Definitions, Licensure Requirements, Licensure Procedure, Personnel, Clinical Records, Advance Directives, Emergency Management Plans

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-8.002Definitions

59A-8.003Licensure Requirements

59A-8.004Licensure Procedure

59A-8.0095Personnel

59A-8.022Clinical Records

59A-8.0245Advance Directives

59A-8.027Emergency 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. 39, No. 27, February 8, 2013 issue of the Florida Administrative Register.

The changes to 59A-8.0095(1), (2) are in response to written comments received from persons working for home health agencies. The remaining changes are made based on comments received from the Joint Administrative Procedures attorney. The changes are as follows:

 

59A-8.002 Definitions. No change.

 

59A-8.003 Licensure Requirements.

(1) The issuance of an initial license shall be based upon compliance with Chapter 400, Part III, F.S., and this rule as evidenced by a signed and notarized, complete and accurate home health agency application, as referenced in subsection 59A-35.060(1)(m) 59A-8.004(1), F.A.C., and the results of a survey conducted by an accrediting organization as required in Section 400.471, F.S

(3) Surveys of Accredited Home Health Agencies:

(a) It is the responsibility of the home health agency to request exemption from state licensure surveys pursuant to Section 400.471(2), F.S., by submitting documentation of accreditation by an approved accrediting organization and the most recent survey from the accrediting organization to the AHCA Home Care Unit.

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

1. The home health agency HHA has been denied accreditation, has received a preliminary determination of denial of accreditation, or has received a provisional, conditional, or deferred accreditation report from the accrediting organization on its most recent survey, or

2. The home health agency 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.

(6) An application package for a change of ownership shall be made on a form prescribed by AHCA, as referenced in rule 59A-35.060(1)(m), F.A.C.

(d) Failure to apply for a change of ownership of a licensed home health agency as required by Sections 408.806(2)(b) and 400.471, F.S., shall result in a fine set and levied by AHCA pursuant to Section 400.474(1)(2)(a) and 408.813(3)(b), F.S. This is also applicable to owners who incorporate and do not report this change of ownership to the home health agency.

Rulemaking Authority 400.497 FS. Law Implemented 400.464, 400.471, 400.474, 400.484, 400.497 FS., 408.806, 408.807, 408.810 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, 7-18-01, 9-22-05, 8-15-06, 3-29-07, ________.

 

59A-8.004 Licensure Procedure.

(4) An applicant for initial license shall sign the form AHCA 3110-1026, Attestation of Compliance with Distance Requirements, March 2013 April 2010, which is incorporated by reference, pursuant to Section 400.471(7), F.S. The form may be obtained at the AHCA web site, http://ahca.myflorida.com/homecare; at the site, select “Home Health Agency” and then select the “Application” tab.

Rulemaking Authority 400.497 FS. Law Implemented 400.471, 400.512, 408.810, 408.806, 408.8065, 408.809, 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 4-27-93, 10-27-94, 1-30-97, 1-17-00, 7-18-01, 9-22-05, 8-15-06, 3-29-07,_________.

 

59A-8.0095 Personnel.

(1)Administrator.

(b) If an agency changes administrator the agency shall notify the AHCA Home Care Unit office in Tallahassee as required in 59A-35.110(1). Notification shall consist of submission of the person’s name and a statement that the person meets the qualifications in Sections 400.476(1) and 400.462(1), F.S. Send the notification by email, fax or mail to [e-mail], fax [phone], or AHCA Home Care Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308. The administrator also must submit level 2 screening, pursuant to 408.809, F.S. and 59A-35.090 or inform the Home Care Unit that level 2 screening was previously submitted.

(2) Director of Nursing.

(d) Pursuant to Section 400.497(5)(a), F.S., the The director of nursing shall establish a process to verify that skilled nursing and personal care services were provided. The home health agency must be able to validate that patient or client care was provided as ordered and specified in the plan of care or written agreement. When requested by an AHCA employee, the The director of nursing shall provide surveyor may request a certified report that lists verifies the home health services provided by a specified direct service staff person or contracted staff person for a specified time period as permitted in 400.497(5)(b), F.S. A certified report shall be in the form of a written or typed document or computer printout and signed by the director of nursing. The report must be provided to the surveyor within two hours of the request, unless the time period requested is longer than one year, then the report must be provided within three hours of the request.

(e)The director of nursing shall establish, and conduct, and document an ongoing quality assurance program. The program shall include at least quarterly, documentation of the review of the care and services of a sample of both active and closed clinical records by the director of nursing or his or her delegate. The director of nursing assumes overall responsibility for the quality assurance program. The director of nursing may delegate some of the record review to registered nurses or therapists when there are therapy patient records to review.

(5) Home Health Aide and Certified Nursing Assistant

(j) A licensed home health agency may choose to administer the Home Health Aide Competency Test, form number AHCA 3110-1007, February, 2001, incorporated by reference, in lieu of the forty hours of training required in paragraph 59A-8.0095(5)(d), F.A.C. This test is designed for home health agencies to determine competency of potential employees. Home health agencies may obtain the form by sending a request to [e-mail]. This written and practical test can only be used by licensed-only agencies. Medicare and Medicaid home health agencies must follow the training requirements in 42 Code of Federal Regulations 484.

(k) Home health aides and CNA’s must receive in-service training each calendar year, pursuant to Section 400.497(1), F.S. Training must be provided to obtain and maintain a certificate in cardiopulmonary resuscitation. Medicare and Medicaid agencies should check federal regulations for additional in-service training requirements.

(l) Responsibilities of the home health aide and CNA shall include:

1. The performance of all personal care activities contained in a written assignment by a licensed health professional employee or contractor of the home health agency and which include assisting the patient or client with personal hygiene, ambulation, eating, dressing, shaving, physical transfer, and other duties as assigned;.

2. Maintenance of a clean, safe and healthy environment, which may include light cleaning and straightening of the bathroom, straightening the sleeping and living areas, washing the patient’s or client’s dishes or laundry, and such tasks to maintain cleanliness and safety for the patient or client;.

3. Other activities as taught by a licensed health professional employee or contractor of the home health agency for a specific patient or client and are restricted to the following:

a. Assisting with reinforcement of dressing;,

b. Assisting with tasks associated with elimination:

i. Toileting

ii. Assisting with the use of the bedpan and urinal

iii. Providing catheter care including changing the urinary catheter bag

iv. Collecting specimens

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

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

d. Assisting with prescribed range of motion exercises;,

e. Assisting with prescribed ice cap or collar;,

f. Doing simple urine tests for sugar, acetone or albumin;,

g. Measuring and preparing special diets;,

h. Measuring intake and output of fluids;, and

i. Measuring temperature, pulse, respiration or blood pressure.

4. Keeping records of personal health care activities.; and

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

6. Supervision of self-administered medication in the home is limited to the following:

a. Obtaining the medication container from the storage area for the patient or client;,

b. Ensuring that the medication is prescribed for the patient or client;,

c. Reminding the patient or client that it is time to take the medication as prescribed;, and

d. Observing the patient or client self-administering the medication.

 

59A-8.022 Clinical Records.

(6) The following applies to signatures in the clinical record:

(a) No change.

(b) Alternative Signatures. 1. Home health agencies that maintain patient records by computer rather than hard copy may use electronic signatures. However, all such entries must be appropriately authenticated and dated. Authentication must include signatures, written initials, or computer secure entry by a unique identifier of a primary author who has reviewed and approved the entry. The home health agency must have safeguards to prevent unauthorized access to the records and a process for reconstruction of the records in the event of a system breakdown.

 

59A-8.0245 Advance Directives.

(3) Pursuant to Section 400.487(7), F.S., a home health agency may honor a DNRO as follows: (a) Cardiopulmonary resuscitation may be withheld or withdrawn from a patient only if a valid Do Not Resuscitate Order (DNRO) is present, executed pursuant to Section 401.45, F.S. The Department of Health has developed a DNRO form that is described and available to the public as stated in rule 64J-2.018.

 

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 “Comprehensive Emergency Management Plan (CEMP),” AHCA Form 3110-1022, Revised March 2013 May 2010, incorporated by reference. This document is available from the Agency for Health Care Administration at http://ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml and shall be used as the format for 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.

The following changes have been made to the Attestation of Compliance with Distance Requirements form incorporated by reference in subection 59A-8.004(4):

The signature of a notary public and the reference to the date the law became effective are removed from the form.

The following changes have been made to the Comprehensive Emergency Management Plan form incorporated by reference in subsection 59A-8.027(1):

On page 1 of the form, the quotation of Section 381.0303(7) is corrected. On page 5, the reference to subection 59A-8.027(12) was updated to (13) since the paragraph numbering changed. Also, on page 5, item C.5., the term “voluntary cessation” was replaced with “inability to operate.”

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