FL
Florida House Bill H1529

Florida 2025 Regular Session

Florida House Bill H1529 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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1414 A bill to be entitled 1
1515 An act relating to the home health aide for medically 2
1616 fragile children program; amending s. 400.54, F.S.; 3
1717 providing requirements for the annual assessment of 4
1818 home health aide for medically fragile children 5
1919 program; amending s. 400.4765, F.S.; revising program 6
20-training requirements; requiring an employing home 7
21-health agency to provide specified training and ensure 8
22-each home health aide for medically fragile chil dren 9
23-holds and maintains specified certification; revising 10
24-the utilization cap of a Medicaid fee schedule; 11
25-requiring a home health aide for medically fragile 12
26-children who works more than 40 hours per week to 13
27-provide specified justification; providing 14
28-requirements for the Agency for Health Care 15
29-Administration to seek federal approval and a federal 16
30-waiver for specified purposes; amending s. 400.462, 17
31-F.S.; conforming provisions to changes made by the 18
32-act; amending s. 409.903, F.S.; requiring the agency 19
33-to seek federal approval and implement federal waivers 20
34-and state plan amendments for specified purposes; 21
35-providing construction; providing an effective date. 22
36- 23
37-Be It Enacted by the Legislature of the State of Florida: 24
38- 25
20+training requirements; revising the utilization cap of 7
21+a Medicaid fee schedule; requiring a home health aide 8
22+for medically fragile children who works more than 40 9
23+hours per week to provide specified justification; 10
24+providing requirements for the Agency for Health Care 11
25+Administration to seek federal approval and a federal 12
26+waiver for specified purposes; amending s. 400.462, 13
27+F.S.; conforming provisions to chang es made by the 14
28+act; amending s. 409.903, F.S.; requiring the agency 15
29+to seek federal approval and implement federal waivers 16
30+and state plan amendments for specified purposes; 17
31+providing construction; providing an effective date. 18
32+ 19
33+Be It Enacted by the Legi slature of the State of Florida: 20
34+ 21
35+ Section 1. Section 400.54, Florida Statutes, is amended to 22
36+read: 23
37+ 400.54 Annual assessment of the home health aide for 24
38+medically fragile children program. — 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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51- Section 1. Section 400.54, Florida St atutes, is amended to 26
52-read: 27
53- 400.54 Annual assessment of the home health aide for 28
54-medically fragile children program. — 29
55- (1) The agency shall conduct an annual assessment of the 30
56-home health aide for medically fragile children program. The 31
57-assessment must report caregiver satisfaction with the program, 32
58-report data on adverse incidents, and identify additional 33
59-support that may be needed by the home health aide for medically 34
60-fragile children, and assess the rate and extent of 35
61-hospitalization of children in ho me health services who are 36
62-attended by a home health aide for medically fragile children 37
63-compared to those in home health services provided by a 38
64-registered nurse or a licensed practical nurse without a home 39
65-health aide for medically fragile children. Medicaid managed 40
66-care plans shall provide to the agency data necessary to perform 41
67-this assessment. 42
68- (2) The home health agency must report all adverse 43
69-incidents occurring under the care of a home health aide for 44
70-medically fragile children to the agency and man aged care plan 45
71-within 48 hours of the incident. For purposes of reporting to 46
72-the agency under this section, the term "adverse incident" 47
73-means: 48
74- (a) Death. 49
75- (b) Brain or spinal damage. 50
51+ (1) The agency shall conduct an annual assessment of the 26
52+home health aide for medically fragile children program. The 27
53+assessment must report caregiver satisfaction with the program, 28
54+report data on adverse incidents, and identify additional 29
55+support that may be needed by the home health aide for medically 30
56+fragile children, and assess the rate and extent of 31
57+hospitalization of children in home health services who are 32
58+attended by a home health aide for medically fragile children 33
59+compared to those in home health services provided by a 34
60+registered nurse or a licensed pract ical nurse without a home 35
61+health aide for medically fragile children. Medicaid managed 36
62+care plans shall provide to the agency data necessary to perform 37
63+this assessment. 38
64+ (2) The home health agency must report all adverse 39
65+incidents occurring under the care of a home health aide for 40
66+medically fragile children to the agency and managed care plan 41
67+within 48 hours of the incident. For purposes of reporting to 42
68+the agency under this section, the term "adverse incident" 43
69+means: 44
70+ (a) Death. 45
71+ (b) Brain or spinal dam age. 46
72+ (c) Permanent disfigurement. 47
73+ (d) Fracture or dislocation of bones or joints. 48
74+ (e) A limitation of neurological, physical, or sensory 49
75+function. 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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88- (c) Permanent disfigurement. 51
89- (d) Fracture or dislocation of bones or joints. 52
90- (e) A limitation of neurological, physical, or sensory 53
91-function. 54
92- (f) An event that is reported to law enforcement or its 55
93-personnel for investigation. 56
94- 57
95-By January 1 of each year, beginning January 1, 2025, the agency 58
96-shall report its findings to the Governor, the President of the 59
97-Senate, and the Speaker of the House of Representatives. 60
98- Section 2. Paragraph (a) of subsection (3) and subsection 61
99-(9) of section 400.4765, Florida Statutes, are amended, and 62
100-subsection (10) is added to that section, to read: 63
101- 400.4765 Home health aide for medically fragile children 64
102-program.— 65
103- (3) TRAINING.— 66
104- (a) Before providing services to an eligible relative, a 67
105-home health aide for medically fragile children must complete an 68
106-agency-approved training pro gram. The employing home health 69
107-agency must provide validation of competency by a registered 70
108-nurse, and maintain documentation of training completion and 71
109-competency validation. The employing home health agency must 72
110-provide additional training and competenc y validation as the 73
111-medically fragile child's care needs change, consistent with any 74
112-changes to the plan of care. The employing home health agency 75
88+ (f) An event that is reported to law enforcement or its 51
89+personnel for investigation . 52
90+ 53
91+By January 1 of each year, beginning January 1, 2025, the agency 54
92+shall report its findings to the Governor, the President of the 55
93+Senate, and the Speaker of the House of Representatives . 56
94+ Section 2. Paragraph (a) of subsection (3) and subsection 57
95+(9) of section 400.4765, Florida Statutes, are amended, and 58
96+subsection (10) is added to that section, to read: 59
97+ 400.4765 Home health aide for medically fragile children 60
98+program.— 61
99+ (3) TRAINING.— 62
100+ (a) Before proving services to an eligible relative, a 63
101+home health aide for medically fragile children must complete an 64
102+approved training program. The employing home health agency must 65
103+provide validation of competency by a registered nurse, and 66
104+maintain documentation of training completion and competency 67
105+validation. The employ ing home health agency must provide 68
106+additional training and competency validation as the medically 69
107+fragile child's care needs change and consistent with any 70
108+changes to the plan of care. 71
109+ (b)(a) The agency, in consultation with the Board of 72
110+Nursing, shall approve home health aide for medically fragile 73
111+children training programs developed by home health agencies in 74
112+accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 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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125-must provide training on HIV infections and AIDS and must ensure 76
126-that each home health aide for medically fra gile children holds 77
127-and maintains a certification in cardiopulmonary resuscitation. 78
128- (b)(a) The agency, in consultation with the Board of 79
129-Nursing, shall approve home health aide for medically fragile 80
130-children training programs developed by home health age ncies in 81
131-accordance with 42 C.F.R. ss. 483.151 -483.154 and 484.80 to 82
132-train family caregivers as home health aides for medically 83
133-fragile children to increase the health care provider workforce 84
134-and to authorize persons to provide trained nursing services as 85
135-delegated by a registered nurse to eligible relatives. The 86
136-training programs program must include supervised practical 87
137-training under the direct supervision of a licensed registered 88
138-nurse which must be tailored to the needs of an eligible 89
139-relative. consist of at least 85 hours of training, including, 90
140-but not limited to, all of the following: 91
141- 1. A minimum of 40 hours of theoretical instruction in 92
142-nursing, including, but not limited to, instruction on all of 93
143-the following: 94
144- a. Person-centered care. 95
145- b. Communication and interpersonal skills. 96
146- c. Infection control. 97
147- d. Safety and emergency procedures. 98
148- e. Assistance with activities of daily living. 99
149- f. Mental health and social service needs. 100
125+train family caregivers as home health aides for medically 76
126+fragile children to increa se the health care provider workforce 77
127+and to authorize persons to provide trained nursing services as 78
128+delegated by a registered nurse to eligible relatives. The 79
129+program shall include must consist of at least 85 hours of 80
130+training, including, but not be limited to, all of the 81
131+following: 82
132+ 1. A minimum of 20 40 hours of theoretical instruction in 83
133+nursing, including, but not limited to, instruction on all of 84
134+the following: 85
135+ a. Person-centered care. 86
136+ b. Communication and interpersonal skills. 87
137+ c. Infection control. 88
138+ d. Safety and emergency procedures. 89
139+ e. Assistance with activities of daily living. 90
140+ f. Mental health and social service needs. 91
141+ g. Care of cognitively impaired individuals. 92
142+ h. Basic restorative care and rehabilitation. 93
143+ i. Patient rights an d confidentiality of personal 94
144+information and medical records. 95
145+ j. Relevant legal and ethical issues. 96
146+ 97
147+Such instruction must be offered in various formats, and any 98
148+interactive instruction must be provided during various times of 99
149+the day. 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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162- g. Care of cognitively impaired individuals. 101
163- h. Basic restorative care and rehabilitation. 102
164- i. Patient rights and confidentiality of personal 103
165-information and medical records. 104
166- j. Relevant legal and ethical issues. 105
167- 106
168-Such instruction must be offered in various formats, and any 107
169-interactive instruction must be prov ided during various times of 108
170-the day. 109
171- 2. A minimum of 20 hours of skills training on basic 110
172-nursing skills, including, but not limited to: 111
173- a. Hygiene, grooming, and toileting. 112
174- b. Skin care and pressure sore prevention. 113
175- c. Nutrition and hydration. 114
176- d. Measuring vital signs, height, and weight. 115
177- e. Safe lifting, positioning, and moving of patients. 116
178- f. Wound care. 117
179- g. Portable Oxygen use and safety and other respiratory 118
180-procedures. 119
181- h. Tracheostomy care. 120
182- i. Enteral care and therapy. 121
183- j. Peripheral Intravenous assistive activities and 122
184-alternative feeding methods. 123
185- k. Urinary catheterization and ostomy care. 124
186- 3. At least 16 hours of clinical training under direct 125
162+ 2. Up to A minimum of 20 hours of skills training on basic 101
163+nursing skills tailored to the child's care needs as specified 102
164+in the ordering provider's plan of care and individualized care 103
165+needs, which may include training on the following topics, as 104
166+applicable 105
167+, including, but not limited to: 106
168+ a. Hygiene, grooming, and toileting. 107
169+ b. Skin care and pressure sore prevention. 108
170+ c. Nutrition and hydration. 109
171+ d. Measuring vital signs, height, and weight. 110
172+ e. Safe lifting, positioning, and moving of patients. 111
173+ f. Wound care. 112
174+ g. Portable Oxygen use and safety and other respiratory 113
175+procedures. 114
176+ h. Tracheostomy care. 115
177+ i. Enteral care and therapy. 116
178+ j. Peripheral Intravenous assistive activities and 117
179+alternative feeding methods. 118
180+ k. Urinary catheterization and care and ostomy care. 119
181+ 3. Up to At least 16 hours of clinical training related to 120
182+the specific needs of the eligible relative under direct 121
183+supervision of a licensed registered nurse. 122
184+ 4. Training concerning HIV infections and AIDS and is 123
185+required to obtain and maintain a current certificate in 124
186+cardiopulmonary resuscitation . 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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199-supervision of a licensed registered nurse. 126
200- 4. Training concerning HIV infections and AIDS and is 127
201-required to obtain and maintain a current certificate in 128
202-cardiopulmonary resuscitation. 129
203- (9) FEE SCHEDULE.—The agency shall modify any state 130
204-Medicaid plans and implement any federal waivers necessary to 131
205-implement this section an d shall establish a Medicaid fee 132
206-schedule for home health agencies employing a home health aide 133
207-for medically fragile children at minimum rate of $25 per hour 134
208-with a utilization cap of no more than 12 8 hours per day and 40 135
209-hours per week, per medically fr agile child. The utilization cap 136
210-of 40 hours per week, per recipient may be exceeded; however 137
211-justification must be provided as to why there is no other 138
212-qualified provider available, and the request must be approved 139
213-by the home health agency and the manage d care plan. 140
214- (10) FEDERAL APPROVAL. —The agency shall seek necessary 141
215-federal approval, including seeking the appropriate federal 142
216-waiver, to: 143
217- (a) Allow Medicaid private duty nursing specialty 144
218-providers and home health services providers to participate in 145
219-and receive reimbursement for services rendered under this 146
220-program. 147
221- (b) Provide that the income earned under this program by a 148
222-home health aide for medically fragile children is disregarded 149
223-in Medicaid eligibility determinations. 150
199+ 5. Obtain and maintain a current certificate in 126
200+cardiopulmonary resuscitation. 127
201+ (9) FEE SCHEDULE.—The agency shall modify any state 128
202+Medicaid plans and implement any federal waivers nec essary to 129
203+implement this section and shall establish a Medicaid fee 130
204+schedule for home health agencies employing a home health aide 131
205+for medically fragile children at minimum rate of $25 per hour 132
206+with a utilization cap of no more than 12 8 hours per day and 40 133
207+hours per week, per medically fragile child. The utilization cap 134
208+of 40 hours per week, per recipient may be exceeded; however 135
209+justification must be provided as to why there is no other 136
210+qualified provider available, and the request must be approved 137
211+by the home health agency and the managed care plan . 138
212+ (10) FEDERAL APPROVAL. —Within 30 days after the effective 139
213+date of this act, the agency shall seek federal approval, 140
214+including seeking the appropriate federal waiver, to: 141
215+ (a) Allow Medicaid private duty nu rsing specialty 142
216+providers and home health services providers to participate in 143
217+and receive reimbursement for services rendered under this 144
218+program. 145
219+ (b) Provide that the income earned under this program by a 146
220+home health aide for medically fragile children is disregarded 147
221+in eligibility considerations for public assistance as defined 148
222+in s. 414.0252. 149
223+ Section 3. Subsection (18) of section 400.462, Florida 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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236- Section 3. Subsecti on (18) of section 400.462, Florida 151
237-Statutes, is amended to read: 152
238- 400.462 Definitions. —As used in this part, the term: 153
239- (18) "Home health aide for medically fragile children" 154
240-means a family caregiver who meets the qualifications specified 155
241-in this part and who performs tasks delegated to him or her 156
242-under chapter 464 while caring for an eligible relative, and 157
243-provides care relating to activities of daily living, including 158
244-those associated with personal care; maintaining mobility; 159
245-nutrition and hydration; t oileting and elimination; assistive 160
246-devices; safety and cleanliness; data gathering; reporting 161
247-abnormal signs and symptoms; postmortem care; patient 162
248-socialization and reality orientation; end -of-life care; 163
249-cardiopulmonary resuscitation and emergency care; residents' or 164
250-patients' rights; documentation of services performed; infection 165
251-control; safety and emergency procedures; hygiene, grooming, 166
252-skin care, and pressure sore prevention; wound care; portable 167
253-oxygen use and safety and other respiratory procedures ; 168
254-tracheostomy care; enteral care and therapy; peripheral 169
255-intravenous assistive activities and alternative feeding 170
256-methods; and any other tasks delegated to the family caregiver 171
257-under chapter 464. 172
258- Section 4. Paragraph (c) of subsection (1) of section 173
259-409.903, Florida Statutes, is amended to read: 174
260- 409.903 Mandatory payments for eligible persons. —The 175
236+Statutes, is amended to read: 151
237+ 400.462 Definitions. —As used in this part, the term: 152
238+ (18) "Home health aide for medically fragile children" 153
239+means a family caregiver who meets the qualifications specified 154
240+in this part and who performs tasks delegated to him or her 155
241+under chapter 464 while caring for an eligible relative, and 156
242+provides care relating to activi ties of daily living, including 157
243+those associated with personal care; maintaining mobility; 158
244+nutrition and hydration; toileting and elimination; assistive 159
245+devices; safety and cleanliness; data gathering; reporting 160
246+abnormal signs and symptoms; postmortem care ; patient 161
247+socialization and reality orientation; end -of-life care; 162
248+cardiopulmonary resuscitation and emergency care; residents' or 163
249+patients' rights; documentation of services performed; infection 164
250+control; safety and emergency procedures; hygiene, grooming, 165
251+skin care, and pressure sore prevention; wound care; portable 166
252+oxygen use and safety and other respiratory procedures; 167
253+tracheostomy care; enteral care and therapy; peripheral 168
254+intravenous assistive activities and alternative feeding 169
255+methods; and any other t asks delegated to the family caregiver 170
256+under chapter 464. 171
257+ Section 4. Paragraph (c) of subsection (1) of section 172
258+409.903, Florida Statutes, is amended to read: 173
259+ 409.903 Mandatory payments for eligible persons. —The 174
260+agency shall make payments for medical assistance and related 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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273-agency shall make payments for medical assistance and related 176
274-services on behalf of the following persons who the department, 177
275-or the Social Security Admini stration by contract with the 178
276-Department of Children and Families, determines to be eligible, 179
277-subject to the income, assets, and categorical eligibility tests 180
278-set forth in federal and state law. Payment on behalf of these 181
279-Medicaid eligible persons is subje ct to the availability of 182
280-moneys and any limitations established by the General 183
281-Appropriations Act or chapter 216. 184
282- (1) Low-income families with children are eligible for 185
283-Medicaid provided they meet the following requirements: 186
284- (c) The family's countable income and resources do not 187
285-exceed the applicable Aid to Families with Dependent Children 188
286-(AFDC) income and resource standards under the AFDC state plan 189
287-in effect in July 1996, except as amended in the Medicaid state 190
288-plan to conform as closely as possible to the requirements of 191
289-the welfare transition program, to the extent permitted by 192
290-federal law. The agency shall seek federal approval, including 193
291-seeking the appropriate federal waiver or state plan amendment, 194
292-to exclude from the family's countable income any income earned 195
293-through employment as a home health aide for medically fragile 196
294-children under s. 400.4765. 197
295- Section 5. Within 60 days after this act becomes law, the 198
296-Agency for Health Care Administration shall make all necessary 199
297-requests and submissio ns to obtain federal approval to implement 200
273+services on behalf of the following persons who the department, 176
274+or the Social Security Administration by contract with the 177
275+Department of Children and Families, determines to be eligible, 178
276+subject to the income, assets, and categorica l eligibility tests 179
277+set forth in federal and state law. Payment on behalf of these 180
278+Medicaid eligible persons is subject to the availability of 181
279+moneys and any limitations established by the General 182
280+Appropriations Act or chapter 216. 183
281+ (1) Low-income families with children are eligible for 184
282+Medicaid provided they meet the following requirements: 185
283+ (c) The family's countable income and resources do not 186
284+exceed the applicable Aid to Families with Dependent Children 187
285+(AFDC) income and resource standards under the A FDC state plan 188
286+in effect in July 1996, except as amended in the Medicaid state 189
287+plan to conform as closely as possible to the requirements of 190
288+the welfare transition program, to the extent permitted by 191
289+federal law. The agency shall seek federal approval, inc luding 192
290+seeking the appropriate federal waiver or state plan amendment, 193
291+to exclude from the family's countable income any income earned 194
292+through employment as a home health aide for medically fragile 195
293+children under s. 400.4765. 196
294+ Section 5. Within 60 days after this act becomes law, the 197
295+Agency for Health Care Administration shall make all necessary 198
296+requests and submissions to obtain federal approval to implement 199
297+this act amending s. 409.903, Florida Statutes, and initiate any 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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310-this act amending s. 409.903, Florida Statutes, and initiate any 201
311-necessary rulemaking to implement the provisions of this act 202
312-amending s. 400.4765, Florida Statutes. 203
313- Section 6. This act shall take effect upon becoming a law. 204
310+necessary rulemaking to impleme nt the provisions of this act 201
311+amending s. 400.4765, Florida Statutes. 202
312+ Section 6. This act shall take effect upon becoming a law. 203