CS/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
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 the administration of certain 17
medications to specified residents under certain 18
conditions; amending s. 464.2035, F.S.; authorizing 19
certified nursing assistants to administer certain 20
medications to specified residents and patients under 21
certain conditions; requiring the board, in 22
consultation with the agency, to establish standards 23
and procedures that a certified nursing assistant must 24
follow when administering medi cation to a resident of 25
CS/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
a nursing home facility; providing an effective date. 26
27
Be It Enacted by the Legislature of the State of Florida: 28
29
Section 1. Subsection (5) is added to section 400.211, 30
Florida Statutes, to read: 31
400.211 Persons employed a s nursing assistants; 32
certification requirement. — 33
(5) A nursing home, in accordance with chapter 464 and 34
rules adopted pursuant to this section, may authorize a 35
registered nurse to delegate tasks, including medication 36
administration, to a certified nursi ng assistant who meets the 37
requirements of this subsection. 38
(a) In addition to the initial 6 -hour training course and 39
determination of competency required under s. 464.2035, to be 40
eligible to administer medication to a resident of a nursing 41
home facility, a certified nursing assistant must: 42
1. Hold a clear and active certification from the 43
Department of Health for at least 1 year immediately preceding 44
the delegation. 45
2. Complete an additional 34 -hour training course approved 46
by the Board of Nursing in medication administration and 47
associated tasks, including, but not limited to, blood glucose 48
level checks, dialing oxygen flow meters to prescribed settings, 49
and assisting with continuous positive airway pressure devices. 50
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3. Demonstrate clinical compete ncy by successfully 51
completing a supervised clinical practice in medication 52
administration and associated tasks conducted in the facility. 53
(b) Upon completion of the training, competency, and 54
initial validation requirements under s. 464.2035 and this 55
subsection, a certified nursing assistant whose delegated tasks 56
include medication administration is designated as a qualified 57
medication aide. 58
(c) A qualified medication aide must satisfactorily 59
complete the annual validation and 2 hours of inservice train ing 60
in medication administration and medication error prevention in 61
accordance with s. 464.2035. 62
(d) A qualified medication aide may administer medication 63
only under the direct supervision of a nurse licensed under part 64
I of chapter 464. 65
(e) Medication administration must be included in 66
performance improvement activities in accordance with 42 C.F.R. 67
s. 483.75(e)(2). 68
(f) The Board of Nursing, in consultation with the agency, 69
shall adopt rules to implement this subsection. 70
Section 2. Paragraph (b) o f subsection (3) of section 71
400.23, Florida Statutes, is amended to read: 72
400.23 Rules; evaluation and deficiencies; licensure 73
status.— 74
(3) 75
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(b)1. Each facility must determine its direct care 76
staffing needs based on the facility assessment and the 77
individual needs of a resident based on the resident's care 78
plan. At a minimum, staffing must include, for each facility, 79
the following requirements: 80
a. A minimum weekly average of 3.6 hours of care by direct 81
care staff per resident per day. As used in t his sub-82
subparagraph, a week is defined as Sunday through Saturday. 83
b. A minimum of 2.0 hours of direct care by a certified 84
nursing assistant per resident per day. A facility may not staff 85
below one certified nursing assistant per 20 residents. 86
c. A minimum of 1.0 hour of direct care by a licensed 87
nurse per resident per day. A facility may not staff below one 88
licensed nurse per 40 residents. 89
2. Nursing assistants employed under s. 400.211(2) may be 90
included in computing the hours of direct care provid ed by 91
certified nursing assistants and may be included in computing 92
the staffing ratio for certified nursing assistants if their job 93
responsibilities include only nursing -assistant-related duties. 94
3. Certified nursing assistants performing the duties of a 95
qualified medication aide under s. 400.211(5) may not be 96
included in computing the hours of direct care provided by, or 97
the staffing ratios for, certified nursing assistants or 98
licensed nurses under sub -subparagraph 1.b. or sub -subparagraph 99
1.c., respectively. 100
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4.3. Each nursing home facility must document compliance 101
with staffing standards as required under this paragraph and 102
post daily the names of licensed nurses and certified nursing 103
assistants on duty for the benefit of facility residents and the 104
public. Facilities must maintain the records documenting 105
compliance with minimum staffing standards for a period of 5 106
years and must report staffing in accordance with 42 C.F.R. s. 107
483.70(q). 108
5.4. The agency must recognize the use of licensed nurses 109
for compliance with minimum staffing requirements for certified 110
nursing assistants if the nursing home facility otherwise meets 111
the minimum staffing requirements for licensed nurses and the 112
licensed nurses are performing the duties of a certified nursing 113
assistant. Unless otherwise approved by the agency, licensed 114
nurses counted toward the minimum staffing requirements for 115
certified nursing assistants must exclusively perform the duties 116
of a certified nursing assistant for the entire shift and not 117
also be counted toward the minimum staffing requirements for 118
licensed nurses. If the agency approved a facility's request to 119
use a licensed nurse to perform both licensed nursing and 120
certified nursing assistant duties, the facility must allocate 121
the amount of staff time specifically spent on certified nursing 122
assistant duties for the purpose of documenting compliance with 123
minimum staffing requirements for certified and licensed nursing 124
staff. The hours of a licensed nurse with dual job 125
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responsibilities may not be counted twice. 126
6.5. Evidence that a facility complied with the minimum 127
direct care staffing requirements under subparagraph 1. is not 128
admissible as evidence of compliance with the nursing services 129
requirements under 42 C.F.R. s. 483.35 or s. 483.70. 130
Section 3. Subsection (2) of section 464.0156, Florida 131
Statutes, is amended to read: 132
464.0156 Delegation of duties. — 133
(2)(a) A registered nurse may delegate to a certified 134
nursing assistant the administration of oral, transdermal, 135
ophthalmic, otic, inhaled, or topical prescription medication to 136
a resident of a nursing home facility as defined in s. 400.021 137
if the certified nursing assistant meets the requirements of s. 138
400.211(5) and s. 464.2035. 139
(b) A registered nurse may delegate to a certified nursing 140
assistant or a home health aide the administration of oral, 141
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 142
topical prescription medications to a patient of a home health 143
agency licensed under part III of chapter 400 or to a patient in 144
a local county detention facility as defined in s. 951.23(1) , if 145
the certified nursing assistant or home health aide meets the 146
requirements of s. 464.2035 or s. 400.489, respectively. 147
(c) A registered nurse may not delegate the administration 148
of any controlled substa nce listed in Schedule II, Schedule III, 149
or Schedule IV of s. 893.03 or 21 U.S.C. s. 812, except for the 150
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administration of an insulin syringe that is prefilled with the 151
proper dosage by a pharmacist or an insulin pen that is 152
prefilled by the manufacturer. 153
Section 4. Subsections (1) and (3) of section 464.2035, 154
Florida Statutes, are amended to read: 155
464.2035 Administration of medication. — 156
(1) A certified nursing assistant may administer oral, 157
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 158
topical prescription medication to a resident of a nursing home 159
facility as defined in s. 400.021 or may administer oral 160
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 161
topical prescription medication to a patient of a home health 162
agency licensed under part III of chapter 400 or to a patient in 163
a county detention facility as defined in s. 951.23(1) if the 164
certified nursing assistant has been delegated such task by a 165
registered nurse licensed under part I of this chapter, has 166
satisfactorily completed an initial 6-hour training course 167
approved by the board, and has been found competent to 168
administer medication to a patient in a safe and sanitary 169
manner. The training, determination of competency, and initial 170
and annual validation required under th is section must be 171
conducted by a registered nurse licensed under this chapter or a 172
physician licensed under chapter 458 or chapter 459. 173
(3) The board, in consultation with the Agency for Health 174
Care Administration, shall establish by rule standards and 175
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procedures that a certified nursing assistant must follow when 176
administering medication to a resident of a nursing home 177
facility or to a patient of a home health agency. Such rules 178
must, at a minimum, address qualification requirements for 179
trainers, requirements for labeling medication, documentation 180
and recordkeeping, the storage and disposal of medication, 181
instructions concerning the safe administration of medication, 182
informed-consent requirements and records, and the training 183
curriculum and validation pr ocedures. 184
Section 5. This act shall take effect July 1, 2023. 185