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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 home health aides for medically 2
fragile children; amending s. 400.462, F.S.; providing 3
definitions; amending s. 400.464, F.S.; requiring home 4
health agencies to ensure that any tasks delegated to 5
home health aides for medically fragile c hildren meet 6
specified requirements; amending s. 400.476, F.S.; 7
requiring that home health aides for medically fragile 8
children employed by or under contract with home 9
health agencies be adequately trained to perform 10
delegated tasks; providing certain indi viduals an 11
exemption from costs associated with specified 12
training; creating s. 400.4765, F.S.; providing 13
legislative findings and intent; providing 14
requirements for a family caregiver to be employed as 15
a home health aide for medically fragile children; 16
requiring the Agency for Health Care Administration, 17
in consultation with the Board of Nursing, to develop 18
a home health aide for medically fragile children 19
training programs; providing requirements for the 20
program; requiring home health aides for medically 21
fragile children to complete inservice training as a 22
condition of employment; requiring home health aides 23
for medically fragile children to maintain 24
documentation demonstrating compliance with such 25
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training requirements; exempting home health agencies 26
from civil liability for terminating or denying 27
employment to a home health aide for medically fragile 28
children under certain circumstances; extending the 29
exemption to certain agents of the home health 30
agencies; prohibiting home health agencies or their 31
agents from using certain criminal records or juvenile 32
records other than for a specified purpose; requiring 33
the agency to maintain confidentiality of certain 34
confidential and exempt records; providing 35
requirements for services provided by a home health 36
aide for medically fragile children; authorizing the 37
agency, in consultation with the board, to adopt rules 38
to implement the act; requiring the agency to modify 39
any state Medicaid plans and implement any federal 40
waivers necessary to implement this act and establis h 41
a specified Medicaid fee schedule for home health 42
agencies employing a home health aide for medically 43
fragile children; ss. 400.489 and 400.490, F.S.; 44
conforming provisions to changes made by the act; 45
amending; creating s. 400.54, F.S.; requiring the 46
Agency for Health Care Administration to conduct an 47
annual assessment related to the certified health aide 48
program; providing requirements for the assessment; 49
requiring the agency to submit a report to the 50
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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
Governor and the Legislature annually, by and 51
beginning on a specified date; amending s. 408.822, 52
F.S.; conforming a provision to changes made by the 53
act; amending s. 464.0156, F.S.; conforming provisions 54
to changes made by the act; providing appropriations; 55
providing an effective date. 56
57
Be It Enacted by the Legislature of the State of Florida: 58
59
Section 1. Subsections (5) through (10) of section 60
400.462, Florida Statutes, are renumbered as subsections (6) 61
through (11), present subsection (11) is renumbered as 62
subsection (13), present subsections (12), (13), and (14) are 63
renumbered as subsections (15), (16), and (17), and present 64
subsections (15) through (29) are renumbered as subsections (19) 65
through (33), respectively, subsection (1) and present 66
subsection (10) are amended, and new subsections (5), (1 2), 67
(14), and (18), are added to that section, to read: 68
400.462 Definitions. —As used in this part, the term: 69
(1) "Administrator" means a direct employee, as defined in 70
subsection (10) (9), who is a licensed physician, physician 71
assistant, or registered nurse licensed to practice in this 72
state or an individual having at least 1 year of supervisory or 73
administrative experience in home health care or in a facility 74
licensed under chapter 395, under part II of this chapter, or 75
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under part I of chapter 429. 76
(5) "Approved training program" means a course of training 77
approved by the agency, in consultation with the Board of 78
Nursing, to train a family caregiver as a home health aide for 79
medically fragile children. 80
(11)(10) "Director of nursing" means a registe red nurse 81
who is a direct employee, as defined in subsection (10) (9), of 82
the agency and who is a graduate of an approved school of 83
nursing and is licensed in this state; who has at least 1 year 84
of supervisory experience as a registered nurse; and who is 85
responsible for overseeing the delivery of professional nursing 86
and home health aide aid delivery of services of the agency. 87
(12) "Eligible relative" means a patient 21 years of age 88
or younger who has an underlying physical, mental, or cognitive 89
impairment that prevents him or her from safely living 90
independently, is eligible to receive skilled care or respite 91
care services under the Medicaid program, and is related to his 92
or her family caregiver. 93
(14) "Family caregiver" means a person who provides or 94
intends to provide significant personal care to an eligible 95
relative. 96
(18) "Home health aide for medically fragile children" 97
means a family caregiver who meets the qualifications specified 98
in this part and who performs tasks delegated to him or her 99
under s. 400.4765 while caring for an eligible relative, and 100
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provides care relating to activities of daily living, including 101
those associated with personal care; maintaining mobility; 102
nutrition and hydration; toileting and elimination; assistive 103
devices; and safety and cleanliness, data gathering, reporting 104
abnormal signs and symptoms, postmortem care, patient 105
socialization and reality orientation, end -of-life care, 106
cardiopulmonary resuscitation and emergency care, residents' or 107
patients' rights, and documentation of services performed. 108
Section 2. Subsection (5) and paragraph (d) of subsection 109
(6) of section 400.464, Florida Statutes, are amended to read: 110
400.464 Home health agencies to be licensed; expiration of 111
license; exemptions; unlawful acts; penalties. — 112
(5) If a licensed home health agency authorizes a 113
registered nurse to delegate tasks, including medication 114
administration, to a certified nursing assistant pursuant to 115
chapter 464 or to a home health aide or a home health aide for 116
medically fragile chi ldren pursuant to s. 400.490, the licensed 117
home health agency must ensure that such delegation meets the 118
requirements of this chapter and chapter 464 and the rules 119
adopted thereunder. 120
(6) The following are exempt from licensure as a home 121
health agency under this part: 122
(d) A home health aide , home health aide for medically 123
fragile children, or certified nursing assistant who is acting 124
in his or her individual capacity, within the definitions and 125
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standards of his or her occupation, and who provides hands -on 126
care to patients in their homes. 127
Section 3. Subsection (3) of section 400.476, Florida 128
Statutes, is amended to read: 129
400.476 Staffing requirements; notifications; limitations 130
on staffing services. — 131
(3) TRAINING.—A home health agency shall ensure that each 132
certified nursing assistant employed by or under contract with 133
the home health agency and each home health aide or home health 134
aide for medically fragile children employed by or under 135
contract with the home health agency is adequately trained to 136
perform the tasks of a home health aide or home health aide for 137
medically fragile children in the home setting. A parent, 138
guardian, or family member who is seeking training required 139
under s. 400.4765 to beco me a home health aide for medically 140
fragile children is not required to repay or reimburse the home 141
health agency for the costs associated with the home health aide 142
for medically fragile children training program. 143
Section 4. Section 400.4765, Florida S tatutes, is created 144
to read: 145
400.4765 Home health aide for medically fragile children 146
program.— 147
(1) LEGISLATIVE FINDINGS AND INTENT. —The home health aide 148
for medically fragile children program is hereby established in 149
response to the existing national health care provider shortage 150
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and the impact that the shortage has on medically fragile 151
children and the family caregivers. This program is created to 152
decrease the hospitalization and institutionalization of 153
medically fragile children, reduce state expendi tures, and 154
provide an opportunity for a family caregiver to receive 155
training and gainful employment. 156
(2) ELIGIBILITY REQUIREMENTS. —A home health agency may 157
employ as a home health aide for medically fragile children any 158
person 18 years of age or older wh o meets all of the following 159
requirements. A person must: 160
(a) Be a family caregiver of an eligible relative. 161
(b) Demonstrate a minimum competency to read and write. 162
(c) Complete an approved training program as set forth in 163
this section or have gradua ted from an accredited prelicensure 164
nursing education program and are waiting to take the state 165
licensing exam. 166
(d) Successfully pass the required background screening 167
pursuant to s. 400.215. If the person has successfully passed 168
the required backgroun d screening pursuant to s. 400.215 or s. 169
408.809 within 90 days before applying for a certificate to 170
practice and the person's background screening results are not 171
retained in the clearinghouse created under s. 435.12, the 172
agency shall waive the requiremen t that the applicant 173
successfully pass an additional background screening pursuant to 174
s. 400.215. 175
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(3) TRAINING.— 176
(a) The agency, in consultation with the Board of Nursing, 177
shall approve home health aide for medically fragile children 178
training programs developed by home health agencies in 179
accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 180
train family caregivers as home health aides for medically 181
fragile children to increase the health care provider workforce 182
and to authorize persons to provide trained nursing services as 183
delegated by a registered nurse to eligible relatives. The 184
program must consist of at least 85 hours of training, 185
including, but not limited to, all of the following: 186
1. A minimum of 40 hours of theoretical instruction in 187
nursing, including, but not limited to, instruction on all of 188
the following: 189
a. Person-centered care. 190
b. Communication and interpersonal skills. 191
c. Infection control. 192
d. Safety and emergency procedures. 193
e. Assistance with activities of daily living. 194
f. Mental health and social service needs. 195
g. Care of cognitively impaired individuals. 196
h. Basic restorative care and rehabilitation. 197
i. Patient rights and confidentiality of personal 198
information and medical records. 199
j. Relevant legal and ethical issues. 200
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201
Such instruction must be offered in various formats, and any 202
interactive instruction must be provided during various times of 203
the day. 204
2. A minimum of 20 hours of skills training on basic 205
nursing skills, including, but not limited to: 206
a. Hygiene, grooming, and toileting. 207
b. Skin care and pressure sore prevention. 208
c. Nutrition and hydration. 209
d. Measuring vital signs, height, and weight. 210
e. Safe lifting, positioning, and moving of patients. 211
f. Wound care. 212
g. Portable oxygen use and safety and other respiratory 213
procedures. 214
h. Tracheostomy care. 215
i. Enteral care and therapy. 216
j. Peripheral intravenous assistive activities and 217
alternative feeding methods. 218
k. Urinary catheterization and ostomy care. 219
3. At least 16 hours of cl inical training under direct 220
supervision of a licensed registered nurse. 221
4. Training concerning HIV infections and AIDS and is 222
required to obtain and maintain a current certificate in 223
cardiopulmonary resuscitation. 224
(b) If a home health aide for medica lly fragile children 225
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allows 24 consecutive months to pass without providing any 226
personal care related services for an eligible relative, the 227
family caregiver must complete an approved training program 228
before providing personal care related services as a ho me health 229
aide for medically fragile children. 230
(4) EMPLOYMENT.—A home health agency that employs a home 231
health aide for medically fragile children must ensure that the 232
home health aide for medically fragile children completes 12 233
hours of inservice traini ng during each 12-month period as a 234
condition of employment. The training concerning HIV infections 235
and AIDS and the cardiopulmonary training may count toward 236
meeting the 12 hours of inservice training. The home health 237
agency shall maintain documentation d emonstrating compliance 238
with this subsection. 239
(5) LIABILITY.—If a home health agency terminates or 240
denies employment to a home health aide for medically fragile 241
children who fails to maintain the requirements of this part or 242
whose name appears on a crimi nal screening report of the 243
Department of Law Enforcement, the home health agency is not 244
civilly liable for such termination and a cause of action may 245
not be brought against the home health agency for damages. There 246
may not be any monetary liability on the part of, and a cause of 247
action for damages may not arise against, any licensed facility 248
or its governing board or members thereof, medical staff, 249
disciplinary board, agents, investigators, witnesses, employees, 250
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or any other person for any action taken in good faith, without 251
intentional fraud, to comply with this part. 252
(6) CONFIDENTIALITY. —A home health agency, or an agent 253
thereof, may not use criminal records or juvenile records 254
relating to vulnerable adults for any purpose other than 255
determining if the person meets the requirements of this part. 256
The agency shall maintain the confidentiality of any such 257
records and information it obtains which are confidential and 258
exempt from s. 119.07(1) and s. 24(a), Art. I of the State 259
Constitution. 260
(7) SERVICES.—Services provided by a home health aide for 261
medically fragile children must reduce an eligible relative's 262
private duty nursing service hours. Such services may not be 263
provided concurrently with any private duty nursing service. 264
(8) RULES.—The agency, in consultation with the Board of 265
Nursing, may adopt rules to implement this section. 266
(9) FEE SCHEDULE.—The agency shall modify any state 267
Medicaid plans and implement any federal waivers necessary to 268
implement this section and shall establish a Medicaid fee 269
schedule for home health agencies employing a home health aide 270
for medically fragile children at $25 per hour with a 271
utilization cap of no more than 8 hours per day. 272
Section 5. Section 400.489, Florida Statutes, is amended 273
to read: 274
400.489 Administrati on of medication by a home health aide 275
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or home health aide for medically fragile children ; staff 276
training requirements. — 277
(1) A home health aide or home health aide for medically 278
fragile children may administer oral, transdermal, ophthalmic, 279
otic, rectal, inhaled, enteral, or topical prescription 280
medications if the home health aide or home health aide for 281
medically fragile children has been delegated such task by a 282
registered nurse licensed under chapter 464, has satisfactorily 283
completed an initial 6 -hour training course approved by the 284
agency, and has been found competent to administer medication to 285
a patient in a safe and sanitary manner. The training, 286
determination of competency, and initial and annual validations 287
required in this section shall be conduc ted by a registered 288
nurse licensed under chapter 464 or a physician licensed under 289
chapter 458 or chapter 459. 290
(2) A home health aide or home health aide for medically 291
fragile children must annually and satisfactorily complete a 2 -292
hour inservice training course approved by the agency in 293
medication administration and medication error prevention. The 294
inservice training course shall be in addition to the annual 295
inservice training hours required by agency rules. 296
(3) The agency, in consultation with the Boar d of Nursing, 297
shall establish by rule standards and procedures that a home 298
health aide or home health aide for medically fragile children 299
must follow when administering medication to a patient. Such 300
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rules must, at a minimum, address qualification requireme nts for 301
trainers, requirements for labeling medication, documentation 302
and recordkeeping, the storage and disposal of medication, 303
instructions concerning the safe administration of medication, 304
informed-consent requirements and records, and the training 305
curriculum and validation procedures. 306
Section 6. Section 400.490, Florida Statutes, is amended 307
to read: 308
400.490 Nurse-delegated tasks.—A certified nursing 309
assistant, home health aide for medically fragile children, or 310
home health aide may perform any tas k delegated by a registered 311
nurse as authorized in this part and in chapter 464, including, 312
but not limited to, medication administration. 313
Section 7. Section 400.54, Florida Statutes, is created to 314
read: 315
400.54 Annual assessment of the home health ai de for 316
medically fragile children program. —The agency shall conduct an 317
annual assessment of the home health aide for medically fragile 318
children program. The assessment must report caregiver 319
satisfaction with the program, identify additional support that 320
may be needed by the home health aide for medically fragile 321
children, and assess the rate and extent of hospitalization of 322
children in home health services who are attended by a home 323
health aide for medically fragile children compared to those in 324
home health services without a home health aide for medically 325
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fragile children. By January 1 of each year, beginning January 326
1, 2025, the agency shall report its findings to the Governor, 327
the President of the Senate, and the Speaker of the House of 328
Representatives. 329
Section 8. Subsection (1) of section 408.822, Florida 330
Statutes, is amended to read: 331
408.822 Direct care workforce survey. — 332
(1) For purposes of this section, the term "direct care 333
worker" means a certified nursing assistant, a home health aide, 334
a home health aide for medically fragile children a personal 335
care assistant, a companion services or homemaker services 336
provider, a paid feeding assistant trained under s. 337
400.141(1)(v), or another individual who provides personal care 338
as defined in s. 400.4 62 to individuals who are elderly, 339
developmentally disabled, or chronically ill. 340
Section 9. Subsections (1) and (2) of section 464.0156, 341
Florida Statutes, are amended to read: 342
464.0156 Delegation of duties. — 343
(1) A registered nurse may delegate a ta sk to a certified 344
nursing assistant certified under part II of this chapter or a 345
home health aide or a home health aide for medically fragile 346
children as defined in s. 400.462 if the registered nurse 347
determines that the certified nursing assistant or the h ome 348
health aide is competent to perform the task, the task is 349
delegable under federal law, and the task meets all of the 350
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following criteria: 351
(a) Is within the nurse's scope of practice. 352
(b) Frequently recurs in the routine care of a patient or 353
group of patients. 354
(c) Is performed according to an established sequence of 355
steps. 356
(d) Involves little or no modification from one patient to 357
another. 358
(e) May be performed with a predictable outcome. 359
(f) Does not inherently involve ongoing assessment, 360
interpretation, or clinical judgment. 361
(g) Does not endanger a patient's life or well -being. 362
(2) A registered nurse may delegate to a certified nursing 363
assistant, or a home health aide, or a home health aide for 364
medically fragile children the administration of oral, 365
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 366
topical prescription medications to a patient of a home health 367
agency or in a local county detention facility as defined in s. 368
951.23(1), if the certified nursing assistant or home healt h 369
aide meets the requirements of s. 464.2035 or s. 400.489, 370
respectively. A registered nurse may not delegate the 371
administration of any controlled substance listed in Schedule 372
II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s. 373
812, except for the administration of an insulin syringe that is 374
prefilled with the proper dosage by a pharmacist or an insulin 375
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pen that is prefilled by the manufacturer. 376
Section 10. For the 2023-2024 fiscal year, four full -time 377
equivalent positions, with associated sal ary rate of 186,483, 378
are authorized and the sums of $353,589 in recurring funds and 379
$118,728 in nonrecurring funds from the Health Care Trust Fund 380
are appropriated to the Agency for Health Care Administration 381
for the purpose of implementing this act. 382
Section 11. This act shall take effect upon becoming a 383
law. 384