Definitions, Licensure Requirements, Procedures, and Fees, Registration Policies, Administrator, Registered Nurse and Licensed Practical Nurse, Certified Nursing Assistant and Home Health Aide, Homemakers or Companions, Acceptance of Patients or ...
AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing
RULE NOS.:RULE TITLES:
59A-18.002Definitions
59A-18.004Licensure Requirements, Procedures, and Fees
59A-18.005Registration Policies
59A-18.006Administrator
59A-18.007Registered Nurse and Licensed Practical Nurse
59A-18.0081Certified Nursing Assistant and Home Health Aide
59A-18.009Homemakers or Companions
59A-18.010Acceptance of Patients or Clients
59A-18.011Medical Plan of Treatment
59A-18.012Clinical Records
59A-18.013Administration of Drugs and Biologicals
59A-18.017Supplemental Staffing for Health Care Facilities
59A-18.018Emergency Management Plans
NOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 40 No. 246, December 22, 2014 issue of the Florida Administrative Register.
59A-18.002 Definitions.
When used in this rule chapter, unless the context otherwise requires, the term:
(5) “FBI” means the Federal Bureau of Investigation.
Renumber subsequent paragraphs.
(8)(9) “Licensed Practical Nurse,” as defined in Section 464.003(16)(5), F.S., means a person who is currently licensed to practice nursing pursuant to Chapter 464, F.S.
(11)(12) “Registered Nurse,” as defined in Section 464.003(22)(4), F.S., means a person who is currently licensed to practice pursuant to Chapter 464, F.S.
59A-18.004 Licensure Requirements, Procedures, and Fees.
(8)(9) A nurse registry has the following responsibility in terms of hours of operation:
(a) The nurse registry administrator, or his alternate, must be available to the public for any eight consecutive hours between 7 a.m. and 6 p.m., Monday through Friday of each week, excluding legal and religious holidays. Available to the public means being readily available on the premises or by telecommunications.
(b) When the administrator, or the designated alternate, are not on the premises during designated business hours, pursuant to paragraph 59A-18.004(8)(9)(a), F.A.C., a staff person must be available to answer the phone and the door and must be able to contact the administrator, or the alternate, by telecommunications during the designated business hours. This individual can be a clerical staff person.
(c) If an AHCA surveyor arrives on the premises to conduct a survey and the administrator, or a person authorized to give access to patient records, is not available on the premises he, or his alternate, must be available on the premises within two hours.
(d) The nurse registry shall provide to the patient or the patient’s representative a list of telephone numbers to be called if a replacement caregiver is needed along with local emergency numbers as determined by the nurse registry.
(e) Failure to be available or to respond, as defined in paragraphs 59A-18.004(9)(a), (b) and (c), F.A.C., will result in a $500 fine, pursuant to Section 400.506(4), F.S. A second incident will be grounds for denial or revocation of the registry license.
Rulemaking Authority 400.497, 400.506, 408.810(8), 408.819 FS. Law Implemented 400.497, 400.506, 400.512, 408.806, 408.809, 408.810(8), 408.811 FS. History–New 2-9-93, Amended 1-27-94, 12-24-00, 8-10-06, 3-15-07,____.
59A-18.005 Registration Policies.
(6) Prior to contact with patients or clients, each independent contractor referred for client care must furnish to the registry a statement from a health care professional licensed under Chapter 458, F.S., or Chapter 459, F.S., a physician’s assistant, or an advanced registered nurse practitioner (ARNP) or a registered nurse licensed under Chapter 464, F.S., under the supervision of a licensed physician, or acting pursuant to an established protocol signed by a licensed physician, dated within the last six months, that the contractor is free from communicable diseases. The independent contractor will provide this statement to the nurse registry when first referred along with the application required in Section 400.506(8), F.S., and annually thereafter.
(7) Each nurse registry shall, in its contracts with independent contractors, provide instructions as to responsibility for the payment of self-employment estimated taxes, and a statement as to the registry’s commitment to compliance with civil rights requirements, pursuant to Chapter 760, F.S.
(7)(8) Registration folders on each independent contractor must contain the information required in Section 400.506(8)(12), F.S., and the following:
(a) For home health aides, evidence of completion of a home health aide training course or certification from the Florida Board of Nursing, Department of Health as a certified nursing assistant;
(b) Evidence of a contract with the nurse registry;
(c) Evidence of eligible background screening that meets the requirements in subsection 408.809(4), F.S.; and
(8)(9) Each nurse registry shall establish a system for the recording and follow-up of complaints involving individuals they refer. to determine if a replacement caregiver should be referred and to provide the complainant with information on how to report the complaint to the appropriate entity:
(a) Report theft to local law enforcement;
(b) Report abuse, neglect or exploitation to the central abuse hotline 1(800) 962-2873;
(c) Report nurses and certified nursing assistants to the Department of Health by completing and submitting the complaint form at http://www.floridahealth.gov/licensing-and-regulation/enforcement/admin-complaint-process/forms.html if there are alleged professional practice violations.
(d) Report other complaints to the Agency for Health Care Administration by calling (888) 419-3456 or submitting the on-line complaint form at http://apps.ahca.myflorida.com/hcfc .
In addition, If the complaints are violations of state law, the nurse registry shall take the actions specified in subsection 400.506(19), F.S. Records of complaints and actions taken by the nurse registry shall be kept in the individual’s registration file or retained in the central files of the nurse registry.
59A-18.006 Administrator.
(4) Be available, or have the alternate administrator available, at all times during operating hours as stated in paragraph 59A-18.004(8)(9)(a), F.A.C., and be responsible for the total operation of the nurse registry. Available during operating hours means being readily available on the premises or by telecommunications during the above operating hours;
59A-18.0081 Certified Nursing Assistant and Home Health Aide.
(14) C.N.A.s and home health aides referred by nurse registries may assist with self-administration of medication as described in Section 400.488, F.S.
(a) Home health aides and C.N.A.s assisting with self-administered medication, as described in Section 400.488, F.S., shall have received a minimum of 2 hours of training covering the following content:
1. Training shall cover state law and rule requirements with respect to the assistance with self-administration of medications in the home, procedures for assisting the resident with self-administration of medication, common medications, recognition of side effects and adverse reactions and procedures to follow when patients appear to be experiencing side effects and adverse reactions. Training must include verification that each C.N.A. and home health aide can read the prescription label and any instructions.
2. Individuals who cannot read shall not be permitted to assist with prescription medications.
(b) Documentation of training on assistance with self-administered medication from one of the following sources is acceptable:
1. Documentation of 2 hours of training in compliance with subsection 59A-8.0095(5), F.A.C., from a home health agency if the home health aide or C.N.A. previously worked for the home health agency;
2. A training certificate for 4 hours of training for assisted living facility staff in compliance with subsection 58A-5.0191(5), F.A.C.
3. A training certificate for at least 2 hours of training from a career education school licensed pursuant to Chapter 1005, F.S., and Rule Division Chapter 6E, F.A.C., by the Department of Education, Commission for Independent Education.
4. Documentation of at least 2 hours of training by a provider approved by the Florida Board of Nursing, Department of Health.
(15) The nurse registry is not obligated to monitor, manage, or supervise a certified nursing assistant or home health aide pursuant to subsection 400.506(19), F.S. The nurse registry is not obligated to review patient or client records per subsection 400.506(20), F.S., but the nurse registry is not prohibited from reviewing records and may do so. In the event of violation of Section 400.488, F.S. or other state laws that comes to the attention of the nurse registry, the nurse registry shall take the actions specified in subsection 400.506(19), F.S.
Rulemaking Authority 400.497, 400.506, 400.488 FS. Law Implemented 400.488, 400.497, 400.506 FS. History–New 1-27-94, Amended 12-24-00, 8-10-06, 3-15-07,____.
59A-18.012 Clinical Records.
The licensed nurse responsible for the delivery of skilled patient care shall maintain a clinical record, pursuant to subsection Section 400.497(8), F.S., for each patient receiving nursing services in the home that shall include, at a minimum, the following:
(1) through (8) No change.
59A-18.017 Supplemental Staffing for Health Care Facilities.
(1) Each nurse registry may provide staffing services as defined in subsection 400.462(29), F.S. to health care facilities licensed under Chapter 395, F.S., Chapter 429, F.S., or under Parts I, II, III , or IV, V, or VI of Chapter 400, F.S., or other business entities on a temporary basis by licensed nurses, home health aides, and certified nursing assistants.
(3) Each nurse registry shall establish a system for the recording and follow-up of complaints involving individuals they referred to health care facilities or other business entity, and such records shall be kept in the individual’s registration file. The nurse registry is not obligated to review records per subsection 400.506(20), F.S., but the nurse registry is not prohibited from reviewing records and may do so.
59A-18.018 Emergency Management Plans.
(1) Pursuant to subsection Section 400.506(12)(16), F.S., each nurse registry shall prepare and maintain a written comprehensive emergency management plan, in accordance with the Comprehensive Emergency Management Plan for Nurse Registries, AHCA Form 3110-1017, Revised ______2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX. This document is available from the Agency for Health Care Administration at http://ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml. The plan shall describe how the nurse registry establishes and maintains an effective response to emergencies and disasters. The plan, once completed, will be sent electronically to the contact designated by the Department of Health as required in subsection Section 400.506(12), F.S.
(5) In the event of an emergency, the nurse registry shall implement the nurse registry’s emergency management plan pursuant to subsection Section 400.506(12), F.S. Also, the registry must meet the following requirements:
(a) All administrative staff shall be informed of responsibilities for implementing the emergency management plan.
(b) If telephone service is not available during an emergency, the registry shall have a contingency plan to support communication, pursuant to Section 400.506(12)(f), F.S. A contingency plan may include cell phones, contact with a community based ham radio group, public announcements through radio or television stations, driving directly to the patient’s home, and, in medical emergency situations, contact with police or emergency rescue services.
(6) Nurse registries shall assist patients who would need assistance and sheltering during evacuations because of physical, mental, or sensory disabilities in registering with the local emergency management agency, as required in subsection Section 400.506(11)(12)(b), F.S.
(9) When a state of emergency has been declared by executive order or proclamation of the Governor, pursuant to subsection 252.36(2), F.S., Upon imminent threat of an emergency or disaster the nurse registry must contact those patients needing ongoing services pursuant to subsection Section 400.506(12), F.S., and confirm each patient’s plan during and immediately following an emergency. The nurse registry shall contact the assisted living facility and adult family care home patients and confirm their plans during and immediately following an emergency.
(10) If the independent contractor is unable to provide services to special needs registry patients, including any assisted living facility and adult family care home special needs registry patients, due to circumstances beyond their control pursuant to Section 400.506(12)(d), F.S., then the nurse registry will contact the independent contractors it has available for referral make reasonable efforts to find another independent contractor for the patient, pursuant to subsection Section 400.506(12), F.S.
(11) During emergency situations, when there is not a mandatory evacuation order issued by the local county emergency management office, some patients, registered pursuant to Section 252.355, F.S., may decide not to evacuate and will stay in their homes. The nurse registry must establish procedures, prior to the time of an emergency, which will delineate to what extent the registry will continue to arrange for care during and immediately following an emergency pursuant to Section 400.506(12)(a), F.S. The registry shall also contact the patients who need continuing services by calling the patient at home or calling the assisted living facility or adult familiy care home the patient resides in to determine if the patient still needs services make reasonable attempts to ascertain which patients remaining at home or in their assisted living facility or adult family care home will need services from the registry and which patients have plans to receive care from their family or other persons. If the assisted living facility or adult family care home does relocate the residents to another assisted living facility or adult family care home in the geographic area served by the nurse registry, the registry will continue to provide services to the residents. If the patients relocated outside the area served by the registry, the registry will assist the assisted living facility and adult family care home in obtaining the services of another registry already licensed for that area until the patient returns back to their original location.
(13) The independent contractor from the nurse registry is required to maintain in the home of the special needs patient a list of patient-specific medications, supplies and equipment required for continuing care and service should the patient be evacuated as per Section 400.506(12)(c), F.S. The list must include the names of all medications, their dose, frequency, route, time of day and any special considerations for administration. The list must also include any allergies; the name of the patient’s physician, physician assistant, or advanced registered nurse practitioner and the physician, physician assistant or advanced registered nurse practitioner’s phone number; and the name, phone number and address of the patient’s pharmacy. If the patient permits, the list can also include the patient’s diagnosis.
Rulemaking Authority 400.506, 408.821(4), FS. Law Implemented 400.506, FS. History–New 8-10-06, Amended 3-15-07,__________.
FORM 3110-1017, Comprehensive Emergency Management Plan for Nurse Registries
On Page 7, item D.1 was revised as follows:
During an emergency, when there is not a mandatory evacuation, some patients registered (pursuant to s. 252.355, F.S.), may decide to stay in their homes, ALF or AFCH. The procedures on how the nurse registry will contact each independent contractor that provides care to the make every reasonable attempt to assure that all patients needing continuing care to determine whether the independent contractor is still providing the care are described below. If the independent contractor is unable to provide the care and the patient still needs care, the procedure will include how the nurse registry will contact other independent contractors and nurse registries to arrange for care to the patient. will receive it, either from the independent contractor referred by the nurse registry or through arrangements made by the patient or the patient’s caregiver:
References to paragraphs in the statutes were changed due to renumbering in the statutes on pages 1, 6 and 7.
