Rule No.: RULE TITLE
59A-8.003: Licensure Requirements
59A-8.004: Licensure Procedure
59A-8.008: Scope of Services
59A-8.0095: Personnel
59A-8.022: Clinical Records
The changes are in response to written comments received from the staff of the Joint Administrative Procedures Committee.
59A-8.003 Licensure Requirements.
(5) In addition to any other penalties imposed pursuant to this rule, AHCA may assess costs related to an investigation that results in a successful prosecution, pursuant to Section 400.484, 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.
59A-8.004 Licensure Procedure.
(6) For initial applications, including changes of ownership, the applicant must submit proof of financial ability to operate, pursuant to Section 400.471, 408.810, and 408.8065, F.S., and Rule 59A-35.062, F.A.C.
(9) Background screening for the administrator and the financial officer shall be in accordance with level 2 standards for screening set forth in Section 408.809, F.S. and Rule 59A-35.090, F.A.C. The fingerprint card for level 2 screening for the administrator and the financial officer can be obtained from the Agency for Health Care Administration, Home Care Unit, by calling (850)412-4403 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 Unit, 2727 Mahan Drive, Mail Stop 34, Tallahassee, Florida 32308.
59A-8.008 Scope of Services.
Rulemaking Authority, 400.497 FS. Law Implemented 400.471, 400.462, 400.497 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:
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 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.
4. When the home health agency provides physical therapy and does not provide nursing, the administrator shall establish procedures for handling biomedical waste when physical therapists provide wound care. The procedures shall also include informing wound care patients of the method for handling biomedical waste at home. If the physical therapists do not provide wound care, no procedures are required. The Department of Health website has information on biomedical waste handling and the requirements at www.doh.state.fl.us/Environment/Community/biomedical.
(2) Director of Nursing.
(b) If the administrator is not a physician or registered nurse, the director of nursing shall:
1. Establish service policies and procedures on biomedical waste for home health agencies providing nursing and physical therapy services. The procedures shall also include informing wound care patients of the method for handling biomedical waste at home. The Department of Health website has information on biomedical waste handling and the requirements at www.doh.state.fl.us/Environment/Community/biomedical;
2. Establish policies and procedures that are consistent with in compliance with Chapter 64E-16, F.A.C., and state health statutes and administrative rules pursuant to Section 381.0011(4), F.S., which generally conform to recommended Centers for Disease Control (CDC) and Occupational Safety and Health Agency (OSHA) guidelines for safety, universal precautions and infection control procedures. The CDC website has information at www.cdc.gov/ncidod/dhqp;
3.2. Employ and evaluate nursing personnel;
4.3. Coordinate patient care services; and
5.4. Set or adopt policies for, and keep records of criteria for admission to service, case assignments and case management.
(c) No change.
(d) The director of nursing shall establish, and conduct, and document an ongoing quality assurance program. The program shall include at least quarterly, the review of the care and services of a sample of both active and closed clinical records by the director of nursing. The director of nursing may delegate some of the record review to registered nurses. The quality assurance program is to assure that:
1. The home health agency accepts patients whose home health service needs can be met by the home health agency;
2. Case assignment and management is appropriate, adequate, and consistent with the plan of care, medical regimen and patient needs.
3. 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. 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. Confidentiality of patient data is maintained; and
7. 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.
(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 within the scope of practice authorized by the license issued by the State of Florida for the practice of a registered nurse in compliance with standards of nursing practice in Chapter 464, F.S., and Chapter 64B-9, Florida Administrative Code.
(4) Licensed Practical 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 within the scope of practice authorized by the license issued by the State of Florida for the practice of a licensed practical nurse 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. Perform other nursing Other duties assigned by the registered nurse, pursuant to Chapter 464, F.S.
(6) Physical Therapist and Physical Therapist Assistant.
(a) The physical therapist shall be currently licensed in the state, pursuant to Chapter 486, F.S. The physical therapist assistant shall be currently licensed in the state, pursuant to Chapter 486, F.S.
1. Services provided by the physical therapist and physical therapy assistant shall be performed within the scope of practice authorized by the license issued by the State of Florida for the practice of physical therapist in compliance with the standards of physical therapy practice in Chapter 486, 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 authorized by the license issued by the State of Florida for the practice of physical therapist assistant in the state rules for physical therapy assistants in Chapter 64B17-6, Florida Administrative Code.
(8) Occupational Therapist and Occupational Therapist Assistant.
(a) The occupational therapist shall be currently licensed in the state, pursuant to Chapter 468, F.S., with one year of experience in occupational therapy and the occupational therapist assistant shall be currently licensed in the state, pursuant to Chapter 468, F.S., with one year of experience under the supervision of a licensed occupational therapist. Duties of the occupational therapist assistant shall be directed by the licensed occupational therapist and shall be within the scope of practice authorized by the license issued by the State of Florida for the practice of occupational therapist assistant not exceed those in the state rules for occupational therapy assistants in Chapter 64B11, Florida Administrative Code.
(c) Services provided by the occupational therapist and occupational therapy assistant shall be within the scope of practice authorized by the license issued by the State of Florida for the practice of occupational therapist 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 is defined shall be provided as required in Section 468.203(8), F.S.
Rulemaking Authority 400.497 FS. Law Implemented 400.462, 400.476, 400.487, 400.488, 400.497 FS. History–New 1-20-97, Amended 1-17-00, 7-18-01, 9-22-05, 8-15-06,_________.
59A-8.022 Clinical Records and Service Records.
(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.