SUMMARY OF UPDATES TO CHAPTER 59A-18
NURSE REGISTRIES STANDARDS AND LICENSING
59A-18.002
Definitions
59A-18.004
Licensure Requirements, Procedures, and Fees
59A-18.005
Registration Policies
59A-18.006
Administrator
59A-18.007
Registered Nurse and Licensed Practical Nurse
59A-18.0081 Certified Nursing Assistant and Home Health Aide
59A-18.009
Homemakers or Companions
59A-18.010
Acceptance of Patients or Clients
59A-18.011
Medical Plan of Treatment
59A-18.012
Clinical Records
59A-18.013
Administration of Drugs and Biologicals
59A-18.017
Supplemental Staffing for Health Care Facilities
59A-18.018
Emergency Management Plans
59A-18.002
Definitions
(3) “Caregiver” – changes the definition to mean the RN, LPN, CNA, Home Health Aide,
Homemaker and Companion referred by the nurse registry. This was done to comply with the
meaning of the word in 400.506(6)(c), F.S.
(8) “Independent contractor”- Adds to the definition that an independent contractor is not an
employee of the nurse registry.
(10) “Nurse registry services” - Deletes reference to 400.509, F.S., since nurse registries that
provide homemakers and companions are not required to register.
(11) “Plan of treatment” – The number of days to get physician’s signature was increased to 30
to match 59A-18.011(2) and 59A-18.013(2)(c). Advanced registered nurse practitioner and
physician assistant are added, since they are also permitted to sign plans of treatment in
400.506(13)(a), F.S.
(13) “Satellite office” definition added: “Satellite office” means a secondary office of the nurse
registry established in the same county as the main office, pursuant to 400.506(1), F.S.
400.506(1), F.S., says: “….Each operational site of the nurse registry must be licensed, unless
1
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.
there is more than one site within a county. If there is more than one site within a county, only
one license per county is required…”
59A-18.004
Licensure Requirements, Procedures, and Fees
The application form is updated. The requirement for the availability of a 24 hour nurse was
removed from the form.
The financial ability to operate requirements and form were removed since they are now in 59A35.062.
The background screening requirements are removed since they are now in 408.809, F.S. for all
programs.
A satellite office may share administration and is not required to be open for a minimum number
of hours like the main office.
The requirement for the 24-hour availability of a nurse on call for patients receiving skilled care
was removed, as was the on-call nurse for home health aides and certified nursing assistants.
Nurse registry must provide a list of telephone numbers to be called if a replacement caregiver is
needed along with local emergency numbers as determined by the nurse registry.
59A-18.005
Registration Policies
Updates the listing of laws and rules that the nurse registry provides to independent contractors.
The documents may be provided by paper copy, email or other means of electronic
communication.
Eliminates the written or oral communications to verify individual licensing with a screen print
from the Department of Health web site. Adds how to report unlicensed nurses and nursing
certified nursing assistants to DOH.
For health statements, the requirements are simplified. The health statement is collected when
the caregiver is first referred.
The requirement that the nurse registry include certain items in its contracts with independent
contractors was removed.
Items required for the independent contractor folders have been updated.
Adds that if the complaints are violations of state law, the nurse registry shall take the actions
specified in 400.506(19), F.S. Follow up on complaints is removed.
2
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.
59A-18.006
Administrator
Eliminates the requirement for a full-time administrator since the administrator requirements are
now at 400.506(18), F.S. (Full time was not enforced since the 7/1/2013 law change.)
Adds that an advanced registered nurse practitioner (ARNP) may be an administrator.
The Administrator is responsible for making sure that the nurse registry advises the patient and
family that (1) the caregiver is an independent contractor and (2) that RNs are available to make
visits when a home health aide or CNA is referred. These are requirements in 400.506(6)(c) and
(e), F.S.
59A-18.007
Registered Nurse and Licensed Practical Nurse
In (1), the phrase referring to the assessment of care by non-licensed independent contractors is
removed because the requirement for an assessment was removed from state law.
The 2014 law at 400.506(19) is referred to and the rule re-states the law that the nurse registry is
not required to monitor or supervise an RN or LPN and that the nurse registry must take the
actions in 400.506(19) if there are any violations of state law that come to the attention of the
nurse registry.
Paragraph (3), re supervision of the LPN, is removed since the nurse registry does not provide
supervision per the 2014 law changes.
59A-18.0081 Certified Nursing Assistant and Home Health Aide
Simplifies the qualifications to work as a home health aide. For new home health aides since the
effective date of the rule (May 4, 2015), requires a certificate or documentation of successful
completion of at least 40 hours of home health aide training from a public vocational technical
school or non-public career education school licensed by the Department of Education,
Commission on Independent Education. Removes the list of topics for training.
For new home health aides since May 4, 2015, that received their training in another state, a
certificate of completion is required from a public vocational technical school or career
education school that is licensed in that state.
Adds that a certified nursing assistant may work as a home health aide. No additional training is
required.
Adds that nurses licensed in FL or another state may work as home health aides as requested by
nurse registries in (11).
Persons who have completed the nursing training but are not licensed yet may work as home
health aides.
3
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.
Requires that CNAs and home health maintain a current CPR certification from an instructor that
is approved to provide training by the American Heart Association of the American Red Cross.
Adds that the training on assistance with self-administered medications can also be from a
provider approved by the Florida Board of Nursing, Department of Health.
For review of medications, when assistance with medication is to be provided by a home health
aide or CNA --- Adds a visit by a nurse is not required and that a nurse may review medications
provided in a written list that includes the dosage, frequency and route of administration
provided by the patient, the patient’s health care surrogate, family member or other person
designated by the patient.
The 2014 law at 400.506(19) is referred to and the rule re-states the law that the nurse registry is
not required to monitor, manage, supervise or train a home health aide or CNA.
Adds that the nurse registry is not obligated to review the patient or client records per
400.506(20), F.S., but the nurse registry is not prohibited from reviewing records and may do so.
Updates the statutory references due to changes in the paragraph numbers in 400.506, F.S.
59A-18.009
Homemakers or Companions
Removes the requirement for hiring trained homemakers and companions, as has been done for
home health agencies.
Changes that any usual incidents or changes in client’s behavior are reported to the person
designated by the client, and not to the nurse registry.
Removes the requirement that homemakers and companions understand the needs of the clients
to who they are referred and recognize conditions that should be reported to the nurse registry
office.
Adds that the nurse registry is not obligated to review the patient or client records per
400.506(20), F.S., but the nurse registry is not prohibited from reviewing records and may do so.
59A-18.010
Acceptance of Patients or Clients
Advanced registered nurse practitioners and physician assistants are added to (3), since they are
also permitted to provide orders per 400.506(13)(a), F.S.
Replaces the word “caregiver” with “person designated by the patient or client” to comply with
the use of the word “caregiver” in the 400.506(6)(e) (2014).
4
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.
59A-18.011 Medical Plan of Treatment
Advanced registered nurse practitioners and physician assistants are added to (1), since they are
also permitted to provide orders for skilled care per 400.506(13)(a), F.S. Also, the word
“skilled” is added to (1) to make it clear that a medical plan of treatment is only required for
skilled care.
59A-18.012
Clinical Records
Updates the statutory references due to changes in the paragraph numbers in state laws.
Adds that the nurse registry is not obligated to review patient or client records per 400.506(20),
F.S., but the nurse registry is not prohibited from reviewing records and may do so. In the event
of violation of state law which comes to the attention of the nurse registry, the nurse registry
shall take the actions specified in 400.506(19), F.S.
59A-18.013
Administration of Drugs and Biologicals
Updates the statutory references due to changes in the paragraph numbers in state law.
59A-18.017
Supplemental Staffing for Health Care Facilities
Updates the statutory references due to changes in state laws.
Removes the requirement to get performance evaluations annually on individuals referred.
Adds that the nurse registry is not obligated to review patient or client records per 400.506(20),
F.S., but the nurse registry is not prohibited from reviewing records and may do so.
Removes background screening requirements that are covered in the background screening state
laws at 408.809, F.S.
Adds that in the event of violation of state law which comes to the attention of the nurse registry,
the nurse registry shall take the actions specified in 400.506(19), F.S.
59A-18.018
Emergency Management Plans
The Comprehensive Emergency Management Plan form has some changes. The changes do not
require nurse registries to revise their emergency management plans. The updated CEMP form
is at the AHCA web site: http://ahca.myflorida.com/MCHQ/Emergency_Activities/index.shtml
Following are the changes:
Page 4 – The term “Safety Liaison” is now used for the primary person in charge during an
emergency, as required by 408.821(1), F.S.
5
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.
Section D, item 1, was revised based on review comments received from the Chief Attorney
at the Joint Administrative Procedures Committee (JAPC) of the Florida Legislature, so that
the vague phrase “make every reasonable attempt” is not used. The paragraph now requires
the nurse registry’s procedure to include how each independent contractor that provides care
to patients needing continuing care during an emergency will be contacted.
Three paragraphs of 59A-18.018 are revised based on JAPC comments:
In paragraph (9) “Upon imminent threat of an emergency or disaster” has been replaced with
“When a state of emergency has been declared by executive order or proclamation of the
Governor, pursuant to Section 252.36(2), F.S.,”
Paragraphs (10) and (11) replace the requirement to “make reasonable efforts” or “attempts”
with a description of the minimum that needs to be done by the nurse registry.
The word “caregiver” is replaced with “family or other person that providers care to the patient”
since the meaning of the word has changed in the 2014 law changes to mean only the
independent contractor referred by the nurse registry.
Web site addresses are updated. Statutory references are also updated due to the changes in
paragraph numbers in state laws.
6
Note: See the AHCA web page: http://ahca.myflorida.com/homecare - select “Nurse Registry,” or see
www.flrules.org for the full text of the rules in chapter 59A-18, Florida Administrative Code.