The Agency proposes to revise the rules related to health care risk manager licensure.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-10.002Definitions

59A-10.036Qualification by Practical Experience

59A-10.037Educational Programs

PURPOSE AND EFFECT: The Agency proposes to revise the rules related to health care risk manager licensure.

SUMMARY: These revisions will: update and consolidate definitions; delete definitions that are obsolete; update/clarify qualifications required to be licensed as health care risk manager; and make a technical change to correct an office name.

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 SERC has not been prepared by the agency. For rules listed where no SERC was prepared, the Agency prepared a checklist for each rule to determine the necessity for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule 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: 395.0197, 395.10973(1), FS.

LAW IMPLEMENTED: 395.0197, 395.10974, FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: Monday, April 4, 2016 10:30 am – 11:30 am

PLACE: Agency for Health Care Administration, Conference Room C, 2727 Mahan Drive, Building #3, 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 3 days before the workshop/meeting by contacting: Jessica Munn, Hospital & Outpatient Services Unit, 2727 Mahan Drive, Tallahassee, Florida, [phone]. 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: Jessica Munn, Hospital & Outpatient Services Unit, Bureau of Health Facility regulation, [phone], email: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

(Substantial renumbering and rewording of Rule 59A-10.002 follows. See Florida Administrative Code for present text.)

 

59A-10.002 Definitions

As used in this Rule:

(1) “Accident prevention” means those risk management techniques that seek to reduce the frequency and/or severity of incidents.

(2) “Accredited institution of higher learning” means universities, colleges, community colleges and junior colleges which are accredited by an accrediting agency.

(3) “Accrediting agency” means those accrediting agencies belonging to the Council on Higher Education Accreditation.

(4) “Agency” means the Agency for Health Care Administration.

(5) “Ambulatory surgical center” means an ambulatory surgical center licensed under Chapter 395 and 408, F.S. and Chapter 59A-5 and 35, F.A.C.

(6) “Applicable federal, state and local health and safety laws and rules” means those laws and rules which govern, directly or indirectly, the delivery of patient care.

(7) “Applicable standards of health care risk management” means those principles, criteria or prevailing techniques used to identify, investigate, analyze, evaluate and select the most advantageous methods of reducing, modifying, correcting or eliminating identifiable risks.

(8) “Basic risk manager” means a person who has a degree, awarded by an accredited institution of higher learning, in risk management or insurance.

(9) “Community interrelationships” means community networks, liaisons and associations that are necessary to promote continuity of care or enhance the delivery of patient care and aid in the prevention and control of health care risks.

(10) “Departmental organization and management” means the organizational structure, goals, objectives, philosophy, policies, procedures, and job descriptions which govern organizational operations of the health care risk management program as it functions within the licensed health care facility.

(11) “General risk management administration” means the establishment, direction and evaluation of procedures, programs and other methods to reduce or minimize personal injury and financial losses. The term includes management of an incident reporting system and reporting of appropriate statistics for hospital and state maintenance.

(12) “Health care administrator” means a person who has a masters degree, awarded by an accredited institution of higher learning, in health or healthcare administration, healthcare management, or other such education which included successful completion of graduate level courses in the management and administration of various healthcare organizations, health care finance, legal and ethical issues related to healthcare, risk management, and health information management.

(13) “Health care facility” or “facility” means an ambulatory surgical center or hospital, as defined in subsections (5) and (15).

(14) “Health care professional” means a physician licensed pursuant to Chapter 458, F.S., an osteopath licensed pursuant to Chapter 459, F.S., a chiropractor licensed pursuant to Chapter 460, F.S., a podiatrist licensed pursuant to Chapter 461, F.S., a pharmacist licensed pursuant to Chapter 465, F.S., a nurse licensed pursuant to Chapter 464, F.S., a radiologic technologist certified pursuant to Chapter 468, F.S., a respiratory therapist licensed pursuant to Chapter 468, F.S., a physical therapist licensed pursuant to Chapter 486, F.S., an occupational therapist licensed pursuant to Chapter 468, F.S., and an emergency medical technician or paramedic certified pursuant to Chapter 401, F.S.

(15) “Hospital” means a hospital licensed under Chapter 395 and 408, F.S. and Chapter 59A-3 and 35, F.A.C.

(16) ICD-10-CM means the International Classification of Diseases, 10th Edition, Clinical Modification and shall be abbreviated as ICD-10-CM in these rules.

(17) “Incident report” means a factual written statement about a particular incident detailing particulars as to time, location, all persons directly involved including functional titles, and the nature of event including description of injuries. The report shall contain a listing of witnesses to the event.

(18) “Incident reporting system” means a series of systematized procedures for detecting, reporting, collating, analyzing, and summarizing incidents.

(19) “Internal risk management program” means the policies and procedures of a health care facility which constitute the internal risk management program as defined in Section 395.0197 or 641.55, F.S.

(20) “Investigation” or “investigate” means the identification, analysis and evaluation of an incident by a risk manager or his designee or by a representative of the Agency.

(21) “Licensed health care risk manager” means an individual licensed under Section 395.10974, F.S.

(22) “Medical care” means that care and treatment rendered by or under the direction of licensed health care professionals.

(23) “Medical intervention” means actions of any health care facility or personnel of the facility, in the provision of health care.

(24) “Medical terminology” means terms and abbreviations most commonly found in medical usage as well as prefixes and suffixes which are employed as elements of medical words.

(25) “Patient care” means those services provided or rendered to meet the patient’s physical, emotional and spiritual needs.

(26) “Patient grievance” means any complaint by a patient relating to patient care or the quality of medical services, except for those matters pertaining to the cost of care.

(27) “Personal and social care” means those human resources and services which are available to meet the individual psychosocial needs of patients to promote well-being and continuity of care.

(28) “Personnel” for purposes of this rule means any employee or independent contractor of a facility or member of a facility’s medical staff.

(29) “Personnel directly involved” for the purposes of reporting to the Agency means personnel as described in subsection (28) who could exercise control over the event which is reportable as an adverse or untoward incident.

(30) “Risk management” means the identification, investigation, analysis, and evaluation of risks and the selection of the most advantageous method of correcting, reducing or eliminating identifiable risks.

(31) “Risk Manager designee” means any person appointed by the facility to work with the licensed health care risk manager or to act as his representative in carrying out risk management activities. This appointment must be in writing.

Rulemaking Authority 395.0197 FS. Law Implemented 395.0197 FS. History–New 8-28-79, Formerly 10D-75.02, Amended 3-25-86, 12-28-89, Formerly 10D-75.002, Amended 9-16-92, _____.

 

59A-10.036 Qualification by Practical Experience.

(1) An applicant shall be considered qualified as competent in the areas listed in subsection 395.10974(1), F.S 59A-10.033(1), F.A.C., if the applicant submits evidence satisfactory to the Agency that he or she has been employed or retained by an authorized insurer or an approved Medical Malpractice Risk Management Trust Fund for a period of one year, equivalent to a minimum of 2,080 hours, to participate in the development or implementation of, or compliance with, an Iinternal Rrisk Mmanagement Pprogram, including the review, investigation, and analysis of a facility’s internal incident reports.

(2) An applicant shall be considered qualified as competent in the areas listed in subsection 395.10974(1), F.S 59A-10.033(1), F.A.C., if he or she submits evidence of satisfactory completion of one year of practical experience in health care risk management, equivalent to a minimum of 2,080 hours, which includes experience in each of the required areas as follows:

(a) To qualify in the area of aApplicable sStandards of hHealth cCare rRisk mManagement, the applicant shall have experience in at least one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to be responsible for the implementation of and/or compliance with the program of internal risk management as established pursuant to Section 395.0197 or 641.55, F.S.; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to participate as a member of the facility’s risk management committee which has principal responsibility for the development and/or implementation and/or compliance with the internal risk management program as established pursuant to Section 395.0197 or 641.55, F.S.

(b) To qualify in the area of aApplicable fFederal, sState and lLocal hHealth and sSafety lLaws and rRules, the applicant shall have experience in at least one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of or staff to that committee panel or other functional groups which have responsibility for:

a. Compliance with applicable health and safety laws, rules, and procedures; or

b. Conducting safety surveys and inspections within the facility.

(c) To qualify in the area of gGeneral rRisk mManagement aAdministration, the applicant shall have experience in at least one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident report; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to establish, implement, supervise or serve as staff to that department or unit, which has responsibility for the internal risk management program as established in compliance with Section 395.0197 or 641.55, F.S.

(d) To qualify in the area of pPatient cCare, the applicant shall have experience in at least one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of, serve as staff to, or to coordinate with those facility committees, panels, or other functional groups which have responsibility for the establishment or review of policies, procedures, or standards which govern patient care or the quality of medical care within the facility; or

3. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review patient grievances related to patient care and the quality of medical services within the facility.

(e) To qualify in the area of mMedical cCare, the applicant shall have experience in at least one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of, serve as staff to, or to coordinate with those facility committees, panels or other functional groups which have responsibility for the establishment or review of policies, procedures, or standards which govern patient care or the quality of medical care within the facility; or

3. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review patient grievances related to patient care and the quality of medical services within the facility.

(f) To qualify in the area of pPersonal and sSocial cCare, the applicant shall have experience in one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of, serve as staff to, or to coordinate with those facility committees, panels or other functional groups which have responsibility for the establishment or review of policies, procedures, or standards which govern patient care or the quality of medical care within the facility; or

3. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review patient grievances related to patient care and the quality of medical services within the facility.

(g) To qualify in the area of aAccident pPrevention, the applicant shall have experience in one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of or staff to that committee, panel or other functional groups which have responsibility for:

a. Facility safety; or

b. The implementation of education and/or training within the facility which is designed to prevent accidents; or

c. The implementation of that portion of internal risk management program which is related to accident prevention.

(h) To qualify in the area of dDepartmental oOrganization and mManagement, the applicant shall have experience in one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to establish, implement, supervise or serve as staff to that department or unit, which has responsibility for the internal risk management program as established in compliance with Section 395.0197 or 641.55, F.S.

(i) To qualify in the area of cCommunity iInterrelationships, the applicant shall have been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to enlist, obtain, and/or coordinate public and/or community service resources in those activities which help achieve the objectives of the internal risk management program. Such activities may include participation in the facility’s community disaster planning activities, infection control activities, toxic waste disposal activities, and coordination of community-based training and education programs for medical service personnel.

(j) To qualify in the area of mMedical tTerminology, the applicant shall have experience in one of the following:

1. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review, investigate, analyze and present recommendations based upon the facility’s internal incident reports; or

2. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to serve as a member of, serve as staff to, or to coordinate with those facility committees, panels, or other functional groups which have responsibility for the establishment or review of policies, procedures, or standards which govern patient care or the quality of medical care within the facility; or

3. Applicant has been employed by or retained by a Florida licensed hospital or ambulatory surgical center health care facility to review patient grievances related to patient care and the quality of medical services within the facility.

(3) As part of the application, the applicant shall file AHCA on either Form 3130-1016 AHCA/RM-002A, February 2016, Verification of Practical Experience, which is hereby incorporated by reference,or AHCA/RM-002B one statement completed by his or her employer(s) and one by the applicant indicating documenting that the applicant has experience in each of the required areas. Forms AHCA/RM-002A and AHCA/RM-002B are hereby incorporated by reference and shall take effect on July 9, 1986. This form These forms is available online at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXXX and available may be obtained from the Agency for Health Care Administration, Risk Management Office, 2727 Mahan Drive, Mail Stop 31, Tallahassee, Florida 32308 or at the web address at: http://ahca.myflorida.com/HQAlicensureforms.

Rulemaking Authority 395.10973(1) FS. Law Implemented 395.10974 FS. History–New 7-9-86, Formerly 4-65.006, 4-217.035. Amended______.

 

59A-10.037 Educational Programs.

(1) through (2) No change.

(3) A health care educational program shall be taught by a licensed hHealth cCare rRisk mManager, Health Care Administrator, or hHealth cCare pProfessional. A risk management educational program shall be taught by a licensed hHealth cCare rRisk mManager or by a bBasic rRisk mManager.

(4) An educational program shall establish a course outline which must be approved by the Agency for Health Care Administration prior to the course being offered and any change in the program or course outline must be approved prior to being implemented.

(5) The outline shall contain a description and schedule of the classes, on-the-job training, and supervised individual study which the program shall provide. The outline shall indicate the method by which the participants shall be evaluated for competency before receiving a Certificate of Completion.

(6) A cCertificate of cCompletion, signed by the supervisor or teacher, shall be issued to each person satisfactorily completing an educational program. The program shall send a copy of the cCertificate of cCompletion for each student to the Agency for Health Care Administration, Risk Management Office, 2727 Mahan Drive, Mail Stop 31, Tallahassee, Florida 32308. The cCertificate of cCompletion shall contain the student’s full name, residential address, social security number, name of program, and beginning and ending dates of the program.

(7) The approval of a program or its course outline shall be withdrawn by the Agency for Health Care Administration if the program or course outline fails to comply with these rules at any time.

Rulemaking Authority 395.10973(1) FS. Law Implemented 395.10974 FS. History–New 7-9-86, Formerly 4-65.007, 4-217.040, Amended_________.

 

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jessica Munn

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 02/22/2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 10/30/2014