Rule 59A-18.0081 outlines the requirements for certified nursing assistants and home health aides to provide health care services to patients in the home or place of residence and specifies the services that a certified ....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NO.:RULE TITLE:

59A-18.0081Certified Nursing Assistant and Home Health Aide

PURPOSE AND EFFECT: Rule 59A-18.0081 outlines the requirements for certified nursing assistants and home health aides to provide health care services to patients in the home or place of residence and specifies the services that a certified nursing assistant or home health aide can perform.

SUMMARY: The Agency is proposing to amend Rule 59A-18.0081, F.A.C., to incorporate additional tasks that a certified nursing assistant or home health aide can perform based on changes made to section 400.488, F.S., from 2022-48, L.O.F.

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: 400.488, 400.497, 400.506 F.S.

LAW IMPLEMENTED: 400.488, 400.497, 400.506 F.S.

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

DATE AND TIME: September 14, 2023, 2:00 p.m. to 3:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C, Tallahassee, FL 32308.You may also participate by dialing the Open Voice conference line, 1(888)585-9008, then enter the conference room number followed by the pound sign, 998-518-088#. The agenda and related materials can be found on the web at:

https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Rulemaking.shtml.

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: John Rainey, Laboratory and In-Home Services, 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).. 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: John Rainey at [phone] or email at: [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-18.0081 Certified Nursing Assistant and Home Health Aide.

The certified nursing assistant (CNA C.N.A.) and the home health aide shall:

(1) through (4) No change.

(5) Perform other activities as taught and documented by a registered nurse, concerning activities for a specific patient and restricted to the following:

(a) Assisting with the placement and removal change of a colostomy bag, excluding the removal of the flange or manipulation of the stoma’s site reinforcement of dressing;

(b) Assisting with the application and removal of anti-embolism stockings and hosiery prescribed for therapeutic treatment of the legs.

(b) through (d) renumbered (c) through (e) No Change.

(f) (e) Administer Doing simple urine tests for sugar, acetone or albumin;

(g) Assisting with the use of a glucometer to perform blood glucose testing;

(h) (f) Measuring and preparing special diets;

(i) (g) Measuring intake and output of fluids; and,

(j) (h) Measuring vital signs, including temperature, pulse, respiration or blood pressure;.

(k) Assisting with oxygen nasal cannulas and continuous positive airway pressure (CPAP) devices, excluding the titration of the prescribed oxygen levels; and

(l) Assisting with the reinforcement of dressing.

(6) A home health aide or CNA shall not perform the following activities:

(a) Administer any nursing or therapeutic service that requires licensure as a health care professional;

(b) Change sterile dressings.

(c) Irrigate body cavities such as giving an enema;

(d) Perform irrigation of any wounds (such as vascular ulcers, diabetic ulcers, pressure ulcers, surgical wounds) or apply agents used in the debridement of necrotic tissues in wounds of any type;

(e) Perform a gastric irrigation or enteral feeding;

(f) Catheterize a patient;

(g) Administer medications;

(h) Apply heat by any method;

(i) Care for a tracheotomy tube;

(j) Provide any service which has not been included in the plan of care; or,

(k) Providing assistance with a pill organizer, such as removing medication from a pill organizer and placing the medication in the patient’s hand or filling a pill organizer with the patient’s medication(s).

(6) Be prohibited from changing sterile dressings, irrigating body cavities such as giving an enema, irrigating a colostomy or wound, performing gastric irrigation or enteral feeding, catheterizing a patient, administering medications, applying heat by any method, or caring for a tracheotomy tube.

(7) CNA Qualifications.

1. For every CNA, a nurse registry shall have on file a copy of the person’s State of Florida certification.

2. Individuals who earn their CNA certificate in another state must contact the Florida Department of Health, Board of Nursing to inquire about taking the written examination prior to working as a CNA in Florida, pursuant to chapter 464, part II, F.S.

3. A CNA may work as a home health aide.

(7) For every CNA, a nurse registry shall have on file a copy of the person’s State of Florida certification.

(8) Home Health Aide Qualifications.

1. For every home health aide registered with the nurse registry since May 4, 2015, a nurse registry shall have on file a certificate or documentation of successful completion of at least forty hours of home health aide training, pursuant to section 400.506(6)(a), F.S., from a public vocational technical school or a nonpublic post-secondary educational institution approved by the Florida Department of Education, Commission for Independent Education.

2. Home health aides registered with the nurse registry since May 4, 2015 who complete their training in another state must provide a certificate of completion of home health aide training from a vocational technical school or a post-secondary educational institution licensed in that state.

(8) For every home health aide registered with the nurse registry since May 4, 2015, a nurse registry shall have on file a certificate or documentation of successful completion of at least forty hours of home health aide training, pursuant to section 400.506(6)(a), F.S., from a public vocational technical school or a non-public postsecondary career school licensed by the Commission on Independent Education, Florida Department of Education.

(9) Individuals who earn their CNA certificate in another state must contact the Florida Certified Nursing Assistant office at the Department of Health to inquire about taking the written examination prior to working as a CNA in Florida, pursuant to chapter 464, part II, F.S.

(10) Home health aides registered with the nurse registry since the effective date of this rule who complete their training in another state must provide a certificate of completion of home health aide training from a public vocational technical school or a career education school that is licensed in that state.

(11) renumbered (9) No change.

(10)(12) Licensed practical nurses and registered nurses that are licensed in Florida or another state may work as home health aides. Also, persons who have completed the licensed practical nurse or registered nurse training from a public school, college, or university or a nonpublic post-secondary educational institution approved by the Florida Department of Education, Commission for Independent Education but licensed nonpublic scareer education school or college in Florida who are not yet licensed may work as home health aides.

(13) A certified nursing assistant may work as a home health aide.

(11)(14) CNAs 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 CNAs 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 CNA 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 CNA C.N.A. previously worked for the home health agency;

2. A training certificate for assisted living facility staff in compliance with section 429.52(6), F.S.;

3. A training certificate for at least 2 hours of training from a post-secondary educational institution approved career education school licensed pursuant to chapter 1005, F.S., and rule division 6E, F.A.C., by the Florida Department of Education , Commission for Independent Education;

4. Documentation of at least 2 hours of training by a provider approved by the Florida Department of Health, Board of Nursing, Department of Health.

(c) Documentation of the training must be maintained in the file of each home health aide and CNA C.N.A. who assists patients with self-administered medication.

(d) In cases where a home health aide or a CNA C.N.A. will provide assistance with self-administered medications as described in section 400.488, F.S., and paragraph (e) below, an RN shall conduct an assessment of the patient and patient’s a review of the medications for which assistance is to be provided shall be conducted by a registered nurse or licensed practical nurse to ensure that a patient receiving such assistance is medically stable and has regularly scheduled medications that are intended to be self administered as required in s. 400.488(2), F.S. and the CNA C.N.A. and home health aide are able to assist in accordance with their training and with the medication prescription and the medication is not required to be administered by a nurse. If the patient will not consent to a visit by the nurse to conduct an assessment review the medications, a written list with the dosage, frequency and route of administration shall be provided by the patient or the patient’s health care surrogate, family member, or person designated by the patient to the home health aide or CNA to have reviewed by the nurse. The patient or the patient’s surrogate, guardian, or attorney in fact must give written consent for a home health aide or CNA C.N.A. to provide assistance with self-administered medications, as required in section 400.488(2), F.S.

(e) The trained home health aide and CNA C.N.A. may also provide the following assistance with self-administered medication, as needed by the patient and as described in section 400.488, F.S.:

1. through 4. No change.

(15) The nurse registry is not obligated to monitor, manage or supervise a certified nursing assistant or home health aide pursuant to section 400.506(19), F.S. The nurse registry is not obligated to review patient or client records per section 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 section 400.506(19), F.S.

Rulemaking Authority 400.488, 400.497, 400.506 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, 5-4-15, 2-8-16,                        .

 

NAME OF PERSON ORIGINATING PROPOSED RULE: John Rainey

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Jason Weida

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 8/7/2023

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 03/29/2023