HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 469 Patient Care in Health Care Facilities
SPONSOR(S): Finance & Facilities Subcommittee, Trabulsy
TIED BILLS: IDEN./SIM. BILLS: SB 718
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Finance & Facilities Subcommittee 15 Y, 0 N, As CS Guzzo Lloyd
2) Professions & Public Health Subcommittee 15 Y, 0 N Guzzo McElroy
3) Health & Human Services Committee 20 Y, 0 N Guzzo Calamas
SUMMARY ANALYSIS
Under current law, home health aides and certified nursing assistants (CNAs) may assist a patient of a home
health agency with self-administration of certain medications after completion of prescribed training.
Current law authorizes home health aides and CNAs to perform certain tasks in providing assistance to
assisted living facility (ALF) residents with self-administration of medication that home health aides and CNAs
are not currently authorized to provide if they work for a home health agency. Current law also authorizes an
ALF to contract with a home health agency to employ home health aides and CNAs, which can cause
confusion as to which tasks a home health aide or CNA may provide when they are employed by a home
health agency but they are working in an ALF. The bill revises home health agency statutes to allow home
health aides and CNAs to perform additional tasks in providing assistance to patients with self-administration of
medication to create consistency.
In addition to assisting patients with self-administration of medication, current law also authorizes a home
health aide or CNA to administer certain medications upon delegation of such authority by a registered nurse.
The bill expands the duties a nurse may delegate to a home health aide or CNA to include administering an
insulin syringe that is prefilled with the proper dosage by a pharmacist or an insulin pen that is prefilled by the
manufacturer.
Current law requires an advanced life support ambulance transporting a patient between two facilities to be
occupied by two people, including one patient attendant (who may be a paramedic, registered nurse, or a
physician) and one qualified ambulance driver who is an EMT, paramedic, registered nurse, or physician. The
bill removes the requirement for the driver to be an EMT, paramedic, registered nurse, or physician.
The bill has no fiscal impact on state or local government.
The bill provides an effective date of July 1, 2022.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
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DATE: 2/1/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Current Situation
Home Health Aides and Certified Nursing Assistants
A home health agency is an organization that provides home health services.1 Home health services
are health and medical services and supplies furnished to an individual in the individual’s home or
place of residence.2
Home health aides 3 and certified nursing assistants 4 (CNAs) are unlicensed health care workers
employed by a home health agency to provide personal care5 to patients and assist them with the
following activities of daily living:
Ambulation;
Bathing;
Dressing;
Eating;
Personal hygiene;
Toileting;
Physical transferring;
Assistance with self-administered medication; and
Administering medications.6
Medication Administration and Assistance with Self-Administration
Medication Administration
Under certain conditions, home health aides and CNAs are authorized to administer certain types of
medication to a patient of a home health agency, including oral, transdermal, ophthalmic, otic, rectal,
inhaled, enteral, or topical prescription medications. Specifically, the home health aide or CNA must:
Be delegated such task by a registered nurse;
Complete an initial 6-hour training course approved by the Board of Nursing (Board) or the
Agency for Health Care Administration (AHCA);
Be found competent to administer medication to a patient in a safe and sanitary manner; and
Complete two hours of annual inservice training in medication administration and medication
error prevention approved by the Board.7
1 S. 400.462(12), F.S.
2
S. 400.462(15), F.S., home health services include the following: nursing care; physical, occupational, respiratory, or speec h therapy;
home health aide services; dietetics and nutrition practice and nutrition counseling; and medical supplies, restricted to drugs and
biologics prescribed by a physician.
3 S. 400.462(14), F.S., a home health aide is a person who is trained or qualified, as provided by rule, and who provides hands -on
personal care, performs simple procedures as an extension of therapy or nursing services, assists in ambulation or exercises, assists in
administering medications as permitted in rule and for which the person has received training established by the agency, or p erforms
tasks delegated to him or her under ch. 464, F.S.
4 S. 464.201(3), F.S., a CNA is a person who meets the qualifications of part II of ch. 464, F.S., and who is certified by the Board of
Nursing as a certified nursing assistant.
5 S. 400.462(23), F.S., defines “personal care” as assistance to a patient in the activi ties of daily living, such as dressing, bathing,
eating, or personal hygiene, and assistance in physical transfer, ambulation, and in administering medications as permitted b y rule.
6 Rule 59A-8.002(3), F.A.C.
7 S. 464.2035, F.S., and s. 400.489, F.S.
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Section 464.0156, F.S., prohibits a registered nurse from delegating to a home health aide or CNA the
administration of a controlled substance listed in Schedule II, Schedule III, or Schedule IV of s. 893.03,
F.S., or 21 U.S.C., s. 812. Controlled substances are classified by their acceptable medical use and
propensity for abuse and dependency.8
As of 2018, 34.2 million Americans, or 10.5 percent of the population, had diabetes,9 and 8.3 million of
those people required insulin to regulate blood glucose levels. 10 There are different types of insulin that
vary by how quickly they work, when they peak, and how long they last. 11 Although not specifically
prohibited, current law does not expressly authorize a registered nurse to delegate the authority for a
home health aide or CNA to administer insulin.
Assistance with Self-Administration
Patients are often capable of administering their own medication, but need assistance to ensure that
they are taking the correct medication, at the proper dosage, and at the correct time. Under current law,
home health aides and CNAs may assist with self-administration of medication after completion of
required training.12
Home health aides and CNAs must complete two hours of training to assist with self-administration of
medication.13 The training must include state law and rule requirements for assistance with self-
administration of medication in the home, procedures for assisting the patient with self-administration,
common medications, recognition of side effects and adverse reactions, and procedures to follow if
patients appear to be experiencing side effects or adverse reactions.14 The training may be provided by
a licensed home health agency or a vocational school approved by the Department of Education. 15
Current law authorizes home health aides and CNAs to perform certain tasks in providing assistance to
assisted living facility (ALF) residents with self-administration of medication that home health aides and
CNAs are not currently authorized to provide if they work for a home health agency. Current law also
authorizes an ALF to contract with a home health agency to employ home health aides and CNAs,16
which can cause confusion as to which tasks a home health aide or CNA may provide when they are
employed by a home health agency but they are working in an ALF.
For example, current law authorizes home health aides and CNAs employed by ALFs to assist a
resident with the self-administration of insulin pens that are prefilled with the proper dosage by a
pharmacist or the manufacturer. However, if a home health aide or CNA works in an ALF, but is
employed by a home health agency, current law does not authorize them to provide such assistance to
ALF residents.
8
U.S. Drug Enforcement Administration, Drug Scheduling, available at https://www.dea.gov/drug-information/drug-scheduling (last
visited November 23, 2021).
9 U.S. Department of Health and Human Services Centers for Disease Control and Prevention, National Diabetes Statistics Report
2020 Estimates of Diab etes and its Burden in the United States, available at https://www.cdc.gov/diabetes/pdfs/data/statistics/national-
diabetes-statistics-report.pdf (last visited November 23, 2021).
10
Tara O’Neill Hayes, Understanding the Insulin Market, American Action Forum (March 3, 2020), available at
https://www.americanactionforum.org/research/understanding-the-insulin-market/ (last visited November 23, 2021).
11 American Diabetes Association, Insulin & Other Injectab les, Insulin Basics, available at https://www.diabetes.org/healthy-
living/medication-treatments/insulin-other-injectables/insulin-basics (last visited November 23, 2021). “Rapid-acting insulin” begins to
work about 15 minutes after injection, peaks within one or two hours, and lasts between two to four hours. “Regular or short -acting
insulin” usually reaches the bloodstream within 30 minutes after injection, peaks within two to three hours, and lasts for three to six
hours. “Intermediate-acting insulin” reaches the bloodstream two to four hours after injection, peaks within four to 12 hours, and lasts for
12 to 18 hours.
12 S. 400.488(1)(b), F.S.
13 Rule 59A-8.0095(5), F.A.C.
14 Id.
15 Rule 59A-8.0095(5)(e)-(f), F.A.C.
16 S. 429.256(1)(b), F.S.
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The table below lists other tasks that a home health aide and a CNA in a home health agency 17 may
assist a patient with compared to when they work in an ALF 18.
Home Health
Task ALF
Agency
Using a glucometer to perform blood-glucose level checks.
Assisting with putting on and taking off antiembolism stockings.
Assisting with applying and removing an oxygen cannula but not
with titrating the prescribed oxygen settings.
Assisting with the use of a continuous positive airway pressure
device but not with titrating the prescribed setting of the device.
Assisting with measuring vital signs.
Assisting with colostomy bags.
Taking the medication, in its properly labeled container, from
where it is stored to the patient.
Confirming that the medication is intended for that patient, orally
advising the patient of the medication name and purpose, opening
the container, removing a prescribed amount of medication from
the container, and closing the container.
Placing an oral dose in the patient’s hand or placing the dosage in
another container and helping the patient by lifting the container to
his or her mouth.
Returning the medication container to proper storage.
Keeping a record of when a patient receives assistance.
Applying topical medications, including routine preventative skin
care and applying and replacing bandages for minor cuts and
abrasions
Assisting with nebulizer treatments.
Current law expressly prohibits home health aides and CNAs from performing certain in providing
assistance with self-administration of medication and a home health aide or CNA within a home health
agency19 or ALF20 may not perform those tasks, as follows:
Mixing, compounding, converting, or calculating medication doses, except for measuring a
prescribed amount of liquid medication or breaking a scored tablet or crushing a tablet as
prescribed;
Preparing syringes for injection or administering medications by any injectable route;
Administering medications by way of a tube inserted in a cavity of the body;
Administering parenteral preparations;21
Irrigating or using debriding agents to treat a skin condition;
Preparing rectal, urethral, or vaginal medications;
17 S. 400.488(3), F.S.
18 S. 429.256(3), F.S.
19 S. 400.488(4), F.S.
20 S. 429.256(4), F.S.
21 Parenteral means administration of a medication by injection, infusion, or implantation. U.S. Food & Drug Administration, Route of
Administration, available at https://www.fda.gov/drugs/data-standards-manual-monographs/route-administration (last visited November
29, 2021).
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Administering medications ordered by the physician or health care professional with prescriptive
authority to be given “as needed,” unless the order is written with specific parameters that
preclude independent judgment on the part of the home health aide or CNA, and at the request
of a competent patient; or
Administering medications for which the time of administration, the amount, the strength of
dosage, the method of administration, or the reason for administration requires judgment or
discretion on the part of the unlicensed person.
Emergency Medical Transport Services
Basic Life Support and Advanced Life Support Ambulance Services
Ambulances 22 are used to transport sick or injured people to or between medical facilities. Ambulances
provide two types of services; basic life support services (BLS) and advanced life support services
(ALS).
BLS ambulance services use only basic life support techniques 23 and transport patients who only
require basic medical monitoring.24 BLS services include the assessment or treatment by a person
qualified under part III of ch. 401, F.S., through the use of techniques described in the EMT-Basic
National Standard Curriculum or the National Emergency Medical Services (EMS) Education Standards
of the U.S. Department of Transportation.25 The term includes the administration of oxygen and other
techniques that have been approved and are performed under specific conditions. 26 BLS services are
usually performed by emergency medical technicians 27 (EMTs).28
ALS ambulance services transport patients who require a higher level of medical monitoring. 29 ALS
services include patient assessment or treatment including the implementation of advanced medical
skills such as endotracheal intubation, the administration of drugs or intravenous fluids, telemetry,
cardiac monitoring, cardiac defibrillation, and other techniques described in the EMT-Paramedic
National Standard Curriculum or the National EMS Education Standards.30 ALS services are usually
provided by paramedics.31
22 S. 401.23(5), F.S., defines “ambulance” or “emergency medical services vehicle” as any privately or publicly owned land or wa ter
vehicle that is designed, constructed, reconstructed, maintained, equipped, or operated for, and is used for, or intended to be used fo r,
land or water transportation of sick or injured persons requiring or likely to require medical attention during transport.
23 S. 401.23(8), F.S.
24
Johns Hopkins Medicine, Lifeline: Basic and Advanced Life Support, available at
https://www.hopkinsmedicine.org/lifeline/trans_se