59A-8.0099. Minimum Training Requirements for Home Health Aides for Medically Fragile Children

(1) A licensed home health agency that provides skilled care and accepts Medicaid may train and employ any person 18 years of age or older as a home health aide for medically fragile children as defined in section 400.462, F.S., hereafter referred to as an “AMFC,” that meets the eligibility requirements of section 400.4765, F.S., and has successfully completed required training.

(2) Home Health Agency Personnel. An AMFC is considered an employee of the home health agency pursuant to section 400.4765, F.S. An AMFC may only provide services to an eligible relative as defined in section 400.462, F.S., as assigned or delegated by, and under the supervision of, a registered nurse (RN).

(a) Prior to an AMFC providing services, the home health agency shall have on file documentation of the aide’s successful completion of an approved training program as outlined by this rule.

(b) An AMFC shall provide services within the scope of their training as outlined by this rule and sections 400.4765 and 400.489, F.S., and may provide other services as taught by a licensed health professional employee or contractor of the home health agency for an eligible relative. A home health aide may be trained to become an AMFC provided they meet the requirements of sections 400.462 and 400.4765, F.S., and complete an approved training program as outlined by this rule.

(c) An RN employed or contracted with the home health agency must conduct supervisory visits of the AMFC at least every 60 days. The home health agency must maintain documentation of such visits.

(d) Home health agencies that offer training in accordance with the minimum requirements outlined by this rule must document their course curriculum to be made available for review as requested by the Agency.    

(3) Approved AMFC Training Curriculum: Minimum Curriculum Requirements. The training curriculum must total at least 86 hours according to sections (a), (b), and (c) below. Training must be provided in a manner that accommodates non-English speakers who are otherwise eligible under section 400.4765, F.S., and this rule to care for an eligible relative.  The Home Health Aide Competency Test shall not be administered in lieu of, nor shall prior passage substitute for, any portion of the training program outlined by this rule. At minimum, the training curriculum must include the following sections: 

(a) A minimum of forty (40) hours of theoretical instruction and training in nursing. This section of training must be conducted by a qualified RN with a minimum of two years nursing experience, with at least one year in pediatric nursing. This section of training must include the following:

1. Pediatric patients diagnosed with complex or chronic medical conditions including:

a. Premature infants with complications that compromise their health.

b. Respiratory conditions including ventilators, tracheostomies, bronchopulmonary dysplasia, or complications from traumatic brain injuries.

c. Cardiac conditions including congenital heart defects and congenital anomalies.

d. Neurological conditions including seizure disorders, cerebral palsy, and related conditions.

e. Gastronomy needs.

f. Developmental disabilities including intellectual disability, Down’s syndrome, autism, spina bifida, brain damage, substance abuse during pregnancy, and how these disabilities affect growth and development.

g. Congenital defects.

2. Assisting with reinforcement of dressing.

3. Applying and removing anti-embolism stockings and hosiery prescribed for therapeutic treatment of the legs.

4. Assisting with tasks associated with elimination:

a. Toileting.

b. Assisting with the use of a bedpan and urinal.

c. Providing catheter care including changing the urinary catheter bag.

d. Collecting specimens.

e. Emptying ostomy bags or changing bags that do not adhere to the skin.

f. Assisting with the placement and removal of colostomy bags, excluding the removal of the flange or manipulation of the stoma's site.

5. Assisting with the use of devices to aid daily living, such as a wheelchair or walker.

6. Assisting with a prescribed ice cap or collar.

7. Performing simple urine tests for sugar, acetone, or albumin.

8. Assisting with the use of a glucometer to perform blood glucose testing.

9. Keeping records of personal health care activities.

10. Observing appearance and gross behavioral changes in the patient or client and reporting to the registered nurse.

11. Recognition of emergencies and emergency procedures, including dialing 911.

12. Basic restorative care and rehabilitation including the application of AFOs (ankle foot orthosis) and other orthopedic braces.

13. Relevant legal and ethical issues, including patient rights and confidentiality of medical records.

14. Mental health and social service needs of children.

15. Other topics pertinent to home health services.

(b) A minimum of thirty (30) hours of skills training in nursing specific to the care of medically fragile pediatric patients. This section of training must be conducted in person by a qualified RN with a minimum of two years nursing experience, with at least one year in pediatric nursing. This section of training must include the following: 

1. An overview of seizure disorders, epilepsy, seizure emergencies, and related first aid and rescue therapies.

2. Tracheostomy care including suctioning, regular cleaning or replacement of inner cannula, trach site care, dressing change, and trach change.

3. Respiratory management including emergency management of desaturation, mucus plugging and dislodgement of trach tube.

4. Enteral care and therapy. Instruction must cover different enteral feeding tubes including nasogastric, nasoduodenal, nasojejunal, gastrostomy, jejunostomy, and gastrojejunal tubes, and gastronomy buttons. Instruction must also cover related equipment, potential complications, and feeding methods to include:

a. Administering enteral feedings: bolus intermittent, cyclic intermittent, intermittent drip, and constant infusion.

b. Equipment including syringes, feeding bags, and feeding pumps.

c. Formula types and preparation.

d. Complications including tube-related mechanical, infectious, gastrointestinal, aspiration pneumonia, and metabolic complications, and complications associated with PEG placement.

5. Assisting with prescribed medical equipment, supplies and devices including oxygen, walkers, wheelchairs, hospital beds, ventilator, C-Pap and BiPap machines, peak flow meters, nebulizers, CPT vests, and apnea monitoring equipment, excluding the titration of the prescribed oxygen levels.

6. Skin care including pressure sore prevention and wound care.

7. Ostomies including ileostomies, colostomies and urostomies, maintaining a healthy stoma and emptying and changing the ostomy pouch or bag.

8. Urinary catheter care including catheter position, hydration, hygiene, complications, changing the catheter bag, removing and inserting a foley catheter.

9. End-of-life care and postmortem care.

10. Peripheral intravenous assistive care activities including care and maintenance of the device and signs and symptoms of complications.

11. Measuring and preparing special diets, excluding IV/TPN services.

12. Measuring intake and output of fluids.

13. Measuring vital signs including temperature, pulse, respiration, and blood pressure.

(c) A minimum of sixteen (16) hours of clinical competency training and validation. Validation of medication routes pursuant to Rule 59A-8.0097, F.A.C., does not count toward the 16 hours required by this section. Validation must be conducted on site with an actual patient and supervised by a qualified RN with a minimum of two years nursing experience, with one year in pediatric nursing. A pseudo-patient may be used for training procedures related to conditions that the relative needing care may not exhibit. Successful validation requires the AMFC to demonstrate, in person, the skills outlined in section (3)(b) to include procedures for the following:

1. Skin care, pressure sore prevention, and wound care.

2. Tracheostomy care.

3. Enteral care and therapy.

4. Peripheral intravenous assistive care activities.

5. Urinary catheter care and foley catheterization.

6. Ostomy care and maintenance.

7. Appropriate use of prescribed medical equipment, supplies and devices.

8. Measuring of vital signs and intake and output of fluids.

(4) Validation. An AMFC must be assessed and validated as competent to provide services by an RN after successfully completing required training.

(a) An AMFC must achieve a score of 100% proficiency in validation of skills prior to providing services.

(b) Validation must take place within 90 days of completing required training.

(c) Validations expire 1 year from the effective date of the validation. An AMFC must be revalidated no more than within 60 days prior to the expiration of their validation to continue providing services.

(5) Pursuant to section 400.4765, F.S., an AMFC that allows 24 consecutive months to pass without providing services to an eligible relative must complete an approved training program as outlined by this rule to resume providing services.

(6) Pursuant to section 400.489, F.S., medication administration training may be provided in addition to the 86 hour curriculum outlined in section (3). An AMFC may administer medication as delegated by an RN if they complete the basic medication administration training pursuant to Rule 59A-8.0097 and the requirements of Rules 59A-8.0219 and 59A-8.0216, F.A.C, are met.

(a) To meet the needs of medically fragile pediatric patients, an AMFC may administer medications via additional routes with written instructions from the delegating RN as prescribed by the patient’s health care provider. The following routes require the AMFC to complete additional medication training specified in section (3)(b):

1. Oral medications to be crushed, diluted, or mixed with foods or liquid.

2. Medications in a liquid form or pills crushed into a powder form via enteral feeding tube.

3. Medications by injection via subcutaneous, intra-dermal, or intra-muscular route.

4. Medication that is inserted rectally, including medications to treat or control seizures.

5. Inhaled medications administered via a tracheostomy tube with a metered-dose inhaler or nebulizer.

(b) Medication Training for Additional Routes of Administration. In addition to the initial 6 hours of training required by Rule 59A-8.0097, F.A.C., the AMFC must complete an additional 4 hours of training to administer medications via the routes described in section (3)(a). The additional training must be provided by an RN with at least two years of experience and must cover the following:

1. Administration of medications utilizing standardized measuring devices for children including oral syringes, special medication dosing spoons, or medication cups.

2. Measuring liquid medication, including conversions of teaspoon/tablespoon to milliliter or cubic centimeter (cc).

3. Indications and procedures for oral medications to be diluted or mixed with foods or liquid.

4. Indications and contraindications to crushing oral medications.

5. Procedure to crush oral medications and mix with foods or liquid.

6. Procedures for medications administered via enteral feeding tubes.

7. Procedures for medications inserted rectally.

8. Procedure for the administration of inhaled medications via a tracheostomy tube utilizing a metered-dose inhaler or nebulizer.

9. Recognition of serious adverse reactions and how to handle the event.

10. Medication errors and reporting to the RN, including when the child does not take all of medication mixed with food or liquids.

11. Infection control measures for administration of medication to pediatric patients.

(c) An AMFC that completes the training outlined in section (3)(b) must be validated in accordance with Rule 59A-8.0097, F.A.C. prior to administering medication via additional routes.

(7) Data Reporting. Pursuant to section 400.54, F.S., each licensed home health agency that provides skilled services to children under the age of 21 must develop procedures to gather data to submit to the Agency covering services provided from October 1st of the previous year to September 30th of the current year. Data must be submitted no later than November 1st each year.

(a) Data must be submitted on Home Health Agency, Aide for Medically Fragile Children Assessment, AHCA Form 3110-9003, April 2024, incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-16716. The form will be available through the link included in the e-blast sent to each licensee required to report one month prior to the due date.

(b) A home health agency that fails to submit the required information by the due date may be fined up to $50 per day late not to exceed $500 in accordance with section 408.813, F.S.

Rulemaking Authority 400.4765, 400.489, 400.497 FS. Law Implemented 400.54, 400.476, 400.4765, 400.489, 400.497 FS. History–New 7-23-24.