The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Health Policy
BILL: CS/SB 700
INTRODUCER: Health Policy Committee and Senator Burgess
SUBJECT: Delegation of Medication Administration
DATE: February 10, 2022 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Rossitto-Vanwinkle Brown HP Fav/CS
2. JU
3. RC
Please see Section IX. for Additional Information:
PLEASE MAKE SELECTION
I. Summary:
CS/SB 700 authorizes a registered nurse (RN) to delegate to a certified nursing assistant (CNA)
or a home health (HH) aide the administration of certain types of prescription medications to a
patient of a nurse registry or patient in a county detention facility if the CNA or HH aide meets
certain requirements in current law. The bill authorizes a CNA to administer such prescription
medications to a patient of a nurse registry or patient in a county detention facility if so delegated
by a RN and if the CNA meets certain requirements in current law. The bill also requires a nurse
registry that authorizes a RN to delegate tasks, including medication administration, to a CNA or
a HH aide, to ensure that such delegation meets certain requirements in statute and rule.
The bill has an effective date of July 1, 2022.
II. Present Situation:
Nurse Practice Act
Florida’s Nurse Practice Act is found in Part I of ch. 464, F.S. The purpose of the Nurse Practice
Act is to ensure that every nurse practicing in this state meets minimum requirements for safe
practice. It is legislative intent that nurses who fall below minimum competency or who
otherwise present a danger to the public are prohibited from practicing in this state.1
1
Section 464.002, F.S.
BILL: CS/SB 700 Page 2
Certified Nursing Assistants
Florida’s statutory governance for CNAs is found in Part II of ch. 464, F.S. Section 464.201(5),
F.S., defines the practice of a CNA as providing care and assisting persons with tasks relating to
the activities of daily living. Activities of daily living include tasks associated with: personal
care, maintaining mobility, nutrition and hydration, toileting and elimination, assistive devices,
safety and cleanliness, data gathering, reporting abnormal signs and symptoms, postmortem care,
patient socialization and reality orientation, end-of-life care, cardiopulmonary resuscitation
(CPR) and emergency care, patients’ rights, documentation of nursing-assistant services, and
other tasks that a CNA may perform after training.2
A CNA can work in nursing homes, assisted living facilities, other community-based settings,
hospitals, or private homes under general supervision.3 The Florida Board of Nursing (BON),
within the Department of Health (DOH), certifies CNAs, who must, among other qualifications,
hold a high school diploma or equivalent, complete a 120-hour BON-approved training program,
and pass a nursing assistant competency exam, which includes written and practical portions.4 A
CNA must biennially complete 24 hours of in-service training to maintain certification.5
The BON establishes the general scope of practice for CNAs. A CNA performs services under
the general supervision6 of a RN or licensed practical nurse (LPN).7 A CNA may perform the
following:
Personal care services, such as bathing, dressing grooming, and light housekeeping;
Tasks associated with maintaining mobility, such as ambulating, transferring, positioning,
lifting, and performing range of motion exercises;
Nutrition and hydration tasks, such a feeding or assisting with eating and drinking;
Tasks associated with elimination, such as toileting, providing catheter care, and emptying or
changing ostomy bags;
Tasks associated with using assistive devices;
Maintaining the environment and resident safety;
Taking measurements and gathering data, i.e. pulse, blood, pressure, height, and weight;
Reporting abnormal resident findings, signs, and symptoms;
Post mortem care;
Tasks associated with end of life care;
Tasks associated with resident socialization, leisure activities, reality orientation, and
validation techniques;
Performing basic first aid, CPR, and emergency care; and
Documentation of CNA services provided to the resident.
2
Section 464.201, F.S.
3
Paraprofessional Healthcare Institute, Who Are Direct-Care Workers?, (Feb. 2011), available at https://phinational.org/wp-
content/uploads/legacy/clearinghouse/NCDCW%20Fact%20Sheet-1.pdf (last visited Feb. 3, 2022).
4
Section 464.203, F.S., and Fla. Admin. code r. 64B9-15.006. Eighty hours must be classroom instruction and 40 hours must
be clinical instruction, 20 of which must be in long term care clinical instruction in a licensed nursing home. 42 C.F.R. §
483.95 requires 75 hours of training; Florida training requirements exceed the federal minimum training requirements.
5
Section 464.203(7), F.S.
6
Under general supervision, the registered nurse or licensed practical nurse does not need to be present but must be available
for consultation and advice, either in person or by a communication device. Fla. Admin. Code R. 64B9-15.001(5).
7
Fla. Admin. Code R. 64B9-15.002.
BILL: CS/SB 700 Page 3
A CNA may not work independently and may not perform any tasks that require specialized
nursing knowledge, judgment, or skills.
Agency for Health Care Administration
The Agency for Health Care Administration (AHCA) is responsible for, among other duties,
health facility licensure, inspection, and regulatory enforcement; investigation of consumer
complaints related to health care facilities and managed care plans; the administration of the
Medicaid program; the administration of the contracts with the Florida Healthy Kids
Corporation; and the certification of health maintenance organizations and prepaid health clinics.
The AHCA is the lead agency responsible for the regulation of hospices, assisted living facilities,
adult day care centers, and adult family-care homes.8 HH agencies and nurse registries are also
both required to be licensed by the AHCA to operate in Florida.9
Home Health Aides
HH aides provide essentially the same care and services as nursing assistants, but they assist
people in their homes or in community settings under the supervision of a nurse or a physical,
speech, occupational, or respiratory therapist.10 In Florida, HH aides are not licensed or certified.
Home Health Aide Training
For every CNA employee, an HH agency must have on file a copy of the person’s Florida CNA
certificate.11 For every HH aide, the HH agency must maintain documentation of successful
completion of at least 40 hours of training in the following subjects or the successful passage of
the AHCA HH aide competency test:
Communication skills;
Observation, reporting, and documentation of patient status and the care provided;
Reading and recording temperature, pulse, and respiration;
Basic infection control procedures;
Basic elements of body functions that must be reported to the RN supervisor;
Maintenance of a clean and safe environment;
Recognition of emergencies and applicable follow-up within the HH aide’s scope of
performance;
Physical, emotional, and developmental characteristics of the populations served by the HH
agency, including respect of the patient’s privacy and property;
Appropriate and safe techniques in personal hygiene and grooming;
Safe transfer techniques, including use of appropriate equipment, and ambulation;
Normal range of motion and positioning;
Nutrition and fluid intake;
8
Section 20.42, F.S.
9
Sections 400.464 and 400.506, F.S.
10
If the only service the home health agency provides, is physical, speech, or occupational therapy, in additional to the home
health aide or CNA services, the licensed therapist may provide supervision.
11
Fla. Admin. Code R. 59A-8.0095(5)(c). A copy of the DOH website CNA information that shows the person’s name,
address, certificate number, original issue date, expire date, and status meet this requirement.
BILL: CS/SB 700 Page 4
Cultural differences in families;
Food preparation and household chores; and
Assistance with self-administered medication.
Home Health Aide Competency Test
The AHCA is required to create the HH aide competency test and establish the curriculum and
instructor qualifications for HH aide training. Licensed HH agencies may provide this training
and must furnish documentation of this training to other licensed HH agencies upon request.12
HH agencies that teach the HH aide course, but who are not an approved nonpublic post-
secondary career school, cannot charge a fee for the training and cannot issue a document of
completion with the words “diploma,” “certificate,” “certification of completion,” or
“transcript.” The HH agency is limited to advertising in the “Help Wanted” section of
newspapers. The HH agency cannot lawfully advertise that it is offering “training for HH aides.”
The HH agency can indicate that it is hiring HH aides and will train.13
Successful passage of the competency test by HH aides may be substituted for the training
required under s. 400.497, F.S.14
However, the AHCA licenses HH agencies and establishes training requirements for HH aides
employed by an agency. HH aides must complete at least 75 hours of training and/or successfully
pass a competency evaluation by the employing agency.15 HH aides who work for a HH agency
that is not certified by Medicare or Medicaid, or who work for a nurse registry, must complete 40
hours of training or pass an AHCA-developed competency examination.16
The AHCA establishes the scope of practice for HH aides performing services under a licensed
HH agency. A HH aide performs services delegated by and under the supervision of a RN, which
include:17
Assisting the patient or client with personal hygiene, ambulation, eating, dressing, shaving,
physical transfer, and other personal care activities;
Maintaining a clean, safe, and healthy environment, including light housekeeping;
Activities taught by a licensed health professional for a specific patient or client and
restricted to:
o Toileting;
o Assisting with tasks related to elimination;
o Assisting with the use of devices to aid daily living, such as a wheelchair;
o Assisting with prescribed range of motion exercises;
o Assisting with prescribed ice cap or collar;
o Doing simple urine tests for sugar, acetone, or albumin;
12
Section 400.497, F.S.
13
Fla. Admin. Code R. 59A-8.0095(5)(h).
14
Section 400.497, F.S.
15
Agency for Health Care Administration, Home Health Aides, available at
https://ahca.myflorida.com/MCHQ/Health_Facility_Regulation/Lab_HomeServ/HHA/Home_health_aides.shtml (last visited
Feb. 2, 2022).
16
Fla. Admin. Code R. 59A-8.0095(5).
17
Id., and Fla. Admin. Code R. 64B9-15.002.
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o Measuring and preparing special diets; and
o Assisting with self-administration of medication.
A HH aide may not change sterile dressings, irrigate body cavities, irrigate a colostomy or
wound, perform gastric irrigation or enteral feeding, catheterize a patient, administer medication,
apply heat by any method, care for a tracheotomy tube, or any other services that has not been
included in the patient’s plan of care.18
Home Health Agencies
A HH agency is defined as a person that provides one or more HH services.19 HH services
include health and medical services and medical supplies furnished to an individual in the
individual’s home or place of residence. The term includes the following:20
Nursing care;
Physical, occupational, respiratory, or speech therapy;
HH aide services;
Medical social services;
Dietetics and nutrition practice and nutrition counseling;
Medical equipment and supplies, including drugs and biologicals prescribed by a physician;
and
Homemaker and companion services.
Home Health Agency Licensure
The licensure process for a HH agency is based upon the applicant’s compliance with Part III of
ch. 400, F.S.; Part II of ch. 408, F.S.; Florida Administrative Code Rules 59A-8 and 59A-35b;
and an inspection by the AHCA.21 To be a licensed HH agency a person must submit to the
AHCA, an application for one or more counties within a geographic service area,22 an
appropriate fee for the application, background checks, and inspection. An application is
considered complete upon the AHCA’s receipt of proof of the following:23
Financial ability to operate, prepared in accordance with generally accepted accounting
principles and signed by a certified public accountant,24 which must include:
o A pro forma balance sheet, pro forma cash flow statement, and a pro forma income and
expense statement for the first two years of operation which provide evidence of
sufficient assets, credit, and projected revenues to cover liabilities and expenses; and
18
Fla. Admin. Code R. 59A-8.0095(5)(p).
19
Section 400.462 (12), F.S.
20
Section 400.462 (15), F.S. See also FloridaHealthFinder.gov, a service of the Agency for Health Care Administration,
Consumer Guides, Home Health Care in Florida, available at https://www.floridahealthfinder.gov/reports-guides/home-
health.aspx (last visited Feb. 8, 2022).
21
Fla. Admin. Code R. 59A-8.003(1), See also ss. 400.471(2) and 408.806(7), F.S.
22
Fla. Admin. Code R. 59A-8.003 and 59A-8.002 (12).
23
Fla. Admin. Code R. 59A-35.060.
24
see Section 408.8065,(2), F.S. Applicants and controlling interests who are nonimmigrant aliens, as described in 8 U.S.C.
s. 1101, must file a surety bond of at least $500,000, payable to the agency, which guarantees that the home health agency,
home medical equipment provider, or health care clinic will act in full conformity with all legal requirements for operation.
BILL: CS/SB 700 Page 6
o A prospective income and expense statement for the next two years of operation which
provide evidence of sufficient assets, credit, and projected revenues to cover liabilities
and expenses;25
All required Level II background screening results for the licensee, administrator, financial
officer, any person with controlling interest, and all persons providing personal care to
clients;26
Liability and malpractice insurance with limits of not less than $250,000 per claim;27
A certificate of occupancy;28
List of all satellite offices and staff at those locations;
A business plan signed by the applicant, including a plan to obtain patients and to maintain
staff; and
Completion of a satisfactory inspection, if required.29
A HH agency’s license is only valid for the licensee, provider, and the location for which the
license is issued.30
Home Health Agencies Responsibilities to Patients
A licensed HH agency has the following responsibility to its patients during hours of operation:31
The HH agency’s administrator and director of nursing, or their alternates, must be available
to the public32 for eight consecutive hours between 7:00 a.m. and 6:00 p.m., Monday through
Friday, every week, excluding legal and religious holidays;
When the administrator and the director of nursing are not on the premises during designated
business hours, a staff member must be available to answer the phone and the door and must
be able to contact the administrator and the director of nursing by telecommunications;
If an AHCA surveyor33 arrives on the HH agency premises to conduct an unannounced
survey and the administrator, the director of nursing, or a person authorized to