Nurse Registry State
Regulatory Update
Anne Menard
Home Care Unit
Bureau of Health Facility Regulation
Agency for Health Care Administration
May 17, 2012
1
Nurse Registry Growth
2012
2009
2006
2003
0
100
200
300
400
500
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license was revoked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
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).
6
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.
7
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.
8
2012 Law Changes – Background Screening
Staggered 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 3year period to spread the cost and workload of
screening.
9
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.
10
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
11
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.
12
2012 Changes to 400.506 Fla Statutes
CS/CS/HB 787 – effective July 1, 2012
400.506(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.
13
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.
15
2012 Law Changes
Chapter 408, Part II, Fla Statutes
CS/CS/HB 787 – effective July 1, 2012
1. 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.”
16
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 license
c. Violating a moratorium imposed per 408.814, F.S
d. 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)
20
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.”
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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
ALF residents care limitations
continued
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
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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.
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 Repealed
continued
59A-18.016 Penalties
Reason 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.
31
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)
35