The purpose of the rule revisions is to conform the rules to changes made to Chapter 400, Part IV, Florida Statutes, by the 2005 Florida Legislature in Chapter 2005-243, Laws of Florida; to make improvements to criteria for emergency management ...

Health Facilities and Agency Licensing

RULE NOS.: RULE TITLES:

59A-8.002 Definitions

59A-8.003 Licensure Requirements

59A-8.004 Licensure Procedure

59A-8.0086 Denial, Suspension, Revocation of License and Imposition of Fines

59A-8.0095 Personnel

59A-8.0185 Personnel Policies

59A-8.020 Acceptance of Patients or Clients

59A-8.0215 Plan of Care

59A-8.022 Clinical Records

59A-8.027 Emergency Management Plans

PURPOSE AND EFFECT: The purpose of the rule revisions is to conform the rules to changes made to Chapter 400, Part IV, Florida Statutes, by the 2005 Florida Legislature in Chapter 2005-243, Laws of Florida; to make improvements to criteria for emergency management plans; to add a retention period for personnel records; to remove the requirement for training homemakers and companions for consistency among programs; to replace the schedule for the frequency of periodic licensure surveys due to budget constraints; and to clarify the financial schedules needed for applications for changes of ownership and for applications for renewal of licenses when there is evidence of financial instability.    The effect will be updated rules that conform to state law; an updated licensure fee for the two-year license based on the same amount per year; a revised renewal licensure application that collects annual patient admissions; one less financial schedule to be completed for change of ownership applications and an additional financial schedule for renewal applicants with evidence of financial instability; a uniform emergency management plan format for home health agencies that includes planning for patients in residential facilities; no requirements for training homemakers and companions consistent with the registered homemaker companion services; and the addition of a one-year retention period for personnel records.      

SUMMARY: The rules are being updated due to the changes to Chapter 400, Part IV, Florida Statutes, made by the 2005 Florida Legislature in Chapter 2005-243, Laws of Florida.  These changes are: adding that advanced registered nurse practitioners and physician assistants may also sign treatment orders and eliminating the 30 day requirement for signature; revising the amount of the licensure fee since the licensure period was increased from one to two years; changing the due date for renewal applications from 90 days to 60 days prior to expiration of the license; deleting the late application fine in rule since it was placed in law; updating the renewal application form to include an item to collect volume data and clarify existing items; updating the date for screening staff that have been continuously employed; updating the rule on exempting accredited home health agencies from licensure surveys; and removing the requirement for an alternate director of nursing.   In addition, the following changes were made: the periodic licensure survey cycle was replaced with the requirement to survey no later than 36 months; one of the financial schedules was removed from the change of ownership application requirements and a financial schedule was added for renewal applicants that have evidence of financial instability; the requirement for training homemakers and companions was removed to be consistent with the homemaker companion registration program; a one-year retention period was added for personnel records; and the emergency management plan criteria form was replaced with a standard plan format and the emergency management plan rule includes patients residing in assisted living facilities and adult family care homes.  Addresses and legal references are also updated and the newer version of the Agency’s background screening form is referenced. 

SUMMARY OF ESTIMATED REGULATORY COST: A Statement of Estimated Regulatory Cost was not prepared. It is anticipated that there will be no additional costs to home health agencies as a result of these amendments.

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

SPECIFIC AUTHORITY: 400.497 FS., 400.471 FS., 400.492 FS., 400.487 FS.

LAW IMPLEMENTED: 400.497 FS., 400.462 FS., 400.464 FS., 400.471 FS., 400.487 FS., 400.492 FS., 400.512 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULES IS: Anne Menard, Licensed Home Health Programs Unit, Bureau of Health Facility Regulation, Agency for Health Care Administration, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308, [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULES IS:

 

59A-8.002 Definitions

(1) through (38) No change.

(39) “Treatment orders” means written orders signed by a physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, which authorizes the provision of care or treatment to a patient in his place of residence by licensed Nurses, Physical Therapists, Occupational Therapists, Speech Therapists, or Dietitians/ Nutritionists.

Specific Authority 400.497 FS. Law Implemented 400.462 FS., 400.487 FS. History–New 4-19-76, Formerly 10D-68.02, Amended 4-30-86, 8-10-88, 5-30-90, 5-27-92, Formerly 10D-68.002, Amended 4-27-93, 10-27-94, 1-17-00, 7-18-01, 9-22-05, ___________

 

59A-8.003 Licensure Requirements.

(1) No change

(2) An application for renewal of license must be submitted to AHCA at least 60 90 days prior to the date of expiration of the license, pursuant to Section 400.471(7)(6), F.S. It is the responsibility of the home health agency to submit an application within the specified time frames whether or not they receive separate notification from AHCA of the impending expiration of the license. Home health agencies that apply for renewal of their licenses will be surveyed on a variable survey cycle, pursuant to Section 400.484, F.S., based on the extent of compliance on previous surveys and complaint investigations with these rules and state laws. Home health agencies After two consecutive full surveys, home health agencies that had no class I, class II, or class III deficiencies, as defined in Sections 400.484(2)(a)-(c), F.S., as a result of the surveys or a complaint survey, will be surveyed on an unannounced basis at least no later than every 36 months. Home health agencies that had no class I or class II deficiencies as defined in Sections 400.484(2)(a) and (b), F.S., as a result of the previous survey or a complaint survey will be surveyed on an unannounced basis no later than a range of 12 to 36 months. Home health agencies that had a change of ownership since the previous survey, a complaint survey or other survey with a class I or class II deficiency citation, as defined in Sections 400.484(2)(a)-(b), F.S., will be surveyed no later than every 9 to 15 months. Area offices may do follow up surveys to check on correction of deficiencies at any time on an unannounced basis, prior to the next full survey cycle. An exit conference will be conducted to report the findings and to receive additional information or clarification concerning the survey.

(3) Surveys of Accredited Home Health Agencies: 

(a) AHCA may accept the survey report of an accrediting organization in lieu of its own periodic licensure inspection, provided that the standards included in the survey report of the accrediting organization are determined by the Agency to document that the home health agency is in compliance with state licensure requirements.

(a)(b) It is the responsibility of the home health agency to request exemption from state licensure surveys pursuant to Section 400.471(9), F.S., by writing to the AHCA Home Care Unit, submitting documentation of accreditation by an approved accrediting organization and the most recent survey from the accrediting organization to the AHCA Licensed Home Health Programs Unit.

(c) The AHCA Home Care Unit will review the request and approve or deny the request, notifying the appropriate AHCA field office.

(b)(d) Home health agencies that complete (a) receive an exemption will not be subject to licensure surveys an inspection by AHCA except under the following circumstances:

1. The HHA has been denied accreditation or has received a provisional or conditional accreditation report from the accrediting organization on its most recent survey, and has not submitted an acceptable plan of correction to the organization and to the agency; or

2. The HHA has received full accreditation but has not authorized the release of the report to the AHCA, or has not ensured that AHCA has received the accrediting organization’s report.

(4) No change.

(5) In addition to any other penalties imposed pursuant to this rule, the agency may assess costs related to an investigation that results in a successful prosecution, pursuant to Section 400.484(3), F.S. The prosecution can be resolved by stipulation settlement or final hearing. The following costs may apply: travel costs related to the investigation; investigative time by AHCA’s surveyor or surveyors including travel time; processing time by AHCA’s professional staff and administrative support staff of Field Operations, and processing time for administrative support staff and professional staff of the AHCA Licensed Home Health Programs Home Care Unit in Tallahassee. The costs related to AHCA’s professional staff and support staff will be determined according to the hourly rate of pay for those positions.

(6) An application package for a change of ownership shall be made on a form prescribed by AHCA, as referenced in subsection 59A-8.004(1), F.A.C.

(a) through (b) No change.

(c) Failure to apply for a change of ownership of a licensed home health agency as required by Section 400.471, F.S., shall result in a fine set and levied by AHCA pursuant to Section 400.471(8), F.S. subsection 59A-8.0086(3), F.A.C. This is also applicable to owners who incorporate and do not report this change of ownership to the agency.

(7) through (8) No change.

(9) If a change of address is to occur, or if an agency intends to open a satellite office, the home health agency must provide 14 days advance notice in writing to the AHCA Licensed Home Health Programs Home Care Unit in Tallahassee and the AHCA area office. The home health agency must submit to the AHCA Licensed Home Health Programs Home Care Unit a certificate of occupancy, certificate of use, or evidence that the location is zoned for a home health agency business for the new address. Failure to notify AHCA within the time frame will result in a $500 fine, pursuant to Section 400.474(1), F.S. Emergency relocations must be reported within seven days, with the reason for the relocation documented, to avoid a penalty assessment. An emergency relocation can be due to any of the following situations: 1) an eviction notice; 2) environmental conditions on or near the site which are not conducive to the health and well being of staff and clients, including a fire or flooding; 3) an element near the site which would make the premises harmful or dangerous; 4) circumstances arising from or caused by weather conditions and/or a natural disaster; or 5) a change in property zoning that requires the home health agency to move.

(10) No change.

(11) The initial, change of ownership and renewal fee for home health licensure is $1,660  $830 .

(12) If licensure application fee checks are returned by the financial institution due to insufficient funds, the issuance of a license may be delayed, denied or revoked license is not valid and shall be returned to the AHCA Home Care Unit by the home health agency.

(13) Upon revocation, suspension, voluntary or involuntary termination of a license, the home health agency shall return its license to AHCA. If the provider voluntarily chooses to terminate the license, the provider must notify AHCA by submitting a letter, to the address: AHCA Licensed Home Health Programs Home Care Unit, 2727 Mahan Drive – Mail Stop 34, Tallahassee, FL 32308, officially declaring the closure date of the home health agency.

Specific Authority 400.497 FS. Law Implemented: 400.464 FS., 400.471 FS., 400.474 FS., 400.484 FS., 400.497 FS. History–New 4-19-76, Formerly 10D-68.03, Amended 4-30-86, 8-10-88, 5-30-90, 6-12-91, Formerly 10D-68.003, Amended 4-27-93,10-27-94, 1-30-97, 1-17-00, 07-18-01, 09-22-05,_________.

 

59A-8.004 Licensure Procedure.

(1) An application for licensure, initial, change of ownership, or renewal, shall be made on a form prescribed by the AHCA: Home Health Agency Application for Initial Licensure, form number, AHCA 3110-1001, Revised July 2005; Application for Renewal of Licensure, form number, AHCA 3110-1011, January 2006 July 2005; and Application for Change of Ownership, form number AHCA 3110-1012, July 2005, all incorporated by reference. These forms may be obtained at the AHCA web site, http://ahca.myflorida.com under Licensing, Home Health Agency www.fdhc.state.fl.us, in the Home Care Unit pages. If the requestor is unable to obtain the documents from the web site, the forms may be obtained from the AHCA Licensed Home Health Programs Home Care Unit by contacting [phone] and sending a check or money order to cover the Agency’s costs for the copying and mailing.

(2) through (4) No change.

(5) For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate, pursuant to Section 400.471(3), F.S. The compliance is demonstrated by completion of AHCA Form 3110-1013, December 2004, as referenced in subsection (1) above. Applications for changes of ownership and applications for initial licensure from agencies that failed to renew their licenses before expiration are not required to submit Schedule 1 of AHCA Form 3110-1013, December 2004.

(6) An applicant for renewal of licenses shall not be required to provide proof of financial ability to operate, unless the applicant has demonstrated financial inability to operate, as defined in subsection 59A-8.002(16), F.A.C. If an agency has shown signs of financial instability AHCA shall require the applicant for renewal of license to provide proof of financial ability to operate, by submitting schedules 2 3 through 7 of AHCA Form 3110-1013, December 2004, described in subsection (5) above.

(7) The applicant shall submit a signed affidavit from the administrator affirming that the administrator, the financial officer, and all direct and contract personnel who enter the home in the capacity of their employment have been screened for good moral character. This affidavit also confirms that all remaining personnel, who enter the home in the capacity of their employment, have worked continuously for the home health agency since before October 1, 2000 1994.

(8) No change.

(9) Screening for good moral character for the administrator and the financial officer shall be in accordance with level 2 standards for screening set forth in Section 400.471(4), F.S. The fingerprint card for level 2 screening for the administrator and the financial officer can be obtained from the Agency for Health Care Administration, Licensed Home Health Programs Home Care Unit, by calling [phone] or sending a request by fax to [phone]. The completed fingerprint card should be submitted with a check or money order to cover the cost of the screening to the Agency for Health Care Administration, Licensed Home Health Programs Home Care Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.

(10) Level 1 Screening for good moral character for all personnel, including contractors, who enter the home shall consist of: Submission of the Request for Level 1 Criminal History Check, AHCA form 3110-0002, July 2005 June 1998, incorporated by reference. The FDLE form can be submitted either through AHCA’s Background Screening Unit, directly to FDLE, or through a third party vendor that obtains the statewide criminal history through the FDLE. The address for submission to AHCA’s Background Screening Unit is AHCA Background Screening Unit, Mail Stop 40, 2727 Mahan Drive, Tallahassee, FL 32308. The address for submission through FDLE is FDLE, Crime Information Bureau, Post Office Box 1489, Tallahassee, Florida 32302. The form may be obtained at the Agency for Health Care Administration web site, http://ahca.myflorida.com http://www.fdhc.state.fl.us, at the Background Screening page. The cost of processing the screening request must be paid by the home health agency or the employee being screened. The check must accompany the screening request and be made payable to AHCA if the request is submitted to AHCA, to the FDLE if the request is submitted to the FDLE, or to the home health agency’s agent, if one is used for FDLE screening.

(11) through (12) No change.

Specific Authority 400.497 FS. Law Implemented 400.471 FS., 400.512 FS.  History–New 4-19-76, Formerly 10D-68.04, Amended 4-30-86, 8-10-88, 5-30-90, 6-12-91, 10-6-91, Formerly 10D-68.004, Amended 4-27-03, 10-27-94, 1-30-97, 1-17-00, 7-18-01, 9-22-05,_______.

 

59A-8.0086 Denial, Suspension, Revocation of License and Imposition of Fines.

(1) The AHCA shall deny, suspend or revoke an application for license, or impose a fine,

(a) If the applicant fails to submit all the information required in the application within 30 days of being notified by AHCA Licensed Home Health Programs Home Care Unit of the omissions in the application, the application shall be denied.

(b) through (e) No change.

(2) No change.

(3) Failure to file an application within the time frames specified in this rule shall result in an administrative fine, pursuant to Section 400.474(1), F.S., in the amount of $50 per day, each day constituting a separate violation. In no event shall such fines aggregate more than $2,500.

(3) This provision does not restrict AHCA from imposing an administrative fine, revoking the license or issuing a moratorium in accordance with Section 400.484(2)(b), F.S.

(4) No change.

Specific Authority 400.497 FS. Law Implemented 120.59 FS., 400.474 FS., 400.484 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01, 9-22-05, ________.

 

59A-8.0095 Personnel.

(1) Administrator.

(a) No change.

(b) If an agency changes administrator or alternate administrator the agency shall notify AHCA Licensed Home Health Programs Home Care Unit office in Tallahassee prior to or on the date of the change. Notification shall consist of submission of the person’s name, professional resume, professional license, if applicable, and a copy of the Affidavit of Good Moral Character. The administrator also must submit level 2 screening, pursuant to subsection 59A-8.004(9), F.A.C., or inform the Licensed Home Health Programs Home Care Unit that level 2 screening was previously submitted.

(2) Director of Nursing.

(a) The director of nursing of the agency shall:

1. Meet the criteria as defined in Section 400.462(10)(7), F.S.;

2. Supervise or manage, directly or through qualified subordinates, all personnel who provide direct patient care;

3. Ensure that the professional standards of community nursing practice are maintained by all nurses providing care;

4. Maintain and adhere to agency procedure and patient care policy manuals; and

5. Designate in writing be a direct employee or an individual covered under a management company contract to manage the home health agency or an employee leasing contract, pursuant to Section 468.520, F.S., who meets the qualifications as defined in Section 400.462(7), F.S., to serve as on-site alternate director of nursing during absences of the director of nursing. This person will be available during designated business hours, when the director of nursing is not available. Available during designated business hours means being readily available on the premises or by telecommunications. During such absences, the on-site alternate director of nursing will have the responsibility and authority for the daily clinical operation of the agency.

(b) If the administrator is not a physician or registered nurse, the director of nursing shall:

1. Establish service policies and procedures in compliance with subsections 64E-16.001(4), (5), F.A.C., and state health statutes and administrative rules pursuant to Section 381.0011(4), F.S., which generally conform to recommended Centers for

Disease Control (CDC) and Occupational Safety and Health Agency (OSHA) guidelines for safety, universal precautions and infection control procedures;

2. through 4. No change.

(c) through (d) No change.

(e) If an individual serves as the director of nursing of more than one licensed agency, pursuant to Section 400.462(7), F.S., a designated alternate director of nursing must be available during designated business hours, at each additional agency, who has the responsibility and authority for the clinical operation. Available during designated business hours means being readily available on the premises or by telecommunications.

(3) through (4) No changes

(5) Home Health Aide and Certified Nursing Assistant.

(a) through (b) No change.

(c) For every certified nursing assistant the home health agency shall have on file the person’s State of Florida certification. A copy of the screen of the Florida Department of Health web site’s Certified Nursing Assistant Information that shows the person’s name, address, certificate number, original issue date, expire date and status will meet this requirement.

(d) For every home health aide, a home health agency shall have on file documentation of successful completion of at least forty hours of training, pursuant to Section 400.497(1), F.S., in the following subject areas:

1. through 14.  No change.

15. Assistance with self-administered medication. Home health aides and CNAs assisting with self-administered medication, pursuant to Section 400.488, F.S., must receive a minimum of 2 hours of training (which can be part of the 40 hour home health

training) prior to assuming this responsibility. Training must cover state law and rule requirements with respect to the assistance with self-administration of medications in the home, procedures for assisting the patient resident with self-administration of medication,

common medications, recognition of side effects and adverse reactions and procedures to follow when patients residents appear to be experiencing side effects and adverse reactions. Training must include verification that each CNA and home health aide can read the prescription label and any instructions. Individuals who cannot read must not be permitted to assist with prescription medications. Other courses taken in fulfillment of this requirement must be documented and maintained in the home health aide’s and the CNA's personnel file.

16. No change.

(e) through (r) No change.

(s) Home health aides who are trained in another state must provide documentation of course completion to the employing home health agency. Individuals who have graduated from an accredited school of nursing and are waiting awaiting to take their boards for

licensure in Florida, can work as a home health aide. Registered nurses and licensed practical nurses who can show proof they are licensed in another state or in Florida, can work as a home health aide in Florida.

(6) Physical Therapist and Physical Therapist Assistant.

(a) No change.

(b) The responsibilities of the physical therapist are:

1. To provide physical therapy services as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice, which can be safely provided in the home and assisting the physician, physician assistant, or advanced registered nurse practitioner in evaluating patients by applying diagnostic and prognostic muscle, nerve, joint and functional abilities test;

2. To observe and record activities and findings in the clinical record and report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in patient’s condition, or when there are deviations from the plan of care;

3. through 5. No change.

(7) Speech Pathologist. The speech pathologist shall be currently licensed in the state, pursuant to Chapter 468, F.S., and shall:

(a) Assist the physician, physician assistant, or advanced registered nurse practitioner in evaluating the patient to determine the type of speech or language disorder and the appropriate corrective therapy;

(b) No change.

(c) Record activities and findings in the clinical record and to report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in the patient’s condition, or when there are deviations from the plan of care; and

(d) No change.

(8) Occupational Therapist and Occupational Therapist Assistant.

(a) No change.

(b) The duties of the occupational therapist are:

1. To provide occupational therapy services as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice, which can be safely provided in the home and to assist the physician, physician assistant, or advanced registered nurse practitioner in evaluating the patient’s level of function by applying diagnostic and therapeutic procedures;

2. No change.

3. To observe and record activities and findings in the clinical record and to report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in the patient’s condition, or when there are deviations from the plan of care; and

4. No change.

(9) Respiratory Therapist.

(a) No change.

(b) The responsibilities of the respiratory therapist are:

1. To provide respiratory therapy services, prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice, which can be safely provided in the home and to assist the physician, physician assistant, or advanced registered nurse practitioner in evaluating patients through the use of diagnostic testing related to the cardiopulmonary system;

2. To observe and record activities and findings in the clinical record and report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in the patient’s condition, or when there are deviations from the plan of care;

3. through 5. No change.

(10) Social Worker.

(a) The social worker shall be a graduate of an accredited school of social work with one year of experience in social services and shall:

1. Assist the physician, physician assistant, or advanced registered nurse practitioner and other members of the health team in understanding significant social and emotional factors related to the patient’s health problems;

2. through 5. No change.

(b) No changes

(11) Dietitian/Nutritionist.

(a) No change.

(b) The responsibilities of the dietitian/nutritionist are:

1. No change.

2. To provide dietetics and nutrition counseling in the home, as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice;

3. To observe and record activities and findings in the clinical record and report to the physician, physician assistant, or advanced registered nurse practitioner, the patient’s reaction to treatment and any changes in a patient’s condition;

4. No change.

(12) Homemakers and Companions.

(a) The homemaker or companion utilized by a home health agency shall receive, or have documentation on file of having received, training in topics related to human development and interpersonal relationships, nutrition, marketing, food storage, use of equipment and supplies, planning and organizing of household tasks and principles of cleanliness and safety;

(a)(b) No change.

(b)(c)  No change.

Specific Authority 400.497 FS. Law Implemented 400.462 FS., 400.471 FS., 400.487 FS., 400.488 FS., 400.497 FS. History–New 1-20-97, Amended 1-17-00, 7-18-01, 9-22-05, ________.

 

59A-8.0185 Personnel Policies.

(1) through (2) No change.

(3) The agency shall maintain a file for all employees which shall include name and address of employee, name and address of next of kin or guardian, evidence of qualifications, licensure or registration if applicable, a signed and notarized Affidavit of Good Moral Character, AHCA Form 3110-0001, December 2004, for any newly hired employee working in a probationary status pending the results of the background screening, results of background screening, and dates of employment and separation from the agency. Evidence of continuing education, in-service training, and the training required in subsection (2), shall be on file and this information shall be kept in the personnel files or in a separate filing system maintained for this purpose and shall be available for inspection within three hours of request. Each employee file shall be retained by the agency for at least one year after the employee has separated from the agency.

(4) No change.

Specific Authority 400.497 FS. Law Implemented 400.471 FS., 400.497 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01, 9-22-05, ________.

 

59A-8.020 Acceptance of Patients or Clients.

(1) When a home health agency accepts a patient or client for service, there shall be a reasonable expectation that the services can be provided safely to the patient or client in his place of residence. This includes being able to communicate with the patient, or with another person designated by the patient, either through a staff person or interpreter that speaks the same language, or through technology that translates so that the services can be provided. The responsibility of the agency is also to assure that the patient or client receives services as defined in a specific plan of care, for those patients receiving care under a physician’s, physician assistant, or advanced registered nurse practitioner’s treatment orders, or in a written agreement, as described in subsection (3) below, for clients receiving care without a physician’s, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient receives all assigned visits.

(2) No change.

(3) The written agreement, as specified in subsection (2) above, shall serve as the home health agency’s service provision plan, pursuant to Section 400.491(2), F.S., for clients who receive homemaker and companion services or home health aide services which do not require a physician’s, physician assistant, or advanced registered nurse practitioner’s treatment order. The written agreement for these clients shall be maintained for one year after termination of services.

(4) When the agency terminates services for a patient or client needing continuing home health care, as determined by the patient’s physician, physician assistant, or advanced registered nurse practitioner, for patients receiving care under a physician’s, physician assistant, or advanced registered nurse practitioner’s treatment order, or as determined by the client or caregiver, for clients receiving care without a physician’s, physician assistant, or advanced registered nurse practitioner’s treatment order, a plan must be developed and a referral made by home health agency staff to another home health agency or service provider prior to termination. The patient or client must be notified in writing of the date of termination, the reason for termination, pursuant to Section 400.491, F.S., and the plan for continued services by the agency or service provider to which the patient or client has been referred, pursuant to Section 400.497(6), F.S. This requirement does not apply to patients paying through personal funds or private insurance who default on their contract through non-payment. The home health agency should provide social work assistance to patients to help them determine their eligibility for assistance from government funded programs if their private funds have been depleted or will be depleted.

Specific Authority 400.497 FS. Law Implemented 400.487 FS. History–New 4-19-76, Formerly 10D-68.20, Amended 4-30-86, 8-10-88, Formerly 10D-68.020, Amended 10-27-94, 1-17-00, 7-18-01, 9-22-05, __________.

 

59A-8.0215 Plan of Care.

(1) A plan of care shall be established in consultation with the physician, physician assistant, or advanced registered nurse practitioner, pursuant to Section 400.487, F.S., and the home health agency staff who are involved in providing the care and services required to carry out the physician’s, physician assistant, or advanced registered nurse practitioner’s treatment orders. The plan must be included in the clinical record and available for review by all staff involved in providing care to the patient. The plan of care shall contain a list of individualized specific goals for each skilled discipline that provides patient care, with implementation plans addressing the level of staff who will provide care, the frequency of home visits to provide direct care and case management.

(2) Home health agency staff must follow the physician’s, physician assistant, or advanced registered nurse practitioner’s treatment orders that are contained in the plan of care. If the orders cannot be followed and must be altered in some way, the patient’s physician, physician assistant, or advanced registered nurse practitioner must be notified and must approve of the change. Any verbal changes are put in writing and signed and dated with the date of receipt by the nurse or therapist who talked with the physician’s, physician assistant, or advanced registered nurse practitioner’s office.

(3) No change.

Specific Authority 400.497 FS. Law Implemented 400.487 FS.  History–New 10-27-94, Amended 1-17-00, 7-18-01, __________.

 

59A-8.022 Clinical Records.

(1) through (4) No change.

(5) Clinical records must contain the following:

(a) No change.

(b) Physician’s, physician assistant, or advanced registered nurse practitioner’s verbal orders initiated by the physician, physician assistant, or advanced registered nurse practitioner prior to start of care and signed by the physician, physician assistant, or advanced registered nurse practitioner as required in Section 400.487(2), F.S. within 30 days after the start of care;

(c) through (j) No change.

(k) Reports to physicians, physician assistants, or advanced registered nurse practitioners;

(l) No change.

(6) No change.

Specific Authority 400.497 FS. Law Implemented 400.491 FS., 400.494 FS., 400.497 FS. History–New 4-19-76, Amended 2-2-77, Formerly 10D-68.22, Amended 4-30-86, 8-10-88, Formerly 10D-68.022, Amended 10-27-94, 1-17-00, 7-18-01, 9-22-05, _________.

 

59A-8.027 Emergency Management Plans.

(1) Pursuant to Section 400.492, F.S., each home health agency shall prepare and maintain a written comprehensive emergency management plan, in accordance with criteria shown in the “Emergency Management Planning Format Criteria for Home Health Agencies,” AHCA Form 3110-1006, Revised December 2005 February, 2001, incorporated by reference. This document is available from the Agency for Health Care Administration at http://ahca.myflorida.com and shall be used as the format for included as part of the home health agency’s emergency management plan. The plan shall describe how the home health agency establishes and maintains an effective response to emergencies and disasters.

(2) The plan, once completed, will be forwarded electronically for approval to the Office of Public Health Nursing, Department of Health by multi-county agencies or to the contact designated by the Department of Health for single county agencies.

Emergency management plans will be reviewed by the local County Health Department or by the Department of Health, pursuant to Section 400.497(8)(c), (d), F.S., in those counties where the Department of Health receives funding for such reviews, pursuant to Section 381.0303(7), F.S. The Agency for Health Care Administration will notify those agencies who will be required to submit their emergency management plans for review.

(3) through (4) No change.

(5) When an agency goes through a change of ownership the new owner shall review its emergency management plan and make any substantive changes, including changes noted in subsection (4) above. Those agencies which previously have had their plans reviewed by the local County Health Department or by the Department of Health, as defined in subsection (2) above, will need to report any substantive changes to the reviewing entity.

(6) through (7) No change.

(8) On admission, each home health agency shall, pursuant to Section 252.355, F.S., inform patients and patient caregivers of the agency’s procedures during and immediately following an emergency and inform patients of the special needs registry maintained by their county Emergency Management office. The agency must document in the patient’s file if the patient plans to evacuate or remain at home; if during the emergency the patient’s caregiver can take responsibility for services normally provided by the agency; or if the agency needs to continue services to the patient. If the patient is a resident of an assisted living facility or an adult family care home, the home health agency must contact the assisted living facility or adult family care home administrator or designated emergency management personnel and find out the plan for evacuation of the resident in order to document the resident’s plans in the agency’s file for the patient.  If it is determined the agency needs to provide continued services, it will be the responsibility of the home health agency to provide care for the patient in the special needs shelter during and after the emergency, equal to the care received prior to the shelter assignment, except in certain situations as specified in Section 400.492(3), F.S.

(9) Upon eminent threat of an emergency or disaster the home health agency must contact those patients needing ongoing services and confirm each patient’s plan during and immediately following an emergency. The home health agency must also contact every assisted living facility and adult family care home where patients are served to confirm the plans during and immediately following the emergency.

(10) During emergency situations, when there is not a mandatory evacuation order issued by the local Emergency Management agency, some patients may decide not to evacuate and will stay in their homes. The home health agency must establish procedures, prior to the time of an emergency, which will delineate to what extent the agency will continue care during and immediately following an emergency. The agency shall also ascertain which patients remaining at home will need care from the home health agency and which patients have plans to receive care from their family or caregivers.  The agency shall designate staff to continue the services specified in the treatment orders to residents in the assisted living facility or adult family care home during and following the emergency.  If the assisted living facility or adult family care home does relocate the residents to another assisted living facility or adult family care home within the geographic area the home health agency is licensed to serve, the agency will continue to provide services to the residents, except in certain situations as specified in Section 400.492(3), F.S.   If the residents should go to a special needs shelter outside the licensed area of the home health agency, the home health agency may provide services to the residents at the shelter pursuant to Section 400.492(4), F.S.

(11) If the agency at some point ceases operation, as defined in Section 400.492(3), F.S., the agency must inform those patients whose services will be discontinued during the emergency.  The agency must also notify assisted living facilities and adult family care homes where residents are served and make arrangements for nursing personnel to continue essential services, such as insulin and other injections, as ordered in treatment orders to residents. If the agency has assisted living facility, adult family care home or other patients in special needs shelters, then the agency will call the local emergency operation center as soon as possible after the disaster and report on the status of the agency’s damage, if any, and the post-disaster availability to continue serving their patients in the special needs shelters and during discharge from the special needs shelters.

(12) through (13) No change.

(14) The prioritized list of registered special needs patients maintained by the home health agency shall be kept current and shall include information as defined in Section 400.492(2), F.S. The prioritized list shall also include residents in assisted living facilities and adult family care homes who require nursing services.  This list will assist home health agency staff during and immediately following an emergency which requires implementation of the emergency management plan. This list also shall be furnished to local County Health Departments and to the county Emergency Management office, upon request.

(15) through (16) No changes

Specific Authority 400.492 FS., 400.497 FS. Law Implemented 400.492 FS., 400.497 FS. History–New 7-18-01, Amended _______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Anne Menard

NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Jeffrey N. Gregg

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 9, 2006

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: October 7, 2005

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