Florida Senate - 2025 CS for SB 1156 By the Committee on Health Policy; and Senator Harrell 588-03192-25 20251156c1 1 A bill to be entitled 2 An act relating to the home health aide for medically 3 fragile children program; amending s. 400.54, F.S.; 4 providing requirements for the annual assessment of 5 the home health aide for medically fragile children 6 program; amending s. 400.4765, F.S.; revising program 7 training requirements; revising the utilization cap of 8 a Medicaid fee schedule; requiring a home health aide 9 for medically fragile children who works more than 40 10 hours per week to provide specified justification; 11 requiring the Agency for Health Care Administration to 12 seek federal approval, including a federal waiver, for 13 specified purposes; amending s. 400.462, F.S.; 14 conforming provisions to changes made by the act; 15 amending s. 409.903, F.S.; requiring the agency to 16 seek federal approval, including a federal waiver or 17 state plan amendment, for specified purposes; 18 providing construction; providing a directive to the 19 agency to carry out certain tasks within a specified 20 timeframe; providing an effective date. 21 22 Be It Enacted by the Legislature of the State of Florida: 23 24 Section 1.Section 400.54, Florida Statutes, is amended to 25 read: 26 400.54Annual assessment of the home health aide for 27 medically fragile children program. 28 (1)The agency shall conduct an annual assessment of the 29 home health aide for medically fragile children program. The 30 assessment must report caregiver satisfaction with the program, 31 report data on adverse incidents, identify additional support 32 that may be needed by the home health aide for medically fragile 33 children, and assess the rate and extent of hospitalization of 34 children in home health services who are attended by a home 35 health aide for medically fragile children compared to those in 36 home health services provided by a registered nurse or a 37 licensed practical nurse without a home health aide for 38 medically fragile children. Medicaid managed care plans shall 39 provide to the agency data necessary to perform this assessment. 40 (2)The home health agency shall report all adverse 41 incidents occurring under the care of a home health aide for 42 medically fragile children to the agency and managed care plan 43 within 48 hours after the incident. For purposes of reporting to 44 the agency under this subsection, the term adverse incident 45 means any of the following: 46 (a)Death. 47 (b)Brain or spinal damage. 48 (c)Permanent disfigurement. 49 (d)Fracture or dislocation of bones or joints. 50 (e)A limitation of neurological, physical, or sensory 51 function. 52 (f)An event that is reported to law enforcement personnel 53 for investigation. 54 55 By January 1 of each year, beginning January 1, 2025, the agency 56 shall report its findings to the Governor, the President of the 57 Senate, and the Speaker of the House of Representatives. 58 Section 2.Present paragraphs (a) and (b) of subsection (3) 59 of section 400.4765, Florida Statutes, are redesignated as 60 paragraphs (b) and (c), respectively, a new paragraph (a) is 61 added to that subsection, subsection (10) is added to that 62 section, and present paragraph (a) of subsection (3) and 63 subsection (9) of that section are amended, to read: 64 400.4765Home health aide for medically fragile children 65 program. 66 (3)TRAINING. 67 (a)Before providing services to an eligible relative, a 68 home health aide for medically fragile children must complete an 69 approved training program. The employing home health agency must 70 provide validation of competency by a registered nurse and 71 maintain documentation of training completion and competency 72 validation. The employing home health agency must provide 73 additional training and competency validation as the medically 74 fragile childs care needs change and consistent with any 75 changes to the plan of care. 76 (b)(a)The agency, in consultation with the Board of 77 Nursing, shall approve home health aide for medically fragile 78 children training programs developed by home health agencies in 79 accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to 80 train family caregivers as home health aides for medically 81 fragile children to increase the health care provider workforce 82 and to authorize persons to provide trained nursing services as 83 delegated by a registered nurse to eligible relatives. The 84 program shall include must consist of at least 85 hours of 85 training, including, but not be limited to, all of the 86 following: 87 1.A minimum of 20 40 hours of theoretical instruction in 88 nursing, including, but not limited to, instruction on all of 89 the following: 90 a.Person-centered care. 91 b.Communication and interpersonal skills. 92 c.Infection control. 93 d.Safety and emergency procedures. 94 e.Assistance with activities of daily living. 95 f.Mental health and social service needs. 96 g.Care of cognitively impaired individuals. 97 h.Basic restorative care and rehabilitation. 98 i.Patient rights and confidentiality of personal 99 information and medical records. 100 j.Relevant legal and ethical issues. 101 102 Such instruction must be offered in various formats, and any 103 interactive instruction must be provided during various times of 104 the day. 105 2.Up to A minimum of 20 hours of skills training on basic 106 nursing skills tailored to the childs care needs as specified 107 in the ordering providers plan of care and individualized care 108 needs, which may include training on the following topics, as 109 applicable, including, but not limited to: 110 a.Hygiene, grooming, and toileting. 111 b.Skin care and pressure sore prevention. 112 c.Nutrition and hydration. 113 d.Measuring vital signs, height, and weight. 114 e.Safe lifting, positioning, and moving of patients. 115 f.Wound care. 116 g.Portable Oxygen use and safety and other respiratory 117 procedures. 118 h.Tracheostomy care. 119 i.Enteral care and therapy. 120 j.Peripheral Intravenous assistive activities and 121 alternative feeding methods. 122 k.Urinary catheterization and care and ostomy care. 123 3.Up to At least 16 hours of clinical training related to 124 the specific needs of the eligible relative under direct 125 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 5.Obtaining and maintaining a current certificate in 130 cardiopulmonary resuscitation. 131 (9)FEE SCHEDULE.The agency shall modify any state 132 Medicaid plans and implement any federal waivers necessary to 133 implement this section and shall establish a Medicaid fee 134 schedule for home health agencies employing a home health aide 135 for medically fragile children at a minimum rate of $25 per hour 136 with a utilization cap of no more than 12 8 hours per day and 40 137 hours per week, per medically fragile child. The utilization cap 138 of 40 hours per week, per recipient may be exceeded; however, 139 justification must be provided as to why there is no other 140 qualified provider available, and the request must be approved 141 by the home health agency and the managed care plan. 142 (10)FEDERAL APPROVAL.Within 30 days after the effective 143 date of this act, the agency shall seek federal approval, 144 including seeking the appropriate federal waiver, to: 145 (a)Allow Medicaid private duty nursing specialty providers 146 and home health services providers to participate in and receive 147 reimbursement for services rendered under this program. 148 (b)Provide that the income earned under this program by a 149 home health aide for medically fragile children is disregarded 150 in eligibility considerations for public assistance as defined 151 in s. 414.0252. 152 Section 3.Subsection (18) of section 400.462, Florida 153 Statutes, is amended to read: 154 400.462Definitions.As used in this part, the term: 155 (18)Home health aide for medically fragile children 156 means a family caregiver who meets the qualifications specified 157 in this part and who performs tasks delegated to him or her 158 under chapter 464 while caring for an eligible relative, and 159 provides care relating to activities of daily living, including 160 those associated with personal care; maintaining mobility; 161 nutrition and hydration; toileting and elimination; assistive 162 devices; safety and cleanliness; data gathering; reporting 163 abnormal signs and symptoms; postmortem care; patient 164 socialization and reality orientation; end-of-life care; 165 cardiopulmonary resuscitation and emergency care; residents or 166 patients rights; documentation of services performed; infection 167 control; safety and emergency procedures; hygiene, grooming, 168 skin care, and pressure sore prevention; wound care; portable 169 oxygen use and safety and other respiratory procedures; 170 tracheostomy care; enteral care and therapy; peripheral 171 intravenous assistive activities and alternative feeding 172 methods; and any other tasks delegated to the family caregiver 173 under chapter 464. 174 Section 4.Paragraph (c) of subsection (1) of section 175 409.903, Florida Statutes, is amended to read: 176 409.903Mandatory payments for eligible persons.The agency 177 shall make payments for medical assistance and related services 178 on behalf of the following persons who the department, or the 179 Social Security Administration by contract with the Department 180 of Children and Families, determines to be eligible, subject to 181 the income, assets, and categorical eligibility tests set forth 182 in federal and state law. Payment on behalf of these Medicaid 183 eligible persons is subject to the availability of moneys and 184 any limitations established by the General Appropriations Act or 185 chapter 216. 186 (1)Low-income families with children are eligible for 187 Medicaid provided they meet the following requirements: 188 (c)The familys countable income and resources do not 189 exceed the applicable Aid to Families with Dependent Children 190 (AFDC) income and resource standards under the AFDC state plan 191 in effect in July 1996, except as amended in the Medicaid state 192 plan to conform as closely as possible to the requirements of 193 the welfare transition program, to the extent permitted by 194 federal law. The agency shall seek federal approval, including 195 seeking the appropriate federal waiver or state plan amendment, 196 to exclude from the familys countable income any income earned 197 through employment as a home health aide for medically fragile 198 children under s. 400.4765. 199 Section 5.Within 60 days after this act becomes a law, the 200 Agency for Health Care Administration shall make all necessary 201 requests and submissions to obtain federal approval to implement 202 the amendment made by this act to s. 409.903, Florida Statutes, 203 and initiate any necessary rulemaking to implement the amendment 204 made by this act to s. 400.4765, Florida Statutes. 205 Section 6.This act shall take effect upon becoming a law.