59A-8.002: Definitions
59A-8.003: Licensure Requirements
59A-8.004: Licensure Procedure
59A-8.008: Scope of Services
59A-8.0086: Denial, Suspension, Revocation of License and Imposition of Fines
59A-8.0095: Personnel
59A-8.0185: Personnel Policies
59A-8.020: Acceptance of Patients or Clients
59A-8.0215: Plan of Care
59A-8.022: Clinical Records
59A-8.0245: Advance Directives
59A-8.027: Emergency 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 provide a rule on the submission of the quarterly report required in Section 400.474(6)(f), F.S.; to update the statutory references in the rule and forms referenced to conform to current statutes, and remove items that are now in Florida Statutes and Chapter 59A-35, F.A.C.; to revise personnel rules to conform to state practice act rules for included professions; to clarify the wording of the rule on health statements and refer to communicable disease that can be spread by casual contact; to require a photo identification tag for staff that have contact with patients in order to protect patients and avoid persons wrongfully representing themselves as someone they are not; to remove rubber stamped signatures for physicians to prevent fraud; and to include minimum requirements for home health aide, certified nursing assistant, homemaker and companion client records and service provision plans which are less than the requirements for clinical records and plans of care for patients receiving nursing and therapy.
SUMMARY: Rule 59A-8.002, F.A.C., adds the definition of temporary basis used in the definition of staffing in Section 400.462, F.S., and deletes two definitions that are now covered in state law.
Paragraph 59A-8.003(6)(c), F.A.C., adds that changes of ownership will demonstrate compliance with state laws by an unannounced inspection as required in Section 400.497(6), F.S. Subsection 59A-8.003(14), F.A.C., adds how home health agency quarterly reports are submitted to the Agency for Health Care Administration. Rule 59A-8.003, F.A.C., also clarifies that satellite offices are expected to meet the law and rule requirements of home health agency offices and that training of home health agency staff may be done at drop-off sites.
Rule 59A-8.004, F.A.C., removes the application forms and licensing procedures, including background screening, and refers to Rules 59A-35.060 and 59A-35.062, F.A.C., and Section 408.809, F.S. that now contain uniform health care licensing procedures for the Agency. A form for attestation of compliance with the 10-mile distance requirement in Section 400.471(7), F.S., is added.
Rule 59A-8.008, F.A.C., adds that when a home health agency provides staffing services, the staff are assigned to patients and supervised by the requesting facility or entity.
Rule 59A-8.0086, F.A.C., on denial, suspension, revocation of licenses and imposition of fines is proposed to be repealed since the contents are now in state law. Fine amounts are now in Sections 400.474 and 400.484, F.S. Denial, suspension, and revocation of licenses are now in Sections 408.806(3), 400.474, 400.484, 408.813, 408.814, and 408.815, F.S.
Rule 59A-8.0095, F.A.C., updates and adds to the requirements for various types of personnel. The administrator shall be responsible for the overall operation of the home health agency. Additional oversight by the director of nursing is added as required in Section 400.497(5), F.S. The home health aides and certified nursing assistants section adds patient care tasks that can be done related to elimination, adds that client records include the tasks performed and any changes observed in the client, and clarifies that demonstration cardiopulmonary resuscitation can still be performed is required when renewing CPR certification. The nurses, physical therapist and occupational therapist sections add that services will be provided in compliance with the state practice acts and rules. The physical therapist and occupational therapist sections clarify supervisory requirements for therapy assistants. The one year of experience requirement for physical therapists and physical therapist assistants is removed. For homemakers and companions minimum requirements for work records are added and clients may be verbally reminded to take their medications. Each home health agency will have a process to verify that services were provided.
Rule 59A-8.0185, F.A.C., clarifies that personnel policies also apply to contracted staff and independent contractors, not just employees. The health statement requirement is updated to clarify that persons are to be free from communicable disease that can be casually transmitted. The requirement for a biennial course on HIV and AIDS is replaced with a one-time course since the state law changed. A photo identification tag that identifies the employee, independent contractor and contracted staff is required.
Rule 59A-8.020, F.A.C., deletes that the written agreement can be the service provision plan required in Section 400.491(2), F.S. since the written agreement does not have sufficient information.
Rule 59A-8.0215, F.A.C., adds the minimum content for the service provision plan for clients that are only receiving home health aide, certified nursing assistant, homemaker, or companion services; and permits the client to participate in the planning of his or her services and receive a copy of the plan. The rule also adds that plans of care and service provision plans must be individualized based on each patient or client’s needs, strengths, limitations and goals.
Rule 59A-8.022, F.A.C., adds the minimum content required in service records. Home health agencies that provide services under contract for patients admitted by another agency should have a copy of the records for the visits made by their staff and a copy of the plan of care or services provision plan. Rubber stamp signatures for physicians can no longer be used.
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.”
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: A statement of estimated regulatory costs has been prepared and is available from the proposed rule contact person below. The following is a summary of the SERC:
As of May 20, 2010, there were 2,349 licensed home health agencies in Florida. These agencies will be required to comply with the rule as well as any new agencies that are licensed in the coming years. The cost to each home health agency will be minimal. 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.
SPECIFIC AUTHORITY: 400.497 FS.
LAW IMPLEMENTED: 400.497(5)(6), 400.474(6)(f) FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN FAW.
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Anne Menard, Supervisor, Home Care Unit, Bureau of Health Facility Regulation, Anne.Menard@ahca.myflorida.com, (850)412-4385
THE FULL TEXT OF THE PROPOSED RULE IS:
59A-8.002 Definitions.
(1) “Accrediting organization” means the Community Health Accreditation Program, The Joint Commission, or the Accreditation Commission for Health Care or 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 (29) renumbered (9) through (28) No change.
(30) “Providing one service directly” means the agency must provide one service, in part, by direct employees, as defined in Section 400.462, F.S.
(31) through (37) renumbered (29) through (35) No change.
(36) “Temporary basis”, as used in the definition of “staffing” in Section 400.462, F.S., means short-term, such as for employee absences, short-term skill shortages, or seasonal workloads.
(37)(38) “Treatment orders” means written orders signed by a physician, physician assistant, or advanced registered nurse practitioner, acting within his or her respective scope of practice, which authorizes the provision of care or treatment to a patient in his place of residence by licensed Nurses, Physical Therapists, Occupational Therapists, Speech Therapists, or Dietitians/ Nutritionists.
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 an accrediting organization pursuant to Section 400.471, F.S., and Rule 59A-8.002, F.A.C the AHCA.
(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, 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(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 or has received a provisional or conditional 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) AHCA will conduct investigations of complaints regarding licensure violations. Complaint investigations will be unannounced. An entrance conference will be conducted to inform the administrator of the nature of the complaint. An exit conference will be conducted to report the findings and to receive additional information or clarification concerning the investigation.
(5) In addition to any other penalties imposed pursuant to this rule, AHCA the agency may assess costs related to an investigation that results in a successful prosecution, pursuant to Section 400.484(3), F.S. The prosecution can be resolved by stipulation settlement or final hearing. The following costs may apply: travel costs related to the investigation; investigative time by AHCA’s surveyor or surveyors including travel time; processing time by AHCA’s professional staff and administrative support staff of Field Operations, and processing time for administrative support staff and professional staff of the AHCA Home Care Unit in Tallahassee. The costs related to AHCA’s professional staff and support staff will be determined according to the hourly rate of pay for those positions.
(6) An application package for a change of ownership shall be made on a form prescribed by AHCA, as referenced in 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 a recent unannounced inspection, pursuant to Section 400.497, 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, F.S.
2. The inspection may be conducted in conjunction with an unannounced Medicare or Medicaid certification survey.
3. The unannounced inspection must have been completed within 18 months prior to submission of the change of ownership application to AHCA.
(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) A licensed home health agency may operate a satellite office. A satellite office must be located in the same county as the agency’s main office. Supplies and records can be stored at a satellite office and phone business can be conducted the same as in the main office. The satellite office shares administration with the main office and is not separately licensed. It must meet the requirements in state law and rules for home health agencies. Signs and advertisements can notify the public of the satellite office location. If the agency wants to open an office outside the county where the main office is located, the second office must be separately licensed.
(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) through (13) No change.
(14) The home health agency shall submit the quarterly report required in Section 400.474, F.S. This rule applies to each home health agency required to be licensed by AHCA pursuant to Chapter 400, Part III, F.S.
(a) During each quarterly submission period each home health agency shall submit the data required by the form AHCA 3110-1027, based on the data as it existed on the last day of the prior calendar quarter.
(b) A separate form AHCA 3110-1027, shall be submitted electronically for each home health agency required to be licensed by AHCA.
(c) For purposes of form AHCA 3110-1027, data includes “0” or “None,” if there were no instances of the specified data item.
(d) The quarterly submission periods are from 12:01 a.m. of the first (1st) day of the period through 12:00 a.m., midnight of the fifteenth (15th) day of the period, Eastern Standard Time or Eastern Daylight Time, as applicable:
1. January 1 through January 15.
2. April 1 through April 15.
3. July 1 through July 15.
4. October 1 through October 15.
(e) For example, if the home health agency was required to be licensed at any time during the period from January 1 through March 31, then pursuant to this rule the home health agency shall submit data for the January 1 through March 31 calendar quarter to AHCA during the April 1 through April 15 submission period.
(f) All filings shall be submitted electronically to https://weblics.fdhc.state.fl.us/datamart/mainMenu.do, the portal to AHCA’s data collection system, as adopted by this rule, by using the interactive electronic form AHCA 3110-1027.
(g) In order to submit the data through form AHCA 3110-1027 electronically, the home health agency must input a User ID and password. A User ID and password must be obtained from AHCA by e-mail from HQAHomeHealth@ahca.myflorida.com or by writing to the Agency for Health Care Administration, Home Care Unit, 2727 Mahan Drive, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308. A request for a User ID and password must not be submitted to AHCA later than the tenth (10th) day of a quarterly submission period. A new User ID and password does not need to be obtained for each calendar quarterly submission period.
(h) Form AHCA 3110-1027 is adopted and incorporated by this reference.
(i) A copy of form AHCA 3110-1027 may be obtained from AHCA’s website at https://weblics.fdhc.state.fl.us/datamart/mainMenu.do, or from AHCA’s Home Care Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.
(j) The home health agency must click the “Submit” button on the screen titled “Quarterly Report – Application Summary” in order to submit the data required by form AHCA 3110-1027 to AHCA.
(k) Following the submission of the data required by form AHCA 3110-1027, by clicking the “Submit” button, form AHCA 3110-1027 will display a submittal acknowledgement screen titled “Application Summary” which the home health agency may wish to print. In any proceeding with AHCA, the form AHCA 3110-1027, “Application Summary” screen will be conclusive evidence of submittal of data during the quarterly submission period.
(l) Failure to submit the data required by form AHCA 3110-1027 during each quarterly submission period will subject the home health agency to the penalties specified at Section 400.474(6), F.S.
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 Rule 59A-35.060, 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. This These forms may be obtained at the AHCA web site, http://ahca.myflorida.com/licensing_cert.shtml, 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 (850)414-6010, 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.
(4) If the applicant is a limited liability company, the name and address of each member, its legal name, and the business name and address must be identified. For initial and change of ownership applicants and name changes, a current authorization for the limited liability company from the Department of State, the operating agreement and the articles of organization pursuant to Chapter 608, F.S., must be submitted.
(5)(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.
(6)(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. The compliance is demonstrated by completion of AHCA Form 3100-0009 pursuant to Rule 59A-35.062, F.A.C 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 3100-0009 3110-1013, December 2004.
(7) An applicant for initial license shall sign the form AHCA 3110-1026, Attestation of Compliance with Distance Requirements, pursuant to Section 400.471, F.S. 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.
(8)(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 3100-0009 3110-1013, December 2004, described in subsection (6)(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.
(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. The fingerprint card for level 2 screening for the administrator and the financial officer can be obtained from the Agency for Health Care Administration, Home Care Licensed Home Health Programs Unit, by calling (850)412-4403 414-6010 or sending a request by fax to (850)922-5374. 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, Home Care Licensed Home Health Programs Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.
(10) Level 21 background sScreening 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, Florida 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 or client contact and are found to have a disqualifying offense cannot continue patient or client 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-8.008 Scope of Services.
(1) In cases of patients requiring only nursing, or in cases requiring nursing and physical, respiratory, occupational or speech therapy services, or nursing and dietetic and nutrition services, the agency shall provide case management by a licensed registered nurse directly employed by the agency.
(2) In cases of patients receiving only physical, speech, respiratory or occupational therapy services, or in cases of patients receiving only one or more of these therapy services and home health aide services, case management shall be provided by the licensed therapist, who is a direct employee of the agency or a contractor.
(3) In cases of patients receiving only dietetic and nutrition services, case management shall be provided by the licensed dietitian/nutritionist who is a direct employee of the agency or an independent contractor.
(4) The agency’s application for licensure shall state explicitly what services will be provided directly by agency employees or by contracted personnel, if services are provided by contract. The home health agency shall provide at least one service directly to patients or clients.
(5) A home health agency that provides home health services to which directly contracts with a resident of an assisted living facility or adult family care home to provide home health services shall coordinate with the facility or home regarding the resident’s condition and the services being provided in accordance with the policy of the facility or home and if agreed to by the resident or the resident’s representative. The home health agency shall retain responsibility for the care and services it provides and it shall avoid duplication of services by not providing care the assisted living facility is obligated, by resident contract, to provide to the patient.
(6) If a home health agency occupies space within a licensed assisted living facility, and this space is not licensed as a home health agency, the home health agency must notify AHCA, in writing, whether the space is a satellite office or a drop-off site, as defined in Rule 59A-8.002, F.A.C.
(7) When a home health agency provides staffing services to a health care facility, school or other business entity, pursuant to Section 400.476, F.S., and defined in Section 400.462, F.S., the facility, school or business entity shall be responsible for the assignment and supervision of the staff.
Rulemaking Specific Authority 400.487, 400.497, 400.509 FS. Law Implemented 400.462, 400.497, 400.487 FS. History–New 4-19-76, Formerly 10D-68.08, Amended 4-30-86,8-10-88, 5-30-90, Formerly 10D-68.008, Amended 10-27-94, 1-17-00, 7-18-01, 9-22-05,__________.
59A-8.0086 Denial, Suspension, Revocation of License and Imposition of Fines.
Rulemaking Specific Authority 400.497 FS. Law Implemented 120.59, 400.474, 400.484 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01, 9-22-05, 8-15-06, 3-29-07, Repealed__________.
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.
2. The administrator shall be responsible for the overall operation of the home health agency to include all provisions of Chapter 400, Part III, F.S. and Chapter 59A-8, F.A.C.
3.2. 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 AHCA Home Care Unit office in Tallahassee prior to or on the date of the change. Notification shall consist of submission of the person’s name, professional resume, professional license, if applicable, and a copy of the Affidavit of Good Moral Character. The administrator also must submit level 2 screening, pursuant to subsection 59A-8.004(9), F.A.C., or inform the Home Care Unit that level 2 screening was previously submitted.
(2) Director of Nursing.
(a) The director of nursing of the agency shall:
1. Meet the criteria as defined in Section 400.462(10), F.S.;
2. Supervise or manage, directly or through qualified subordinates, all personnel who provide direct patient care;
3. Ensure that the professional standards of community nursing practice are maintained by all nurses providing care;
4. Maintain and adhere to agency procedure and patient care policy manuals;
5. Ensure that home health aides and certified nursing assistants are trained or evaluated to determine competency to provide personal care and other tasks as required in subsection 59A-8.0095(5), F.A.C.; and
(b) If the administrator is not a physician or registered nurse, the director of nursing shall:
1. Establish service policies and procedures 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.
5. 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 service provision plan. The surveyor may request a certified report that verifies the services were 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.
(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. In large agencies, the director of nursing may delegate some of the record review to registered nurses. 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. Services provided are consistent with professional practice standards in Chapter 464, F.S., and Chapter 64B-9, F.A.C. Notes of case conferences for information sharing, and coordination are included in the patient record;
4.3. Patients are helped to attain and maintain their highest practicable functional capacity. Goals in the plan of care for anticipated patient outcomes are appropriate to the diagnosis, plan of care, services provided and patient potential. All services and outcomes are completely and legibly documented, dated and signed in the clinical service record;
5. Home health agency 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. The findings are documented and an action plan is prepared to follow up on the findings. A record is kept to show that the action plan is carried out.
(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 that established the treatment orders for patients receiving nursing services when the patient’s condition changes or there are deviations from the plan of care.
4. Provide nursing services in compliance with standards of nursing practice in Chapter 464, F.S., and Chapter 64B-9, Florida Administrative Code.
(b) A registered nurse may assign selected portions of patient care to licensed practical nurses and home health aides but always retains the full responsibility for the care given and for making supervisory visits to the patient’s home.
(4) Licensed Practical Nurse.
(a) A licensed practical nurse shall be currently licensed in the state, pursuant to Chapter 464, F.S., and provide nursing care assigned by and under the direction of a registered nurse who provides on-site supervision as needed, based upon the severity of patients medical condition and the nurse’s training and experience. Supervisory visits will be documented in patient files. Provision shall be made in agency policies and procedures for annual evaluation of the LPN’s performance of duties by the registered nurse.
(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 in compliance with standards of nursing practice for licensed practical nurses in Chapter 464, F.S., and Chapter 64B-9, Florida Administrative Code; and
4. Other duties assigned by the registered nurse, pursuant to Chapter 464, F.S.
(5) Home Health Aide and Certified Nursing Assistant.
(a) A home health aide or a certified nursing assistant (CNA) shall provide personal care services assigned by and under the supervision of a registered nurse. When only physical, speech, or occupational therapy is furnished, in addition to home health aide or CNA services, supervision of the home health aide can be supplied by a licensed therapist directly employed by the home health agency or by an independently contracted employee.
(b) through (k) No change.
(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; including an in-person demonstration to a qualified instructor to show that cardiopulmonary resuscitation can be performed. Medicare and Medicaid agencies should check federal regulations for additional in-service training requirements.
(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 by date and time for filing in the client’s record of personal health care activities; and other tasks performed for each client. Each home health agency will demonstrate a process to verify that services were provided.
5. Observing appearance and gross behavioral changes in the patient or client, and reporting to the registered nurse; and making a note of the changes.
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.
(n) through (s) No change.
(6) Physical Therapist and Physical Therapist Assistant.
(a) The physical therapist shall be currently licensed in the state, pursuant to Chapter 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 485, F.S., with at least 1 year of experience under the supervision of licensed physical therapist.
1. Services provided by the physical therapist and physical therapy assistant shall be in compliance with the standards of physical therapy practice in Chapter 485, F.S., and Chapter 64B17-6, Florida Administrative Code.
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 in the state rules for physical therapy assistants in Chapter 64B17-6, Florida Administrative Code outlined in this section.
a. 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 electronic telecommunication and shall be within the same geographic location as the assistant two way communication, which enables the physical therapist to be readily available for consultation during the delivery of care.
b. The physical therapist should be readily available to the physical therapist assistant with emphasis placed on directing the assistant through reporting, both verbal and written, and observations of the care rendered to the patient.
i. The specific frequency of supervision between the therapist and assistant may vary by the complexity of patient needs and skills of the assistant. More frequent supervision is needed when the needs of the patient are changing and complex. It is the responsibility of the therapist and assistant to recognize when supervision is needed to ensure safe and effective therapy service delivery.
ii. Methods of supervision may include direct, face to face contact and indirect contact including phone conversations, written correspondence, and electronic exchanges.
(b) The responsibilities of the physical therapist are:
1. To provide physical therapy services as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice, which can be safely provided in the home and assisting the physician, physician assistant, or advanced registered nurse practitioner in evaluating patients by applying diagnostic and prognostic muscle, nerve, joint and functional abilities test;
2. To observe and record activities and findings in the clinical record and report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in patient’s condition, or when there are deviations from the plan of care;
3. To instruct the patient and caregiver in care and use of physical therapy devices;
4. To instruct other health team personnel including, when appropriate, home health aides and caregivers in certain phases of physical therapy with which they may work with the patient; and
5. To instruct the caregiver on the patient’s total physical therapy program.
(7) Speech Pathologist. 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 not exceed those in the state rules for occupational therapy assistants in Chapter 64B11, Florida Administrative Code outlined in this section.
(b) The duties of the occupational therapist are:
1. To provide occupational therapy services as prescribed by a physician, physician assistant, or advanced registered nurse practitioner, acting within their scope of practice, which can be safely provided in the home and to assist the physician, physician assistant, or advanced registered nurse practitioner in evaluating the patient’s level of function by applying diagnostic and therapeutic procedures;
2. To guide the patient in the use of therapeutic, creative and self-care activities for the purpose of improving function;
3. To observe and record activities and findings in the clinical record and to report to the physician, physician assistant, or advanced registered nurse practitioner the patient’s reaction to treatment and any changes in the patient’s condition, or when there are deviations from the plan of care; and
4. To instruct the patient, caregivers and other health team personnel, when appropriate, in therapeutic procedures of occupational therapy.
(c) Services provided by the occupational therapist and occupational therapy assistant shall be in compliance with the standards of occupational therapy practice in Chapter 64B11, Florida Administrative Code.
(d) Supervision of the occupational therapy assistant by the occupational therapist shall be provided as required in Section 468.203, F.S.
i. The specific frequency of supervision between the therapist and assistant may vary by the complexity of patient needs and skills of the assistant. More frequent supervision is needed when the needs of the patient are changing and complex. It is the responsibility of the therapist and assistant to recognize how and when supervision is needed to ensure safe and effective therapy service delivery.
ii. Methods of supervision may include direct, face to face contact and indirect contact including phone conversations, written correspondence, and electronic exchanges.
(9) Respiratory Therapist. No change.
(10) Social Worker. No change.
(11) Dietitian/Nutritionist. 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 and make a note in the work record;
6. Report any unusual incidents or changes in the client’s patient’s behavior to the case manager; and
7. Maintain chronological appropriate work records by time and date to be filed in the client’s record. Each home health agency will demonstrate a process to verify that services were provided.
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; by time and date to be filed in the client’s record. Each home health agency will demonstrate a process to verify that services were provided; 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-8.0185 Personnel Policies.
(1) The agency shall have written policies and procedures to ensure the provision of acceptable, adequate and appropriate services.
(2) Personnel policies for all full and part-time employees, independent contractors, and contracted staff shall include the following:
(a) Requirement that, prior to contact with patients or clients the new employee, independent contractor, or contracted staff must submit a statement from a health care professional licensed under Chapter 458 or 459, F.S., a physician’s assistant, or an advanced registered nurse practitioner (ARNP) or a registered nurse licensed under Chapter 464, F.S., under the supervision of a licensed physician, or acting pursuant to an established protocol signed by a licensed physician.,
1. The health statement shall be based on an exam by the health care professional within the last six months.,
2. The statement shall say that the employee is in reasonably good health and appears to be free from apparent signs or symptoms of a communicable disease that could be casually transmitted, including tuberculosis, pursuant to Section 381.0011(4), F.S.
3. It is the responsibility of the agency to ensure that employees continue to appear to be in good health. If any employee is later found to have, or is suspected of having, a communicable disease, he shall be removed from duties until the administrator determines that such condition no longer exists.
4. A new employee, who has been an employee of another licensed home health agency, may provide a copy of his health care statement from the files of the former employer provided that the statement was not issued more than 2 years prior and that the employee has not had a break in service of more than 90 days.
5. Medical information is confidential and must not be disclosed without the specific consent of the person to whom it pertains. The written request to release medical information must be kept on file.
(b) Requirement that records are maintained of training for non-licensed direct care personnel which demonstrates that they have received a one-time continuing educational course biennially on HIV and AIDS pursuant to Section 381.0035, F.S.
(c) Plan for orientation of all health personnel to the policies and objectives of the agency;
(d) Job descriptions for all employees; and
(e) Compliance with requirements of Title VI of the Civil Rights Act of 1964.
(f) Requirement for an identification tag to be worn by each employee, independent contractor, and contracted staff who has direct contact with patients or clients on behalf of the home health agency. The tag will include the person’s full name; the person’s health profession and license or certification number, if any; a photograph of the person; and the name of the home health agency. The size of the lettering on the tag for the person’s name and name of the home health agency must be at least 16 point font size or larger. When the employee, independent contractor, or contracted staff works as a home health aide, homemaker or companion, the tag will state this instead of the profession and license number. When a home health agency contracts with another home health agency or other entity to provide some of the services to a patient or client, the employee or independent contractor who works for the contracted agency or entity may wear the identification tag of the contracted agency.
(3) The agency shall maintain a file for all employees and independent contractors which shall include:
(a) Nname and address of employee, name and address of next of kin or guardian, evidence of qualifications, licensure or registration if applicable a signed and notarized Affidavit of Good Moral Character, AHCA Form 3110-0001, December 2004, for any newly hired employee working in a probationary status pending the results of the background screening;,
(b) Rresults of background screening, and dates of employment and separation from the agency,. and
(c) Evidence of continuing education, in-service training, and the training required in subsection (2).,
(4) The information required in this section shall be available for inspection by AHCA within three hours of request.
(5) Each employee and independent contractor’s file shall be retained by the agency for at least one year after the employee has separated from the agency.
(6)(4) The agency shall maintain a record of the employment or contractual history of all agency personnel, both employed or under contract, and shall make submission of such history a condition of employment or contract.
Rulemaking Specific Authority 400.497 FS. Law Implemented 400.471, 400.497 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01, 9-22-05, 8-15-06,________.
59A-8.020 Acceptance of Patients or Clients.
(1) When a home health agency accepts a patient or client for service, there shall be a reasonable expectation that the services can be provided safely to the patient or client in his place of residence. This includes being able to communicate with the patient or client, or with another person designated by the patient or client, either through a staff person or interpreter that speaks the same language, or through technology that translates so that the services can be provided. The responsibility of the agency is also to assure that the patient or client receives services as defined in a specific plan of care, for those patients receiving care under a physician, physician assistant, or advanced registered nurse practitioner’s treatment orders, or in the service provision plan a written agreement, as described in Rule 59A-8.0215, F.A.C. subsection (3) below, for clients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s orders. This responsibility includes assuring the patient or client receives all assigned visits.
(2) At the start of services a home health agency must establish a written agreement between the agency and the patient or client or the patient’s or client’s legal representative, including the information described in Section 400.487(1), F.S. This written agreement must be signed and dated by a representative of the home health agency and the patient or client or the patient’s or client’s legal representative. A copy of the agreement must be given to the patient or client and the original must be placed in the patient’s or client’s file.
(3) The written agreement, as specified in subsection (2) above, shall serve as the home health agency’s service provision plan, pursuant to Section 400.491(2), F.S., for clients who receive homemaker and companion services or home health aide services which do not require a physician, physician assistant, or advanced registered nurse practitioner’s treatment order. The written agreement for these clients shall be maintained for one year after termination of services.
(3)(4) When the agency terminates services for a patient or client needing continuing home health care, as determined by the patient’s physician, physician assistant, or advanced registered nurse practitioner, for patients receiving care under a physician, physician assistant, or advanced registered nurse practitioner’s treatment order, or as determined by the client or caregiver, for clients receiving care without a physician, physician assistant, or advanced registered nurse practitioner’s treatment order, a plan must be developed and a referral made by home health agency staff to another home health agency or service provider prior to termination. The patient or client must be notified in writing of the date of termination, the reason for termination, pursuant to Section 400.491, F.S., and the plan for continued services by the agency or service provider to which the patient or client has been referred, pursuant to Section 400.497(6), F.S. This requirement does not apply to patients paying through personal funds or private insurance who default on their contract through non-payment. The home health agency should provide social work assistance to patients to help them determine their eligibility for assistance from government funded programs if their private funds have been depleted or will be depleted.
Rulemaking Specific Authority 400.497 FS. Law Implemented 400.487 FS. History–New 4-19-76, Formerly 10D-68.20, Amended 4-30-86, 8-10-88, Formerly 10D-68.020, Amended 10-27-94, 1-17-00, 7-18-01, 9-22-05, 8-15-06,_________.
59A-8.0215 Plan of Care and Service Provision Plan.
(1) A plan of care shall be established for patients receiving skilled services in consultation with the physician, physician assistant, or advanced registered nurse practitioner, pursuant to Section 400.487, F.S., and the home health agency staff who are involved in providing the care and services required to carry out the physician, physician assistant, or advanced registered nurse practitioner’s treatment orders. The plan must be included in the clinical record and available for review by all staff involved in providing care to the patient. The plan of care shall contain a list of individualized specific goals for each skilled discipline that provides patient care, with implementation plans addressing the level of staff who will provide care, the frequency of home visits to provide direct care and case management.
(2) Home health agency staff must follow the physician, physician assistant, or advanced registered nurse practitioner’s treatment orders that are contained in the plan of care. If the orders cannot be followed and must be altered in some way, the patient’s physician, physician assistant, or advanced registered nurse practitioner must be notified and must approve of the change. Any verbal changes are put in writing and signed and dated with the date of receipt by the nurse or therapist who talked with the physician, physician assistant, or advanced registered nurse practitioner’s office.
(3) A service provision plan shall be prepared for clients that receive only services from a home health aide, certified nursing assistant, homemaker or companion and do not receive skilled services as required in Section 400.491, F.S. When the client or patient also receives skilled services, a plan of care is done that includes all services and a service provision plan is not done.
(4) The service provision plan shall include, but is not limited to, the following:
(a) The frequency of visits as agreed to by the client or his or her responsible party. The plan may include a statement that additional or fewer visits will be arranged at the direction of the client. When clients have personal care needs that are dependent on home health aide or certified nursing assistant visits at specific times of the day, the plan will include the specified times for the visits with the frequency.
(b) A description or list of the tasks to be performed for the services provided during the visit.
(c) Whether a home health aide, certified nursing assistant, homemaker or companion will provide the services.
(5)(3) The patient or client, caregiver or guardian must be informed by the home health agency personnel that:
(a) He has the right to be informed of the plan of care or service provision plan;
(b) He has the right to participate in the development of the plan of care or service provision plan; and
(c) He may have a copy of the plan of care or service provision plan if requested.
(6) All plans of care and service provision plans are individualized based on each patient or client’s needs, strengths, limitations and goals.
Rulemaking Specific Authority 400.497 FS. Law Implemented 400.487, 400.491 FS. History–New 10-27-94, Amended 1-17-00, 7-18-01, 8-15-06,________.
59A-8.022 Clinical Records and Service Records.
(1) A clinical record must be maintained for each patient receiving nursing or therapy services that includes all the services provided directly by the employees of the home health agency and those provided by contracted individuals or agencies. A service record must be maintained for each client receiving home health aide, certified nursing assistant, homemaker or companion services that does not also receive nursing or therapy services.
(2) No information may be disclosed from the patient’s or client’s file without the written consent of the patient or client or the patient’s or client’s guardian. All information received by any employee, contractor, or AHCA employee regarding a patient or client of the home health agency is confidential and exempt from Chapter 119, F.S.
(3) If the patient or client transfers to another home health agency, a copy of his record must be transferred at his request.
(4) All clinical records and service records must be retained by the home health agency as required in Section 400.491, F.S. Retained records can be stored as hard paper copy, microfilm, computer disks or tapes and must be retrievable for use during unannounced surveys as required in Section 408.811, F.S.
(5) Clinical records for patients receiving nursing and therapy services must contain the following:
(a) Source of referral;
(b) Physician, physician assistant, or advanced registered nurse practitioner’s verbal orders initiated by the physician, physician assistant, or advanced registered nurse practitioner prior to start of care and signed by the physician, physician assistant, or advanced registered nurse practitioner as required in Section 400.487(2), F.S.
(c) Assessment of the patient’s needs;
(d) Statement of patient or caregiver problems;
(e) Statement of patient’s and caregiver’s ability to provide interim services;
(f) Identification sheet for the patient with name, address, telephone number, date of birth, sex, agency case number, caregiver, next of kin or guardian;
(g) Plan of care or service provision plan and all subsequent updates and changes and the written agreement required in Section 400.487, F.S.;
(h) Clinical and service notes, signed and dated by the staff member providing the service which shall include:
1. Initial assessments and progress notes with changes in the person’s condition;
2. Services rendered;
3. Observations;
4. Instructions to the patient and caregiver or guardian, including administration of and adverse reactions to medications;
(i) Home visits to patients for supervision of staff providing services;
(j) Reports of case conferences;
(k) Reports to physicians, physician assistants, or advanced registered nurse practitioners;
(l) Termination summary including the date of first and last visit, the reason for termination of service, an evaluation of established goals at time of termination, the condition of the patient on discharge and the disposition of the patient.
(6) Service records for clients receiving only home health aide, certified nursing assistant, homemaker and companion services must contain, at a minimum, the following:
(a) Identification sheet for the client with name, address, telephone number, date of birth, sex, caregiver, next of kin or guardian;
(b) Service provision plan and all subsequent updates and changes and written agreement required in Section 400.487, F.S.;
(c) Service notes, signed and dated by the staff member providing the service which shall include the information in subsection 59A-8.0095(5) or (12), F.A.C., depending on the services provided:
(d) Home visits to clients for supervision of staff providing services, if such visits are made;
(e) Termination summary including the date of last visit and the reason for termination of service.
(7) Home health agencies that provide services under contract to patients or clients admitted by another home health agency are expected to have a copy of the records of visits made by their staff and a copy of the plan of care or service provision plan created by the admitting agency for each patient or client.
(8)(6) The following applies to signatures in the clinical record:
(a) Facsimile Signatures. The plan of care or written order may be transmitted by facsimile machine. The home health agency is not required to have the original signature on file. However, the home health agency is responsible for obtaining original signatures if an issue surfaces that would require certification of an original signature.
(b) Alternative Signatures.
1. Home health agencies that maintain patient or client 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/advance-directives.shtml 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 (c) No change.
(d) A home health agency shall be subject to revocation of their license and a fine of not more than $500 per incident, or both, pursuant to Section 400.474(1), F.S., if the home health agency, as a condition of treatment or admission, requires an individual to execute or waive an advance directive, pursuant to Section 765.110, F.S.
(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.
(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/licensing_cert.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 (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,________.