The purpose is to provide new rules for oversight by the director of nursing and the use of a recent unannounced licensure survey related to a licensure application for a change of ownership as required in 400.497(5) and (6), F.S.; to remove items ...

 

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
PURPOSE AND EFFECT: The purpose is to provide new rules for oversight by the director of nursing and the use of a recent unannounced licensure survey related to a licensure application for a change of ownership as required in Sections 400.497(5) and (6), F.S.; to remove items that are now in Florida Statutes and Chapter 59A-35, F.A.C.; to revise personnel rules to remove the one year experience requirement for physical therapists and occupational therapists and their assistants and make other rule revisions to reduce the regulatory burden on home health agencies; to update the license fee to the August 1, 2010 amount to conform to the consumer price index increase required in Section 408.805(2), F.S. and to remove the requirement to remove rubber stamped signatures for physicians to prevent fraud; and to update the web site addresses, the licensing unit’s name and definitions.
SUMMARY: Rule 59A-8.002, F.A.C., adds the definition of “nursing care” used in the definition of “home health services” in Section 400.462, F.S., deletes one definition since the definition is now in state law and updates the definition of “accrediting organization” to add another accrediting organization approved by CMS.
Paragraph 59A-8.003(5)(c), F.A.C.,  adds that changes of ownership will demonstrate compliance with state laws by recent unannounced inspection not more than 24 months prior as required in Section 400.497(6), F.S. Rule 59A-8.003, F.A.C.,  also adds that training of home health agency staff may be done at drop-off sites. The license fee amount is updated to show the consumer price index increase that was implemented August 1, 2010 as required in Section 408.805(2), F.S. The change of address requirements are deleted and the rule refers to Rule 59A-35.040, F.A.C. Makes other minor changes – adds accrediting organization survey where surveys are mentioned since agencies licensed since July 1, 2008 must be accredited per Section 400.471(2)(h), F.S.; updates web site address and unit name; updates numbering of law sections since there have been changes in the laws.
Rule 59A-8.004, F.A.C.,  removes the application forms and licensing procedures, including background screening, and refers to Rules 59A-35.060, 59A-35.062, F.A.C. and Section 408.809, F.S. that now contain uniform health care licensing procedures for the Agency. The submission of an affidavit form for compliance with the background screening requirements in Section 400.512, F.S., has been removed since the affidavit statement has been added to the licensure application form. To comply with Section 400.471(7), F.S., a one page attestation form is submitted with the application when any owners, officers or members of a home health agency in the same county are applying for a license for a new agency.
Rule 59A-8.0095 updates and eliminates various personnel requirements. The requirement to submit resume and affidavit of good moral character when there is a change in the administrator or alternate administrator is removed. Additional oversight by the director of nursing is added as required in Section 400.497(5), F.S., including items for quality assurance and verification that services were provided. Specified competencies for certified nursing assistants are removed. Patient care tasks that can be done related to elimination are clarified for home health aides and certified nursing assistants. The nurses, physical therapist and occupational therapist sections state that services will be provided in compliance with the state practice acts. The one year of experience requirement for physical therapists, physical therapist assistants, occupational therapists, and occupational therapists assistants is removed. For homemakers and companions, clients may be verbally reminded to take their medications.
Rule 59A-8.022, F.A.C., removes rubber stamp signatures for physicians.
Rule 59A-8.0245, F.A.C., revises the date and web site address for the “Health Care Advance Directives – The Patients’ Right to Decide” and removes a paragraph that repeats what is already in state law.
Rule 59A-8.027, F.A.C.,  updates the emergency management plan format to include the title “safety liaison” as the primary contact per Section 408.821, F.S. and include caregivers remaining with patients at special needs shelters per the Department of Health.
Other minor changes are made to update the Agency’s web site address and licensing unit name, and update the numbering of law sections to conform to law changes.
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 been prepared by the agency.
Statement of estimated regulatory costs has been prepared for proposed rule revisions in Rules 59A-8.003 and 59A-8.0095, F.A.C., and is available at http://ahca.myflorida.com/homecare, select “Home Health Agency” or from the person to be contacted regarding this rule listed below. The following is a summary of the SERC:
For proposed paragraph 59A-8.0095(2)(d), F.A.C., the Agency estimates that 3% of the home health agencies may have one-time costs if the certified report required in Section 400.497(5), F.S. is requested by a surveyor for a specified time period when there is concern that services were not provided by a staff person, such as when investigating complaints of patient neglect, false billing or falsification of records. In order to keep costs to a minimum, the proposed rule permits home health agencies to use existing documents in any format to show that staff provided the services.
For proposed paragraph 59A-8.0095(2)(e), F.A.C., any home health agency that provide skilled nursing that is not already doing quality assurance record reviews quarterly will incur a cost each quarter year, depending on the number of records the agency choses to review. The sample size is to be determined by each agency. Two additional items are added to the record reviews that are not in the existing state rule to meet the requirements in Section 400.497(5), F.S. The Agency estimates 400 of the 2,270 home health agencies will incur some cost as explained in the Statement of Estimated Regulatory Cost. The Agency for Health Care Administration will incur the cost of rulemaking, as well the costs associated with enforcing the proposed changes. There is no cost to local government for the revisions in this rule since none of these changes affect local government entities.
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: 400.497 FS.
LAW IMPLEMENTED: 400.497(5)(6) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Anne Menard, Supervisor, Home Care Unit, Bureau of Health Facility Regulation, [e-mail], [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

59A-8.002 Definitions.

(1) “Accrediting organization” means the Community Health Accreditation Program, or The Joint Commission, or the Accreditation Commission for Health Care the Joint Commission on Accreditation of Healthcare Organizations.

(2) through (8) No change.

(9)  "Direct employee" means an employee for whom one of the following entities pays withholding taxes: a home health agency; a management company that has a contract to manage the home health agency on a day-to-day basis; or an employee leasing company that has a contract with the home health agency to handle the payroll and payroll taxes for the home health agency.

(10) through (20)  renumbered (9) through (19) No change.

(20)  “Nursing care” means treatment of the patient’s illness or injury by a registered nurse or a licensed practical nurse that is ordered as required in Section 400.487(2), F.S. and included in the plan of care.

(20) through (38)  renumbered (21) through (39) No change.

Rulemaking Specific Authority 400.497 FS. Law Implemented 400.462, 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, 8-15-06, 3-29-07,_________.

 

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-8.004(1), F.A.C., and the results of a survey conducted by the AHCA. an accrediting organization as required in Section 400.471, F.S.

(2) An application for renewal of the current license must be submitted to AHCA at least 60 days prior to the date of expiration of the license, pursuant to Section 408.806(2), 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 by AHCA or an accrediting organization as defined in Rule 59A-8.002, F.A.C., pursuant to Sections 408.811 and 400.471(2), F.S., based on the extent of compliance on previous surveys and complaint investigations with these rules and state laws. Home health agencies will be surveyed on an unannounced basis at least every 36 months. Area offices may do follow up surveys to check on correction of deficiencies at any time on an unannounced basis. 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) It is the responsibility of the home health agency to request exemption from state licensure surveys pursuant to Section 400.471(2)(9), 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 Licensed Home Health Programs Unit.

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

1. The 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 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) and (5)  No change.

(6) An application package for a change of ownership shall be made on a form prescribed by AHCA, as referenced in paragraph 59A-35.060(1)(m) subsection 59A-8.004(1), F.A.C.

(a) The buyer or lessee must make application to AHCA for a new license at least 60 days before the date of the transfer of ownership as required by Section 408.807(1) and (2), F.S.

(b) At the time of the transfer of ownership all patient or client records held by the current licensee shall be transferred to the applicant.

(c) An application for a change of ownership license will not be approved if a home health agency has not demonstrated compliance with the requirements in Chapter 408, Part II, and Chapter 400, Part III, F.S., through an unannounced inspection not more than 24 months prior to submission of the application, pursuant to Section 400.497(6), F.S.

1.  The inspection may be done by an accrediting organization.  However, if the home health agency being sold is accredited or was licensed July 1, 2008 or later, the inspection must be done by an accrediting organization as required in Section 400.471(2), F.S.; or

2. The inspection may be conducted in conjunction with an unannounced Medicare or Medicaid certification or recertification survey. 

(d)(c) 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) 400.471(8), F.S. This is also applicable to owners who incorporate and do not report this change of ownership to the home health agency.

(7) No change.

(8) A licensed home health agency may operate a drop-off site in any county within the geographic service area specified on the license. A drop-off site may be used for pick-up or drop-off of supplies or records, for agency staff to use to complete paperwork or to communicate with the main office, existing or prospective agency staff, or the agency’s existing patients or clients. Prospective patients or clients cannot be contacted and billing cannot be done from this location. The drop-off site is not a home health agency office, but merely a work station for direct care staff in large areas where the distance is too great for staff to drive back frequently to the home health agency office. Training of home health agency staff can be done at a drop-off site. A drop-off site shall not require a license. No other business shall be conducted at these locations, including housing of records. The agency name cannot appear at the location, unless required by law or by the rental contract, nor can the location appear on agency letterhead or in advertising.

(9) If a change of address is to occur, or if a home health agency intends to open a satellite office, the home health agency must provide 14 days advance notice in writing to the AHCA Home Care Licensed Home Health Programs Unit in Tallahassee and the AHCA area office as required in Rule 59A-35.040, F.A.C.  The home health agency must submit to the AHCA Home Care Licensed Home Health Programs 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 and evidence of legal right to the property in accordance with Section 408.810(6), F.S. Failure to notify AHCA within the time frame will result in a $500 fine, pursuant to Sections 408.813 and 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 $1,705 $1,660.

(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.

(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, as required in Section 408.810(4)(a), F.S. This includes submitting a letter to the address: AHCA Home Care Licensed Home Health Programs Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308, officially declaring the closure date of the home health agency.

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

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 in paragraph 59A-35.060(1)(m), F.A.C.: 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; and Application for Change of Ownership, form number AHCA 3110-1012, July 2005, is all incorporated by reference. These forms may be obtained at the AHCA web site, http://ahca.myflorida.com under “Licensing & Certification” and then under “Home Health Agency”. 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 Unit by contacting [phone], and sending a check or money order to cover the Agency’s costs for the copying and mailing.

(2) The applicant shall identify its legal name, its business name, and the names and addresses of corporate officers and directors, the name and address of each person having at least a 5% equity interest in the entity and other information as required in Section 408.806(1), F.S. For initial and change of ownership applications and corporate name changes, a current certificate of status or authorization pursuant to Chapter 607, F.S., is required.

(3) If the applicant is a partnership, the name and address of each partner, its legal name, and the business name and address must be identified. For initial and change of ownership applications and partnership name changes, a current certificate of status or authorization for limited partnerships, pursuant to Chapter 620, F.S., is required. For initial and change of ownership applications and for name changes for general partnerships, a current certificate of status or authorization or an affidavit of fictitious name must be submitted.

(2)(4) For initial and change of ownership applications and name changes, an affidavit of fictitious name is required when the home health agency chooses to operate under a name other than the name of the partnership, or corporation, or limited liability company pursuant to Section 865.09, F.S.

(3)(5)  For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate, pursuant to Sections 400.471(3), 408.810 and 408.8065, F.S., and Rule 59A-35.062, F.A.C.  The compliance is demonstrated by completion of AHCA Form 3110-1013, December 2004. 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.

(4) An applicant for initial license shall sign the form AHCA 3110-1026, Attestation of Compliance with Distance Requirements, 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.  The authorized representative signing this form attests no officer or controlling interest of the applicant agency are officers or controlling interests of another home health agency located within 10 miles of the applicant agency and is in the same county.

(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 a licensee has shown signs of financial instability at any time, pursuant to Section 408.810(8), F.S., AHCA shall require proof of financial ability to operate, by submitting schedules 2 through 7 of AHCA Form 3110-1013, December 2004, described in subsection (5) above, and documentation of correction of the financial instability, to include evidence of the payment of any bad checks, delinquent bills or liens.  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.

(7) The applicant shall submit a signed affidavit with the application and annually thereafter as required in Sections 400.512 and 435.04(5), F.S., 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. This Affidavit of Compliance with Screening Requirements, form number AHCA 3110 1014, Revised December 2006, incorporated by reference, 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.

(8) New administrators and financial officers may work on probationary status, once they have submitted the documents described in subsection (9) below, including a signed and notarized copy of the Affidavit of Compliance with Background Screening Requirements, AHCA 3100-0008, December 2006, incorporated by reference, pending a determination of compliance with minimum standards set forth in Chapter 435, F.S. New direct or contract personnel who enter the home in the capacity of their employment may work on probationary status, once they have submitted the documents described in subsection (10) below, including a signed and notarized copy of the Affidavit of Good Moral Character, AHCA 3110 0001, Revised December 2006, incorporated by reference, pending a determination of compliance with minimum standards set forth in Chapter 435, F.S.

(5)(9) Background screening for the administrator and the financial officer shall be in accordance with level 2 standards for screening set forth in Section 408.809, F.S. and Rule 59A-35.090, F.A.C. 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 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 Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.

(6)(10) Level 2 1 background screening Screening for good moral character for employees and all personnel, including contractors, who enter the home shall be done as required in Rule 59A-35.090, F.A.C. and Section 408.809, F.S. consist of: Submission of the Request for Level 1 Criminal History Check, AHCA form 3110-0002, July 2005, 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, Forida 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, 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) Employees who have direct patient contact and are found to have a disqualifying offense cannot continue patient contact unless they obtain an exemption. Administrators and financial officers who have a disqualifying offense cannot continue in those positions unless they obtain an exemption. Exemptions can be requested as defined in Section 400.512(1), F.S.

(12) If the home health agency provides staffing to nursing homes, any staff who have not lived in Florida for the past five years must have level 2 screening as required by Section 400.215, F.S.

Rulemaking Specific Authority 400.497 FS. Law Implemented 400.471, 400.512, 408.810 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.

(a) The administrator of the agency shall:

1. Meet the criteria as defined in Section 400.462(1), F.S. and Section 400.476(1), F.S.

2. Designate, in writing 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., that provides the agency with full control over all operational duties and responsibilities to serve as an on-site alternate administrator during absences of the administrator.  This person will be available during designated business hours, when the administrator is not available. Available during designated business hours means being readily available on the premises or by telecommunications. During the absence of the administrator, the on-site alternate administrator will have the responsibility and authority for the daily operation of the agency. The alternate administrator must meet qualifications as stated in Section 400.462(1), F.S.

(b) If an agency changes administrator or alternate administrator the agency shall notify the AHCA Home Care Licensed Home Health Programs Unit office in Tallahassee as required in subsection 59A-35.110(1), F.A.C., prior to or on the date of the change. Notification shall consist of submission of the person’s name, professional resume, and a statement that the person meets the qualifications in Sections 400.476(1) and 400.462(1), F.S. professional license, if applicable, and a copy of the Affidavit of Good Moral Character.  Send the notification by mail to AHCA Home Care Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.  The administrator also must submit level 2 screening, pursuant to Section 408.809, F.S. and Rule 59A-35.090 subsection 59A-8.004(9), F.A.C., or inform the Home Care Licensed Home Health Programs Unit that level 2 screening was previously submitted.

(2) Director of Nursing.

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

1. through 4.  No change.

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

1. Establish service policies and procedures on biomedical waste for home health agencies providing nursing and physical therapy services.  The Department of Health website has information on biomedical waste handling and the requirements at www.doh.state.fl.us/Environment/Community/biomedical.

(c) The director of nursing shall:

1. Establish policies and procedures that are consistent with in compliance with Chapter 64E-16, 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. Employ and evaluate nursing personnel;

3. Coordinate patient care services; and

4. Set or adopt policies for, and keep records of criteria for admission to service, case assignments and case management.

(d) The director of nursing shall establish a process to verify that 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. The surveyor may request a certified report that verifies the services provided by a specified direct service staff person or contracted staff person for a specified time period as permitted in Section 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)(c) The director of nursing shall establish, and conduct, and document an ongoing quality assurance program. The program shall include at least quarterly, the review of the care and services of a sample of both active and closed clinical records by the director of nursing. The director of nursing may delegate some of the record review to registered nurses or therapists when there are therapy patient records to review. The quality assurance program is to assure that which assures:

1. The home health agency accepts patients whose home health service needs can be met by the home health agency;

2.1. Case assignment and management is appropriate, adequate, and consistent with the plan of care, medical regimen and patient needs.  Plans of care are individualized based on the patient’s needs, strengths, limitations and goals.;

3.2. Nursing and other services provided to the patient are coordinated, appropriate, adequate, and consistent with plans of care.

4.3. All services and outcomes are completely and legibly documented, dated and signed in the clinical service record;

5. The home health agency’s policies and procedures are followed;

6.4. Confidentiality of patient data is maintained; and

7.5. Findings of the quality assurance program are used to improve services. 

(f)(d) In an agency with less than a total of 10 full time equivalent employees and contracted personnel, the director of nursing may also be the administrator.

(3) Registered Nurse.

(a) A registered nurse shall be currently licensed in the state, pursuant to Chapter 464, F.S., and:

1. Be the case manager in all cases involving nursing or both nursing and therapy care.

2. Be responsible for the clinical record for each patient receiving nursing care; and

3. Assure that progress reports are made to the physician, physicians assistant or advanced registered nurse practitioner for patients receiving nursing services when the patient’s condition changes or there are deviations from the plan of care.

4. Provide nursing services within the scope of practice authorized by the license issued by the State of Florida for a registered nurse.

(b) No change.

(4) Licensed Practical Nurse.

(a) No change.

(b) A licensed practical nurse shall:

1. Prepare and record clinical notes for the clinical record;

2. Report any changes in the patient’s condition to the registered nurse with the reports documented in the clinical record;

3. Provide care to the patient including the administration of treatments and medications within the scope of practice authorized by the license issued by the State of Florida for a licensed practical nurse; and

4. Perform other Other duties assigned by the registered nurse, pursuant to Chapter 464, F.S.

(5) Home Health Aide and Certified Nursing Assistant.

(a) through (c) No change.

 

(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 or successful passage of the competency test as stated in paragraph (j), pursuant to Section 400.497(1), F.S.:

1. through 16. No change.

(e) through (h) No change.

(i) A home health agency shall ensure that a certified nursing assistant has competency in the home health core curriculum listed in subparagraphs 59A-8.0095(5)(d)2. and 13. through 16., F.A.C.

(i)(j) No change.

(j)(k) 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. 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.

1. through 3. No change.

(k)(l) Home health aides and CNA’s must receive in-service training each calendar year, pursuant to Section 400.497(1), F.S. HIV educational requirements are listed in paragraph 59A-8.0185(2)(b), F.A.C. 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)(m) 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 the change of a colostomy bag, 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.b. Assisting with the use of devices for aid to daily living, such as a wheelchair or walker,

d.c. Assisting with prescribed range of motion exercises,

e.d. Assisting with prescribed ice cap or collar,

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

g.f. Measuring and preparing special diets,

h.g. Measuring intake and output of fluids, and

i.h. 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, and 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.

(m)(n) through (r)(s) No change.

(6) Physical Therapist and Physical Therapist Assistant.

(a) The physical therapist shall be currently licensed in the state, pursuant to Chapter 486 485, F.S., with at least 1 year of experience in physical therapy. The physical therapist assistant shall be currently licensed in the state, pursuant to Chapter 486 485, F.S., with at least 1 year of experience under the supervision of licensed physical therapist.

1. Services provided by the physical therapist shall be performed within the scope of practice authorized by the license issued by the State of Florida for the practice of physical therapist. 

2. Services provided by the physical therapist assistant will be provided under the general supervision of a licensed physical therapist and shall not exceed any of the duties authorized by the license issued by the State of Florida for the practice of physical therapist assistant outlined in this section. General supervision means the supervision of a physical therapist assistant shall not require on-site supervision by the physical therapist. The physical therapists shall be accessible at all times by two way communication, which enables the physical therapist to be readily available for consultation during the delivery of care.

(b) The responsibilities of the physical therapist are:

1. through 5. No change.

(7) No change.

(8) Occupational Therapist and Occupational Therapist Assistant.

(a) The occupational therapist shall be currently licensed in the state, pursuant to Chapter 468, F.S., with one year of experience in occupational therapy and the occupational therapist assistant shall be currently licensed in the state, pursuant to Chapter 468, F.S., with one year of experience under the supervision of a licensed occupational therapist. Duties of the occupational therapist assistant shall be directed by the licensed occupational therapist and shall be within the scope of practice authorized by the license issued by the State of Florida for the practice of occupational therapist assistant not exceed those outlined in this section.

(b) No change

(9) through (11) No change.

(12) Homemakers and Companions.

(a) The homemaker shall:

1. Maintain the home in an optimum state of cleanliness and safety depending upon the client’s patient’s and the caregiver’s resources;

2. Perform the functions generally undertaken by the customary homemaker, including such duties as preparation of meals, laundry, shopping, household chores, and care of children;

3. Perform casual, cosmetic assistance, such as brushing the client’s hair and assisting with make-up, filing and polishing nails but not clipping nails;

4. Stabilize the client when walking, as needed, by holding the client’s arm or hand;

5. Report to the appropriate supervisor any incidents or problems related to his work or to the caregiver;

6. Report any unusual incidents or changes in the client’s patient’s behavior to the case manager; and

7. Maintain appropriate work records.

8. If requested by the client or his responsible party, the homemaker may verbally remind the client that it is time to for the client to take his or her medicine. 

(b) The companion shall:

1. Provide companionship for the client patient;

2. Accompany Provide escort service such as accompanying the client patient to doctor appointments, recreational outings, or shopping;

3. Provide light housekeeping tasks such as preparation of a meal or laundering the client’s patient’s personal garments;

4. Perform casual, cosmetic assistance, such as brushing the client’s hair and assisting with make-up, filing and polishing nails but not clipping nails;

5. Stabilize the client when walking, as needed, by holding the client’s arm or hand;

6. Maintain a chronological written record of services; and

7. Report any unusual incidents or changes in the client’s patient’s behavior to the case manager.

8. If requested by the client or his responsible party, the companion may verbally remind the client that it is time for the client to take his or her medicine. 

Rulemaking Specific Authority 400.497 FS. Law Implemented 400.462, 400.471, 400.476,  400.487, 400.488, 400.497 FS. History–New 1-20-97, Amended 1-17-00, 7-18-01, 9-22-05, 8-15-06,_________.

59A-8.022 Clinical Records.

(1) through (5) No change.

(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.

2. Home health agencies may accept a physician’s rubber stamp signature. The individual whose signature the stamp represents must place in the administrative offices of the home health agency a signed statement attesting that he/she is the only one who has the stamp and uses it.

Rulemaking Specific Authority 400.497 FS. Law Implemented 400.491, 400.494, 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, 8-15-06, 3-29-07, _________.  

59A-8.0245 Advance Directives.

(1) No change.

(2) The home health agency’s policy shall include:

(a) Providing each adult patient, in advance of receiving services, with a copy of “Health Care Advance Directives – The Patients’ Right to Decide”, as prepared by the Agency for Health Care Administration, revised April 2006 February, 2004, and available at http://www.floridahealthfinder.gov/reports-guides/ reports-guides.aspx http://www.fdhc.state.fl.us/MCHQ/Health_Facility_Regulation/HC_Advance_Directives, which is hereby incorporated by reference, or with a copy of a document drafted by a person or organization other than AHCA which is a written description of Florida’s state law regarding advance directives;

(b) through (d) No change.

(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, F.A.C.

(b) Home health personnel and agencies shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct for withholding or withdrawing cardiopulmonary resuscitation pursuant to such a Do Not Resuscitate Order (DNRO) and rules adopted by the agency, pursuant to Section 400.487(7), F.S. Any licensed professional home health agency personnel, who, in good faith, obeys the directives of an existing DNRO, executed pursuant to Section 401.45, F.S., will not be subject to prosecution or civil liability for his/her performance regarding patient care.

Rulemaking Specific Authority 400.487, 765.110 FS. Law Implemented 400.487, 400.497, 765.110 FS. History–New 10-27-94, Amended 1-17-00, 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 “Comprehensive Emergency Management Plan (CEMP),” AHCA Form 3110-1022, Revised May 2010 December 2006, incorporated by reference. This document is available from the Agency for Health Care Administration at http://ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml http://ahca.myflorida.com 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.

(2) 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 home health 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 home health 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 home health agency; or if the home health 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 home health agency’s file for the patient. If it is determined the home health agency needs to provide continued services, it will be the responsibility of the home health agency to provide the same type and quantity of care for the patient in the special needs shelter during and after the emergency, equal to the care received prior to the shelter assignment as specified in Section 400.492, F.S., except in certain situations as specified in Section 400.492(3), F.S.

(9) through (17) No change.

Rulemaking Specific Authority 400.492, 400.497 FS. Law Implemented 400.492, 400.497 FS. History–New 7-18-01, Amended 8-15-06, 3-29-07,________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Anne Menard, Supervisor, Home Care Unit, Bureau of Health Facility Regulation
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek, Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 16, 2013
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: July 15, 2011