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Florida Senate - 2025 CS for CS for SB 1156 By the Committees on Fiscal Policy; and Health Policy; and Senator Harrell 594-03846-25 20251156c2 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; requiring an employing home 8 health agency to provide specified training and ensure 9 that each home health aide for medically fragile 10 children holds and maintains specified certification; 11 revising the utilization cap of a Medicaid fee 12 schedule; requiring a home health aide for medically 13 fragile children who works more than 40 hours per week 14 to provide specified justification; providing 15 requirements for the Agency for Health Care 16 Administration to seek federal approval and a federal 17 waiver for specified purposes; amending s. 400.462, 18 F.S.; conforming provisions to changes made by the 19 act; amending s. 409.903, F.S.; requiring the agency 20 to seek federal approval and implement federal waivers 21 and state plan amendments for specified purposes; 22 providing an effective date. 23 24 Be It Enacted by the Legislature of the State of Florida: 25 26 Section 1.Section 400.54, Florida Statutes, is amended to 27 read: 28 400.54Annual assessment of the home health aide for 29 medically fragile children program. 30 (1)The agency shall conduct an annual assessment of the 31 home health aide for medically fragile children program. The 32 assessment must report caregiver satisfaction with the program, 33 report data on adverse incidents, and identify additional 34 support that may be needed by the home health aide for medically 35 fragile children, and assess the rate and extent of 36 hospitalization of children in home health services who are 37 attended by a home health aide for medically fragile children 38 compared to those in home health services provided by a 39 registered nurse or a licensed practical nurse without a home 40 health aide for medically fragile children. Medicaid managed 41 care plans shall provide to the agency data necessary to perform 42 this assessment. 43 (2)The home health agency must report all adverse 44 incidents occurring under the care of a home health aide for 45 medically fragile children to the agency and managed care plan 46 within 48 hours of the incident. For purposes of reporting to 47 the agency under this section, the term adverse incident 48 means: 49 (a)Death. 50 (b)Brain or spinal damage. 51 (c)Permanent disfigurement. 52 (d)Fracture or dislocation of bones or joints. 53 (e)A limitation of neurological, physical, or sensory 54 function. 55 (f)An event that is reported to law enforcement or its 56 personnel for investigation. 57 58 By January 1 of each year, beginning January 1, 2025, the agency 59 shall report its findings to the Governor, the President of the 60 Senate, and the Speaker of the House of Representatives. 61 Section 2.Paragraph (a) of subsection (3) and subsection 62 (9) of section 400.4765, Florida Statutes, are amended, and 63 subsection (10) is added to that section, 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 agency-approved training program. The employing home health 70 agency must provide validation of competency by a registered 71 nurse, and maintain documentation of training completion and 72 competency validation. The employing home health agency must 73 provide additional training and competency validation as the 74 medically fragile childs care needs change, consistent with any 75 changes to the plan of care. The employing home health agency 76 must provide training on HIV infections and AIDS and must ensure 77 that each home health aide for medically fragile children holds 78 and maintains a certification in cardiopulmonary resuscitation. 79 (b)(a)The agency, in consultation with the Board of 80 Nursing, shall approve home health aide for medically fragile 81 children training programs developed by home health agencies in 82 accordance with 42 C.F.R. ss. 483.151-483.154 and 484.80 to 83 train family caregivers as home health aides for medically 84 fragile children to increase the health care provider workforce 85 and to authorize persons to provide trained nursing services as 86 delegated by a registered nurse to eligible relatives. The 87 training programs program must include supervised practical 88 training under the direct supervision of a licensed registered 89 nurse which must be tailored to the needs of an eligible 90 relative. consist of at least 85 hours of training, including, 91 but not limited to, all of the following: 92 1.A minimum of 40 hours of theoretical instruction in 93 nursing, including, but not limited to, instruction on all of 94 the following: 95 a.Person-centered care. 96 b.Communication and interpersonal skills. 97 c.Infection control. 98 d.Safety and emergency procedures. 99 e.Assistance with activities of daily living. 100 f.Mental health and social service needs. 101 g.Care of cognitively impaired individuals. 102 h.Basic restorative care and rehabilitation. 103 i.Patient rights and confidentiality of personal 104 information and medical records. 105 j.Relevant legal and ethical issues. 106 107 Such instruction must be offered in various formats, and any 108 interactive instruction must be provided during various times of 109 the day. 110 2.A minimum of 20 hours of skills training on basic 111 nursing skills, including, but not limited to: 112 a.Hygiene, grooming, and toileting. 113 b.Skin care and pressure sore prevention. 114 c.Nutrition and hydration. 115 d.Measuring vital signs, height, and weight. 116 e.Safe lifting, positioning, and moving of patients. 117 f.Wound care. 118 g.Portable Oxygen use and safety and other respiratory 119 procedures. 120 h.Tracheostomy care. 121 i.Enteral care and therapy. 122 j.Peripheral Intravenous assistive activities and 123 alternative feeding methods. 124 k.Urinary catheterization and ostomy care. 125 3.At least 16 hours of clinical training under direct 126 supervision of a licensed registered nurse. 127 4.Training concerning HIV infections and AIDS and is 128 required to obtain and maintain a current certificate in 129 cardiopulmonary resuscitation. 130 (9)FEE SCHEDULE.The agency shall modify any state 131 Medicaid plans and implement any federal waivers necessary to 132 implement this section and shall establish a Medicaid fee 133 schedule for home health agencies employing a home health aide 134 for medically fragile children at minimum rate of $25 per hour 135 with a utilization cap of no more than 12 8 hours per day and 40 136 hours per week, per medically fragile child. The utilization cap 137 of 40 hours per week, per recipient may be exceeded; however, 138 justification must be provided as to why there is no other 139 qualified provider available, and the request must be approved 140 by the home health agency and the managed care plan. 141 (10)FEDERAL APPROVAL.The agency shall seek necessary 142 federal approval, including seeking the appropriate federal 143 waiver, to: 144 (a)Allow Medicaid private duty nursing specialty providers 145 and home health services providers to participate in and receive 146 reimbursement for services rendered under this 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 Section 3.Subsection (18) of section 400.462, Florida 151 Statutes, is amended to read: 152 400.462Definitions.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; toileting 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: 174 409.903Mandatory payments for eligible persons.The agency 175 shall make payments for medical assistance and related services 176 on behalf of the following persons who the department, or the 177 Social Security Administration by contract with the Department 178 of Children and Families, determines to be eligible, subject to 179 the income, assets, and categorical eligibility tests set forth 180 in federal and state law. Payment on behalf of these Medicaid 181 eligible persons is subject to the availability of moneys and 182 any limitations established by the General Appropriations Act or 183 chapter 216. 184 (1)Low-income families with children are eligible for 185 Medicaid provided they meet the following requirements: 186 (c)The familys 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 familys 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 submissions to obtain federal approval to implement 200 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.
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