The Agency is amending the rules relating to nurse registries to revise definitions of “geographic service area” and “satellite office”, update the licensing application form, modify the requirements for nurse registry satellite offices due to ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-18.002Definitions

59A-18.004Licensure Requirements, Procedures, and Fees

PURPOSE AND EFFECT: The Agency is amending the rules relating to nurse registries to revise definitions of “geographic service area” and “satellite office”, update the licensing application form, modify the requirements for nurse registry satellite offices due to statutory changes, and make technical changes for clarification.

SUMMARY: The licensure requirements for nurse registries are being revised to conform to statutory changes in Sections 400.462(28) and 400.509(1), F.S. that became effective on July 1, 2015. Rule 59A-18.002, F.A.C. is amended to revise the definitions of “geographic service area” and “satellite office”. Rule 59A-18.004, F.A.C. is amended to update the nurse registry licensing application form, modify requirements relating to satellite offices due to statutory changes, clarify requirements for changes of address, and make technical changes.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. A SERC has not been prepared by the Agency. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, these rules will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 400.497, 400.509, 408.810(8), 408.819 FS.

LAW IMPLEMENTED: 400.497, 400.506, 400.512, 408.806, 408.809, 408.810, 408.811 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: March 7, 2016, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration Ft. Knox Bldg. 3, Conference Room C, 2727 Mahan Drive, Tallahassee, FL 32308

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Ruby Grantham, Home Care Unit, Bureau of Health Facility Regulation, [phone] or [e-mail]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice). If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Ruby Grantham, Home Care Unit, Bureau of Health Facility Regulation, [e-mail], [phone]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-18.002 Definitions.

When used in this rule chapter, unless the context otherwise requires, the term:

(1) “AHCA” means Agency for Health Care Administration.

(2) “Assistance with activities of daily living” means a certified nursing assistant or a home health aide providing an individual assistance with activities promoting self-care and independence, to include the following:

(a) Ambulation. Providing physical support to enable the patient to move about within or outside of the patient’s place of residence. Physical support includes holding the patient’s hand, elbow, under the arm, or holding on to a support belt worn by the patient to assist in providing stability or direction while the patient ambulates.

(b) Bathing. Helping the patient in and out of the bathtub or shower, adjusting water temperatures, washing and drying portions of the body which are difficult for the patient to reach, and being available while the patient is bathing. Can also include washing and drying the patient who is bed-bound.

(c) Dressing. Helping the patient put on and remove clothing.

(d) Eating. Helping with feeding patients who require assistance with feeding themselves.

(e) Personal hygiene. Helping the patient with shaving and with oral, hair, skin and nail care.

(f) Toileting. Reminding the patient about using the toilet, assisting to the bathroom, helping to undress, positioning on the commode, and helping with related personal hygiene, including assistance with changing of an adult brief. Also includes assisting with positioning the patient on the bedpan, and helping with related personal hygiene.

(g) Assistance with physical transfer. Providing verbal and physical cueing, physical assistance, or both while the patient moves from one position to another, for example between the following: a bed, chair, wheelchair, commode, bathtub or shower, or a standing position. Transfer can also include use of a mechanical lift, if a home health aide or CNA is trained in its use.

(3) “Caregiver” means a registered nurse, licensed practical nurse, certified nursing assistant, home health aide, homemaker or companion that is referred by a nurse registry to provide services to patients.

(4) “Entity” means a partnership, corporation, or other business organization.

(5) “Financial instability” means the nurse registry cannot meet its financial obligation. The issuance of bad checks or an accumulation of delinquent bills or liens or failure to pay any outstanding fines unless the fine has been appealed is evidence of financial instability.

(6) “Geographic Service Area” means one or more of the counties within the health service planning district area, as specified on the license, in which the nurse registry may refer its independent contractors to provide services to patients or clients in their homes or to provide staffing in facilities.

(7) “Independent Contractor” means a person who contracts through a referral from a nurse registry. The independent contractor maintains control over the method and means of delivering the services provided, and is responsible for the performance of such services. An independent contractor is not an employee of the nurse registry.

(8) “Licensed Practical Nurse,” as defined in Section 464.003(16), F.S., means a person who is currently licensed to practice nursing pursuant to Chapter 464, F.S.

(9) “Main Office” means the primary office established in a geographic service area which houses all components of the nurse registry operational site including the administration, fiscal management, service provision and supplies.

(10)(9) “Nurse registry services” means referral of independent contractors to provide health care related services to a patient or client in the person’s home or place of residence or through staffing in a health care facility by an independent contractor referred through a nurse registry. Such services shall be limited to:

(a) Nursing care provided by licensed registered nurses or licensed practical nurses; or

(b) Care and services provided by certified nursing assistants or home health aides; or

(c) Homemaker or companion services.

(11)(10) “Plan of treatment” means written plan of care and treatment, including a medical plan of treatment, signed within 30 days by the physician, advanced registered nurse practitioner, or physician assistant to assure the delivery of safe and adequate care provided by a licensed nurse to a patient in the home.

(12)(11) “Registered Nurse,” as defined in Section 464.003(22), F.S., means a person who is currently licensed to practice pursuant to Chapter 464, F.S.

(12) “Satellite office” means a secondary office of the nurse registry established in the same county as the office, pursuant to Section 400.506(1), F.S.

Rulemaking Authority 400.497, 400.506 FS. Law Implemented 400.497, 400.506 FS. History–New 2-9-93, Amended 1-27-94, 12-24-00, 3-15-07, 5-4-15,                        .

 

59A-18.004 Licensure Requirements, Procedures, and Fees.

(1) Prior to operating a nurse registry as defined under Section 400.462, F.S., the owner shall make application for a license on the Health Care Licensing Application, Nurse Registry, AHCA Form 3110-7004, January 2016 October 2014, incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX, and the Health Care Licensing Application Addendum prescribed in subsection 59A-35.060(1), F.A.C. The application shall be accompanied by a $2,000 licensure fee. The application and other pertinent information can be obtained at the AHCA web site: http://ahca.myflorida.com/HQAlicensureforms. The receipt of a license from AHCA shall be based upon compliance with all applicable rules and laws, as evidenced by a signed application and upon the results of a survey conducted by AHCA representatives.

(2) For renewal and change of ownership licensure, the application forms and licensure fee in subsection (1) must be submitted as required in Section 408.806(2), F.S.

(3) A license shall not be granted to anyone under 18 years of age.

(4) Evidence of financial ability to operate for initial licensure and change of ownership applications must be submitted with the application, which shall consist of the completion of the financial schedules contained in a form as prescribed in subsection 59A-35.062(2), F.A.C.

(5) Satellite offices – One or more additional offices within the county where the main office is located may be added to the initial, renewal or change of ownership application and included on the license certificate pursuant to Section 400.506(1), F.S. A satellite office shares administration, fiscal management, and services with the main operational site; it is not separately licensed office and is exempt from the requirements in paragraphs 59A-18.004(8)(a) and (b), F.A.C. A satellite office must be listed on the license of the nurse registry operational site. A nurse registry that operates a satellite office must:

(a) Maintain a system of communication and integration of services between the nurse registry operational site and the satellite office;

(b) Provide access to patient records at the satellite office;

(c) Ensure periodic onsite visits to each satellite office by the nurse registry’s administrator;

(d) Make the satellite office’s hours of operation available to the public if different than the hours of operation maintained by the nurse registry operational site.

(6) Evidence of compliance with local zoning authorities for the main operational site office of the nurse registry and any satellite offices must be submitted with the application.

(7) All nurse registries must apply for a geographic service area on their initial license application. Nurse registries may apply for a geographic service area which encompasses one or more of the counties within the health services planning district specific AHCA area boundaries, pursuant to Sections 408.032(5) and 400.497(9), F.S., in which the main operational site office is located. However, any agency holding a current nurse registry license from AHCA, as of December 24, 2000, may continue to serve patients or clients in those counties listed on its current license.

(8) If a change of address is to occur, or if a nurse registry intends to change the counties served within the geographic service area, or open or close a satellite office, the nurse registry must complete and submit the Health Care Licensing Application, Nurse Registry, AHCA Form 3110-7004, January 2016 as required in Rule 59A-35.040(2)(b), F.A.C. For changes of address and addition of satellite offices, the nurse registry must submit, with the application, evidence that the location is zoned for a nurse registry for the new address and evidence of legal right to occupy the property in accordance with Section 408.810(6), F.S.

(9)(8) 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 7:00 a.m. and 6:00 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)(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.

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, 408.811 FS. History–New 2-9-93, Amended 1-27-94, 12-24-00, 8-10-06, 3-15-07, 5-4-15,                     .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Ruby Grantham

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: February 02, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: October 30, 2015