Florida Senate - 2025 CS for SB 1156
By the Committee on Health Policy; and Senator Harrell
588-03192-25 20251156c1
1 A bill to be entitled
2 An act relating to the home health aide for medically
3 fragile children program; amending s. 400.54, F.S.;
4 providing requirements for the annual assessment of
5 the home health aide for medically fragile children
6 program; amending s. 400.4765, F.S.; revising program
7 training requirements; revising the utilization cap of
8 a Medicaid fee schedule; requiring a home health aide
9 for medically fragile children who works more than 40
10 hours per week to provide specified justification;
11 requiring the Agency for Health Care Administration to
12 seek federal approval, including a federal waiver, for
13 specified purposes; amending s. 400.462, F.S.;
14 conforming provisions to changes made by the act;
15 amending s. 409.903, F.S.; requiring the agency to
16 seek federal approval, including a federal waiver or
17 state plan amendment, for specified purposes;
18 providing construction; providing a directive to the
19 agency to carry out certain tasks within a specified
20 timeframe; providing an effective date.
21
22 Be It Enacted by the Legislature of the State of Florida:
23
24 Section 1. Section 400.54, Florida Statutes, is amended to
25 read:
26 400.54 Annual assessment of the home health aide for
27 medically fragile children program.—
28 (1) The agency shall conduct an annual assessment of the
29 home health aide for medically fragile children program. The
30 assessment must report caregiver satisfaction with the program,
31 report data on adverse incidents, identify additional support
32 that may be needed by the home health aide for medically fragile
33 children, and assess the rate and extent of hospitalization of
34 children in home health services who are attended by a home
35 health aide for medically fragile children compared to those in
36 home health services provided by a registered nurse or a
37 licensed practical nurse without a home health aide for
38 medically fragile children. Medicaid managed care plans shall
39 provide to the agency data necessary to perform this assessment.
40 (2) The home health agency shall report all adverse
41 incidents occurring under the care of a home health aide for
42 medically fragile children to the agency and managed care plan
43 within 48 hours after the incident. For purposes of reporting to
44 the agency under this subsection, the term “adverse incident”
45 means any of the following:
46 (a) Death.
47 (b) Brain or spinal damage.
48 (c) Permanent disfigurement.
49 (d) Fracture or dislocation of bones or joints.
50 (e) A limitation of neurological, physical, or sensory
51 function.
52 (f) An event that is reported to law enforcement personnel
53 for investigation.
54
55 By January 1 of each year, beginning January 1, 2025, the agency
56 shall report its findings to the Governor, the President of the
57 Senate, and the Speaker of the House of Representatives.
58 Section 2. Present paragraphs (a) and (b) of subsection (3)
59 of section 400.4765, Florida Statutes, are redesignated as
60 paragraphs (b) and (c), respectively, a new paragraph (a) is
61 added to that subsection, subsection (10) is added to that
62 section, and present paragraph (a) of subsection (3) and
63 subsection (9) of that section are amended, to read:
64 400.4765 Home health aide for medically fragile children
65 program.—
66 (3) TRAINING.—
67 (a) Before providing services to an eligible relative, a
68 home health aide for medically fragile children must complete an
69 approved training program. The employing home health agency must
70 provide validation of competency by a registered nurse and
71 maintain documentation of training completion and competency
72 validation. The employing home health agency must provide
73 additional training and competency validation as the medically
74 fragile child’s care needs change and consistent with any
75 changes to the plan of care.
76 (b)(a) The agency, in consultation with the Board of
77 Nursing, shall approve home health aide for medically fragile
78 children training programs developed by home health agencies in
79 accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
80 train family caregivers as home health aides for medically
81 fragile children to increase the health care provider workforce
82 and to authorize persons to provide trained nursing services as
83 delegated by a registered nurse to eligible relatives. The
84 program shall include must consist of at least 85 hours of
85 training, including, but not be limited to, all of the
86 following:
87 1. A minimum of 20 40 hours of theoretical instruction in
88 nursing, including, but not limited to, instruction on all of
89 the following:
90 a. Person-centered care.
91 b. Communication and interpersonal skills.
92 c. Infection control.
93 d. Safety and emergency procedures.
94 e. Assistance with activities of daily living.
95 f. Mental health and social service needs.
96 g. Care of cognitively impaired individuals.
97 h. Basic restorative care and rehabilitation.
98 i. Patient rights and confidentiality of personal
99 information and medical records.
100 j. Relevant legal and ethical issues.
101
102 Such instruction must be offered in various formats, and any
103 interactive instruction must be provided during various times of
104 the day.
105 2. Up to A minimum of 20 hours of skills training on basic
106 nursing skills tailored to the child’s care needs as specified
107 in the ordering provider’s plan of care and individualized care
108 needs, which may include training on the following topics, as
109 applicable, including, but not limited to:
110 a. Hygiene, grooming, and toileting.
111 b. Skin care and pressure sore prevention.
112 c. Nutrition and hydration.
113 d. Measuring vital signs, height, and weight.
114 e. Safe lifting, positioning, and moving of patients.
115 f. Wound care.
116 g. Portable Oxygen use and safety and other respiratory
117 procedures.
118 h. Tracheostomy care.
119 i. Enteral care and therapy.
120 j. Peripheral Intravenous assistive activities and
121 alternative feeding methods.
122 k. Urinary catheterization and care and ostomy care.
123 3. Up to At least 16 hours of clinical training related to
124 the specific needs of the eligible relative under direct
125 supervision of a licensed registered nurse.
126 4. Training concerning HIV infections and AIDS and is
127 required to obtain and maintain a current certificate in
128 cardiopulmonary resuscitation.
129 5. Obtaining and maintaining a current certificate in
130 cardiopulmonary resuscitation.
131 (9) FEE SCHEDULE.—The agency shall modify any state
132 Medicaid plans and implement any federal waivers necessary to
133 implement this section and shall establish a Medicaid fee
134 schedule for home health agencies employing a home health aide
135 for medically fragile children at a minimum rate of $25 per hour
136 with a utilization cap of no more than 12 8 hours per day and 40
137 hours per week, per medically fragile child. The utilization cap
138 of 40 hours per week, per recipient may be exceeded; however,
139 justification must be provided as to why there is no other
140 qualified provider available, and the request must be approved
141 by the home health agency and the managed care plan.
142 (10) FEDERAL APPROVAL.—Within 30 days after the effective
143 date of this act, the agency shall seek federal approval,
144 including seeking the appropriate federal waiver, to:
145 (a) Allow Medicaid private duty nursing specialty providers
146 and home health services providers to participate in and receive
147 reimbursement for services rendered under this program.
148 (b) Provide that the income earned under this program by a
149 home health aide for medically fragile children is disregarded
150 in eligibility considerations for public assistance as defined
151 in s. 414.0252.
152 Section 3. Subsection (18) of section 400.462, Florida
153 Statutes, is amended to read:
154 400.462 Definitions.—As used in this part, the term:
155 (18) “Home health aide for medically fragile children”
156 means a family caregiver who meets the qualifications specified
157 in this part and who performs tasks delegated to him or her
158 under chapter 464 while caring for an eligible relative, and
159 provides care relating to activities of daily living, including
160 those associated with personal care; maintaining mobility;
161 nutrition and hydration; toileting and elimination; assistive
162 devices; safety and cleanliness; data gathering; reporting
163 abnormal signs and symptoms; postmortem care; patient
164 socialization and reality orientation; end-of-life care;
165 cardiopulmonary resuscitation and emergency care; residents’ or
166 patients’ rights; documentation of services performed; infection
167 control; safety and emergency procedures; hygiene, grooming,
168 skin care, and pressure sore prevention; wound care; portable
169 oxygen use and safety and other respiratory procedures;
170 tracheostomy care; enteral care and therapy; peripheral
171 intravenous assistive activities and alternative feeding
172 methods; and any other tasks delegated to the family caregiver
173 under chapter 464.
174 Section 4. Paragraph (c) of subsection (1) of section
175 409.903, Florida Statutes, is amended to read:
176 409.903 Mandatory payments for eligible persons.—The agency
177 shall make payments for medical assistance and related services
178 on behalf of the following persons who the department, or the
179 Social Security Administration by contract with the Department
180 of Children and Families, determines to be eligible, subject to
181 the income, assets, and categorical eligibility tests set forth
182 in federal and state law. Payment on behalf of these Medicaid
183 eligible persons is subject to the availability of moneys and
184 any limitations established by the General Appropriations Act or
185 chapter 216.
186 (1) Low-income families with children are eligible for
187 Medicaid provided they meet the following requirements:
188 (c) The family’s countable income and resources do not
189 exceed the applicable Aid to Families with Dependent Children
190 (AFDC) income and resource standards under the AFDC state plan
191 in effect in July 1996, except as amended in the Medicaid state
192 plan to conform as closely as possible to the requirements of
193 the welfare transition program, to the extent permitted by
194 federal law. The agency shall seek federal approval, including
195 seeking the appropriate federal waiver or state plan amendment,
196 to exclude from the family’s countable income any income earned
197 through employment as a home health aide for medically fragile
198 children under s. 400.4765.
199 Section 5. Within 60 days after this act becomes a law, the
200 Agency for Health Care Administration shall make all necessary
201 requests and submissions to obtain federal approval to implement
202 the amendment made by this act to s. 409.903, Florida Statutes,
203 and initiate any necessary rulemaking to implement the amendment
204 made by this act to s. 400.4765, Florida Statutes.
205 Section 6. This act shall take effect upon becoming a law.