AHCA Nurse Registry Regulatory Update Anne Menard Home Care Unit Bureau of Health Facility Regulation Agency for Health Care Administration July 22, 2014

2 Licensed as of July 7, , 079 home health agencies statewide Counties with the most: Miami-Dade 524 Broward 242 Palm Beach nurse registries Broward 114 Palm Beach 112 1,638 homemaker companion services Broward 171 Miami-Dade 163 Palm Beach 141

2014 Nurse Registry Law Changes HB 1179 (Chapter , Laws of Florida) amended , F.S. Removes any requirement for nurse registries to monitor, manage, supervise or train the RNs, LPNs, CNAs, home health aides, homemakers and companions that they refer to provide patient care. The nurse registry shall advise the patient or person acting on behalf of the patient: –that the caregiver referred is an independent contractor and –the nurse registry is not obligated to monitor, supervise, manage or train the caregiver. If there is a violation of state laws or a deficiency in the caregiver’s credentials that the nurse registry becomes aware of, the nurse registry will: 1. advise the patient to terminate the referred individual, 2. provide the reason for termination, 3. cease to refer the person to other patients or facilities, and, 4. if there are practice violations, notify the appropriate licensing board. 3

2014 Nurse Registry Law Changes Nurse registries will continue to collect the records required in chapter 400, F.S., and state rules as a repository of records but has no obligation to review the records. The Agency will be holding a rule development workshop for public input into what needs to be changed in the rules and the wording of those rules as the result of the law changes. An will be sent to all nurse registries on the law changes and the rule development workshop. A notice is at the AHCA Nurse Registry web page on the law change with a link to the bill that passed. ( - select “Nurse Registry”) 4

Assistance with Self-Administration of Medication Home Health Agencies and Nurse Registries The patient may need a registered nurse or licensed practical nurse to administer medication. Home health aides and certified nursing assistants that are trained can only assist with medication in its previously dispensed, prescription labeled container or over-the-counter medication that has directions per state law. They cannot put pills in pill boxes or remove the pills from the pill boxes and give to the patient. Pills should be kept in the bottles that were dispensed by the pharmacy if assistance is to be provided. Patients need to be medically stable and have routine, regularly scheduled medications that are intended to be self- administered. Assistance with self-administration does not include: Medications for which the time of administration, the amount, the strength of dosage, the method of administration, or reason for administration requires judgment or discretion. Medications to be given “as needed”, unless the order is written with specific parameters that preclude independent judgment, and at the request of a competent patient. Administration of medications through a tube into a body cavity, through intermittent positive pressure breathing machine or nebulizer, or by injections. Homemakers and companions cannot assist. They can only verbally remind the client to take medicine , F.S. and 59A (5)(m)-(p), FAC 5

2014 Background Screening Law Changes AHCA Background Screening Unit sent an to all licensed providers on the law changes effective July 1 that affect section and chapter 435, Florida Statutes: 1.Screenings must be initiated through the Care Provider Background Screening Clearinghouse 2.Additional crimes were added to the list of crimes which disqualify an applicant subject to background screening. 3.Permits an employee, if previously screened and qualified under the applicable statutes but has a disqualifying offense that became effective July 1, 2014, to continue to work upon rescreening if agreed to by the employer, while applying for an exemption and waiting for a determination as long as the employee is eligible to apply for an exemption and the application is received by the appropriate agency within 30 days after receipt of the rescreening results. 4.The 3 year waiting period after payment of court-ordered monetary amounts that was required to be eligible for exemption from disqualification for certain felony convictions is eliminated. However, all court ordered fees, fines or other monetary requirements must be paid in full and 3 years must have elapsed since being lawfully released from confinement, supervision, or nonmonetary condition imposed by the court as a condition of being able to apply for an exemption. 6

Background Screening Reminders Failure to screen and re-screen employees including contract staff is a violation of state law and subject to a fine of $500 per person. Staff required to be screened must be re-screened every 5 years through AHCA. Because of the background screening law change to level 2 several years ago, there was a phase-in time frame in state law: If the last screening was between January 1, 2005 and December 31, 2008, must be re-screened by July 31, If the last screening was between January 1, 2009 and July 31,2011, must be re- screened by July 31, When your agency re-hires staff that used to work for your agency, make sure to re- screen if there was a lapse in employment greater than 90 days , F.S. 7

Initiating a Clearinghouse Screening Screenings handled through the Clearinghouse must now be initiated and registered through the Clearinghouse prior to referring the employee or potential employee for fingerprinting. (Effective July 1, 2014 in SB 674, Chapter Laws of Florida) “Initiating screening” requires the employer register the employee or potential employee through the AHCA Background Screening website before sending the person to a Livescan Vendor for screening. Initiating the original screening online will provide the privacy policy required for the employee to be included in the Clearinghouse and will also supply a view of the Florida Public Rap Sheet. Also, initiating the screening allows the ability to track a screening through the process and updates when an employee’s status has been changed or updated. To register and begin initiating screenings please visit the website at Note: Your agency can initiate a screening and have the employee schedule and pay their own LiveScan appointment. (This is not available for all LiveScan vendors. Please contact the vendor and ask.) Print the LiveScan Request form for the applicant, employee or contractor to take to the vendor. 8

Employee Roster “Employee” means any person required by law to be screened pursuant to this chapter, including, but not limited to, persons who are contractors, licensees, or volunteers (2), F.S. According to section (2)(c), F.S., an employer of persons subject to screening by a specified agency must register with the Clearinghouse and maintain the employment status of all employees within the Clearinghouse. Initial employment status and any changes in status must be reported within 10 business days. You must add an employee to your employee roster to receive arrest and criminal registration notifications. Please remember, per section (2)(b), F.S., if an employer becomes aware that an employee has been arrested for a disqualifying offense, the employer must remove the employee from contact with any vulnerable person that places the employee in a role that requires background screening. Even though the requirement is only for employees/contractors with a Clearinghouse screening, it is highly recommended that ALL employees/contractors are added to the employee roster. By doing so the provider will receive notifications of employment status changes for all employees. 9

Current Clearinghouse Functionality Privacy Policy: Applicants must sign a privacy policy in order for their screening to be entered into the Clearinghouse. The privacy policy is available during the ‘Initiate New Screening’ process on the website. Employers must retain a copy of the privacy policy in the employee’s personnel file. Initiating an Agency Review: If an individual has been screened by another specified agency (i.e. Dept. of Health) and entered into the Clearinghouse, an AHCA provider must request an agency review on the Clearinghouse website. This will allow AHCA to make an eligibility determination for employment purposes without the provider having to pay for a completely new screening. 10

Current Clearinghouse Functionality continued Initiating a Resubmission: The retention of fingerprints (effective for screenings on or after January 1, 2013) provides a cost savings for applicants that are in the Clearinghouse but have had a lapse in employment greater than 90 days. If there has been a 90 day lapse in employment, these applicants would only require a new national criminal history check – a resubmission of the retained fingerprints. A new state criminal history search will also be conducted, at no additional charge. A resubmission can be requested and paid for directly through the Clearinghouse website. Arrest and Criminal Registration Notifications: The retention of fingerprints will allow the Florida Department of Law Enforcement (FDLE) to report any new arrest/registration information to the specified state agencies. Bulletin Messages: Important updates will be displayed on the Home Page of the Clearinghouse results website. Providers should regularly check the home page for notifications regarding system outages, new regulations, etc. 11

Benefits of the Clearinghouse Allows the results of criminal history checks to be shared among specified state agencies, thereby reducing duplicative screenings for individuals requiring screening across multiple state agencies. Applicants will now have their fingerprints retained for a period of 5 years. The retention of fingerprints enables a provider to be notified of an arrest of their employee as soon as the information is reported to the Agency by the Florida Department of Law Enforcement (FDLE). The retention of fingerprints will also provide a cost savings for those employees that are in the Clearinghouse but have had a lapse in employment greater than 90 days. After a 90 day lapse in employment, these applicants would only be required to pay for a new national criminal history check (currently $16.50). Provides a photo of the applicant taken at the time of screening. –The provider can verify that the person who applied for the position is the same person that had their background screening done. 12

Clearinghouse Statistics From January 1, 2013 to June 30, 2014: –4,856 individuals were arrested AFTER they were screened (rap backs)  1,499 individuals went from Eligible to Not Eligible for offenses including:  Grand Theft  Battery and Assault  Sex Offenses  Exploitation of the Elderly 13

Agency for Health Care Administration Background Screening Resources Agency for Health Care Administration Web Site -- Select “Clearinghouse Website Information” at the home page. Questions/Comments/Issues: 14

Surveys If you have questions about the deficiencies cited: 1. Ask the surveyor to show you the survey standard, law or regulation 2. Discuss with surveyor during the Exit Interview 3. Contact the AHCA Field Office Manager or If your agency is accredited, contact your accrediting organization. 15

Statewide Medicaid Managed Care Where can I find more information? Visit the SMMC website at: See the Frequently Asked Questions at Questions about the program can be ed to: Keep up to date by signing up to receive program updates at Click the red “Sign Up for Program Updates” box on the right hand side of the page. 16

Statewide Medicaid Managed Care View the prior webinar presentations at Youtube.com/AHCAFlorida Facebook.com/AHCAFlorida; Twitter.com/AHCA_FL 17

Questions? Home Care Unit (850)