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Nurse Registry State Regulatory Update

Anne Menard

Home Care Unit

Bureau of Health Facility Regulation

Agency for Health Care Administration

May 17, 2012

Nurse Registry Growth

2003

2006

2009

2012

0 50 100 150 200 250 300 350 400 450

Nurse Registries by Area as of May 4, 2012

Area 1 & 2 - NW Florida-Tallahassee/Pensacola – 3

Area 3 - Gainesville area – 25

Area 4 - Jacksonville area – 14

Area 5 & 6 - St.Pete-Tampa area – 58

Area 7 - Orlando area – 24

Area 8 - Ft. Myers area – 40

Area 9 - Palm Beach area – 112

Area 10 - Broward – 95

Area 11 - Miami- Dade area – 37

In the past year

• 62 applications received for new nurse registry licenses

• 17 nurse registries voluntarily closed

• 1 application for a licenses was denied and 1 license was revoked

• 5 had survey deficiency fines

www.FloridaHealthFinder.gov

See “Find Facilities and Providers” to view licensed nurse registries

Now has inspection reports for each

Can now get Excel listings by county & statewide

Updated nightly from licensing data

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2012 Florida Legislature - Law Changes Background Screening

HB 943 (Chapter 2012-73, Laws of Florida) effective when signed by Governor - April 7, 2012

1. Screening from other state agencies

AHCA may accept proof of Level 2 screening conducted within the previous 5 years from the Department of Elder Affairs. DOEA can accept AHCA’s.

Proof of screening received from other state agencies must use the equivalent screening standards as AHCA.

In addition, the individual must not have had a break in service from a position that requires screening for more than 90 days. (408.809(2), Florida Statutes).

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2012 Law Changes - Background Screening Screening from Other State Agencies

Explanation: AHCA may accept proof of Level 2 from the Department of Children and Families, the Department of Health, the Agency for Persons with Disabilities and now the Department of Elder Affairs.

– Prior laws did not differentiate in the screening standards. The new law now requires the screening standards to be the same as AHCA.

– At this time, the screening conducted for certification as a Certified Nursing Assistant through the Department of Health is the only screening at DOH that is the same as AHCA’s.

– Screening conducted for day care, foster care & adoption through the Department of Children & Families does not use the same criteria & is not acceptable.

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2012 Law Changes Background Screening

2. Provides a staggered rescreening schedule for AHCA regulated providers over a 3-year period (2013-2015) (408.809(5), Florida Statutes). Get level 1 staff screened for level 2 by this schedule if they have not had level 2 screening within 5 years.

 

The schedule is as follows:– Individuals for whom the last screening was conducted on or

before December 31, 2004, must be rescreened by July 31, 2013. – Individuals last screened between January 1, 2005 and December

31, 2008, must be rescreened by July 31, 2014. – Individuals last screened between January 1, 2009 and July 31,

2011, must be rescreened by July 31, 2015.

 

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2012 Law Changes – Background ScreeningStaggered Re-Screening - continued

Explanation: Changes in 2010 required all employees to have level 2 screening (fingerprints, FDLE & FBI) every 5 years beginning August 1, 2010. • Many of the persons working at the time of the law

change had level 1 screening & qualified and would be subject to the 5 year rescreening on July 31, 2015.

• The change in law now allows rescreening over a 3-year period to spread the cost and workload of screening.

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2012 Law Changes Background Screening

3. Employer may hire a person prior to completion of a screening for training and orientation purposes. The individual may not have direct contact with any client/resident until successful completion of a screening. (Section 435.06(2)(d), Florida Statutes).

Explanation: Previously, the law prohibited an employer from hiring an individual until the screening process was complete and the person was deemed “Eligible”. Now, employer can hire and place a person in a training or orientation program while the screening process is underway. The person is not to have any direct contact with a client or resident until screening determines person is Eligible. If the final screening determination is “Not Eligible”, the employer must terminate the person or place the person in a position that is not required to undergo screening.

Note: This would generally not apply to nurse registries since they cannot do training unless they have a licensed school & nurse registries are not the employer of the independent contractors.

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2012 Law Changes Background Screening – Future Implementation

4. Creates a “Care Background Screening Clearinghouse” Implementation is expected to begin October 1, 2012• Purpose: to provide a single data source for

background screening results of persons required to be screened by law for employment in a position that provides services to children & aged and/or disabled individuals.  (435.12, F.S.)

• To be entered into the Clearinghouse, the person screened must: – Undergo Level 2 screening & have fingerprints

retained by the FDLE and – Have a photograph taken at time of fingerprinting 

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2012 Law Changes - Background Screening Care Background Screening Clearinghouse continued

• State agencies that may participate in the Clearinghouse– Department of Children and Families – Department of Health– Agency for Health Care Administration– Department of Elder Affairs – Department of Juvenile Justice– Agency for Persons with Disabilities – Vocational Rehabilitation

• AHCA will be responsible for maintaining the Clearinghouse & will be working with the other agencies to become part of the Clearinghouse over time.

• The fee for retaining fingerprints is $24.00 for 5 years.  This fee is in addition to the screening fee & the LiveScan Service Provider processing fee & is required at the time of screening. 

Note: the retention of fingerprints eliminates the need for subsequent fingerprinting and state rescreening, providing future cost savings.

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2012 Changes to 400.506 Fla Statutes

CS/CS/HB 787 – effective July 1, 2012400.506(18) “An administrator may manage only one nurse registry, except that an administrator may manage up to five registries if all five registries have identical controlling interests as defined in s. 408.803 and are located within one agency [AHCA] geographic service area or within an immediately contiguous county.”

Note: State law has authority over the state rule 59A-18.006 Administrator first sentence.

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2012 Law Changes - Administrator continued

“Identical controlling interests” means the nurse registries share:

• the same legal entity (same Employer ID #) • have the same people or entities with the exact same %

of ownership• have the same board of directors (if applicable) and • have the exact same people or entities with the exact

same percentage of ownership in the management company (if applicable).

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2012 Law Changes - Administrator continued

“Immediately contiguous county” means the borders of the counties touch each other. There needs to be a licensed nurse registry office in each of the counties that are contiguous.

Example: Nurse registry licensed office is in Palm Beach County. This company also has a NR licensed office in Broward. They can share the same administrator if the controlling interests are identical.

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2012 Law ChangesChapter 408, Part II, Fla Statutes

CS/CS/HB 787 – effective July 1, 20121. 408.804(3), F.S. “Any person who knowingly alters, defaces, or falsifies a license certificate issued by the agency, or causes or procures any person to commit such an offense, commits a misdemeanor of the second degree, punishable as provided in s. 775.082 or s. 775.083. Any licensee or provider who displays an altered, defaced, or falsified license certificate is subject to the penalties set forth in s. 408.815 and an administrative fine of $1,000 for each day of illegal display.”

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2012 Law Changes Chapter 408, Part II, Fla Statutes

2. A late application fee* will be included in the omissions letter. It must be paid prior to issuing the license.

408.804(2)(e), F.S.

Fee is still $50 per day up to a max of $500

* For applications received less than 60 days prior to expiration but not past the expiration date.

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2012 Law Changes Chapter 408, Part II, Fla Statutes

3. 408.813(3), F.S. “A controlling interest shall notify the agency within 10 days after a court action to initiate bankruptcy, foreclosure, or eviction proceedings concerning the provider in which the controlling interest is a petitioner or defendant.”

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2012 Law Changes Chapter 408, Part II, Fla Statutes

4. Fine 408.813(3) - AHCA may impose a fine for a violation that is not designated as class I, II, III, or IV. Unless otherwise specified in law, the amount may not exceed $500 for each violation.

Unclassified violations are:a. Violating any term or condition of a license

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2012 Law Changes Chapter 408, Part II, Fla Statutes

Unclassified Violations Fine 408.813(3) continued:

b. Providing services beyond the scope of the licensec. Violating a moratorium imposed per 408.814, F.Sd. Violating any law in this part, authorizing statutes, or applicable rules.

Example: Not reporting change of administrator within 21 days (59A-35.110(1)(c), FAC)

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2012 Law Change for Nurse Registries & Home Health Agencies

400.462(27) “Remuneration” means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind. However, if the term is used in any provision of law relating to health care providers, the term does not apply to an item that has an individual value of up to $15, including, but not limited to, a plaque, a certificate, a trophy, or a novelty item that is intended solely for presentation or is customarily given away solely for promotional, recognition, or advertising purposes.”

When nurses are providing wound care to ALF residents

• A resident cannot remain in any ALF with stage 3 or 4 pressure sores.

• If a resident is admitted with a stage 2 pressure sore, the ALF must:– Have a Limited Nursing Services (LNS) or Extended

Congregate Care (ECC) license – Employ or contract with a nurse to provide the care

or the resident must contract directly with a nurse (such as from a nurse registry) or a licensed home health agency to provide care

If there is no improvement in 30 days, the resident must be discharged.

ALF residents care limitations

Prohibited Services:• Mechanical lifting equipment – such as Hoyer lifts• Restraints - only ½ bed rails with physician order every 6 months• Oral, nasopharyngeal, or tracheotomy suctioning - unless under

care of hospice (but ECC can do tracheotomy suctioning)• Peg tubes (feeding tubes) – unless self maintained; except hospice

patients where there is licensed staff to maintain

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ALF residents care limitationscontinued

Restricted Services• Residents cannot be bed bound – unless Extended Congregate

Care license & then only up to 14 days.• 24 hour nursing services

– Residents may not be admitted to any ALF if they need 24-hour nursing supervision

– Residents who later need 24 hour nursing supervision may stay in an ALF if:

• ALF has an ECC and necessary licensed staff or • ALF has LNS license hospice is providing necessary

licensed staff

Please report ALF concerns

• Resident rights – grievances go unanswered or rights were violated

• Residents neglect – not receiving their medication – not getting enough food– hygiene neglect, wet clothing, – no staff present

Please report ALF concerns

• Building Safety. Obvious and urgent safety hazards related to the building such as:– Unstable construction– Fire alarms/building systems– Building safety devices (locking mechanisms)

• Concerns should be made to local building officials

• Obvious and urgent safety hazards unrelated to the building may be reported to AHCA.

Reporting AHCA Complaints

• AHCA Contact (888) 419-3456• Online report Health Care Facility

Complaint Form at: ahca.myflorida.com/Complaint

• Provide detailed information such as patient/resident names, dates, times of events and where the event occurred

Reporting abuse, neglect & exploitation

• Florida law 415.1034, F.S., requires that any person who “knows, or has reasonable cause to suspect, that a vulnerable adult has been or is being abused, neglected, or exploited shall immediately report such knowledge or suspicion to the central abuse hotline.”

• There is a similar law for children, 39.201, F.S.

• Nurse registries, home health agencies & anyone should report any suspected or known abuse, neglect or exploitation of patients to the Department of Children and Families Abuse Hotline at 1-800-962-2873.

Penalties for providing less than fair market value services or staffing to ALFs

AHCA may deny, suspend or revoke

the license & shall impose a fine of $5,000 for a nurse registry 400.506(15)(a), F.S.

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Nurse Registry – 3 Rules Repealed Effective May 14, 2012

59A-18.001 Purpose Reason for repeal: repeated the purpose that is in state law 400.461(2), F.S.

59A-18.015 Surveys and Inspections Reason for repeal – substantially repeats what is in now in state law 408.811, F.S.

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Nurse Registry – 3 Rules Repealedcontinued

59A-18.016 PenaltiesReason for repeal: No longer needed.(1) requirements for injunctive proceedings now in

408.816, F.S.

(2) the time frame & amount of fines for late renewal applications are in 408.806(2)(d), F.S.

(3) the classes of deficiencies found on inspections & fine amounts for each class are specified in 400.464(2), F.S.

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State Rules

Rule repeals had to be completed first per the Governor’s office. 3 of our unit’s 6 programs had rule repeals.

Then rules required by state laws. The home health agency laws requiring two new rules so the HHA rules are being completed first.

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If you don’t agree with the surveyor

1. Ask the surveyor to show you the survey standard or law, rule

2. Discuss with surveyor at Exit Interview

3. Contact the AHCA Field Office Manager

http://ahca.myflorida.com/MCHQ/Areas

4. If still not resolved, contact Chief of Field Operations, Polly Weaver (850) 412-4301

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Contacting AHCA• When you have questions about your survey or any

standard that was cited as not met

- Call the Field Office Manager or Supervisor• When you have questions about laws, rules, the

application form or requirements

– 1st check http://ahca.myflorida.com/homecare - click on “Nurse Registry” - See Frequently Asked Questions

– Then call the Home Care Unit (850) 412-4403

or, send an email to HQAHOMEHEALTH@ahca.myflorida.com

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Contact information• Anne Menard – Supervisor, 6 programs

Anne.Menard@ahca.myflorida.com

These staff do nurse registry & home health agency licensing:

• Jan Benesh - (Janet.Benesh@ahca.myflorida.com) manager for HHA & NR licensing

• Ed Barnes –(Edward.Barnes)

Areas 1 to 8 & all changes of ownership

• Lenora Lowry (Lenora.Lowry) – Areas 9 & 10 (Palm Bch area & Broward)

• Natarsha Humphries (Natarsha.Humphries)– Area 11 (Dade/Monroe)