Florida Senate - 2025 CS for CS for SB 1156
By the Committees on Fiscal Policy; and Health Policy; and
Senator Harrell
594-03846-25 20251156c2
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; requiring an employing home
8 health agency to provide specified training and ensure
9 that each home health aide for medically fragile
10 children holds and maintains specified certification;
11 revising the utilization cap of a Medicaid fee
12 schedule; requiring a home health aide for medically
13 fragile children who works more than 40 hours per week
14 to provide specified justification; providing
15 requirements for the Agency for Health Care
16 Administration to seek federal approval and a federal
17 waiver for specified purposes; amending s. 400.462,
18 F.S.; conforming provisions to changes made by the
19 act; amending s. 409.903, F.S.; requiring the agency
20 to seek federal approval and implement federal waivers
21 and state plan amendments for specified purposes;
22 providing an effective date.
23
24 Be It Enacted by the Legislature of the State of Florida:
25
26 Section 1. Section 400.54, Florida Statutes, is amended to
27 read:
28 400.54 Annual assessment of the home health aide for
29 medically fragile children program.—
30 (1) The agency shall conduct an annual assessment of the
31 home health aide for medically fragile children program. The
32 assessment must report caregiver satisfaction with the program,
33 report data on adverse incidents, and identify additional
34 support that may be needed by the home health aide for medically
35 fragile children, and assess the rate and extent of
36 hospitalization of children in home health services who are
37 attended by a home health aide for medically fragile children
38 compared to those in home health services provided by a
39 registered nurse or a licensed practical nurse without a home
40 health aide for medically fragile children. Medicaid managed
41 care plans shall provide to the agency data necessary to perform
42 this assessment.
43 (2) The home health agency must report all adverse
44 incidents occurring under the care of a home health aide for
45 medically fragile children to the agency and managed care plan
46 within 48 hours of the incident. For purposes of reporting to
47 the agency under this section, the term “adverse incident”
48 means:
49 (a) Death.
50 (b) Brain or spinal damage.
51 (c) Permanent disfigurement.
52 (d) Fracture or dislocation of bones or joints.
53 (e) A limitation of neurological, physical, or sensory
54 function.
55 (f) An event that is reported to law enforcement or its
56 personnel for investigation.
57
58 By January 1 of each year, beginning January 1, 2025, the agency
59 shall report its findings to the Governor, the President of the
60 Senate, and the Speaker of the House of Representatives.
61 Section 2. Paragraph (a) of subsection (3) and subsection
62 (9) of section 400.4765, Florida Statutes, are amended, and
63 subsection (10) is added to that section, 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 agency-approved training program. The employing home health
70 agency must provide validation of competency by a registered
71 nurse, and maintain documentation of training completion and
72 competency validation. The employing home health agency must
73 provide additional training and competency validation as the
74 medically fragile child’s care needs change, consistent with any
75 changes to the plan of care. The employing home health agency
76 must provide training on HIV infections and AIDS and must ensure
77 that each home health aide for medically fragile children holds
78 and maintains a certification in cardiopulmonary resuscitation.
79 (b)(a) The agency, in consultation with the Board of
80 Nursing, shall approve home health aide for medically fragile
81 children training programs developed by home health agencies in
82 accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to
83 train family caregivers as home health aides for medically
84 fragile children to increase the health care provider workforce
85 and to authorize persons to provide trained nursing services as
86 delegated by a registered nurse to eligible relatives. The
87 training programs program must include supervised practical
88 training under the direct supervision of a licensed registered
89 nurse which must be tailored to the needs of an eligible
90 relative. consist of at least 85 hours of training, including,
91 but not limited to, all of the following:
92 1. A minimum of 40 hours of theoretical instruction in
93 nursing, including, but not limited to, instruction on all of
94 the following:
95 a. Person-centered care.
96 b. Communication and interpersonal skills.
97 c. Infection control.
98 d. Safety and emergency procedures.
99 e. Assistance with activities of daily living.
100 f. Mental health and social service needs.
101 g. Care of cognitively impaired individuals.
102 h. Basic restorative care and rehabilitation.
103 i. Patient rights and confidentiality of personal
104 information and medical records.
105 j. Relevant legal and ethical issues.
106
107 Such instruction must be offered in various formats, and any
108 interactive instruction must be provided during various times of
109 the day.
110 2. A minimum of 20 hours of skills training on basic
111 nursing skills, including, but not limited to:
112 a. Hygiene, grooming, and toileting.
113 b. Skin care and pressure sore prevention.
114 c. Nutrition and hydration.
115 d. Measuring vital signs, height, and weight.
116 e. Safe lifting, positioning, and moving of patients.
117 f. Wound care.
118 g. Portable Oxygen use and safety and other respiratory
119 procedures.
120 h. Tracheostomy care.
121 i. Enteral care and therapy.
122 j. Peripheral Intravenous assistive activities and
123 alternative feeding methods.
124 k. Urinary catheterization and ostomy care.
125 3. At least 16 hours of clinical training under direct
126 supervision of a licensed registered nurse.
127 4. Training concerning HIV infections and AIDS and is
128 required to obtain and maintain a current certificate in
129 cardiopulmonary resuscitation.
130 (9) FEE SCHEDULE.—The agency shall modify any state
131 Medicaid plans and implement any federal waivers necessary to
132 implement this section and shall establish a Medicaid fee
133 schedule for home health agencies employing a home health aide
134 for medically fragile children at minimum rate of $25 per hour
135 with a utilization cap of no more than 12 8 hours per day and 40
136 hours per week, per medically fragile child. The utilization cap
137 of 40 hours per week, per recipient may be exceeded; however,
138 justification must be provided as to why there is no other
139 qualified provider available, and the request must be approved
140 by the home health agency and the managed care plan.
141 (10) FEDERAL APPROVAL.—The agency shall seek necessary
142 federal approval, including seeking the appropriate federal
143 waiver, to:
144 (a) Allow Medicaid private duty nursing specialty providers
145 and home health services providers to participate in and receive
146 reimbursement for services rendered under this program.
147 (b) Provide that the income earned under this program by a
148 home health aide for medically fragile children is disregarded
149 in Medicaid eligibility determinations.
150 Section 3. Subsection (18) of section 400.462, Florida
151 Statutes, is amended to read:
152 400.462 Definitions.—As used in this part, the term:
153 (18) “Home health aide for medically fragile children”
154 means a family caregiver who meets the qualifications specified
155 in this part and who performs tasks delegated to him or her
156 under chapter 464 while caring for an eligible relative, and
157 provides care relating to activities of daily living, including
158 those associated with personal care; maintaining mobility;
159 nutrition and hydration; toileting and elimination; assistive
160 devices; safety and cleanliness; data gathering; reporting
161 abnormal signs and symptoms; postmortem care; patient
162 socialization and reality orientation; end-of-life care;
163 cardiopulmonary resuscitation and emergency care; residents’ or
164 patients’ rights; documentation of services performed; infection
165 control; safety and emergency procedures; hygiene, grooming,
166 skin care, and pressure sore prevention; wound care; portable
167 oxygen use and safety and other respiratory procedures;
168 tracheostomy care; enteral care and therapy; peripheral
169 intravenous assistive activities and alternative feeding
170 methods; and any other tasks delegated to the family caregiver
171 under chapter 464.
172 Section 4. Paragraph (c) of subsection (1) of section
173 409.903, Florida Statutes, is amended to read:
174 409.903 Mandatory payments for eligible persons.—The agency
175 shall make payments for medical assistance and related services
176 on behalf of the following persons who the department, or the
177 Social Security Administration by contract with the Department
178 of Children and Families, determines to be eligible, subject to
179 the income, assets, and categorical eligibility tests set forth
180 in federal and state law. Payment on behalf of these Medicaid
181 eligible persons is subject to the availability of moneys and
182 any limitations established by the General Appropriations Act or
183 chapter 216.
184 (1) Low-income families with children are eligible for
185 Medicaid provided they meet the following requirements:
186 (c) The family’s countable income and resources do not
187 exceed the applicable Aid to Families with Dependent Children
188 (AFDC) income and resource standards under the AFDC state plan
189 in effect in July 1996, except as amended in the Medicaid state
190 plan to conform as closely as possible to the requirements of
191 the welfare transition program, to the extent permitted by
192 federal law. The agency shall seek federal approval, including
193 seeking the appropriate federal waiver or state plan amendment,
194 to exclude from the family’s countable income any income earned
195 through employment as a home health aide for medically fragile
196 children under s. 400.4765.
197 Section 5. Within 60 days after this act becomes law, the
198 Agency for Health Care Administration shall make all necessary
199 requests and submissions to obtain federal approval to implement
200 this act amending s. 409.903, Florida Statutes, and initiate any
201 necessary rulemaking to implement the provisions of this act
202 amending s. 400.4765, Florida Statutes.
203 Section 6. This act shall take effect upon becoming a law.