CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 1 of 8 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 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 2 of 8 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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 3 of 8 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 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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 4 of 8 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 (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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 5 of 8 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 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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 6 of 8 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 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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 7 of 8 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 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 CS/HB 351 2023 CODING: Words stricken are deletions; words underlined are additions. hb0351-01-c1 Page 8 of 8 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 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