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