FL
Florida House Bill H0391

Florida 2023 Regular Session

Florida House Bill H0391 Compare Versions

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1010 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
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14+A bill to be entitled 1
1515 An act relating to home health aides for medically 2
1616 fragile children; amending s. 400.462, F.S.; providing 3
1717 definitions; amending s. 400.464, F.S.; requiring home 4
1818 health agencies to ensure that any tasks delegated to 5
1919 home health aides for medically fragile c hildren meet 6
2020 specified requirements; amending s. 400.476, F.S.; 7
2121 requiring that home health aides for medically fragile 8
2222 children employed by or under contract with home 9
2323 health agencies be adequately trained to perform 10
2424 delegated tasks; providing certain indi viduals an 11
2525 exemption from costs associated with specified 12
2626 training; creating s. 400.4765, F.S.; providing 13
2727 legislative findings and intent; providing 14
2828 requirements for a family caregiver to be employed as 15
2929 a home health aide for medically fragile children; 16
3030 requiring the Agency for Health Care Administration, 17
3131 in consultation with the Board of Nursing, to develop 18
3232 a home health aide for medically fragile children 19
3333 training programs; providing requirements for the 20
3434 program; requiring home health aides for medically 21
3535 fragile children to complete inservice training as a 22
3636 condition of employment; requiring home health aides 23
3737 for medically fragile children to maintain 24
3838 documentation demonstrating compliance with such 25
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4747 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
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5151 training requirements; exempting home health agencies 26
5252 from civil liability for terminating or denying 27
5353 employment to a home health aide for medically fragile 28
5454 children under certain circumstances; extending the 29
5555 exemption to certain agents of the home health 30
5656 agencies; prohibiting home health agencies or their 31
5757 agents from using certain criminal records or juvenile 32
5858 records other than for a specified purpose; requiring 33
5959 the agency to maintain confidentiality of certain 34
6060 confidential and exempt records; providing 35
6161 requirements for services provided by a home health 36
6262 aide for medically fragile children; authorizing the 37
6363 agency, in consultation with the board, to adopt rules 38
6464 to implement the act; requiring the agency to modify 39
6565 any state Medicaid plans and implement any federal 40
6666 waivers necessary to implement this act and establis h 41
6767 a specified Medicaid fee schedule for home health 42
6868 agencies employing a home health aide for medically 43
6969 fragile children; ss. 400.489 and 400.490, F.S.; 44
7070 conforming provisions to changes made by the act; 45
7171 amending; creating s. 400.54, F.S.; requiring the 46
7272 Agency for Health Care Administration to conduct an 47
7373 annual assessment related to the certified health aide 48
7474 program; providing requirements for the assessment; 49
7575 requiring the agency to submit a report to the 50
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8484 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
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8888 Governor and the Legislature annually, by and 51
8989 beginning on a specified date; amending s. 408.822, 52
9090 F.S.; conforming a provision to changes made by the 53
9191 act; amending s. 464.0156, F.S.; conforming provisions 54
9292 to changes made by the act; providing appropriations; 55
9393 providing an effective date. 56
9494 57
9595 Be It Enacted by the Legislature of the State of Florida: 58
9696 59
9797 Section 1. Subsections (5) through (10) of section 60
9898 400.462, Florida Statutes, are renumbered as subsections (6) 61
9999 through (11), present subsection (11) is renumbered as 62
100100 subsection (13), present subsections (12), (13), and (14) are 63
101101 renumbered as subsections (15), (16), and (17), and present 64
102102 subsections (15) through (29) are renumbered as subsections (19) 65
103103 through (33), respectively, subsection (1) and present 66
104104 subsection (10) are amended, and new subsections (5), (1 2), 67
105105 (14), and (18), are added to that section, to read: 68
106106 400.462 Definitions. —As used in this part, the term: 69
107107 (1) "Administrator" means a direct employee, as defined in 70
108108 subsection (10) (9), who is a licensed physician, physician 71
109109 assistant, or registered nurse licensed to practice in this 72
110110 state or an individual having at least 1 year of supervisory or 73
111111 administrative experience in home health care or in a facility 74
112112 licensed under chapter 395, under part II of this chapter, or 75
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121121 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
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125125 under part I of chapter 429. 76
126126 (5) "Approved training program" means a course of training 77
127127 approved by the agency, in consultation with the Board of 78
128128 Nursing, to train a family caregiver as a home health aide for 79
129129 medically fragile children. 80
130130 (11)(10) "Director of nursing" means a registe red nurse 81
131131 who is a direct employee, as defined in subsection (10) (9), of 82
132132 the agency and who is a graduate of an approved school of 83
133133 nursing and is licensed in this state; who has at least 1 year 84
134134 of supervisory experience as a registered nurse; and who is 85
135135 responsible for overseeing the delivery of professional nursing 86
136136 and home health aide aid delivery of services of the agency. 87
137137 (12) "Eligible relative" means a patient 21 years of age 88
138138 or younger who has an underlying physical, mental, or cognitive 89
139139 impairment that prevents him or her from safely living 90
140140 independently, is eligible to receive skilled care or respite 91
141141 care services under the Medicaid program, and is related to his 92
142142 or her family caregiver. 93
143143 (14) "Family caregiver" means a person who provides or 94
144144 intends to provide significant personal care to an eligible 95
145145 relative. 96
146146 (18) "Home health aide for medically fragile children" 97
147147 means a family caregiver who meets the qualifications specified 98
148148 in this part and who performs tasks delegated to him or her 99
149149 under chapter 464 while caring for an eligible relative, and 100
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158158 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
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162162 provides care relating to activities of daily living, including 101
163163 those associated with personal care; maintaining mobility; 102
164164 nutrition and hydration; toileting and elimination; assistive 103
165165 devices; safety and cleanliness; data gathering; reporting 104
166166 abnormal signs and symptoms; postmortem care; patient 105
167167 socialization and reality orientation; end -of-life care; 106
168168 cardiopulmonary resuscitation and emergency care; residents' or 107
169169 patients' rights; documentation of serv ices performed; infection 108
170170 control; safety and emergency procedures; hygiene, grooming, 109
171171 skin care, and pressure sore prevention; wound care; portable 110
172172 oxygen use and safety and other respiratory procedures; 111
173173 tracheostomy care; enteral care and therapy; periph eral 112
174174 intravenous assistive activities and alternative feeding 113
175175 methods; and any other tasks delegated to the family caregiver 114
176176 under chapter 464. 115
177177 Section 2. Subsection (5) and paragraph (d) of subsection 116
178178 (6) of section 400.464, Florida Statutes, are amen ded to read: 117
179179 400.464 Home health agencies to be licensed; expiration of 118
180180 license; exemptions; unlawful acts; penalties. — 119
181181 (5) If a licensed home health agency authorizes a 120
182182 registered nurse to delegate tasks, including medication 121
183183 administration, to a cert ified nursing assistant pursuant to 122
184184 chapter 464 or to a home health aide or a home health aide for 123
185185 medically fragile children pursuant to s. 400.490, the licensed 124
186186 home health agency must ensure that such delegation meets the 125
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195195 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
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199199 requirements of this chapter an d chapter 464 and the rules 126
200200 adopted thereunder. 127
201201 (6) The following are exempt from licensure as a home 128
202202 health agency under this part: 129
203203 (d) A home health aide , home health aide for medically 130
204204 fragile children, or certified nursing assistant who is acting 131
205205 in his or her individual capacity, within the definitions and 132
206206 standards of his or her occupation, and who provides hands -on 133
207207 care to patients in their homes. 134
208208 Section 3. Subsection (3) of section 400.476, Florida 135
209209 Statutes, is amended to read: 136
210210 400.476 Staffing requirements; notifications; limitations 137
211211 on staffing services. — 138
212212 (3) TRAINING.—A home health agency shall ensure that each 139
213213 certified nursing assistant employed by or under contract with 140
214214 the home health agency and each home health aide or home health 141
215215 aide for medically fragile children employed by or under 142
216216 contract with the home health agency is adequately trained to 143
217217 perform the tasks of a home health aide or home health aide for 144
218218 medically fragile children in the home setting. A parent, 145
219219 guardian, or family member who is seeking training required 146
220220 under s. 400.4765 to become a home health aide for medically 147
221221 fragile children is not required to repay or reimburse the home 148
222222 health agency for the costs associated with the home health aide 149
223223 for medically fragile children training program. 150
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232232 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
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235235
236236 Section 4. Section 400.4765, Florida Statutes, is created 151
237237 to read: 152
238238 400.4765 Home health aide for medically fragile children 153
239239 program.— 154
240240 (1) LEGISLATIVE FINDINGS AND INTENT. —The home health aide 155
241241 for medically fragile ch ildren program is hereby established in 156
242242 response to the existing national health care provider shortage 157
243243 and the impact that the shortage has on medically fragile 158
244244 children and the family caregivers. This program is created to 159
245245 decrease the hospitalization an d institutionalization of 160
246246 medically fragile children, reduce state expenditures, and 161
247247 provide an opportunity for a family caregiver to receive 162
248248 training and gainful employment. 163
249249 (2) ELIGIBILITY REQUIREMENTS. —A home health agency may 164
250250 employ as a home health aide for medically fragile children any 165
251251 person 18 years of age or older who meets all of the following 166
252252 requirements. A person must: 167
253253 (a) Be a family caregiver of an eligible relative. 168
254254 (b) Demonstrate a minimum competency to read and write. 169
255255 (c) Complete an approved training program as set forth in 170
256256 this section or have graduated from an accredited prelicensure 171
257257 nursing education program and are waiting to take the state 172
258258 licensing exam. 173
259259 (d) Successfully pass the required background screening 174
260260 pursuant to s. 400.215. If the person has successfully passed 175
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269269 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
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273273 the required background screening pursuant to s. 400.215 or s. 176
274274 408.809 within 90 days before applying for a certificate to 177
275275 practice and the person's background screening results are not 178
276276 retained in the clearinghouse created under s. 435.12, the 179
277277 agency shall waive the requirement that the applicant 180
278278 successfully pass an additional background screening pursuant to 181
279279 s. 400.215. 182
280280 (3) TRAINING.— 183
281281 (a) The agency, in consultation with the Board of Nursing, 184
282282 shall approve home health aide for medically fragile children 185
283283 training programs developed by home health agencies in 186
284284 accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 187
285285 train family caregivers as home health aides for medically 188
286286 fragile children to increa se the health care provider workforce 189
287287 and to authorize persons to provide trained nursing services as 190
288288 delegated by a registered nurse to eligible relatives. The 191
289289 program must consist of at least 85 hours of training, 192
290290 including, but not limited to, all of th e following: 193
291291 1. A minimum of 40 hours of theoretical instruction in 194
292292 nursing, including, but not limited to, instruction on all of 195
293293 the following: 196
294294 a. Person-centered care. 197
295295 b. Communication and interpersonal skills. 198
296296 c. Infection control. 199
297297 d. Safety and emergency procedures. 200
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306306 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
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310310 e. Assistance with activities of daily living. 201
311311 f. Mental health and social service needs. 202
312312 g. Care of cognitively impaired individuals. 203
313313 h. Basic restorative care and rehabilitation. 204
314314 i. Patient rights and confidentiality of personal 205
315315 information and medical records. 206
316316 j. Relevant legal and ethical issues. 207
317317 208
318318 Such instruction must be offered in various formats, and any 209
319319 interactive instruction must be provided during various times of 210
320320 the day. 211
321321 2. A minimum of 20 hours of skills training on basic 212
322322 nursing skills, including, but not limited to: 213
323323 a. Hygiene, grooming, and toileting. 214
324324 b. Skin care and pressure sore prevention. 215
325325 c. Nutrition and hydration. 216
326326 d. Measuring vital signs, height, and weight. 217
327327 e. Safe lifting, positioning, and moving of patients. 218
328328 f. Wound care. 219
329329 g. Portable oxygen use and safety and other respiratory 220
330330 procedures. 221
331331 h. Tracheostomy care. 222
332332 i. Enteral care and therapy. 223
333333 j. Peripheral intravenous assistive activities and 224
334334 alternative feeding meth ods. 225
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343343 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
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345345
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347347 k. Urinary catheterization and ostomy care. 226
348348 3. At least 16 hours of clinical training under direct 227
349349 supervision of a licensed registered nurse. 228
350350 4. Training concerning HIV infections and AIDS and is 229
351351 required to obtain and maintain a current certif icate in 230
352352 cardiopulmonary resuscitation. 231
353353 (b) If a home health aide for medically fragile children 232
354354 allows 24 consecutive months to pass without providing any 233
355355 personal care related services for an eligible relative, the 234
356356 family caregiver must complete an ap proved training program 235
357357 before providing personal care related services as a home health 236
358358 aide for medically fragile children. 237
359359 (4) EMPLOYMENT.—A home health agency that employs a home 238
360360 health aide for medically fragile children must ensure that the 239
361361 home health aide for medically fragile children completes 12 240
362362 hours of inservice training during each 12 -month period as a 241
363363 condition of employment. The training concerning HIV infections 242
364364 and AIDS and the cardiopulmonary training may count toward 243
365365 meeting the 12 hours of inservice training. The home health 244
366366 agency shall maintain documentation demonstrating compliance 245
367367 with this subsection. 246
368368 (5) LIABILITY.—If a home health agency terminates or 247
369369 denies employment to a home health aide for medically fragile 248
370370 children who fails to maintain the requirements of this part or 249
371371 whose name appears on a criminal screening report of the 250
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380380 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
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384384 Department of Law Enforcement, the home health agency is not 251
385385 civilly liable for such termination and a cause of action may 252
386386 not be brought against the home health agency for damages. There 253
387387 may not be any monetary liability on the part of, and a cause of 254
388388 action for damages may not arise against, any licensed facility 255
389389 or its governing board or members thereof, medical staff, 256
390390 disciplinary board, agents, in vestigators, witnesses, employees, 257
391391 or any other person for any action taken in good faith, without 258
392392 intentional fraud, to comply with this part. 259
393393 (6) CONFIDENTIALITY. —A home health agency, or an agent 260
394394 thereof, may not use criminal records or juvenile recor ds 261
395395 relating to vulnerable adults for any purpose other than 262
396396 determining if the person meets the requirements of this part. 263
397397 The agency shall maintain the confidentiality of any such 264
398398 records and information it obtains which are confidential and 265
399399 exempt from s. 119.07(1) and s. 24(a), Art. I of the State 266
400400 Constitution. 267
401401 (7) SERVICES.—Services provided by a home health aide for 268
402402 medically fragile children must reduce an eligible relative's 269
403403 private duty nursing service hours. Such services may not be 270
404404 provided concurrently with any private duty nursing service. 271
405405 (8) RULES.—The agency, in consultation with the Board of 272
406406 Nursing, may adopt rules to implement this section. 273
407407 (9) FEE SCHEDULE.—The agency shall modify any state 274
408408 Medicaid plans and implement any federal wa ivers necessary to 275
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417417 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
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421421 implement this section and shall establish a Medicaid fee 276
422422 schedule for home health agencies employing a home health aide 277
423423 for medically fragile children at $25 per hour with a 278
424424 utilization cap of no more than 8 hours per day. 279
425425 Section 5. Section 400.489, Florida Statutes, is amended 280
426426 to read: 281
427427 400.489 Administration of medication by a home health aide 282
428428 or home health aide for medically fragile children ; staff 283
429429 training requirements. — 284
430430 (1) A home health aide or home health aide for medical ly 285
431431 fragile children may administer oral, transdermal, ophthalmic, 286
432432 otic, rectal, inhaled, enteral, or topical prescription 287
433433 medications if the home health aide or home health aide for 288
434434 medically fragile children has been delegated such task by a 289
435435 registered nurse licensed under chapter 464, has satisfactorily 290
436436 completed an initial 6 -hour training course approved by the 291
437437 agency, and has been found competent to administer medication to 292
438438 a patient in a safe and sanitary manner. The training, 293
439439 determination of competen cy, and initial and annual validations 294
440440 required in this section shall be conducted by a registered 295
441441 nurse licensed under chapter 464 or a physician licensed under 296
442442 chapter 458 or chapter 459. 297
443443 (2) A home health aide or home health aide for medically 298
444444 fragile children must annually and satisfactorily complete a 2 -299
445445 hour inservice training course approved by the agency in 300
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454454 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
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458458 medication administration and medication error prevention. The 301
459459 inservice training course shall be in addition to the annual 302
460460 inservice training hours required by agency rules. 303
461461 (3) The agency, in consultation with the Board of Nursing, 304
462462 shall establish by rule standards and procedures that a home 305
463463 health aide or home health aide for medically fragile children 306
464464 must follow when administering medicati on to a patient. Such 307
465465 rules must, at a minimum, address qualification requirements for 308
466466 trainers, requirements for labeling medication, documentation 309
467467 and recordkeeping, the storage and disposal of medication, 310
468468 instructions concerning the safe administration of medication, 311
469469 informed-consent requirements and records, and the training 312
470470 curriculum and validation procedures. 313
471471 Section 6. Section 400.490, Florida Statutes, is amended 314
472472 to read: 315
473473 400.490 Nurse-delegated tasks.—A certified nursing 316
474474 assistant, home health aide for medically fragile children, or 317
475475 home health aide may perform any task delegated by a registered 318
476476 nurse as authorized in this part and in chapter 464, including, 319
477477 but not limited to, medication administration. 320
478478 Section 7. Section 400.54, Florida Statutes, is created to 321
479479 read: 322
480480 400.54 Annual assessment of the home health aide for 323
481481 medically fragile children program. —The agency shall conduct an 324
482482 annual assessment of the home health aide for medically fragile 325
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491491 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
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495495 children program. The assessment must repo rt caregiver 326
496496 satisfaction with the program, identify additional support that 327
497497 may be needed by the home health aide for medically fragile 328
498498 children, and assess the rate and extent of hospitalization of 329
499499 children in home health services who are attended by a h ome 330
500500 health aide for medically fragile children compared to those in 331
501501 home health services without a home health aide for medically 332
502502 fragile children. By January 1 of each year, beginning January 333
503503 1, 2025, the agency shall report its findings to the Governor, 334
504504 the President of the Senate, and the Speaker of the House of 335
505505 Representatives. 336
506506 Section 8. Subsection (1) of section 408.822, Florida 337
507507 Statutes, is amended to read: 338
508508 408.822 Direct care workforce survey. — 339
509509 (1) For purposes of this section, the term "direct care 340
510510 worker" means a certified nursing assistant, a home health aide, 341
511511 a home health aide for medically fragile children a personal 342
512512 care assistant, a companion services or homemaker services 343
513513 provider, a paid feeding assistant trained under s. 344
514514 400.141(1)(v), or another individual who provides personal care 345
515515 as defined in s. 400.462 to individuals who are elderly, 346
516516 developmentally disabled, or chronically ill. 347
517517 Section 9. Subsections (1) and (2) of section 4 64.0156, 348
518518 Florida Statutes, are amended to read: 349
519519 464.0156 Delegation of duties. — 350
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528528 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
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532532 (1) A registered nurse may delegate a task to a certified 351
533533 nursing assistant certified under part II of this chapter or a 352
534534 home health aide or a home health aide for medicall y fragile 353
535535 children as defined in s. 400.462 if the registered nurse 354
536536 determines that the certified nursing assistant or the home 355
537537 health aide is competent to perform the task, the task is 356
538538 delegable under federal law, and the task meets all of the 357
539539 following criteria: 358
540540 (a) Is within the nurse's scope of practice. 359
541541 (b) Frequently recurs in the routine care of a patient or 360
542542 group of patients. 361
543543 (c) Is performed according to an established sequence of 362
544544 steps. 363
545545 (d) Involves little or no modification from one patie nt to 364
546546 another. 365
547547 (e) May be performed with a predictable outcome. 366
548548 (f) Does not inherently involve ongoing assessment, 367
549549 interpretation, or clinical judgment. 368
550550 (g) Does not endanger a patient's life or well -being. 369
551551 (2) A registered nurse may delegate to a certified nursing 370
552552 assistant, or a home health aide, or a home health aide for 371
553553 medically fragile children the administration of oral, 372
554554 transdermal, ophthalmic, otic, rectal, inhaled, enteral, or 373
555555 topical prescription medications to a patient of a home health 374
556556 agency or in a local county detention facility as defined in s. 375
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565565 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
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569569 951.23(1), if the certified nursing assistant or home health 376
570570 aide meets the requirements of s. 464.2035 or s. 400.489, 377
571571 respectively. A registered nurse may not delegate the 378
572572 administration of any controlled substance listed in Schedule 379
573573 II, Schedule III, or Schedule IV of s. 893.03 or 21 U.S.C. s. 380
574574 812, except for the administration of an insulin syringe that is 381
575575 prefilled with the proper dosage by a pharmacist or an insulin 382
576576 pen that is prefilled by the manufacturer. 383
577577 Section 10. For the 2023-2024 fiscal year, four full -time 384
578578 equivalent positions, with associated salary rate of 186,483, 385
579579 are authorized and the sums of $353,589 in recurring funds and 386
580580 $118,728 in nonrecurring funds from the Health C are Trust Fund 387
581581 are appropriated to the Agency for Health Care Administration 388
582582 for the purpose of implementing this act. 389
583583 Section 11. This act shall take effect upon becoming a 390
584584 law. 391