CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 1 of 16
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
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 2 of 16
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
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
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 3 of 16
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
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 4 of 16
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
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 chapter 464 while caring for an eligible relative, and 100
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 5 of 16
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
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; 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; documentation of serv ices performed; infection 108
control; safety and emergency procedures; hygiene, grooming, 109
skin care, and pressure sore prevention; wound care; portable 110
oxygen use and safety and other respiratory procedures; 111
tracheostomy care; enteral care and therapy; periph eral 112
intravenous assistive activities and alternative feeding 113
methods; and any other tasks delegated to the family caregiver 114
under chapter 464. 115
Section 2. Subsection (5) and paragraph (d) of subsection 116
(6) of section 400.464, Florida Statutes, are amen ded to read: 117
400.464 Home health agencies to be licensed; expiration of 118
license; exemptions; unlawful acts; penalties. — 119
(5) If a licensed home health agency authorizes a 120
registered nurse to delegate tasks, including medication 121
administration, to a cert ified nursing assistant pursuant to 122
chapter 464 or to a home health aide or a home health aide for 123
medically fragile children pursuant to s. 400.490, the licensed 124
home health agency must ensure that such delegation meets the 125
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 6 of 16
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
requirements of this chapter an d chapter 464 and the rules 126
adopted thereunder. 127
(6) The following are exempt from licensure as a home 128
health agency under this part: 129
(d) A home health aide , home health aide for medically 130
fragile children, or certified nursing assistant who is acting 131
in his or her individual capacity, within the definitions and 132
standards of his or her occupation, and who provides hands -on 133
care to patients in their homes. 134
Section 3. Subsection (3) of section 400.476, Florida 135
Statutes, is amended to read: 136
400.476 Staffing requirements; notifications; limitations 137
on staffing services. — 138
(3) TRAINING.—A home health agency shall ensure that each 139
certified nursing assistant employed by or under contract with 140
the home health agency and each home health aide or home health 141
aide for medically fragile children employed by or under 142
contract with the home health agency is adequately trained to 143
perform the tasks of a home health aide or home health aide for 144
medically fragile children in the home setting. A parent, 145
guardian, or family member who is seeking training required 146
under s. 400.4765 to become a home health aide for medically 147
fragile children is not required to repay or reimburse the home 148
health agency for the costs associated with the home health aide 149
for medically fragile children training program. 150
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 7 of 16
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
Section 4. Section 400.4765, Florida Statutes, is created 151
to read: 152
400.4765 Home health aide for medically fragile children 153
program.— 154
(1) LEGISLATIVE FINDINGS AND INTENT. —The home health aide 155
for medically fragile ch ildren program is hereby established in 156
response to the existing national health care provider shortage 157
and the impact that the shortage has on medically fragile 158
children and the family caregivers. This program is created to 159
decrease the hospitalization an d institutionalization of 160
medically fragile children, reduce state expenditures, and 161
provide an opportunity for a family caregiver to receive 162
training and gainful employment. 163
(2) ELIGIBILITY REQUIREMENTS. —A home health agency may 164
employ as a home health aide for medically fragile children any 165
person 18 years of age or older who meets all of the following 166
requirements. A person must: 167
(a) Be a family caregiver of an eligible relative. 168
(b) Demonstrate a minimum competency to read and write. 169
(c) Complete an approved training program as set forth in 170
this section or have graduated from an accredited prelicensure 171
nursing education program and are waiting to take the state 172
licensing exam. 173
(d) Successfully pass the required background screening 174
pursuant to s. 400.215. If the person has successfully passed 175
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 8 of 16
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
the required background screening pursuant to s. 400.215 or s. 176
408.809 within 90 days before applying for a certificate to 177
practice and the person's background screening results are not 178
retained in the clearinghouse created under s. 435.12, the 179
agency shall waive the requirement that the applicant 180
successfully pass an additional background screening pursuant to 181
s. 400.215. 182
(3) TRAINING.— 183
(a) The agency, in consultation with the Board of Nursing, 184
shall approve home health aide for medically fragile children 185
training programs developed by home health agencies in 186
accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 187
train family caregivers as home health aides for medically 188
fragile children to increa se the health care provider workforce 189
and to authorize persons to provide trained nursing services as 190
delegated by a registered nurse to eligible relatives. The 191
program must consist of at least 85 hours of training, 192
including, but not limited to, all of th e following: 193
1. A minimum of 40 hours of theoretical instruction in 194
nursing, including, but not limited to, instruction on all of 195
the following: 196
a. Person-centered care. 197
b. Communication and interpersonal skills. 198
c. Infection control. 199
d. Safety and emergency procedures. 200
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 9 of 16
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
e. Assistance with activities of daily living. 201
f. Mental health and social service needs. 202
g. Care of cognitively impaired individuals. 203
h. Basic restorative care and rehabilitation. 204
i. Patient rights and confidentiality of personal 205
information and medical records. 206
j. Relevant legal and ethical issues. 207
208
Such instruction must be offered in various formats, and any 209
interactive instruction must be provided during various times of 210
the day. 211
2. A minimum of 20 hours of skills training on basic 212
nursing skills, including, but not limited to: 213
a. Hygiene, grooming, and toileting. 214
b. Skin care and pressure sore prevention. 215
c. Nutrition and hydration. 216
d. Measuring vital signs, height, and weight. 217
e. Safe lifting, positioning, and moving of patients. 218
f. Wound care. 219
g. Portable oxygen use and safety and other respiratory 220
procedures. 221
h. Tracheostomy care. 222
i. Enteral care and therapy. 223
j. Peripheral intravenous assistive activities and 224
alternative feeding meth ods. 225
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 10 of 16
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
k. Urinary catheterization and ostomy care. 226
3. At least 16 hours of clinical training under direct 227
supervision of a licensed registered nurse. 228
4. Training concerning HIV infections and AIDS and is 229
required to obtain and maintain a current certif icate in 230
cardiopulmonary resuscitation. 231
(b) If a home health aide for medically fragile children 232
allows 24 consecutive months to pass without providing any 233
personal care related services for an eligible relative, the 234
family caregiver must complete an ap proved training program 235
before providing personal care related services as a home health 236
aide for medically fragile children. 237
(4) EMPLOYMENT.—A home health agency that employs a home 238
health aide for medically fragile children must ensure that the 239
home health aide for medically fragile children completes 12 240
hours of inservice training during each 12 -month period as a 241
condition of employment. The training concerning HIV infections 242
and AIDS and the cardiopulmonary training may count toward 243
meeting the 12 hours of inservice training. The home health 244
agency shall maintain documentation demonstrating compliance 245
with this subsection. 246
(5) LIABILITY.—If a home health agency terminates or 247
denies employment to a home health aide for medically fragile 248
children who fails to maintain the requirements of this part or 249
whose name appears on a criminal screening report of the 250
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 11 of 16
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
Department of Law Enforcement, the home health agency is not 251
civilly liable for such termination and a cause of action may 252
not be brought against the home health agency for damages. There 253
may not be any monetary liability on the part of, and a cause of 254
action for damages may not arise against, any licensed facility 255
or its governing board or members thereof, medical staff, 256
disciplinary board, agents, in vestigators, witnesses, employees, 257
or any other person for any action taken in good faith, without 258
intentional fraud, to comply with this part. 259
(6) CONFIDENTIALITY. —A home health agency, or an agent 260
thereof, may not use criminal records or juvenile recor ds 261
relating to vulnerable adults for any purpose other than 262
determining if the person meets the requirements of this part. 263
The agency shall maintain the confidentiality of any such 264
records and information it obtains which are confidential and 265
exempt from s. 119.07(1) and s. 24(a), Art. I of the State 266
Constitution. 267
(7) SERVICES.—Services provided by a home health aide for 268
medically fragile children must reduce an eligible relative's 269
private duty nursing service hours. Such services may not be 270
provided concurrently with any private duty nursing service. 271
(8) RULES.—The agency, in consultation with the Board of 272
Nursing, may adopt rules to implement this section. 273
(9) FEE SCHEDULE.—The agency shall modify any state 274
Medicaid plans and implement any federal wa ivers necessary to 275
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 12 of 16
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
implement this section and shall establish a Medicaid fee 276
schedule for home health agencies employing a home health aide 277
for medically fragile children at $25 per hour with a 278
utilization cap of no more than 8 hours per day. 279
Section 5. Section 400.489, Florida Statutes, is amended 280
to read: 281
400.489 Administration of medication by a home health aide 282
or home health aide for medically fragile children ; staff 283
training requirements. — 284
(1) A home health aide or home health aide for medical ly 285
fragile children may administer oral, transdermal, ophthalmic, 286
otic, rectal, inhaled, enteral, or topical prescription 287
medications if the home health aide or home health aide for 288
medically fragile children has been delegated such task by a 289
registered nurse licensed under chapter 464, has satisfactorily 290
completed an initial 6 -hour training course approved by the 291
agency, and has been found competent to administer medication to 292
a patient in a safe and sanitary manner. The training, 293
determination of competen cy, and initial and annual validations 294
required in this section shall be conducted by a registered 295
nurse licensed under chapter 464 or a physician licensed under 296
chapter 458 or chapter 459. 297
(2) A home health aide or home health aide for medically 298
fragile children must annually and satisfactorily complete a 2 -299
hour inservice training course approved by the agency in 300
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 13 of 16
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
medication administration and medication error prevention. The 301
inservice training course shall be in addition to the annual 302
inservice training hours required by agency rules. 303
(3) The agency, in consultation with the Board of Nursing, 304
shall establish by rule standards and procedures that a home 305
health aide or home health aide for medically fragile children 306
must follow when administering medicati on to a patient. Such 307
rules must, at a minimum, address qualification requirements for 308
trainers, requirements for labeling medication, documentation 309
and recordkeeping, the storage and disposal of medication, 310
instructions concerning the safe administration of medication, 311
informed-consent requirements and records, and the training 312
curriculum and validation procedures. 313
Section 6. Section 400.490, Florida Statutes, is amended 314
to read: 315
400.490 Nurse-delegated tasks.—A certified nursing 316
assistant, home health aide for medically fragile children, or 317
home health aide may perform any task delegated by a registered 318
nurse as authorized in this part and in chapter 464, including, 319
but not limited to, medication administration. 320
Section 7. Section 400.54, Florida Statutes, is created to 321
read: 322
400.54 Annual assessment of the home health aide for 323
medically fragile children program. —The agency shall conduct an 324
annual assessment of the home health aide for medically fragile 325
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 14 of 16
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
children program. The assessment must repo rt caregiver 326
satisfaction with the program, identify additional support that 327
may be needed by the home health aide for medically fragile 328
children, and assess the rate and extent of hospitalization of 329
children in home health services who are attended by a h ome 330
health aide for medically fragile children compared to those in 331
home health services without a home health aide for medically 332
fragile children. By January 1 of each year, beginning January 333
1, 2025, the agency shall report its findings to the Governor, 334
the President of the Senate, and the Speaker of the House of 335
Representatives. 336
Section 8. Subsection (1) of section 408.822, Florida 337
Statutes, is amended to read: 338
408.822 Direct care workforce survey. — 339
(1) For purposes of this section, the term "direct care 340
worker" means a certified nursing assistant, a home health aide, 341
a home health aide for medically fragile children a personal 342
care assistant, a companion services or homemaker services 343
provider, a paid feeding assistant trained under s. 344
400.141(1)(v), or another individual who provides personal care 345
as defined in s. 400.462 to individuals who are elderly, 346
developmentally disabled, or chronically ill. 347
Section 9. Subsections (1) and (2) of section 4 64.0156, 348
Florida Statutes, are amended to read: 349
464.0156 Delegation of duties. — 350
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 15 of 16
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
(1) A registered nurse may delegate a task to a certified 351
nursing assistant certified under part II of this chapter or a 352
home health aide or a home health aide for medicall y fragile 353
children as defined in s. 400.462 if the registered nurse 354
determines that the certified nursing assistant or the home 355
health aide is competent to perform the task, the task is 356
delegable under federal law, and the task meets all of the 357
following criteria: 358
(a) Is within the nurse's scope of practice. 359
(b) Frequently recurs in the routine care of a patient or 360
group of patients. 361
(c) Is performed according to an established sequence of 362
steps. 363
(d) Involves little or no modification from one patie nt to 364
another. 365
(e) May be performed with a predictable outcome. 366
(f) Does not inherently involve ongoing assessment, 367
interpretation, or clinical judgment. 368
(g) Does not endanger a patient's life or well -being. 369
(2) A registered nurse may delegate to a certified nursing 370
assistant, or a home health aide, or a home health aide for 371
medically fragile children the administration of oral, 372
transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 373
topical prescription medications to a patient of a home health 374
agency or in a local county detention facility as defined in s. 375
CS/CS/CS/HB 391 2023
CODING: Words stricken are deletions; words underlined are additions.
hb0391-03-c3
Page 16 of 16
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
951.23(1), if the certified nursing assistant or home health 376
aide meets the requirements of s. 464.2035 or s. 400.489, 377
respectively. A registered nurse may not delegate the 378
administration of any controlled substance listed in Schedule 379
II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s. 380
812, except for the administration of an insulin syringe that is 381
prefilled with the proper dosage by a pharmacist or an insulin 382
pen that is prefilled by the manufacturer. 383
Section 10. For the 2023-2024 fiscal year, four full -time 384
equivalent positions, with associated salary rate of 186,483, 385
are authorized and the sums of $353,589 in recurring funds and 386
$118,728 in nonrecurring funds from the Health C are Trust Fund 387
are appropriated to the Agency for Health Care Administration 388
for the purpose of implementing this act. 389
Section 11. This act shall take effect upon becoming a 390
law. 391