Pursuant to HB 767 (2020-68, L.O.F.) which amended sections 429.41, 429.07, and 429.929, F.S., the Agency proposes to revise rules 59A-36.002, 36.006, 36.021, and 36.022 F.A.C. Revisions will update an incorporated form ....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Health Facility and Agency Licensing

RULE NOS.:RULE TITLES:

59A-36.002Definitions

59A-36.006Admission Procedures, Appropriateness of Placement and Continued Residency Criteria

59A-36.021Extended Congregate Care Services

59A-36.022Limited Nursing Services

PURPOSE AND EFFECT: Pursuant to HB 767 (2020-68, L.O.F.) which amended sections 429.41, 429.07, and 429.929, F.S., the Agency proposes to revise rules 59A-36.002, 36.006, 36.021, and 36.022 F.A.C. Revisions will update an incorporated form (AHCA Form 1823), amend admission criteria and extended congregate care continued residency criteria to include residents receiving hospice services pursuant to s. 429.26(1)(c), F.S. and clarify requirements relating to nursing progress notes and AHCA Form 1823.

SUMMARY: The Agency proposes to revise rules 59A-36.002, 36.006, 36.021, and 36.022 F.A.C. to update an incorporated form (AHCA Form 1823), amend admission criteria and extended congregate care continued residency criteria to include residents receiving hospice services pursuant to s. 429.26(1)(c), F.S. and clarify requirements relating to nursing progress notes and AHCA Form 1823.

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: 429.41, 429.07, 429.929, FS

LAW IMPLEMENTED: 429.07, 429.255, 429.26, 429.28, 429.075, 429.11, 429.14, 429.19, 429.41, 429.47, 429.52, 429.905, FS.

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

DATE AND TIME: June 24, 2021, 2:00 p.m. to 3:00 p.m.

PLACE: No public face-to-face meeting. This hearing will be conducted via teleconference. Participate by dialing the Open Voice conference line, 1(888)585-9008, then enter the conference room number followed by the pound sign, 476-211-242#. The agenda and related materials can also 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: [e-mail], Bureau of Health Facility Regulation, 2727 Mahan Drive, MS 28A, Tallahassee, Florida, 32308 at [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 RULE IS: Keisha Woods, [phone] or email at [e-mail]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59A-36.002 Definitions.

In addition to the terms defined in section 429.02, F.S., the following definitions are applicable in this rule chapter:

(1) through (7) No change.

(8) “Bedridden” means confined to bed because of inability to ambulate or transfer to a wheelchair even with assistance, or to sit safely in a chair or wheelchair without personal assistance or physical restraint.

(9) through (41) renumbered (8) through (40) No change.

(41) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.41, 429.929 FS. Law Implemented 429.07, 429.075, 429.11, 429.14, 429.19, 429.41, 429.47, 429.52, 429.905 FS. History–New 9-30-92, Formerly 10A-5.0131, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 1-9-02, 7-30-06, 4-15-10, 4-17-14, 5-10-18, Formerly 58A-5.0131, 7-1-19, Amended________.

 

59A-36.006 Admission Procedures, Appropriateness of Placement and Continued Residency Criteria.

(1) ADMISSION CRITERIA.

(a) An individual must meet the following minimum criteria in order to be admitted to a facility holding a standard, limited nursing services, or limited mental health license:

1. through 8. No change

9. Not be bedridden, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.;

10. Not have any stage 3 or 4 pressure sores. A resident requiring care of a stage 2 pressure sore may be admitted provided that:

a. The resident either:

(I) Resides in a standard or limited nursing services licensed facility and contracts directly with a licensed home health agency or a nurse to provide care; or

(II) Resides in a limited nursing services licensed facility and care is provided by the facility pursuant to a plan of care issued by a health care practitioner provider;

b. The condition is documented in the resident’s record and admission and discharge logs; and,

c. If the resident’s condition fails to improve within 30 days as documented by a health care practitioner provider, the resident must be discharged from the facility.

11. through 12. No change

13. Not require 24-hour nursing supervision, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.;

14. Not require skilled rehabilitative services as described in rule 59G-4.290, F.A.C.

15. Be appropriate for admission to the facility as determined by the facility administrator. The administrator must base the determination on:

a. An assessment of the strengths, needs, and preferences of the individual;

b. The medical examination report required by section 429.26, F.S., and subsection (2) of this rule, if available;

c. The facility’s admission policy and the services the facility is prepared to provide or arrange in order to meet resident needs. Such services may not exceed the scope of the facility’s license unless specified elsewhere in this rule; and,

d. The ability of the facility to meet the uniform fire safety standards for assisted living facilities established in rule chapter 69A-40, F.A.C.

(b) through (c) no change.

(d) Not withstanding any other provisions of this rule, aAn individual enrolled in and receiving licensed hospice services may be admitted to an assisted living facility pursuant to Section 429.26(1)(d). F.S. as long as the individual otherwise meets resident admission criteria.

(e) Resident admission criteria for facilities holding an extended congregate care license are described in rule 59A-36.021, F.A.C.

(2) HEALTH ASSESSMENT. As part of the admission criteria, an individual must undergo a face-to-face medical examination completed by a health care practitioner provider as specified in either paragraph (a) or (b) of this subsection.

(a) A medical examination completed within 60 calendar days before or within 30 days after the individual’s admission to a facility pursuant to section 429.26(5)(4), F.S. The examination must address the following:

1. through 6. no change

7. A statement on the day of the examination that, in the opinion of the examining health care practitioner provider, the individual’s needs can be met in an assisted living facility; and,

8. The date of the examination, and the name, signature, address, telephone number, and license number of the examining health care practitioner provider. The medical examination may be conducted by a health care practitioner provider licensed under chapter 458, 459 or 464, F.S.

(b) When a health care practitioner conducts a A medical examination, completed after the resident’s admission to the facility within 30 calendar days of the admission date. tThe examination must be recorded on the practitioner’s form or on AHCA Form 1823, Resident Health Assessment for Assisted Living Facilities, April 2021 March 2017, which is incorporated by reference and available online at: http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX. Faxed or electronic copies of the completed form are acceptable. If AHCA Form 1823 is used, tThe form must be completed as instructed.

1. Items on the form that have been omitted by the health care practitioner provider during the examination may be obtained by the facility either orally or in writing from the health care practitioner provider.

2. Omitted information must be documented in the resident’s record. Information received orally must include the name of the health care practitioner provider, the name of the facility staff recording the information, and the date the information was provided.

3. Electronic documentation may be used in place of completing the section on AHCA Form 1823 referencing Services Offered or Arranged by the Facility for the Resident. The electronic documentation must include all of the elements described in this section of AHCA Form 1823.

(c) Any information required by paragraph (a), that is not contained in the medical examination report conducted before the individual’s admission to the facility must be obtained by the administrator or designee and placed in the resident’s record using AHCA Form 1823 within 30 days after admission.

(d) through (e) no change.

(f) Any orders issued by the health care practitioner provider conducting the medical examination for medications, nursing services, treatments, therapy, or therapeutic diets, or other services to be provided or supervised by the facility may be attached to the health assessment. A health care practitioner provider may attach a DH Form 1896, Florida Do Not Resuscitate Order Form, for residents who do not wish cardiopulmonary resuscitation to be administered in the case of cardiac or respiratory arrest.

(g) No change.

(3) No change.

(4) CONTINUED RESIDENCY. Except as follows in paragraphs (a) through (c) of this subsection, criteria for continued residency in any licensed facility must be the same as the criteria for admission. As part of the continued residency criteria, a resident must have a face-to-face medical examination by a health care practitioner provider at least every 3 years after the initial assessment, or after a significant change, whichever comes first. A significant change is defined in rule 59A-36.002, F.A.C. The results of the examination must be recorded on the practitioner’s form or on AHCA Form 1823, which is incorporated by reference in paragraph (2)(b) of this rule and must be completed in accordance with that paragraph. Exceptions to the requirement to meet the criteria for continued residency are:

(a) The resident may be bedridden for no more than 7 consecutive days, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.

(b) A resident requiring care of a stage 2 pressure sore may be retained provided that:

1. The resident contracts directly with a licensed home health agency or a nurse to provide care, or the facility has a limited nursing services license and services are provided pursuant to a plan of care issued by a health care practitioner provider,

2. The condition is documented in the resident’s record; and,

3. If the resident’s condition fails to improve within 30 days, as documented by a health care practitioner provider, the resident must be discharged from the facility.

(c) A terminally ill resident who no longer meets the criteria for continued residency may continue to reside in the facility if the following conditions are met:

1. The resident qualifies for, is admitted to, and consents to receive services from a licensed hospice that coordinates and ensures the provision of any additional care and services that the resident may need;

2. Both the resident, or the resident’s legal representative if applicable, and the facility agree to continued residency;

3. A licensed hospice, in consultation with the facility, develops and implements an interdisciplinary care plan that specifies the services being provided by hospice and those being provided by the facility; and,

4. Documentation of the requirements of this paragraph is maintained in the resident’s file.

(d) through (g) no change

(5) DISCHARGE. If the resident no longer meets the criteria for continued residency, or the facility is unable to meet the resident’s needs, as determined by the facility administrator or health care practitioner provider, the resident must be discharged in accordance with section 429.28, F.S.

(6) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.26, 429.28, 429.41 FS. History–New 9-17-84, Formerly 10A-5.181, Amended 10-20-86, 6-21-88, 8-15-90, 9-30-92, Formerly 10A-5.0181, Amended 10‑30‑95, 6‑2-96, 10-17-99, 7-30-06, 10-9-06, 4-15-10, 10-14-10, 4-17-14, 5-10-18, Formerly 58A-5.0181, 7-1-19, Amended_______.       

 

59A-36.021 Extended Congregate Care Services.

(1) through (3) No change.

(4) ADMISSION AND CONTINUED RESIDENCY.

(a) An individual must meet the following minimum criteria in order to receive extended congregate care services:

1. through 3. No change.

4. Not be a danger to self or others as determined by a health care practitioner provider or mental health practitioner licensed under chapter 490 or 491, F.S.;

5. Not be bedridden, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S.;

6. through 7. No change.

8. Not require 24-hour nursing supervision, unless the resident is receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S. and,

9. No change.

10. Notwithstanding any other provision of this rule, an individual enrolled and receiving licensed hospice services pursuant to Section 429.26(1)(c), F.S. may be admitted and receive extended congregate care services.

(b) No change.

(5) HEALTH ASSESSMENT. Before receiving extended congregate care services, all persons. including residents transferring within the same facility to that portion of the facility licensed to provide extended congregate care services, must be examined by a health care practitioner provider pursuant to rule 59A-36.006, F.A.C. A health assessment conducted no more than 60 days before receiving extended congregate care services meets this requirement. Once receiving services, a new health assessment must be obtained at least annually.

(6) No change.

(7) EXTENDED CONGREGATE CARE SERVICES. All services must be provided in the least restrictive environment, and in a manner that respects the resident’s independence, privacy, and dignity.

(a) No change.

(b) A facility providing extended congregate care services must make available the following additional services if required by the resident’s service plan:

1. through 4. No change.

5. Assistance with self-administered medications, or the administration of medications and treatments pursuant to a health care practitioner’s provider’s order. If the individual needs assistance with self-administration the facility must inform the resident of the qualifications of staff who will be providing this assistance, and if unlicensed persons will be providing such assistance, obtain the resident’s or the resident’s surrogate, guardian, or attorney-in-fact’s informed written consent to provide such assistance as required in section 429.256, F.S.,

6. through 9. No change.

(c) Nursing staff providing extended congregate care services may provide any nursing service permitted within the scope of their license consistent with the residency requirements of this rule and the facility’s written policies and procedures, provided the nursing services are:

1. Authorized by a health care practitioner’s provider’s order and pursuant to a plan of care,

2. through 6. no change.

(d) No change.

(8) RECORDS. In addition to the records required in rule 59A-36.015, F.A.C., a facility providing extended congregate care services must maintain the following:

(a) No change.

(b) The nursing progress notes for each resident receiving nursing services from the facility’s staff;

(c) through (d) No change.

(9) No change.

(10) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.07, 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.28, 429.41 FS. History–New 9-30-92, Formerly 10A-5.030, Amended 10-30-95, 6-2-96, 4-20-98, 11-2-98, 10-17-99, 7-30-06, 4-17-14, 5-10-18, Formerly 58A-5.030, 7-1-19, Amended_______.

 

59A-36.022 Limited Nursing Services.

Any facility intending to provide limited nursing services must obtain a license from the agency.

(1) through (2) No change.

(3) RECORDS.

(a) A record of all residents receiving limited nursing services and the type of services provided must be maintained at the facility.

(b) Nursing progress notes must be maintained for each resident who receives limited nursing services from facility staff.

(c) No change.

(4) This rule is in effect for five years from its effective date.

Rulemaking Authority 429.41 FS. Law Implemented 429.07, 429.255, 429.26, 429.41 FS. History–New 9-30-92, Formerly 10A-5.031, Amended 10-30-95, 10-17-99, 7-30-06, 3-13-14, 5-10-18, Formerly 58A-5.031, 7-1-19, Amended _______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Keisha Woods

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: 5/18/2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 3/02/2021