The purpose of the rule revisions is to conform the rules and Comprehensive Emergency Management Plan format to changes made by the 2006 Florida Legislature in Chapter 2006-71 and Chapter 2006-192, Laws of Florida; to clarify language regarding ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Health Facility and Agency Licensing

RULE NO: RULE TITLE
59A-18.002: Definitions
59A-18.004: Licensure Requirements, Procedures, and Fees
59A-18.005: Registration Policies
59A-18.0081: Certified Nursing Assistant and Home Health Aide
59A-18.010: Acceptance of Patients or Clients
59A-18.013: Administration of Drugs and Biologicals
59A-18.015: Surveys and Inspections
59A-18.016: Penalties
59A-18.018: Emergency Management Plans
PURPOSE AND EFFECT: The purpose of the rule revisions is to conform the rules and Comprehensive Emergency Management Plan format to changes made by the 2006 Florida Legislature in Chapter 2006-71 and Chapter 2006-192, Laws of Florida; to clarify language regarding financial instability; to revise the Affidavit of Compliance with Screening Requirement form to add level 2 screening and annual submission as required in Section 435.04, F.S.; to delete the requirement for providing the names and license numbers of independent contractors with the renewal applications; to delete the requirement for insurance since there is no legal authority; to add the law regarding assistance with medications to the laws given to independent contractors; and to include that physician assistants and advanced registered nurse practitioners may order medications for patients, as permitted in Chapter 2005-243, Laws of Florida. The effect will be updated rules with uniform licensure procedures that conform to state laws; a revised Comprehensive Emergency Management Plan format that includes the means by which the same type and quantity of services will be provided to patients evacuated to special needs shelters; an updated Affidavit of Compliance with Screening Requirement form for administrators to attest to completion of both level 1 and 2 screening for staff as required in law; a decrease in the items required to be submitted with applications for licensure due to the elimination of the requirement to submit proof of insurance and the elimination of the requirement to submit information on independent contractors with renewal applications; a corrected Rule 59A-18.013, F.A.C., that includes orders from physician assistants and advanced registered nurse practitioners as permitted in the 2005 changes to Section 400.506(17), F.S.; and the inclusion of the law on assistance with medication with the laws distributed to independent contractors.

SUMMARY: The rules are being updated due to the changes to Chapter 400, Part III, Florida Statutes, made by the 2006 Florida Legislature in Chapter 2006-71 and 2006-192, Laws of Florida. The changes in the rule for Chapter 2006-71, Laws of Florida are: revising Rule 59A-18.018, F.A.C., and the Comprehensive Emergency Management Plan to include the means by which the same type and quantity of services will be provided to special needs patients in shelters that they received prior to the evacuation; removing the Department of Health as the reviewer of multi-county plans as requested by the Department and referring to the contact designated by the Department for plan reviews; and adding the requirement for documentation of efforts made to deliver the same type and quantity of services in the patient record if the agency is unable to continue services. The following revisions are made to comply with Chapter 2006-192, Laws of Florida: the change of ownership definition is deleted in Rule 59A-18.002, F.A.C., since the definition is now in Section 408.803, F.S.; the conditional license is removed from Rule 59A-18.004, F.A.C., as Chapter 408, Part II, F.S., permits either a standard or a provisional license; and Rule 59A-18.016, F.A.C., is revised pursuant to Section 408.806, F.S., for late renewal application fines, and a separate subsection is added for the change of ownership late application fine, decreasing the maximum amount to $500. Legal references from Chapter 408, Part II, F.S., replace Chapter 400, Part III, F.S., references in sections of the rule pertaining to initial, renewal and change of ownership licensure applications; surveys; voluntary relinquishment of license; level 2 background screening for administrators and financial officers; and financial instability. Legal references from Chapter 408, Part II, F.S., are inserted in sections of the rule pertaining to administrative fines, denials, moratoriums and injunctions in addition to the Chapter 400, Part III, F.S., references. Other changes include the elimination of the insurance requirement since there is no legal authority; the elimination of the requirement for a listing of independent contractor names and license numbers with the renewal application; the addition of Section 400.488, F.S., on administration of medications to the laws given by nurse registries to independent contractors; and the revision of Rule 59A-18.005, F.A.C., to include that physician assistants and advanced registered nurse practitioners may order medications in addition to physicians, as permitted in Section 400.506(17), F.S.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COST: No Statement of Estimated Regulatory Cost was prepared.

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.

SPECIFIC AUTHORITY: 400.497, 400.506 FS.
LAW IMPLEMENTED: 400.506, 408.806, 408.807, 408.809, 408.810, 408.811, 408.813, 408.814, 408.815, 408.816 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAW.

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 2 days before the workshop/meeting by contacting: Jan Benesh, 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] or call [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 RULES IS: Jan Benesh, 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] or call [phone]

 

THE FULL TEXT OF THE PROPOSED RULES IS:

59A-18.002 Definitions.

(1) through (3) No change.

(4) “Change of ownership” means when a nurse registry is purchased by a new person, corporation or partnership from the person or entity which currently holds the nurse registry license. A one hundred percent stock purchase of the current corporate or partnership owner, or a change in the principals in the existing corporation or partnership, do not constitute a change of ownership, if that corporation or partnership continues to be the owner of the nurse registry.

(5) through (6) renumbered (4) through (5) No change.

(6)(7) “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.

(8) through (13) renumbered (7) through (12) No change.

Specific 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,_________.

 

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

(1) Prior to operating a nurse registry as defined under Section 400.506, F.S., the owner shall make application for a license on AHCA Form 3110-7001, Nurse Registry Application for Initial License, Revised May 2006, incorporated by reference. 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 under “Licensing, & Certification” and then on “Nurse Registry”. If the requestor is unable to obtain the forms and related information from the web site, the documents may be obtained from the AHCA Licensed Home Health Programs Unit by contacting [phone] and sending a check or money order to cover the Agency’s costs for copying and mailing. The receipt of a license from AHCA shall be based upon compliance with all applicable rules and laws regulations, as evidenced by a signed application under oath and upon the results of a survey conducted by AHCA representatives. It is unlawful to operate a registry without first obtaining from AHCA a license authorizing such operation.

(2) The registry license is not transferable. Sale of the licensed nurse registry, assignment, lease or other transfer, whether voluntary or involuntary, shall require relicensure by the new owner prior to taking over the operation, pursuant to Section 400.506(8), F.S. The prospective owner shall submit, at least 60 days prior to the effective date of the change, an application for a new license.

(2)(3) No change.

(3)(4) An initial licensure application shall include: Initial licensure – An application for an initial license to operate a nurse registry shall be submitted per Section 408.806, F.S., for a new operation or change of licensee accompanied by a non-refundable license fee of $2,000 for each site in operation to be licensed, and must be submitted and signed under oath on AHCA Form 3110-7001, Nurse Registry Application for Initial License, Revised May 2006, which is incorporated by reference, provided by the agency, and shall include:

(a) through (f) No change.

(g) The name of the registry’s administrator, the alternate administrator and the name and license or certification number for the registered nurse or nurses that the nurse registry has available to meet the requirements in Section 400.506(10)(c), F.S. An application for renewal will include the same information for the administrator, alternate administrator and registered nurse or nurses available to meet the requirements in Section 400.506(10)(c), F.S., unless there have been no changes since the previous application for licensure, as well as the name and license or certification number of current independent contractors for registered nurses, licensed practical nurses and certified nursing assistants, and the name of current independent contractors for home health aids, homemakers and companions.

(h) Evidence of liability insurance coverage for the nurse registry;

(h)(i) A signed Affidavit of Compliance with Screening Requirements, AHCA Form 3110-1014, Revised December May 2006, incorporated by reference, from the administrator, will be submitted with the application and annually thereafter as required in Section 435.04(5) and 400.512, F.S., stating that the administrator, the financial officer, and each direct care contractor who enters the home of patients or clients and who was registered with the nurse registry on or after October 1, 2000, has been screened in accordance with level 1 standards and that the remaining contractors have been continuously registered with the nurse registry since before October 1, 2000, pursuant to Section 400.512(2), F.S.

1. Screening for the administrator, or similarly titled individual who is the managing employee responsible for the daily operation of the nurse registry, and for the financial officer, or similarly titled individual who is responsible for the financial operation of the nurse registry, including billings for patient care and services, shall be in accordance with level 2 standards for screening set forth in Section 408.809, F.S. Chapter 435, F.S., and in accordance with Section 400.506(2), F.S. The fingerprint card for level 2 screening for the administrator and the financial officer can be obtained from, and must be submitted to, the Agency for Health Care Administration, Licensed Home Health Programs Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308. Screening processing fees for level 2 screening shall be made payable to the Agency for Health Care Administration.

2. No change.

(i)(j) Evidence of financial ability to operate, which shall consist of the completion of the financial schedules contained in the application which includes and a balance sheet and income and expense statement for the first year of operation as well as documented which provides evidence of sufficient assets, credit and projected revenues to cover projected liabilities and expenses pursuant to Section 408.810(8), F.S.

(5) through (6) renumbered (4) through (5) No change.

(6)(7) An application for renewal of a registry license shall be submitted, as referenced in Section 400.506(5), F.S., not less than 60 days prior to expiration of the license pursuant to Section 408.806 (2), F.S. The submission shall be on AHCA Form 3110-7004, Nurse Registry Application for Renewal of License May 2006, incorporated by reference, and shall include a renewal fee of $2,000. The application shall include: All of the information required by paragraphs (4)(a) through (h)(i) above.

(7)(8) An application for renewal of a license shall not be required to provide proof of financial ability to operate, unless the applicant has demonstrated financial instability at any time, pursuant to Section 408.810(8), F.S., in which case AHCA shall require the applicant for renewal to provide proof of financial ability to operate by submitting Schedules 2 through 6 from AHCA Form 3110-7001, Nurse Registry Application for Initial License, Revised May 2006 and documentation of correction of the financial instability, to include evidence of the payment in full of any bad checks, delinquent bills or liens and all associated fees, costs, and changes related to the instability. If complete payment cannot be made, evidence must be submitted of partial payment along with a plan for payment of any liens or delinquent bills. If the lien is with a government agency or repayment is ordered by a federal, state, or district court, an accepted plan of repayment must be provided. If the licensed nurse registry has demonstrated financial instability as outlined above at any time the AHCA will request proof of financial ability to operate Such proof may include a copy of the corporation’s tax return, three corporate checking and savings account statements, or a financial statement prepared and signed by a CPA.

(8)(9) An application for a change of ownership of a registry shall be submitted, on AHCA Form 3110-7001, Nurse Registry Application for Initial License, Revised May 2006, as referenced in subsection 59A-18.004(1), F.A.C., not less than 60 days prior to the effective date of the change in accordance with Section 408.806(2)(b), F.S. The submission shall include the change of ownership licensure fee of $2,000. The application shall include all of the information required by paragraphs (4)(a) through (l)(m) above.

(10) A conditional license shall be issued to an applicant against whom revocation or suspension action is pending at the time of license renewal, effective until final disposition of such proceedings by AHCA.

(9)(11) A nurse registry has the following responsibility in terms of hours of operation:

(a) through (e) No change.

Specific Authority 400.497, 400.506 FS, Law Implemented 400.497, 400.506, 400.512 FS. History–New 2-9-93, Amended 1-27-94, 12-24-00, 8-10-06,_________.

 

59A-18.005 Registration Policies.

(1) Each nurse registry shall disseminate the following rules and statutes to each applicable independent contractor at the time of registration.

(a) Registered nurses and licensed practical nurses shall receive for their use and reference:

1. through 5. No change.

6. Sections 400.506, 400.512, 400.484, 400.462, 400.488, and 400.495, F.S.

(b) Certified nursing assistants and home health aides shall receive for their use and refes.

3. Sections 400.506, 400.512, 400.484, 400.462, 400.488, and 400.495, F.S.

(2) through (8) No change.

Specific 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, 8-10-06,_________.

 

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

(1) through (9) No change.

(10) Home health aides who complete their training in another state must provide a copy of the course work and a copy of their training documentation to the nurse registry. If the course work is equivalent to Florida’s requirements, the nurse registry may refer the home health aide for contract. If the home health aide’s course work does not meet Florida’s requirements, the home health aide must receive training in a school approved by the Department of Education to the extent necessary to bring the training into compliance with subsection 59A-18.0081(8)(6), F.A.C., prior to being referred for contract.

Specific 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, ________.

 

59A-18.010 Acceptance of Patients or Clients.

(1) through (2) No change.

(3) The nurse registry must inform the patient or client of their right to report abuse, neglect, or exploitation by calling the toll-free 1(800) 96 ABUSE telephone number, and information on the toll-free Agency for Health Care Administration Complaint Line number 1-888-419-3456 pursuant to Section 400.495, F.S.;

(4) through (5) renumbered (3) through (4) No change.

Specific Authority 400.497, 400.506 FS. Law Implemented 400.497, 400.506 FS. History–New 2-9-93, Amended 12-24-00,________.

 

59A-18.013 Administration of Drugs and Biologicals.

(1) No change.

(2) The procedures shall include the following:

(a) An order for medications to be administered by the licensed nurse shall be dated and signed by the attending physician, physician assistant, or advanced registered nurse practitioner as required in Section 400.506(17), F.S.;

(b) An order for medications shall contain the name of the patient, the name of the drug, dosage, frequency, method or site of injection, and order from the physician, physician assistant, or advanced registered nurse practitioner if the patient or caregiver are to be taught to give the medication; and

(c) A verbal order for medication or change in the medication orders from the physician, physician assistant, or advanced registered nurse practitioner shall be taken by a licensed registered nurse, reduced to writing, to include the patient’s name, the date, time, order received, signature and title. The physician, physician assistant, or advanced registered nurse practitioner shall acknowledge the telephone order within 30 days by signing and dating the orders. A verbal order or change in medication order shall be on file in the clinical record at the nurse registry within 30 days.

Specific 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, ________.

 

59A-18.015 Surveys and Inspections.

(1) AHCA shall conduct surveys, based on a variable survey cycle, and make inspections, as necessary, pursuant to Section 408.811 400.506(9), F.S., in order to respond to complaints or to determine compliance with the provisions of Chapter Section 400, Part III 506, F.S., and these rules.

(2) No change.

(3) Nurse registries that apply for renewal of their licenses will be surveyed based on the extent of compliance on previous surveys with these rules and state laws in accordance with Section 408.811, F.S. After two consecutive full surveys, nurse registries that had no deficiencies on the previous survey, and no confirmed complaints, will be surveyed on an unannounced basis no later than every 36 months. Nurse registries that had no patient care or independent contractor registration deficiencies that affect patient health and safety will be surveyed on an unannounced basis no later than a range of 18 to 24 months. Nurse registries that had a change of ownership since the previous survey, a complaint survey with deficiency citations, or patient care or independent contractor registration deficiencies that affect patient health and safety during the last survey will receive an unannounced survey no later than a range of 12 to 18 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.

Specific Authority 400.497, 400.506 FS. Law Implemented 400.481, 400.484, 400.506 FS. History–New 2-9-93, Amended 1-27-94, 12-24-00,_________.

 

59A-18.016 Penalties.

(1) AHCA will institute injunctive proceedings in accordance with Section 408.816, F.S., in a court of competent jurisdiction when violations of the provisions of Section 400.506, F.S., or any rules promulgated thereunder constitute an emergency affecting the immediate health and safety of a patient or client receiving services.

(2) through (3) No change.

(4) The failure to file a timely renewal licensure application shall result in an administrative fine, pursuant to Section 408.806(2)(d), F.S. 400.506(4), F.S., charged to the registry in the amount of $50.00 per day, each day constituting a separate violation. In no event shall such fine aggregate more than $2,500.

(5) The failure to file a timely change of ownership licensure application shall result in an administrative fine, pursuant to Section 400.506(4), F.S., charged to the registry in the amount of $50.00 per day, each day constituting a separate violation. In no event shall such fine aggregate more than $500.

Specific 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, ___________.

 

59A-18.018 Emergency Management Plans.

(1) Pursuant to Section 400.506(16), F.S., each nurse registry shall prepare and maintain a written comprehensive emergency management plan, in accordance with the Comprehensive Emergency Management Plan for Nurse Registries, AHCA Form 3110-10176, Revised December 20065, incorporated by reference. This document is available from the Agency for Health Care Administration at http://ahca.myflorida.com under “Licensing & Certification”, and then under Nurse Registry. The plan shall describe how the nurse registry establishes and maintains an effective response to emergencies and disasters. The plan, once completed, will be sent electronically by e-mail by multi-county nurse registries to the Office of Public Health Nursing, Department of Health or to the contact designated by the Department of Health for single county nurse registries as required in Section 400.506(16)(e), F.S.

(2) through (5) No change.

(6) Nurse registries shall assist patients who would need assistance and sheltering during evacuations because of physical, mental, or sensory disabilities in registering with the local emergency management agency, as required in Section 400.506(15), F.S.

(a) through (b) No change.

(c) The independent contractors referred by the nurse registry, or registry staff, shall inform patients registered with the special needs registry that special needs shelters are an option of last resort and that services may will not be equal to what they have received in their homes.

(d) No change.

(7) The person referred for contract to a patient registered with the special needs registry, which shall include special needs registry patients being served in assisted living facilities and adult family care homes, shall ensure that the same type and quantity of continuous care is provided, either in the special needs shelter that was provided prior to the emergency as specified in, or in the patient’s home pursuant to Section 400.506(16)(a), F.S., unless circumstances beyond the control of the independent contractor as described in Section 400.506(16)(d), F.S., make it impossible to continue services.

(8) When a nurse registry is unable to continue services to special needs patients registered under Section 252.355, F.S., that patient’s record must contain documentation of the efforts made by the registry to comply with their emergency management plan in accordance with Section 400.506(16), F.S. Documentation includes but is not limited to contacts made to the patient’s caregivers, if applicable, contacts made to the assisted living facility and adult family care home if applicable; contacts made to local emergency operation centers to obtain assistance in reaching patients and contacts made to other agencies which may be able to provide temporary services.

(8) through (12) renumbered (9) through (13) No change.

(14)(13) The patient record for each person registered as a special needs patient shall include the list described in subsection (13)(12) above and information as listed in Sections 400.506(16)(a) and (b), F.S.

Specific Authority 400.506 FS. Law Implemented 400.506 FS. History–New 8-10-06, Amended_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jan Benesh

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

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 18, 2006

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: November 3, 2006