  following:
   68         1. A minimum of 20 40 hours of theoretical instruction in
   69  nursing, including, but not limited to, instruction on all of
   70  the following:
   71         a. Person-centered care.
   72         b. Communication and interpersonal skills.
   73         c. Infection control.
   74         d. Safety and emergency procedures.
   75         e. Assistance with activities of daily living.
   76         f. Mental health and social service needs.
   77         g. Care of cognitively impaired individuals.
   78         h. Basic restorative care and rehabilitation.
   79         i. Patient rights and confidentiality of personal
   80  information and medical records.
   81         j. Relevant legal and ethical issues.
   82  
   83  Such instruction must be offered in various formats, and any
   84  interactive instruction must be provided during various times of
   85  the day.
   86         2. Up to A minimum of 20 hours of skills training on basic
   87  nursing skills tailored to the child’s care needs as specified
   88  in the ordering provider’s plan of care and individualized care
   89  needs, which may include training on the following topics, as
   90  applicable, including, but not limited to:
   91         a. Hygiene, grooming, and toileting.
   92         b. Skin care and pressure sore prevention.
   93         c. Nutrition and hydration.
   94         d. Measuring vital signs, height, and weight.
   95         e. Safe lifting, positioning, and moving of patients.
   96         f. Wound care.
   97         g. Portable Oxygen use and safety and other respiratory
   98  procedures.
   99         h. Tracheostomy care.
  100         i. Enteral care and therapy.
  101         j. Peripheral Intravenous assistive activities and
  102  alternative feeding methods.
  103         k. Urinary catheterization and care and ostomy care.
  104         3. Up to At least 16 hours of clinical training related to
  105  the specific needs of the eligible relative under direct
  106  supervision of a licensed registered nurse.
  107         4. Training concerning HIV infections and AIDS and is
  108  required to obtain and maintain a current certificate in
  109  cardiopulmonary resuscitation.
  110         5. Obtaining and maintaining a current certificate in
  111  cardiopulmonary resuscitation.
  112         (9) FEE SCHEDULE.—The agency shall modify any state
  113  Medicaid plans and implement any federal waivers necessary to
  114  implement this section and shall establish a Medicaid fee
  115  schedule for home health agencies employing a home health aide
  116  for medically fragile children at a minimum rate of $25 per hour
  117  with a utilization cap of no more than 12 8 hours per day and 40
  118  hours per week, per medically fragile child. The utilization cap
  119  of 40 hours per week, per recipient may be exceeded; however,
  120  justification must be provided as to why there is no other
  121  qualified provider available, and the request must be approved
  122  by the home health agency and the managed care plan.
  123         (10) FEDERAL APPROVAL.—Within 30 days after the effective
  124  date of this act, the agency shall seek federal approval,
  125  including seeking the appropriate federal waiver, to:
  126         (a) Allow Medicaid private duty nursing specialty providers
  127  and home health services providers to participate in and receive
  128  reimbursement for services rendered under this program.
  129         (b) Provide that the income earned under this program by a
  130  home health aide for medically fragile children is disregarded
  131  in eligibility considerations for public assistance as defined
  132  in s. 414.0252.
  133         Section 3. Subsection (18) of section 400.462, Florida
  134  Statutes, is amended to read:
  135         400.462 Definitions.—As used in this part, the term:
  136         (18) “Home health aide for medically fragile children”
  137  means a family caregiver who meets the qualifications specified
  138  in this part and who performs tasks delegated to him or her
  139  under chapter 464 while caring for an eligible relative, and
  140  provides care relating to activities of daily living, including
  141  those associated with personal care; maintaining mobility;
  142  nutrition and hydration; toileting and elimination; assistive
  143  devices; safety and cleanliness; data gathering; reporting
  144  abnormal signs and symptoms; postmortem care; patient
  145  socialization and reality orientation; end-of-life care;
  146  cardiopulmonary resuscitation and emergency care; residents’ or
  147  patients’ rights; documentation of services performed; infection
  148  control; safety and emergency procedures; hygiene, grooming,
  149  skin care, and pressure sore prevention; wound care; portable
  150  oxygen use and safety and other respiratory procedures;
  151  tracheostomy care; enteral care and therapy; peripheral
  152  intravenous assistive activities and alternative feeding
  153  methods; and any other tasks delegated to the family caregiver
  154  under chapter 464.
  155         Section 4. Paragraph (c) of subsection (1) of section
  156  409.903, Florida Statutes, is amended to read:
  157         409.903 Mandatory payments for eligible persons.—The agency
  158  shall make payments for medical assistance and related services
  159  on behalf of the following persons who the department, or the
  160  Social Security Administration by contract with the Department
  161  of Children and Families, determines to be eligible, subject to
  162  the income, assets, and categorical eligibility tests set forth
  163  in federal and state law. Payment on behalf of these Medicaid
  164  eligible persons is subject to the availability of moneys and
  165  any limitations established by the General Appropriations Act or
  166  chapter 216.
  167         (1) Low-income families with children are eligible for
  168  Medicaid provided they meet the following requirements:
  169         (c) The family’s countable income and resources do not
  170  exceed the applicable Aid to Families with Dependent Children
  171  (AFDC) income and resource standards under the AFDC state plan
  172  in effect in July 1996, except as amended in the Medicaid state
  173  plan to conform as closely as possible to the requirements of
  174  the welfare transition program, to the extent permitted by
  175  federal law. The agency shall seek federal approval, including
  176  seeking the appropriate federal waiver or state plan amendment,
  177  to exclude from the family’s countable income any income earned
  178  through employment as a home health aide for medically fragile
  179  children under s. 400.4765.
  180         Section 5. Within 60 days after this act becomes a law, the
  181  Agency for Health Care Administration shall make all necessary
  182  requests and submissions to obtain federal approval to implement
  183  the amendment made by this act to s. 409.903, Florida Statutes,
  184  and initiate any necessary rulemaking to implement the amendment
  185  made by this act to s. 400.4765, Florida Statutes.
  186         Section 6. This act shall take effect upon becoming a law.
  187  
  188  ================= T I T L E  A M E N D M E N T ================
  189  And the title is amended as follows:
  190         Delete everything before the enacting clause
  191  and insert:
  192                        A bill to be entitled                      
  193         An act relating to the home health aide for medically
  194         fragile children program; amending s. 400.54, F.S.;
  195         providing requirements for the annual assessment of
  196         the home health aide for medically fragile children
  197         program; amending s. 400.4765, F.S.; revising program
  198         training requirements; revising the utilization cap of
  199         a Medicaid fee schedule; requiring a home health aide
  200         for medically fragile children who works more than 40
  201         hours per week to provide specified justification;
  202         requiring the Agency for Health Care Administration to
  203         seek federal approval, including a federal waiver, for
  204         specified purposes; amending s. 400.462, F.S.;
  205         conforming provisions to changes made by the act;
  206         amending s. 409.903, F.S.; requiring the agency to
  207         seek federal approval, including a federal waiver or
  208         state plan amendment, for specified purposes;
  209         providing construction; providing a directive to the
  210         agency to carry out certain tasks within a specified
  211         timeframe; providing an effective date.