Florida 2023 Regular Session

Florida House Bill H0351 Latest Draft

Bill / Comm Sub Version Filed 03/10/2023

                               
 
CS/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 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     
 
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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