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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 the home health aide for medically 2
fragile children program; amending s. 400.54, F.S.; 3
providing requirements for the annual assessment of 4
home health aide for medically fragile children 5
program; amending s. 400.4765, F.S.; revising program 6
training requirements; revising the utilization cap of 7
a Medicaid fee schedule; requiring a home health aide 8
for medically fragile children who works more than 40 9
hours per week to provide specified justification; 10
providing requirements for the Agency for Health Care 11
Administration to seek federal approval and a federal 12
waiver for specified purposes; amending s. 400.462, 13
F.S.; conforming provisions to chang es made by the 14
act; amending s. 409.903, F.S.; requiring the agency 15
to seek federal approval and implement federal waivers 16
and state plan amendments for specified purposes; 17
providing construction; providing an effective date. 18
19
Be It Enacted by the Legi slature of the State of Florida: 20
21
Section 1. Section 400.54, Florida Statutes, is amended to 22
read: 23
400.54 Annual assessment of the home health aide for 24
medically fragile children program. — 25
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(1) The agency shall conduct an annual assessment of the 26
home health aide for medically fragile children program. The 27
assessment must report caregiver satisfaction with the program, 28
report data on adverse incidents, and identify additional 29
support that may be needed by the home health aide for medically 30
fragile children, and assess the rate and extent of 31
hospitalization of children in home health services who are 32
attended by a home health aide for medically fragile children 33
compared to those in home health services provided by a 34
registered nurse or a licensed pract ical nurse without a home 35
health aide for medically fragile children. Medicaid managed 36
care plans shall provide to the agency data necessary to perform 37
this assessment. 38
(2) The home health agency must report all adverse 39
incidents occurring under the care of a home health aide for 40
medically fragile children to the agency and managed care plan 41
within 48 hours of the incident. For purposes of reporting to 42
the agency under this section, the term "adverse incident" 43
means: 44
(a) Death. 45
(b) Brain or spinal dam age. 46
(c) Permanent disfigurement. 47
(d) Fracture or dislocation of bones or joints. 48
(e) A limitation of neurological, physical, or sensory 49
function. 50
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(f) An event that is reported to law enforcement or its 51
personnel for investigation . 52
53
By January 1 of each year, beginning January 1, 2025, the agency 54
shall report its findings to the Governor, the President of the 55
Senate, and the Speaker of the House of Representatives . 56
Section 2. Paragraph (a) of subsection (3) and subsection 57
(9) of section 400.4765, Florida Statutes, are amended, and 58
subsection (10) is added to that section, to read: 59
400.4765 Home health aide for medically fragile children 60
program.— 61
(3) TRAINING.— 62
(a) Before proving services to an eligible relative, a 63
home health aide for medically fragile children must complete an 64
approved training program. The employing home health agency must 65
provide validation of competency by a registered nurse, and 66
maintain documentation of training completion and competency 67
validation. The employ ing home health agency must provide 68
additional training and competency validation as the medically 69
fragile child's care needs change and consistent with any 70
changes to the plan of care. 71
(b)(a) The agency, in consultation with the Board of 72
Nursing, shall approve home health aide for medically fragile 73
children training programs developed by home health agencies in 74
accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 75
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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
train family caregivers as home health aides for medically 76
fragile children to increa se the health care provider workforce 77
and to authorize persons to provide trained nursing services as 78
delegated by a registered nurse to eligible relatives. The 79
program shall include must consist of at least 85 hours of 80
training, including, but not be limited to, all of the 81
following: 82
1. A minimum of 20 40 hours of theoretical instruction in 83
nursing, including, but not limited to, instruction on all of 84
the following: 85
a. Person-centered care. 86
b. Communication and interpersonal skills. 87
c. Infection control. 88
d. Safety and emergency procedures. 89
e. Assistance with activities of daily living. 90
f. Mental health and social service needs. 91
g. Care of cognitively impaired individuals. 92
h. Basic restorative care and rehabilitation. 93
i. Patient rights an d confidentiality of personal 94
information and medical records. 95
j. Relevant legal and ethical issues. 96
97
Such instruction must be offered in various formats, and any 98
interactive instruction must be provided during various times of 99
the day. 100
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2. Up to A minimum of 20 hours of skills training on basic 101
nursing skills tailored to the child's care needs as specified 102
in the ordering provider's plan of care and individualized care 103
needs, which may include training on the following topics, as 104
applicable 105
, including, but not limited to: 106
a. Hygiene, grooming, and toileting. 107
b. Skin care and pressure sore prevention. 108
c. Nutrition and hydration. 109
d. Measuring vital signs, height, and weight. 110
e. Safe lifting, positioning, and moving of patients. 111
f. Wound care. 112
g. Portable Oxygen use and safety and other respiratory 113
procedures. 114
h. Tracheostomy care. 115
i. Enteral care and therapy. 116
j. Peripheral Intravenous assistive activities and 117
alternative feeding methods. 118
k. Urinary catheterization and care and ostomy care. 119
3. Up to At least 16 hours of clinical training related to 120
the specific needs of the eligible relative under direct 121
supervision of a licensed registered nurse. 122
4. Training concerning HIV infections and AIDS and is 123
required to obtain and maintain a current certificate in 124
cardiopulmonary resuscitation . 125
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5. Obtain and maintain a current certificate in 126
cardiopulmonary resuscitation. 127
(9) FEE SCHEDULE.—The agency shall modify any state 128
Medicaid plans and implement any federal waivers nec essary to 129
implement this section and shall establish a Medicaid fee 130
schedule for home health agencies employing a home health aide 131
for medically fragile children at minimum rate of $25 per hour 132
with a utilization cap of no more than 12 8 hours per day and 40 133
hours per week, per medically fragile child. The utilization cap 134
of 40 hours per week, per recipient may be exceeded; however 135
justification must be provided as to why there is no other 136
qualified provider available, and the request must be approved 137
by the home health agency and the managed care plan . 138
(10) FEDERAL APPROVAL. —Within 30 days after the effective 139
date of this act, the agency shall seek federal approval, 140
including seeking the appropriate federal waiver, to: 141
(a) Allow Medicaid private duty nu rsing specialty 142
providers and home health services providers to participate in 143
and receive reimbursement for services rendered under this 144
program. 145
(b) Provide that the income earned under this program by a 146
home health aide for medically fragile children is disregarded 147
in eligibility considerations for public assistance as defined 148
in s. 414.0252. 149
Section 3. Subsection (18) of section 400.462, Florida 150
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Statutes, is amended to read: 151
400.462 Definitions. —As used in this part, the term: 152
(18) "Home health aide for medically fragile children" 153
means a family caregiver who meets the qualifications specified 154
in this part and who performs tasks delegated to him or her 155
under chapter 464 while caring for an eligible relative, and 156
provides care relating to activi ties of daily living, including 157
those associated with personal care; maintaining mobility; 158
nutrition and hydration; toileting and elimination; assistive 159
devices; safety and cleanliness; data gathering; reporting 160
abnormal signs and symptoms; postmortem care ; patient 161
socialization and reality orientation; end -of-life care; 162
cardiopulmonary resuscitation and emergency care; residents' or 163
patients' rights; documentation of services performed; infection 164
control; safety and emergency procedures; hygiene, grooming, 165
skin care, and pressure sore prevention; wound care; portable 166
oxygen use and safety and other respiratory procedures; 167
tracheostomy care; enteral care and therapy; peripheral 168
intravenous assistive activities and alternative feeding 169
methods; and any other t asks delegated to the family caregiver 170
under chapter 464. 171
Section 4. Paragraph (c) of subsection (1) of section 172
409.903, Florida Statutes, is amended to read: 173
409.903 Mandatory payments for eligible persons. —The 174
agency shall make payments for medical assistance and related 175
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services on behalf of the following persons who the department, 176
or the Social Security Administration by contract with the 177
Department of Children and Families, determines to be eligible, 178
subject to the income, assets, and categorica l eligibility tests 179
set forth in federal and state law. Payment on behalf of these 180
Medicaid eligible persons is subject to the availability of 181
moneys and any limitations established by the General 182
Appropriations Act or chapter 216. 183
(1) Low-income families with children are eligible for 184
Medicaid provided they meet the following requirements: 185
(c) The family's countable income and resources do not 186
exceed the applicable Aid to Families with Dependent Children 187
(AFDC) income and resource standards under the A FDC state plan 188
in effect in July 1996, except as amended in the Medicaid state 189
plan to conform as closely as possible to the requirements of 190
the welfare transition program, to the extent permitted by 191
federal law. The agency shall seek federal approval, inc luding 192
seeking the appropriate federal waiver or state plan amendment, 193
to exclude from the family's countable income any income earned 194
through employment as a home health aide for medically fragile 195
children under s. 400.4765. 196
Section 5. Within 60 days after this act becomes law, the 197
Agency for Health Care Administration shall make all necessary 198
requests and submissions to obtain federal approval to implement 199
this act amending s. 409.903, Florida Statutes, and initiate any 200
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necessary rulemaking to impleme nt the provisions of this act 201
amending s. 400.4765, Florida Statutes. 202
Section 6. This act shall take effect upon becoming a law. 203