RULE REVISIONS to CHAPTER 59A-8 HOME HEALTH AGENCY, FLORIDA ADMINISTRATIVE CODE

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1 RULE S to CHAPTER 59A-8 HOME HEALTH AGENCY, FLORIDA ADMINISTRATIVE CODE There were changes made to the regulatory rules for Home Health agencies effective July 11, Recently the Agency for Health Care administration published a SUMMARY OF OCTOBER 1, 2013 UPDATES TO to reflect the changes in regulation that we can expect to see on subsequent surveys. Remember that regardless of which accreditation entity your agency using you are subject to Florida regulatory requirements. As a courtesy to our members we have made an analysis of the changes as they might affect your agency s next survey. You should have already made revisions to your policies and operations to reflect the changes effective July 11, We are providing the following table as a reference to ensure that you are prepared for your next survey. The changes are described, the column to the far left advises you of any actions you might need to take. We would like to extend a special thank you to HCAF s Board of Director s Secretary and Associate Member, Glenda Burke from Alternatives, A Consulting & Education Service, for providing HCAF members with this analysis.

2 PROVIDER ACTION STANDARD S CURRENT AND ENSURE THAT IT IS IN COMPLIANCE WITH THIS REGULATION INFORMATIONAL OPERATIONAL CAN BE REVISED H 103 Accreditation H 104 HHA Operational* H 106 Satellite office H 107 Drop-off site H 121 License Number in Ads* No change to Regulation Definition. The Interpretive Guidelines were revised to state the AHCA Home Care Unit will initiate legal action, instead of the Field Office, if the home health agency (HHA) failed to maintain accreditation as required in law. No change to Regulation Definition. The Interpretive Guidelines were revised to clarify when H 104 is cited as not met, in comparison with H 310 and H 110. The AHCA Home Care Unit prepares the Recommendation for Sanction. The 2 nd paragraph of the Regulation Definition and the Interpretive Guideline were revised since HHA rule now refers to 59A , the rule for all programs. The time frame for advance notification [21 days] and fine amount are in HZ 806 that quotes 59A The Regulation Definition has a sentence added to the rule that training of HHA staff can be done at a drop-off site. Interpretive Guidelines now include a reminder that it is unlicensed activity when a drop-off site is found operating as a HHA office. Revised Interpretive Guidelines to show that the AHCA Home Care Unit, instead of the Field Office, will issue the fine notice. H 126 Geographic Service Area Deleted Standard is not needed. Requests for expansion of geographic area are handled by the AHCA Home Care Unit. CHECK H/R TO ENSURE THAT IT IS CURRENT H 207 Falsifying Training Records* Removed health statements from Regulation Definition since the rule for health statements was repealed in October 2011 and the survey standard on health statements was previously removed. H 209 Screening if Staff Nursing Deleted. Content is in HZ 815 Background Screening

3 PROVIDER ACTION STANDARD S CHECK H/R TO ENSURE THAT IT IS CURRENT CHECK H/R TO ENSURE THAT IT IS CURRENT CHANGE CHANGE CHANGE REMEMBER THAT THE REFERENCE TO Homes H 210 Background Screening H 216 Personnel - Administrator H 218 Personnel- Alternate Administrator H 219 Personnel-Administrator H 223 Director of Nursing Duties H 224 Director of Nursing QA H 225 Director of Nursing may be Administrator H 230 Personnel- Registered Nurse Deleted. The annual affidavit signed by the administrator that staff is screened is no longer required. There are no changes in requirements. The only revision is that the HHA rule in the Regulation Definition now includes reference to HHA law. There are no changes in requirements. Legal reference removed in the 1 st sentence of Regulation Definition. The Regulation Definition was revised since notification requirements have been reduced and the HHA rule now refers to 59A (1), the rule for all programs. The Regulation Definition and Interpretive Guidelines refer to HZ 821 that has the time frame for notification [within 21 days]. The Regulation Definition and Interpretive Guidelines are revised based on HHA rule revisions as required in state law. The rules include a certified report for a specified staff person or persons for a specified time period when requested by an AHCA surveyor or employee. The rules also simplify the biomedical waste, safety, and infection control policy and procedure requirements. The Regulation Definition and Interpretive Guidelines are revised to include the additional requirements for quality assurance in the HHA rules, as required by state law. There are no changes in the requirements. The rule paragraph letter was The Regulation Definition is revised since the HHA rule adds that an RN shall provide nursing services within the scope of practice authorized by the RN license and that progress reports may be made to the physician assistant or ARNP in addition to the physician. The Interpretive Guidelines include information regarding RN nursing practice from state law and that a referral can be made to the

4 PROVIDER ACTION STANDARD S THE ARNP DOES NOT APPLY TO CERTIFIED AGENCIES INFORMATIONAL H 236 Personnel Licensed Practical Nurse H 242 Personnel Home Health Aide* H 243 Personnel Certified Nursing Assistant H 245 Home Health Aide Competency Test* H 247 Home Health Aide and CNA In-Service H 248 Home Health Aide and CNA Responsibilities Department of Health. The Regulation Definition is revised since the state rule adds that an LPN shall provide nursing services within the scope of practice authorized by the LPN license. The Interpretive Guidelines include information regarding LPN nursing practice from state law and that a referral can be made to the Department of Health. There is no change in requirements. A sentence was added to the rule to make it clearer that a home health aide either has training or has passed the competency test. The requirement in state rule for CNAs to have training in specific topics has been removed in the Regulation Definition. The law still requires HHA to ensure that the CNA is adequately trained to perform the tasks of a home health aide. Thus, the Interpretive Guidelines are revised to list possible ways. There are no changes to the requirements. A note is added to the Interpretive Guidelines that there are additional federal requirements for Medicare and Medicaid home health agencies and the state competency test alone is not sufficient. The similar statement in state rule was removed since federal Medicare and Medicaid requirements cannot be in a state licensure rules. There are no changes in the requirements. The rule paragraph was changed from (l) to (k) in the Regulation Definition and a reference to a statute was removed. Additional tasks that home health aides and CNAs may do have been added in the state rule and are in the updated Regulation Definition. The Interpretive Guidelines are updated.

5 PROVIDER ACTION STANDARD S L L H 250 Assistance with Medications Consent H 251 Assistance with Medications Tasks* H 252 Assistance with Medications Assess H 253 Assistance with Medications Training H 254 Personnel- Home Health Aide and CNA* H 255 Personnel- Home Health Aide and CNA H 256 Personnel- Home Health Aide and CNA H 260 Personnel PT and PT Assistant H 261 Physical Therapist* H 266 Personnel Occupational Therapist and Assistant H 267 Personnel Occupational Therapist and Assistant* There are no changes in the requirements. The rule paragraph letter was changed in the Regulation Definition. There are no changes in the requirements. The rule paragraph from H 254 was inserted into the Regulation Definition since H 254 was deleted. All tasks that can be done to assist are in one standard now. There are no changes in the requirements. Paragraph letters were There are no changes in the requirements. Paragraph letter was Deleted rule paragraph moved to H 251. There are no changes in the requirements. Paragraph letter was There are no changes in the requirements. Paragraph letters were The 1-year experience requirement is removed for physical therapist and physical therapist assistant. Services provided by the PT and PTA must be within the scope of practice authorized by their professional licenses. Scope of practice information for PTA added to Interpretive Guidelines. Changed title of standard since it only pertains to physical therapist. Added physical therapy practice act and link to rule reference for PT in Interpretive Guidelines. The 1-year experience requirement is removed. Services provided by the OT and OTA must be within the scope of practice authorized by their professional licenses. Scope of practice information is added to the Interpretive Guidelines. Clarified the Interpretive Guidelines to only check what is in the existing Regulation Definition for this standard.

6 PROVIDER ACTION STANDARD S H 291 Homemakers H 292 Companions H 310 Direct Services The Regulation Definition is updated per rule revision to add that homemakers can do household chores and can remind clients to take medicines if requested. The Interpretive Guidelines are updated for clarification. The Regulation Definition is updated per rule revision to add that companions can accompany clients on recreational outings and shopping, and can remind clients to take medicines if requested. The Interpretive Guidelines are updated for clarification. The new definition of nursing care in the rule and definitions from state law are added to the Regulation Definition. The Interpretive Guidelines are updated to clarify what is a direct service. H Serving patients in unlicensed facilities* There are no changes in requirements. The Interpretive Guidelines are revised to show that either a fine or revocation should be done. CHECK TO MAKE SURE YOU ARE USING THE CURRENT FORMAT PLAN TO ENSURE THAT H 322 Advance Directives* The reference to the document on advance directives is updated to show the date of the current document and the revised web site address. H 323 DNRO There are no changes to the requirements. Paragraph 59A (3)(b) was removed from the rule, and from the Regulation Definition, since the paragraph repeats what (7), F.S. says. H 356 Clinical Records Contents A physician s rubber stamp signature can no longer be accepted and was removed from rule. It is no longer in the Regulation Definition H 373 Emergency Management Plan and Interpretive Guidelines. The web site address to get the plan form was updated:

7 PROVIDER ACTION STANDARD S YOU HAVE MADE THE APPROPRIATE S The plan form has the following three changes and has a new date. The law quoted on the cover page was updated since the term State Surgeon General is used instead of the Secretary of the Department of Health. The title safety liaison is now used for the person in charge during an emergency as required in , F.S. It is on page 3, item I.2. One sentence in Appendix B is revised about family members or other caregivers remaining with patients at special needs shelters as required by the Department of Health. Existing HHAs that already have a plan do not have to update the plan for the changes but must provide the revised Appendix B to patients that may go to special needs shelters. H 374 Emergency Management Patient Records H 379 Emergency Management Servicing Patients AHCA Home Care Unit, Bureau of Health Facility Regulation 9/18/2013 There are no changes to the requirements. The rule was revised to remove the phrase to inform patients and their caregivers of the home health agency s procedures because it is in the emergency management plan form on page 4, item II.B.1. There are no changes to the requirements. Same rule revision as H 374.