HB 1239 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to nursing home facility staffing 2
requirements; amending s. 400.23, F.S.; providing 3
definitions; specifying functions that do not 4
constitute direct care staffing hours for purposes of 5
required nursing home staffing ratios; revising 6
nursing home staffing requirements; requiring nursing 7
home facilities to maintain and report staffing 8
information consistent with federal law; amending ss. 9
400.141 and 651.118, F.S.; conforming cross -references 10
and provisions to changes made by the act; providing 11
an effective date. 12
13
Be It Enacted by the Legislature of the State of Florida: 14
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Section 1. Subsection (3) of section 400.23, Florida 16
Statutes, is amended to read: 17
400.23 Rules; evaluation and deficiencies; licensure 18
status.— 19
(3)(a)1. As used in this subsection, the term: 20
a. "Average monthly hours of direct care per resident per 21
day" means the total number of direct care service hours 22
provided by direct care staff in a month at the facility divided 23
by the sum of each daily resident census for that month. 24
b. "Direct care staff" means individuals who, through 25
HB 1239 2022
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interpersonal contact with residents or resident care 26
management, provide care and services to allow residents to 27
attain or maintain the highest practicable physical, mental, and 28
psychosocial well-being. The term includes, but is not limited 29
to, disciplines and professions that must be reported in 30
accordance with 42 C.F.R. s. 483.70(q) and all o f the following: 31
(I) Licensed nurses. 32
(II) Certified nursing assistants. 33
(III) Physical therapy staff. 34
(IV) Occupational therapy staff. 35
(V) Speech therapy staff. 36
(VI) Respiratory therapy staff. 37
(VII) Activities staff. 38
(VIII) Social services staff. 39
(IX) Mental health service workers. 40
41
The term does not include individuals whose primary duties are 42
maintaining the physical environment of the facility, including, 43
but not limited to, food preparation, laundry, and housekeeping. 44
c. "Non-nursing direct care staff" means direct care staff 45
who are not licensed to practice nursing under part I of chapter 46
464. 47
2. For purposes of this subsection, direct care staffing 48
hours do not include time spent on nursing administration, staff 49
development, staffing coordination, and the administrative 50
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portion of the minimum data set and care plan coordination for 51
Medicaid. 52
(b)1. The agency shall adopt rules providing minimum 53
staffing requirements for nursing home facilities. These 54
requirements must include, fo r each facility: 55
a. A minimum monthly weekly average of 3.8 certified 56
nursing assistant and licensed nursing staffing combined of 3.6 57
hours of direct care per resident per day , as determined by the 58
facility assessment staffing needs in accordance with 42 C.F.R. 59
s. 483.70(e). As used in this sub-subparagraph, a week is 60
defined as Sunday through Saturday. 61
b. A minimum certified nursing assistant staffing of 2.5 62
hours of direct care by non-nursing direct care staff per 63
resident per day, with at least 1.8 o f those hours provided by a 64
certified nursing assistant . A facility may not staff below a 65
ratio of one certified nursing assistant per 20 residents. 66
c. A minimum licensed nursing staffing of 1.0 hour of 67
direct care by licensed nurses per resident per day . A facility 68
may not staff below a ratio of one licensed nurse per 40 69
residents. 70
2. Nursing assistants employed under s. 400.211(2) may be 71
included in computing the hours of non -nursing direct care 72
provided to residents and may be included in computing t he 73
staffing ratio for certified nursing assistants if their job 74
responsibilities include only nursing -assistant-related duties. 75
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3. Each nursing home facility must document compliance 76
with staffing standards as required under this paragraph and 77
post daily the names of licensed nurses and certified nursing 78
assistants staff on duty for the benefit of facility residents 79
and the public. Facilities must maintain records of staffing in 80
accordance with 42 C.F.R. s. 483.35(g) and must report staffing 81
in accordance with 42 C.F.R. s. 483.70(q). 82
4. The agency must shall recognize the use of licensed 83
nurses for compliance with minimum staffing requirements for 84
non-nursing direct care staff certified nursing assistants if 85
the nursing home facility otherwise meets the minimum staffing 86
requirements for licensed nurses and the licensed nurses are 87
performing the duties of a certified nursing assistant. Unless 88
otherwise approved by the agency, licensed nurses counted toward 89
the minimum staffing requirements for non-nursing direct care 90
staff certified nursing assistants must exclusively perform the 91
duties of a certified nursing assistant for the entire shift and 92
not also be counted toward the minimum staffing requirements for 93
licensed nurses. If the agency approved a facility 's request to 94
use a licensed nurse to perform both licensed nursing and 95
certified nursing assistant duties, the facility must allocate 96
the amount of staff time specifically spent on certified nursing 97
assistant duties for the purpose of documenting complian ce with 98
minimum staffing requirements for non-nursing direct care staff 99
certified and licensed nursing staff. The hours of a licensed 100
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nurse with dual job responsibilities may not be counted twice. 101
(c)(b) Paid feeding assistants and non-nursing direct care 102
nonnursing staff who have successfully completed the feeding 103
assistant training program under s. 400.141(1)(v) and who 104
provide providing eating assistance to residents shall not count 105
toward compliance with minimum staffing standards. 106
(d)(c) Licensed practical nurses licensed under chapter 107
464 who provide are providing nursing services in nursing home 108
facilities under this part may supervise the activities of other 109
licensed practical nurses, certified nursing assistants, and 110
other unlicensed personne l providing services in such facilities 111
in accordance with rules adopted by the Board of Nursing. 112
Section 2. Paragraphs (g), (n), and (r) of subsection (1) 113
of section 400.141, Florida Statutes, are amended to read: 114
400.141 Administration and manageme nt of nursing home 115
facilities.— 116
(1) Every licensed facility shall comply with all 117
applicable standards and rules of the agency and shall: 118
(g) If the facility has a standard license, exceeds the 119
minimum required hours of direct care provided by licensed 120
nurses nursing and non-nursing certified nursing assistant 121
direct care staff per resident per day, and is part of a 122
continuing care facility licensed under chapter 651 or a 123
retirement community that offers other services pursuant to part 124
III of this chapter or part I or part III of chapter 429 on a 125
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single campus, be allowed to share programming and staff. At the 126
time of inspection, a continuing care facility or retirement 127
community that uses this option must demonstrate through 128
staffing records that minimu m staffing requirements for the 129
facility were met. Licensed nurses and non-nursing direct care 130
staff certified nursing assistants who work in the facility may 131
be used to provide services elsewhere on campus if the facility 132
exceeds the minimum number of dir ect care hours required per 133
resident per day and the total number of residents receiving 134
direct care services from a licensed nurse or non-nursing direct 135
care staff a certified nursing assistant does not cause the 136
facility to violate the staffing ratios re quired under s. 137
400.23(3)(b) s. 400.23(3)(a). Compliance with the minimum 138
staffing ratios must be based on the total number of residents 139
receiving direct care services, regardless of where they reside 140
on campus. If the facility receives a conditional licen se, it 141
may not share staff until the conditional license status ends. 142
This paragraph does not restrict the agency's authority under 143
federal or state law to require additional staff if a facility 144
is cited for deficiencies in care which are caused by an 145
insufficient number of certified nursing assistants or licensed 146
nurses. The agency may adopt rules for the documentation 147
necessary to determine compliance with this provision. 148
(n) Comply with state minimum -staffing requirements: 149
1. A facility that has fail ed to comply with state 150
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minimum-staffing requirements for 2 consecutive days is 151
prohibited from accepting new admissions until the facility has 152
achieved the minimum -staffing requirements for 6 consecutive 153
days. For the purposes of this subparagraph, any pe rson who was 154
a resident of the facility and was absent from the facility for 155
the purpose of receiving medical care at a separate location or 156
was on a leave of absence is not considered a new admission. 157
Failure by the facility to impose such an admissions m oratorium 158
is subject to a $1,000 fine. 159
2. A facility that does not have a conditional license may 160
be cited for failure to comply with the standards in s. 161
400.23(3)(b)1.b. and c. s. 400.23(3)(a)1.b. and c. only if it 162
has failed to meet those standards on 2 consecutive days or if 163
it has failed to meet at least 97 percent of those standards on 164
any one day. 165
3. A facility that has a conditional license must be in 166
compliance with the standards in s. 400.23(3)(b) s. 400.23(3)(a) 167
at all times. 168
(r) Maintain in the medical record for each resident a 169
daily chart of direct care certified nursing assistant services 170
provided to the resident. The direct care staff certified 171
nursing assistant who is caring for the resident must complete 172
this record by the end of his o r her shift. This record must 173
indicate assistance with activities of daily living, assistance 174
with eating, and assistance with drinking, and any other direct 175
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care provided and must record each offering of nutrition and 176
hydration for those residents whose p lan of care or assessment 177
indicates a risk for malnutrition or dehydration. 178
Section 3. Subsections (6) and (13) of section 651.118, 179
Florida Statutes, are amended to read: 180
651.118 Agency for Health Care Administration; 181
certificates of need; sheltered beds; community beds. — 182
(6) Unless the provider already has a component that is to 183
be a part of the continuing care facility and that is licensed 184
under chapter 395, part II of chapter 400, or part I of chapter 185
429 at the time of construction of the contin uing care facility, 186
the provider must construct the non-nursing nonnursing home 187
portion of the facility and the nursing home portion of the 188
facility at the same time. If a provider constructs less than 189
the number of residential units approved in the certif icate of 190
authority, the number of licensed sheltered nursing home beds 191
shall be reduced by a proportionate share. 192
(13) Residents, as defined in this chapter, are not 193
considered new admissions for the purpose of s. 400.141(1)(n)1. 194
Section 4. This act shall take effect July 1, 2022. 195