HB 351 2023
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A bill to be entitled 1
An act relating to certified nursing assistants; 2
amending s. 400.211, F.S.; providing that a nursing 3
home may authorize a registered nurse to delegate 4
certain tasks to specified certified nursing 5
assistants; providing requirements for such 6
assistants; providing for the designation of certain 7
certified nursing assistants as qualified medication 8
aides; providing requirements for such aides; 9
requiring the Board of Nursing, in consultation with 10
the Agency for Health Care Administration, to adopt 11
rules; amending s. 400.23, F.S.; prohibiting qualified 12
medication aides from being included in the 13
computation of specified hours of direct care and 14
staffing ratios; amending s. 464.0156, F.S.; 15
authorizing registered nurses to delegate to certified 16
nursing assistants and home health aides the 17
administration of certain medications to specified 18
residents and patients under certain conditions; 19
amending s. 464.2035, F.S.; authorizing certified 20
nursing assistants to administer certain medications 21
to specified residents and patients under certain 22
conditions; requiring the board, in consultation with 23
the agency, to establish standards and procedures that 24
a certified nursing assistant must follow when 25
HB 351 2023
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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
administering medication to a resident of a nursing 26
home facility; providing an effective date. 27
28
Be It Enacted by the Legislature of the State of Florida: 29
30
Section 1. Subsection (5) is added to section 400.211, 31
Florida Status, to r ead: 32
400.211 Persons employed as nursing assistants; 33
certification requirement. — 34
(5) A nursing home, in accordance with chapter 464 and 35
rules adopted pursuant to this section, may authorize a 36
registered nurse to delegate tasks, including medication 37
administration, to a certified nursing assistant who meets the 38
requirements of this subsection. 39
(a) In addition to the initial 6 -hour training course and 40
determination of competency required under s. 464.2035, to be 41
eligible to administer medication to a re sident of a nursing 42
home facility, a certified nursing assistant must: 43
1. Hold a clear and active certification from the 44
Department of Health for a minimum of 1 year immediately 45
preceding the delegation; 46
2. Complete an additional 34 -hour training course approved 47
by the Board of Nursing in medication administration and 48
associated tasks including blood glucose level checks, dialing 49
oxygen flow meters to prescribed settings, and assisting with 50
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continuous positive airway pressure devices; and 51
3. Demonstrate clinical competency by successfully 52
completing a supervised clinical practice in medication 53
administration and associated tasks conducted in the facility. 54
(b) Upon completion of the training, competency, and 55
initial validation requirements under s. 46 4.2035 and this 56
subsection, a certified nursing assistant whose tasks include 57
medication administration is designated as a qualified 58
medication aide. 59
(c) A qualified medication aide must satisfactorily 60
complete the annual validation and 2 hours of inserv ice training 61
in medication administration and medication error prevention in 62
accordance with s. 464.2035. 63
(d) A qualified medication aide may only administer 64
medication under the direct supervision of a nurse licensed 65
under part I of chapter 464. 66
(e) The Board of Nursing, in consultation with the agency, 67
shall adopt rules to implement this subsection. 68
Section 2. Paragraph (b) of subsection (3) of section 69
400.23, Florida Statutes, is amended to read: 70
400.23 Rules; evaluation and deficiencies; licensure 71
status.— 72
(3) 73
(b)1. Each facility must determine its direct care 74
staffing needs based on the facility assessment and the 75
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individual needs of a resident based on the resident's care 76
plan. At a minimum, staffing must include, for each facility, 77
the following requirements: 78
a. A minimum weekly average of 3.6 hours of care by direct 79
care staff per resident per day. As used in this sub -80
subparagraph, a week is defined as Sunday through Saturday. 81
b. A minimum of 2.0 hours of direct care by a certifi ed 82
nursing assistant per resident per day. A facility may not staff 83
below one certified nursing assistant per 20 residents. 84
c. A minimum of 1.0 hour of direct care by a licensed 85
nurse per resident per day. A facility may not staff below one 86
licensed nurse per 40 residents. 87
2. Nursing assistants employed under s. 400.211(2) may be 88
included in computing the hours of direct care provided by 89
certified nursing assistants and may be included in computing 90
the staffing ratio for certified nursing assistants if their job 91
responsibilities include only nursing -assistant-related duties. 92
3. Certified nursing assistants who perform the duties of 93
a qualified medication aide under s. 400.211(5) may not be 94
included in computing the hours of direct care provided by, or 95
the staffing ratios for, certified nursing assistants or 96
licensed nurses under sub -subparagraph 1.b. or sub -subparagraph 97
1.c., respectively. 98
4.3. Each nursing home facility must document compliance 99
with staffing standards as required under this paragraph and 100
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post daily the names of licensed nurses and certified nursing 101
assistants on duty for the benefit of facility residents and the 102
public. Facilities must maintain the records documenting 103
compliance with minimum staffing standards for a period of 5 104
years and must report staffing in accordance with 42 C.F.R. s. 105
483.70(q). 106
5.4. The agency must recognize the use of licensed nurses 107
for compliance with minimum staffing requirements for certified 108
nursing assistants if the nursing home facility otherwise meets 109
the minimum staffing requirements for licensed nurses and the 110
licensed nurses are performing the duties of a certified nursing 111
assistant. Unless otherwise approved by the agency, licensed 112
nurses counted toward the minimum staffing requirements for 113
certified nursing assistants must exclusively perform the duties 114
of a certified nursing assistant for the entire shift and not 115
also be counted toward the minimum staffing requirements for 116
licensed nurses. If the agency approved a facility's request to 117
use a licensed nurse to perform both licensed nursing and 118
certified nursing assistant duties, the facility must allocate 119
the amount of staff time specifically spent on certified nursing 120
assistant duties for the purpose of documenting compliance with 121
minimum staffing requirements for certified and licensed nursing 122
staff. The hours of a licensed nurse with dual job 123
responsibilities may not be counted twice. 124
6.5. Evidence that a facility complied with the minimum 125
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direct care staffing requirements under subparagraph 1. i s not 126
admissible as evidence of compliance with the nursing services 127
requirements under 42 C.F.R. s. 483.35 or s. 483.70. 128
Section 3. Subsection (2) of section 464.0156, Florida 129
Statutes, is amended to read: 130
464.0156 Delegation of duties. — 131
(2)(a) A registered nurse may delegate to a certified 132
nursing assistant the administration of oral, transdermal, 133
ophthalmic, otic, inhaled, or topical prescription medication to 134
a resident of a nursing home facility as defined in s. 400.021 135
if the certified nursing assistant meets the requirements of s. 136
400.211(5) and s. 464.2035. 137
(b) A registered nurse may delegate to a certified nursing 138
assistant or a home health aide the administration of oral, 139
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 140
topical prescription medications to a patient of a home health 141
agency licensed under part III of chapter 400 or to a patient in 142
a local county detention facility as defined in s. 951.23(1) , if 143
the certified nursing assistant or home health aide meets the 144
requirements of s. 464.2035 or s. 400.489, respectively . 145
(c) A registered nurse may delegate to a home health aide 146
the administration of oral, transdermal, ophthalmic, otic, 147
rectal, inhaled, enteral, or topical prescription medication to 148
a patient of a home heal th agency licensed under part III of 149
chapter 400 or to a patient in a local county detention facility 150
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as defined in s. 951.23(1) if the home health aide meets the 151
requirements of s. 400.489. 152
(d) A registered nurse may not delegate the administration 153
of any controlled substance listed in Schedule II, Schedule III, 154
or Schedule IV of s. 893.03 or 21 U.S.C. s. 812, except for the 155
administration of an insulin syringe that is prefilled with the 156
proper dosage by a pharmacist or an insulin pen that is 157
prefilled by the manufacturer. 158
Section 4. Subsections (1) and (3) of section 464.2035, 159
Florida Statutes, are amended to read: 160
464.2035 Administration of medication. — 161
(1) A certified nursing assistant may administer oral, 162
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 163
topical prescription medication to a resident of a nursing home 164
facility as defined in s. 400.021 or may administer oral 165
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 166
topical prescription medication to a patient of a home health 167
agency licensed under part III of chapter 400 or to a patient in 168
a county detention facility as defined in s. 951.23(1) if the 169
certified nursing assistant has been delegated such task by a 170
registered nurse licensed under part I of this chapter, ha s 171
satisfactorily completed an initial 6 -hour training course 172
approved by the board, and has been found competent to 173
administer medication to a patient in a safe and sanitary 174
manner. The training, determination of competency, and initial 175
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and annual validation required under this section must be 176
conducted by a registered nurse licensed under this chapter or a 177
physician licensed under chapter 458 or chapter 459. 178
(3) The board, in consultation with the Agency for Health 179
Care Administration, shall establish by rule standards and 180
procedures that a certified nursing assistant must follow when 181
administering medication to a resident of a nursing home 182
facility or to a patient of a home health agency. Such rules 183
must, at a minimum, address qualification requirements for 184
trainers, requirements for labeling medication, documentation 185
and recordkeeping, the storage and disposal of medication, 186
instructions concerning the safe administration of medication, 187
informed-consent requirements and records, and the training 188
curriculum and validation procedures. 189
Section 5. This act shall take effect July 1, 2023. 190