Notice of Change/Withdrawal

Health Facility and Agency Licensing
59A-8.003: Licensure Requirements
59A-8.004: Licensure Procedure
59A-8.008: Scope of Services
59A-8.0095: Personnel
59A-8.0215: Plan of Care
59A-8.022: Clinical Records
59A-8.0245: Advance Directives
59A-8.027: Emergency Management Plans
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 36 No. 28, July 16, 2010 issue of the Florida Administrative Weekly.

SUMMARY:  Rule 59A-8.0095 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., paragraph 59A-8.0095(2)(d), F.A.C., is removed because its content is now included in Section 400.476(1)(b), F.S. Rule 59A-8.0245 revises the date and web site address for the “Health Care Advance Directives – The Patients’ Right to Decide.” Paragraph 59A-8.0245(3)(b) is removed because it repeats what is stated in Section 400.487(7), F.S.

59A-8.003 Licensure Requirements.

(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, 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. 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.

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

(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, April 2010, shall be submitted electronically for each home health agency required to be licensed by AHCA.

59A-8.004 Licensure Procedure.

(1) An application for licensure, initial, change of ownership, or renewal, shall be made on a form prescribed by the AHCA in paragraph 59A-35.060(1)(m), F.A.C.  This form may be obtained at the AHCA web site, cert.shtml, and then under “Home Health Agency”.

(6) For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate, pursuant to Sections 400.471, 408.810, and 408.8065, F.S., and Rule 59A-35.062, F.A.C. The compliance is demonstrated by completion of AHCA Form 3100-0009 pursuant to Rule 59A-35.062. 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.

(7) An applicant for initial license shall sign the form AHCA 3110-1026, Attestation of Compliance with Distance Requirements, April 2010, pursuant to Section 400.471(7), 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) 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(14), 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, described in subsection (6) 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.

59A-8.008 Scope of Services.

Rulemaking Authority 400.487, 400.497 FS. Law Implemented 400.471, 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-8.0095 Personnel.

(1) Administrator.

(a) The administrator of the agency shall:

3. 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.

(2) Director of Nursing.

(c)5. The director of nursing shall establish 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. A certified report shall be in the form of a computer print out or other printed document and signed by the director of nursing. The report must be provided to the surveyor within two hours of the request.

(d)(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 the director of nursing may delegate some of the record review to registered nurses.

(6) Physical Therapist and Physical Therapist Assistant.

(a) The physical therapist shall be currently licensed in the state, pursuant to Chapter 486 485, F.S. The physical therapist assistant shall be currently licensed in the state, pursuant to Chapter 486 485, F.S.

1. Services provided by the physical therapist and physical therapy assistant shall be in compliance with the standards of physical therapy practice in Chapter 486 485, F.S., and Chapter 64B17-6, Florida Administrative Code.

(8) Occupational Therapist and Occupational Therapist Assistant.

(d) Supervision of the occupational therapy assistant by the occupational therapist shall be provided as required in 468.203(8), F.S.

59A-8.0215 Plan of Care and Service Provision Plan.

(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 must be 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.

59A-8.022 Clinical Records and Service Records.

Rulemaking 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.

(3) Pursuant to Section 400.487(7), F.S., a home health agency may honor a DNRO as follows:

(a) Cardiopulmonary resuscitation may be withheld or withdrawn from a patient only if a valid Do Not Resuscitate Order (DNRO) is present, executed pursuant to Section 401.45, F.S. The Department of Health has developed a DNRO form that is described and available to the public as stated in Rule 64J-2.018, F.A.C.

(b) Home health personnel and agencies shall not be subject to criminal prosecution or civil liability, nor be considered to have engaged in negligent or unprofessional conduct for withholding or withdrawing cardiopulmonary resuscitation pursuant to such a Do Not Resuscitate Order (DNRO) and rules adopted by the agency, pursuant to Section 400.487, 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 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.

(8) On admission, each home health agency shall, pursuant to Section 252.355, F.S., inform patients and patient caregivers of the home health agency’s procedures during and immediately following an emergency and inform patients of the special needs registry maintained by their county Emergency Management office. The home health agency must document in the patient’s file if the patient plans to evacuate or remain at home; if during the emergency the patient’s caregiver can take responsibility for services normally provided by the home health agency; or if the home health agency needs to continue services to the patient. If the patient is a resident of an assisted living facility or an adult family care home, the home health agency must contact the assisted living facility or adult family care home administrator or designated emergency management personnel and find out the plan for evacuation of the resident in order to document the resident’s plans in the home health agency’s file for the patient. If it is determined the home health agency needs to provide continued services, it will be the responsibility of the home health agency to provide the same type and quantity of care for the patient in the special needs shelter during and after the emergency, equal to the care received prior to the shelter assignment as specified in Section 400.492, F.S., except in certain situations as specified in Section 400.492(3), F.S.

Rulemaking 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,__________.