Bill Text: FL S1676 | 2020 | Regular Session | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Direct Care Workers

Spectrum: Slight Partisan Bill (? 2-1)

Status: (Introduced - Dead) 2020-03-10 - Laid on Table, refer to CS/CS/HB 607 [S1676 Detail]

Download: Florida-2020-S1676-Introduced.html
       Florida Senate - 2020                                    SB 1676
       
       
        
       By Senator Albritton
       
       
       
       
       
       26-01666-20                                           20201676__
    1                        A bill to be entitled                      
    2         An act relating to direct care workers; amending s.
    3         400.141, F.S.; requiring a nursing home facility that
    4         authorizes a registered nurse to delegate tasks to a
    5         certified nursing assistant to ensure that certain
    6         requirements are met; creating s. 400.212, F.S.;
    7         authorizing a certified nursing assistant to perform
    8         tasks delegated by a registered nurse; amending s.
    9         400.23, F.S.; authorizing certain nonnursing staff to
   10         count toward compliance with staffing standards;
   11         amending s. 400.462, F.S.; revising the definition of
   12         the term “home health aide”; amending s. 400.464,
   13         F.S.; requiring a licensed home health agency that
   14         authorizes a registered nurse to delegate tasks to a
   15         certified nursing assistant to ensure that certain
   16         requirements are met; amending s. 400.488, F.S.;
   17         authorizing an unlicensed person to assist with self
   18         administration of certain treatments; revising the
   19         requirements for such assistance; creating s. 400.489,
   20         F.S.; authorizing a home health aide to administer
   21         certain prescription medications under certain
   22         conditions; requiring the home health aide to meet
   23         certain training and competency requirements;
   24         requiring the training, determination of competency,
   25         and annual validations of home health aides to be
   26         conducted by a registered nurse or a physician;
   27         requiring a home health aide to complete annual
   28         inservice training in medication administration and
   29         medication error prevention, in addition to existing
   30         annual inservice training requirements; requiring the
   31         Agency for Health Care Administration, in consultation
   32         with the Board of Nursing, to adopt rules for
   33         medication administration by home health aides;
   34         creating s. 400.490, F.S.; authorizing a certified
   35         nursing assistant or home health aide to perform tasks
   36         delegated by a registered nurse; creating s. 400.52,
   37         F.S.; creating the Excellence in Home Health Program
   38         within the agency; requiring the agency to adopt rules
   39         establishing program criteria; requiring the agency to
   40         annually evaluate certain home health agencies that
   41         apply for a program designation; providing program
   42         designation eligibility requirements; providing that a
   43         program designation is not transferrable, with an
   44         exception; providing for the expiration of awarded
   45         designations; requiring home health agencies to
   46         reapply biennially to renew the awarded program
   47         designation; authorizing a program designation award
   48         recipient to use the designation in advertising and
   49         marketing; prohibiting a home health agency from using
   50         a program designation in any advertising or marketing,
   51         under certain circumstances; creating s. 408.064,
   52         F.S.; defining the terms “home care services provider”
   53         and “ home care worker”; requiring the agency to
   54         develop and maintain a voluntary registry of home care
   55         workers; requiring the agency to display a link to the
   56         registry on its website homepage; providing
   57         requirements for the registry; requiring a home care
   58         worker to apply to the agency to be included in the
   59         registry; requiring the agency to develop a process by
   60         which a home care services provider may include its
   61         employees on the registry; requiring certain home care
   62         workers to undergo background screening and training;
   63         requiring each page of the registry website to contain
   64         a specified notice; requiring the agency to adopt
   65         rules; creating s. 408.822, F.S.; defining the term
   66         “direct care worker”; requiring certain licensees to
   67         provide specified information about their employees in
   68         a survey beginning on a specified date; requiring that
   69         the survey be completed on a form with a specified
   70         attestation adopted by the agency by rule; requiring
   71         licensees to submit such survey before the agency
   72         renews their licenses; requiring the agency to
   73         continually analyze the results of such surveys and
   74         publish their results on the agency’s website;
   75         requiring the agency to update such information
   76         monthly; creating s. 464.0156, F.S.; authorizing a
   77         registered nurse to delegate certain tasks to a
   78         certified nursing assistant or home health aide under
   79         certain conditions; providing the criteria that a
   80         registered nurse must consider in determining if a
   81         task may be delegated; authorizing a registered nurse
   82         to delegate medication administration to a certified
   83         nursing assistant or home health aide, subject to
   84         certain requirements; providing an exception for
   85         certain controlled substances; requiring the Board of
   86         Nursing, in consultation with the agency, to adopt
   87         rules; amending s. 464.018, F.S.; subjecting a
   88         registered nurse to disciplinary action for delegating
   89         certain tasks to a person who the registered nurse
   90         knows or has reason to know is unqualified to perform
   91         such tasks; creating s. 464.2035, F.S.; authorizing
   92         certified nursing assistants to administer certain
   93         prescription medications under certain conditions;
   94         requiring the certified nursing assistants to meet
   95         certain training and competency requirements;
   96         requiring the training, determination of competency,
   97         and annual validations of certified nursing assistants
   98         to be conducted by a registered nurse or a physician;
   99         requiring a certified nursing assistant to complete
  100         annual inservice training in medication administration
  101         and medication error prevention in addition to
  102         existing annual inservice training requirements;
  103         requiring the board, in consultation with the agency,
  104         to adopt rules for medication administration by
  105         certified nursing assistants; providing an effective
  106         date.
  107          
  108  Be It Enacted by the Legislature of the State of Florida:
  109  
  110         Section 1. Paragraph (v) is added to subsection (1) of
  111  section 400.141, Florida Statutes, to read:
  112         400.141 Administration and management of nursing home
  113  facilities.—
  114         (1) Every licensed facility shall comply with all
  115  applicable standards and rules of the agency and shall:
  116         (v) Ensure that a certified nursing assistant meets the
  117  requirements of chapter 464 and the rules adopted thereunder, if
  118  the facility authorizes a registered nurse to delegate tasks,
  119  including medication administration, to the certified nursing
  120  assistant.
  121         Section 2. Section 400.212, Florida Statutes, is created to
  122  read:
  123         400.212 Nurse-delegated tasks.—A certified nursing
  124  assistant may perform any task delegated to him or her by a
  125  registered nurse as authorized in chapter 464, including, but
  126  not limited to, medication administration.
  127         Section 3. Paragraph (b) of subsection (3) of section
  128  400.23, Florida Statutes, is amended to read:
  129         400.23 Rules; evaluation and deficiencies; licensure
  130  status.—
  131         (3)
  132         (b) Nonnursing staff providing eating assistance to
  133  residents may shall not count toward compliance with minimum
  134  staffing standards.
  135         Section 4. Subsection (15) of section 400.462, Florida
  136  Statutes, is amended to read:
  137         400.462 Definitions.—As used in this part, the term:
  138         (15) “Home health aide” means a person who is trained or
  139  qualified, as provided by rule, and who provides hands-on
  140  personal care, performs simple procedures as an extension of
  141  therapy or nursing services, assists in ambulation or exercises,
  142  or assists in administering medications as permitted in rule and
  143  for which the person has received training established by the
  144  agency under this part or a person who performs tasks delegated
  145  to him or her pursuant to chapter 464 s. 400.497(1).
  146         Section 5. Present subsections (5) and (6) of section
  147  400.464, Florida Statutes, are redesignated as subsections (6)
  148  and (7), respectively, a new subsection (5) is added to that
  149  section, and present subsection (6) of that section is amended,
  150  to read:
  151         400.464 Home health agencies to be licensed; expiration of
  152  license; exemptions; unlawful acts; penalties.—
  153         (5) If a licensed home health agency authorizes a
  154  registered nurse to delegate tasks, including medication
  155  administration, to a certified nursing assistant pursuant to
  156  chapter 464 or to a home health aide pursuant to s. 400.490, the
  157  licensed home health agency must ensure that such delegation
  158  meets the requirements of this chapter and chapter 464, and the
  159  rules adopted thereunder.
  160         (7)(6) Any person, entity, or organization providing home
  161  health services which is exempt from licensure under subsection
  162  (6) subsection (5) may voluntarily apply for a certificate of
  163  exemption from licensure under its exempt status with the agency
  164  on a form that specifies its name or names and addresses, a
  165  statement of the reasons why it is exempt from licensure as a
  166  home health agency, and other information deemed necessary by
  167  the agency. A certificate of exemption is valid for a period of
  168  not more than 2 years and is not transferable. The agency may
  169  charge an applicant $100 for a certificate of exemption or
  170  charge the actual cost of processing the certificate.
  171         Section 6. Subsections (2) and (3) of section 400.488,
  172  Florida Statutes, are amended to read:
  173         400.488 Assistance with self-administration of medication.—
  174         (2) Patients who are capable of self-administering their
  175  own medications without assistance shall be encouraged and
  176  allowed to do so. However, an unlicensed person may, consistent
  177  with a dispensed prescription’s label or the package directions
  178  of an over-the-counter medication, assist a patient whose
  179  condition is medically stable with the self-administration of
  180  routine, regularly scheduled medications that are intended to be
  181  self-administered. Assistance with self-medication by an
  182  unlicensed person may occur only upon a documented request by,
  183  and the written informed consent of, a patient or the patient’s
  184  surrogate, guardian, or attorney in fact. For purposes of this
  185  section, self-administered medications include both legend and
  186  over-the-counter oral dosage forms, topical dosage forms, and
  187  topical ophthalmic, otic, and nasal dosage forms, including
  188  solutions, suspensions, sprays, and inhalers, intermittent
  189  positive pressure breathing treatments, and nebulizer
  190  treatments.
  191         (3) Assistance with self-administration of medication
  192  includes:
  193         (a) Taking the medication, in its previously dispensed,
  194  properly labeled container, from where it is stored and bringing
  195  it to the patient.
  196         (b) In the presence of the patient, confirming that the
  197  medication is intended for that patient, orally advising the
  198  patient of the medication name and purpose reading the label,
  199  opening the container, removing a prescribed amount of
  200  medication from the container, and closing the container.
  201         (c) Placing an oral dosage in the patient’s hand or placing
  202  the dosage in another container and helping the patient by
  203  lifting the container to his or her mouth.
  204         (d) Applying topical medications, including providing
  205  routine preventative skin care and basic wound care.
  206         (e) Returning the medication container to proper storage.
  207         (f) For intermittent positive pressure breathing treatments
  208  or for nebulizer treatments, assisting with setting up and
  209  cleaning the device in the presence of the patient, confirming
  210  that the medication is intended for that patient, orally
  211  advising the patient of the medication name and purpose, opening
  212  the container, removing the prescribed amount for a single
  213  treatment dose from a properly labeled container, and assisting
  214  the patient with placing the dose into the medicine receptacle
  215  or mouthpiece.
  216         (g)(f) Keeping a record of when a patient receives
  217  assistance with self-administration under this section.
  218         Section 7. Section 400.489, Florida Statutes, is created to
  219  read:
  220         400.489 Administration of medication by a home health aide;
  221  staff training requirements.—
  222         (1) A home health aide may administer oral, transdermal,
  223  ophthalmic, otic, rectal, inhaled, enteral, or topical
  224  prescription medications if the home health aide has been
  225  delegated such task by a registered nurse licensed under chapter
  226  464; has satisfactorily completed an initial 6-hour training
  227  course approved by the agency; and has been found competent to
  228  administer medication to a patient in a safe and sanitary
  229  manner. The training, determination of competency, and initial
  230  and annual validations required in this section shall be
  231  conducted by a registered nurse licensed under chapter 464 or a
  232  physician licensed under chapter 458 or chapter 459.
  233         (2) A home health aide must annually and satisfactorily
  234  complete a 2-hour inservice training course in medication
  235  administration and medication error prevention approved by the
  236  agency. The inservice training course shall be in addition to
  237  the annual inservice training hours required by agency rules.
  238         (3) The agency, in consultation with the Board of Nursing,
  239  shall establish by rule standards and procedures that a home
  240  health aide must follow when administering medication to a
  241  patient. Such rules must, at a minimum, address qualification
  242  requirements for trainers, requirements for labeling medication,
  243  documentation and recordkeeping, the storage and disposal of
  244  medication, instructions concerning the safe administration of
  245  medication, informed-consent requirements and records, and the
  246  training curriculum and validation procedures.
  247         Section 8. Section 400.490, Florida Statutes, is created to
  248  read:
  249         400.490 Nurse-delegated tasks.—A certified nursing
  250  assistant or home health aide may perform any task delegated by
  251  a registered nurse as authorized in chapter 464, including, but
  252  not limited to, medication administration.
  253         Section 9. Section 400.52, Florida Statutes, is created to
  254  read:
  255         400.52 Excellence in Home Health Program.—
  256         (1) There is created within the agency the Excellence in
  257  Home Health Program for the purpose of awarding program
  258  designations to home health agencies that meet the criteria
  259  specified in this section.
  260         (2)(a) The agency shall adopt rules establishing criteria
  261  for the program which must include, at a minimum, meeting
  262  standards relating to:
  263         1. Patient satisfaction.
  264         2. Patients requiring emergency care for wound infections.
  265         3. Patients admitted or readmitted to an acute care
  266  hospital.
  267         4. Patient improvement in the activities of daily living.
  268         5. Employee satisfaction.
  269         6. Quality of employee training.
  270         7. Employee retention rates.
  271         (b) The agency shall annually evaluate home health agencies
  272  seeking the program designation which apply on a form and in the
  273  manner designated by rule.
  274         (3) To receive a program designation, the home health
  275  agency must:
  276         (a) Be actively licensed and have been operating for at
  277  least 24 months before applying for the program designation. A
  278  designation awarded under the program is not transferrable to
  279  another licensee, unless the existing home health agency is
  280  being relicensed in the name of an entity related to the current
  281  licenseholder by common control or ownership, and there will be
  282  no change in the management, operation, or programs of the home
  283  health agency as a result of the relicensure.
  284         (b) Have not had any licensure denials, revocations, or
  285  Class I, Class II, or uncorrected Class III deficiencies within
  286  the 24 months before the application for the program
  287  designation.
  288         (4) The program designation expires on the same date as the
  289  home health agency’s license. A home health agency must reapply
  290  and be approved for the program designation to continue using
  291  the program designation in the manner authorized under
  292  subsection (5).
  293         (5) A home health agency that is awarded a designation
  294  under the program may use the designation in advertising and
  295  marketing. A home health agency may not use the program
  296  designation in any advertising or marketing if the home health
  297  agency:
  298         (a) Has not been awarded the designation;
  299         (b) Fails to renew the designation upon expiration of the
  300  awarded designation;
  301         (c) Has undergone a change in ownership that does not
  302  qualify for an exception under paragraph (3)(a); or
  303         (d) Has been notified that it no longer meets the criteria
  304  for the award upon reapplication after expiration of the awarded
  305  designation.
  306         Section 10. Section 408.064, Florida Statutes, is created
  307  to read:
  308         408.064 Home Care Services Registry.—
  309         (1) As used in this section, the term:
  310         (a) “Home care services provider” means a home health
  311  agency licensed under part III of chapter 400 or a nurse
  312  registry licensed under part III of chapter 400.
  313         (b) “Home care worker” means a home health aide as defined
  314  in s. 400.462 or a certified nursing assistant certified under
  315  part II of chapter 464.
  316         (2) The agency shall develop and maintain a voluntary
  317  registry of home care workers. The agency shall display a link
  318  to the registry on its website homepage.
  319         (3) The registry must include, at a minimum:
  320         (a) Each home care worker’s full name, date of birth,
  321  social security number, and a fullface, passport-type, color
  322  photograph of the home care worker. The home care worker’s date
  323  of birth and social security number may not be publicly
  324  displayed on the website.
  325         (b) Each home care worker’s contact information, including,
  326  but not limited to, his or her address and phone number. If
  327  employed by a home care services provider, the home care worker
  328  may use the provider’s contact information.
  329         (c) Any other identifying information of the home care
  330  worker, as determined by the agency.
  331         (d) The name of the state-approved training program
  332  successfully completed by the home care worker and the date on
  333  which such training was completed.
  334         (e) The number of years the home care worker has provided
  335  home health care services for compensation. The agency may
  336  automatically populate employment history as provided by current
  337  and previous employers of the home care worker. The agency shall
  338  provide a method for a home care worker to correct inaccuracies
  339  and supplement the automatically populated employment history.
  340         (f) For a certified nursing assistant, any disciplinary
  341  action taken or pending against the nursing assistant’s
  342  certification by the Department of Health. The agency may enter
  343  into an agreement with the Department of Health to obtain
  344  disciplinary history.
  345         (g) Whether the home care worker provides services to
  346  special populations and, if so, the special populations served.
  347         (4) A home care worker must submit an application on a form
  348  adopted by the agency to be included in the registry. The agency
  349  shall develop a process by which a home care services provider
  350  may include its employees in the registry by providing the
  351  information specified in subsection (3).
  352         (5) A home care worker who is not employed by a home care
  353  services provider must meet the background screening
  354  requirements under s. 408.809 and chapter 435 and the training
  355  requirements of part III of chapter 400 or part II of chapter
  356  464, as applicable, the results of which must be included in the
  357  registry.
  358         (6) Each page of the registry website must contain the
  359  following notice in at least 14-point boldfaced type:
  360  
  361                               NOTICE                              
  362  
  363         The Home Care Services Registry provides limited
  364         information about home care workers. Information
  365         contained in the registry is provided by third
  366         parties. The Agency for Health Care Administration
  367         does not guarantee the accuracy of such third-party
  368         information and does not endorse any individual listed
  369         in the registry. In particular, the information in the
  370         registry may be outdated or the individuals listed in
  371         the registry may have lapsed certifications or may
  372         have been denied employment approval due to the
  373         results of a background screening. It is the
  374         responsibility of those accessing this registry to
  375         verify the credentials, suitability, and competency of
  376         any individual listed in the registry.
  377  
  378         (7) The agency shall adopt rules necessary to implement the
  379  requirements of this section.
  380         Section 11. Section 408.822, Florida Statutes, is created
  381  to read:
  382         408.822 Direct care workforce survey.—
  383         (1) For purposes of this section, the term “direct care
  384  worker” means a certified nursing assistant, a home health aide,
  385  a personal care assistant, a companion services or homemaker
  386  services provider, or another individual who provides personal
  387  care as defined in s. 400.462 to individuals who are elderly,
  388  developmentally disabled, or chronically ill.
  389         (2) Beginning January 1, 2021, each licensee that applies
  390  for licensure renewal as a nursing home facility licensed under
  391  part II of chapter 400; an assisted living facility licensed
  392  under part I of chapter 429; or a home health agency, nurse
  393  registry, or companion services or homemaker services provider
  394  licensed under part III of chapter 400 shall furnish the
  395  following information to the agency in a survey on the direct
  396  care workforce:
  397         (a) The number of direct care workers employed by the
  398  licensee.
  399         (b) The turnover and vacancy rates of direct care workers
  400  and contributing factors to these rates.
  401         (c) The average employee wage for each category of direct
  402  care worker.
  403         (d) Employment benefits for direct care workers and the
  404  average cost of such benefits to the employer and the employee.
  405         (e) Type and availability of training for direct care
  406  workers.
  407         (3) An administrator or designee shall include the
  408  information required in subsection (2) on a survey form
  409  developed by the agency by rule which must contain an
  410  attestation that the information provided is true and accurate
  411  to the best of his or her knowledge.
  412         (4) The licensee must submit the completed survey prior to
  413  the agency issuing the license renewal.
  414         (5) The agency shall continually analyze the results of the
  415  surveys and publish the results on its website. The agency shall
  416  update the information published on its website monthly.
  417         Section 12. Section 464.0156, Florida Statutes, is created
  418  to read:
  419         464.0156 Delegation of duties.—
  420         (1) A registered nurse may delegate a task to a certified
  421  nursing assistant certified under part II of this chapter or a
  422  home health aide as defined in s. 400.462, if the registered
  423  nurse determines that the certified nursing assistant or the
  424  home health aide is competent to perform the task, the task is
  425  delegable under federal law, and the task:
  426         (a) Is within the nurse’s scope of practice.
  427         (b) Frequently recurs in the routine care of a patient or
  428  group of patients.
  429         (c) Is performed according to an established sequence of
  430  steps.
  431         (d) Involves little or no modification from one patient to
  432  another.
  433         (e) May be performed with a predictable outcome.
  434         (f) Does not inherently involve ongoing assessment,
  435  interpretation, or clinical judgment.
  436         (g) Does not endanger a patient’s life or well-being.
  437         (2) A registered nurse may delegate to a certified nursing
  438  assistant or a home health aide the administration of oral,
  439  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  440  topical prescription medications, if the certified nursing
  441  assistant or home health aide meets the requirements of s.
  442  464.2035 or s. 400.489, respectively. A registered nurse may not
  443  delegate the administration of any controlled substance listed
  444  in Schedule II, Schedule III, or Schedule IV of s. 893.03 or 21
  445  U.S.C. s. 812.
  446         (3) The board, in consultation with the Agency for Health
  447  Care Administration, may adopt rules to implement this section.
  448         Section 13. Paragraph (r) is added to subsection (1) of
  449  section 464.018, Florida Statutes, to read:
  450         464.018 Disciplinary actions.—
  451         (1) The following acts constitute grounds for denial of a
  452  license or disciplinary action, as specified in ss. 456.072(2)
  453  and 464.0095:
  454         (r) Delegating professional responsibilities to a person
  455  when the nurse delegating such responsibilities knows or has
  456  reason to know that such person is not qualified by training,
  457  experience, certification, or licensure to perform them.
  458         Section 14. Section 464.2035, Florida Statutes, is created
  459  to read:
  460         464.2035 Administration of medication.—
  461         (1) A certified nursing assistant may administer oral,
  462  transdermal, ophthalmic, otic, rectal, inhaled, enteral, or
  463  topical prescription medication to a resident of a nursing home
  464  or a patient of a home health agency if the certified nursing
  465  assistant has been delegated such task by a registered nurse
  466  licensed under part I of this chapter, has satisfactorily
  467  completed an initial 6-hour training course approved by the
  468  board, and has been found competent to administer medication to
  469  a resident or patient in a safe and sanitary manner. The
  470  training, determination of competency, and initial and annual
  471  validations required under this section must be conducted by a
  472  registered nurse licensed under this chapter or a physician
  473  licensed under chapter 458 or chapter 459.
  474         (2) A certified nursing assistant shall annually and
  475  satisfactorily complete 2 hours of inservice training in
  476  medication administration and medication error prevention
  477  approved by the board, in consultation with the Agency for
  478  Health Care Administration. The inservice training is in
  479  addition to the other annual inservice training hours required
  480  under this part.
  481         (3) The board, in consultation with the Agency for Health
  482  Care Administration, shall establish by rule standards and
  483  procedures that a certified nursing assistant must follow when
  484  administering medication to a resident or patient. Such rules
  485  must, at a minimum, address qualification requirements for
  486  trainers, requirements for labeling medication, documentation
  487  and recordkeeping, the storage and disposal of medication,
  488  instructions concerning the safe administration of medication,
  489  informed-consent requirements and records, and the training
  490  curriculum and validation procedures.
  491         Section 15. This act shall take effect upon becoming a law.

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