Transcript Florida Nursing Homes - Health administration

A Message of Change
Agency for Health Care
Administration
2001 Legislation Affecting
Florida Nursing Homes and
Assisted Living Facilities
Senate Bill 1202 - Initiatives
• Quality Enhancements
• Enhanced Enforcement
• Tort Reform
• Signed May 15, 2001
SB 1202
Implementation Status
Initiative
Implementation Date
(GAA/Legislation)
Status
Nursing Home Risk Management and
Internal Quality Assurance Program
5/16/01
Complete
Nursing Home and Assisted Living
Facility Adverse Incident Reporting
5/16/01
Complete
Nursing Home 6 Month Survey Cycles
5/16/01
Complete
Quality of Care Monitor Visits to Nursing
Homes and Assisted Living Facilities
5/16/01
Complete
Bed Vacancy Report
5/16/01
Complete
Monthly Liability Claim Report
5/16/01
Complete
Surveyor Guidelines for SB 1202
7/17/01
Complete
Increased Staffing
1/1/02
On-going
Long Term Care Reimbursement Plan
1/1/02
On-going
Nursing Home and Assisted Living
Facility Liability Insurance
1/1/02
On-going
Adverse Incident Statistics
As of 8/24/01
• Total 2675 adverse incidents
• 1975 (74%) nursing homes
• 700 (26%) assisted living facilities
• 21 investigated
Increased Monitoring
SB 1202 pages 42 & 115
(sections 18 & 46)
Nursing Homes
• Quality of Care
Monitors
• Quarterly Visits
• Focus on Risk
Management
• 209 Quarterly
Visits Conducted
to Date
Assisted Living
Facilities
• Registered Nurse
Monitors
• Extended
Congregate Care
Quarterly Visits
• Limited Nursing
Services Semiannual Visits
• 107 Visits
Conducted to Date
Liability Insurance
SB 1202 pages 52 & 140 (sections 22 & 66)
Nursing Homes
• Liability
Insurance
Required
• AHCA Action
Delayed Until
January 1, 2002
Assisted Living
Facilities
• Existing
Requirement
Remains
• AHCA Action
Delayed Until
January 1, 2002
Medicaid Nursing Home
Reimbursement
• AHCA directed to modify the nursing
home reimbursement plan to split
patient care into direct and indirect
• Eliminate an increase in the Medicaid
nursing home reimbursement rate due
to a change of ownership to an
unrelated party - Effective September 1,
2001
• AHCA annual report of direct and
indirect care costs and staff salaries
each July 1st
• AHCA to request federal waiver to use
Medicaid per diem to fund risk retention
group for self-insurance
Additional Provisions in SB 1202
• Medicaid Up or Out
• Study of Electronic Monitoring
Devices in Nursing Homes
• Moratorium on CON for Nursing
Home Beds
• SB 1202 Applies Only to Nursing
Homes and Assisted Living Facilities
Licensed Under Chapter 400
NEW
Medicaid Up or Out
• Improve the quality of care for
Medicaid residents in poor performing
nursing homes and assisted living
facilities
• Develop a pilot to demonstrate the
affect of assigning skilled and trained
medical personnel to ensure the
quality of care, safety, and continuity of
care for long-term Medicaid recipients
in the consistently poor performing
facilities
NEW
Medicaid Up or Out Strategy
• Maximize the capacity of Medicare
HMOs to manage the medical and
supportive care needs of long term
residents
• Contract for programs which would
assign skilled geriatric nurses to the
poor performing facilities
Certificate of Need Moratorium
Nursing Home Beds
• Five Year Moratorium Until
July 1, 2006
• Excludes Sheltered Beds
• Low Nursing Home Bed Occupancy
• Intended to Promote Development
of Home and Community-Based
Alternatives
Electronic Monitoring Devices
• Joint Project Between AHCA and the
Attorney General’s Office
• Initial Research Completed
• Public Meeting Scheduled in October
• Report Due January, 2002
Additional 2001 Legislation
• Immunization Requirements HB
1003 to Nursing Homes 8/24/01
-Mailed
• Additional Funding for the Teaching
Nursing Home
- Geri U Web Site
- Dementia Training Modules
• Center on Nursing
• DOEA Promulgating ALF Rules and
Nursing Home Alzheimer’s Training
• AHCA Nursing Home Rule Revisions
Workshop August 17, 2001
Update on Legislation
• Medical Director Requirements
59A-4.1075, Effective August 2,
2001
• Nursing Home Gold Seal Rule 59A4.200, Effective August 17, 2001
• Nursing Home Guide
Beta Testing for Internet
• Consumer Satisfaction Survey
Medical Director Criteria
• Designate One Physician to Serve as
Medical Director
• Must Have Hospital Privileges or be
Certified or Credentialed
• Principle Office within 60 Miles
(Exceptions for Rural Locations)
• Maximum of Ten Facilities
• Visit Facility at least Once a Month
• Review all Policies, Incident Reports,
and Grievance Logs for Clinical Issues
Gold Seal Award Criteria
Nursing Home Must Be Licensed
For 30 Months
Quality of Care Standards
• Consider Past 30 Months
• Top 25% In Quality of Care Rank
• No Conditional Licenses
• No Class I or II Deficiencies
Gold Seal Award Criteria
Financial Standards
• Free of Bankruptcy Proceedings
For Past 30 Months
• Meet Two of Three Financial
Thresholds Over 30 Months or All
Three Thresholds For Past SixMonths:
- Positive Current Ratio of At Least One
- Positive Tangible Net Worth
- Time Interest Earned Ratio of At Least
115%
Gold Seal Award Criteria
Staff Stability
• Turnover Rate of Not More Than
85%
• A Stability Rate of At Least 50%
• Evidence of Efforts To Maintain
Stable Workforce
Gold Seal Award Criteria
• Outstanding Ombudsman Complaint
History
• Evidence of Family And Community
Involvement
• Targeted In-Service Training
Programs
Gold Seal Review
• Governor’s Panel on Excellence in
Long Term Care will Review
Applications at Meetings (Locations
Vary)
• Opportunity to Present Before the
Governor’s Panel on Excellence in
Long Term Care
• Facility Site Visit by Panel Members
• Recommendations to Governor
Gold Seal Application
Nursing Home Guide
Information
AHCA Web Site: www.fdhc.state.fl.us
See Nursing Home Guide Button
Elizabeth Dudek, Deputy Secretary
Managed Care and Health Quality
(850) 487-2528
Journey Through Chapter 400
Changes
2001 Senate Bill 1202
Regulatory Impact on Florida Nursing
Homes
Relevant Materials
• Bill on Page 15 of Handouts
• New 2001 Statutes Available:
www.myflorida.com
• ASPEN State Regulation Set for
Nursing Home Licensure
- Survey Guidance
- Available AHCA (850) 488-5861
Public Records
• All Records at AHCA are Public
Record
• Unless Specifically Exempt from Public
Review (Adverse Incidents)
- Each Letter Received
- Each Survey Report
- Each Application Submitted
• Hundreds of Requests Each Month
• Accuracy of Information Submitted is
Critical, Including Resident Census
672
Quality Measures
• Nursing Home
Risk Management
• Assisted Living
Adverse Incident
Reporting
• Increased Monitor
Visits by the
Agency
• Nursing Home
Staffing
Requirements
• Staff Training
• Discharge &
Transfer
• Liability Insurance
• Care Plan Signed
by DON and
Resident
• Physician Referral
for Signs of
Dementia or
Cognitive
Impairment
• Daily ADL Charting
Risk Management
SB 1202 pages 53
(section 24)
Nursing Homes
• Risk Manager
• Program & Committee
• Monthly Meetings
• Adverse Incident Investigation &
Report
AHCA Risk Management Forms
• 1-Day Adverse Incident Report
• 15-Day Adverse Incident Report
• Monthly Report of Liability Claim
Information
Nursing Home Risk Manager
Question – Must a nursing home risk manager be
licensed or credentialed?
Answer - Section 400.147(1)(a) does not require
that the risk manager have particular
credentials, only that the facility have a risk
manager designated who is responsible for the
implementation and oversight of the facility’s
risk management and quality assurance
program.
Adverse Incident Reports
SB 1202 page 55
(sections 24)
Nursing Home
• Initial Report
• 3 Days to Risk Manager
• 1 Day from Risk Manager to Agency
• Complete Report 15 Days to Agency
Adverse Incidents Defined
Facility Responsibility
Nursing Homes
An event over which facility
personnel could exercise control
and which is associated in whole
or in part with the facility's
intervention, rather than the
condition for which such
intervention occurred, and which
results in one of the following:
Adverse Incidents Defined
Facility Responsibility
•
•
•
•
•
•
•
Death
Brain or spinal damage
Permanent disfigurement
Fracture or dislocation of bones or joints
A limitation of neurological, physical, or sensory
function
Any condition that required medical attention to
which the resident has not given his or her consent,
including failure to honor advanced directives
Any condition that required the transfer of the
resident, within or outside the facility, to a unit
providing a more acute level of care due to the
adverse incident, rather than the resident's condition
prior to the adverse incident
Adverse Incidents Defined
Facility Responsibility is Not Considered
for:
• Abuse, neglect, or exploitation as
defined in s.415.102
• Abuse, neglect and harm as defined in
s. 39.01
• Resident elopement
• An event that is reported to law
enforcement
Resident Elopement
Question: How is “elopement” defined for
the purposes of adverse incident
reporting?
Answer: Elopement is when a resident
leaves the facility without following
facility policy and procedure.
Adverse Incident Reporting
Question – If, prior to the required report date, facility
staff determine that an incident does not meet the
definition of an adverse incident as specified in
statute, is a report to the Agency still required?
Answer – Only those incidents that meet the
definition of an Adverse Incident must be reported
to the Agency. If the facility is able to determine
that the incident does not meet the definition,
prior to the required report date, then a report is
not required. However, if the facility has not yet
determined if the incident meets the definition the
incident must be reported on the 1-Day report.
After the facility investigation is complete and if it
is determined that the incident does not meet the
definition of an adverse incident, then the facility
staff may report on the 15-Day report that the
incident was determined not to be an adverse
incident.
Confidential Nursing Home Initial
Adverse Incident Report – 1 Day
Confidential Nursing Home Complete
Adverse Incident Report – 15 Day
AHCA Adverse Incident Review
1- Day Reports are reviewed by a clinician
to determine necessary AHCA
involvement. Possible outcomes:
• Decision to wait for 15 – Day Report
(facility investigation)
• For situations that rise to level of threat
to resident health and safety:
*On-site review by Field Office
surveyors
*Review of report for possible
practitioner involvement
• Additional information requested
AHCA Adverse Incident Review
15- Day Reports are reviewed by a
clinician to determine necessary
AHCA involvement. Possible
outcomes:
• On-site review by surveyors for
situations that rise to level of threat
to resident health and safety
• Review of report for possible
practitioner involvement
• No action necessary
• Reports will be used for surveyor offsite preparation
Adverse Incident Reports
When completing a report, providing
answers to basic questions allows
AHCA reviewers to determine
appropriate action.
Basic Questions:
Who, What, Where, When, Why
AHCA Annual
Adverse Incident Reports
AHCA Annual Reports to Legislature
detailing:
• Total number of adverse incidents
by county
• Categories of incidents and type of
staff involved
• Types and number of injuries by
categories
• Types of liability claims filed based
on adverse incidents
• Disciplinary action taken against
staff
Nursing Home Monthly
Liability Claim Information
Nursing Home Monthly Liability Claim
Information Form Completion
• Include the Facility Name on Each
Form
• Do Not Use the Monthly Liability
Claim Information Form to Report
Adverse Incidents
Nursing Home Staffing
SB 1202 page 72 (section 30)
Hours of Direct Care per Resident per Day
Certified Nursing
Assistants
• 1/1/02 - 2.3 Hours
Never Below 1:20
• 1/1/03 - 2.6 Hours
• 1/1/04 - 2.9 Hours
Licensed Nurses
• Effective 1/1/02
• 1.0 Hours
• Never Below 1:40
Never Below 1:20 CNA and 1:40 Licensed Nurse is
an Alternative to Per Shift Ratios
Staff Counted Toward Ratio
SB 1202 page 72 (section 30)
• Nursing Assistants (awaiting
certification – see definition 400.211)
may be counted toward CNA ratio if
providing nursing assistance services to
residents on a full-time basis
• 4-Month Window - in an approved (by
Dept of Education) training program or
awaiting reciprocity
• CNAs and Licensed Nurses – time spent
providing direct care to residents
• Nurse Managers – can count time spent
providing direct care if part of their
duties
Report Staffing Information
SB 1202 page 50 (section 22)
• 400.141(15) Requires minimum of semiannual reporting of staff ratios,
turnover and stability to AHCA
• Gold Seal criteria
• Ratio in categories specified in
400.23(3)(a) and rules – average for the
most recent calendar quarter
• Turnover for most recent 12-month
period
• Staff stability – employees employed
for more than 12 months
Report Staffing Information
Question - When will providers have to
begin submitting staff information to
the Agency? Will the format for
reporting be specified by the Agency?
Answer – The Agency will request the first
report in October 2001 for the period
ending September 30, 2001. The report
format will be provided by the Agency.
Moratorium for Insufficient Staff
SB 1202 page 51 (section 22)
• Self-Imposed Moratorium
• No New Admissions if Fail to Meet
Staffing Minimums for 2 Consecutive
Days
• Moratorium Stands Until Staffing
Minimums are Achieved for 6
Consecutive Days
• Class II Deficiency for Failure to Comply
Alzheimer’s Training &
Information for Nursing Homes
SB 1202 page 62 (section 26)
• Alzheimer’s Information Provided to
All Staff
• For Staff Hired After July 1, 2001:
– 1- Hour Training for Direct Contact
Staff
– 3- Hours Training for Direct Care
Staff
Alzheimer’s Training
Direct Contact
Question - For the purpose of the required
1-hour training, how is "direct contact"
defined? Would this definition include
housekeeping and dietary personnel?
Answer – Guidance to surveyors defines
direct contact as person to person
contact whether the contact be
physical, verbal, or within the
resident’s surroundings. Staff meeting
this definition include but are not
limited to nursing staff, dietary staff,
activity staff, social service staff,
housekeeping staff and maintenance
staff.
Alzheimer’s Training
Direct Care
Question - For the purposes of the
required 3-hour training, how is "direct
care" defined? Would this definition
include only nursing staff or therapists
and others?
Answer – Direct care would include
providing personal or health care
services to residents.
Efforts to Develop Training
• Department of Elder Affairs
Final Criteria Not Yet Approved
• Teaching Nursing Home
• Alzheimer's Resource Center
Alzheimer’s Training
Affected Staff / CNA Inservice
Question - Are all existing direct care staff required to
have 3 hours of Alzheimer’s training by July 1, 2002
or only those hired after July 1, 2001?
Answer - Only those hired after July 1, 2001. However,
all staff are required to have the skills and education
to provide the necessary care and services to
residents.
Question - Can the Alzheimer’s training requirement
count toward the 18 hours of CNA training required
annually?
Answer – Yes.
Certified Nursing Assistants
SB 1202 pages 68 &124 (sections 29 & 50)
Nursing Homes CNA In-service
400.211(4)
• Requires 18 Hours of In-service
Annually
• In-service Must Address Areas of
Weakness As Determined by CNA
Performance Review
Certification of All CNAs 464.203
• Requires Work in a 24 Month Period
to Maintain Certification
• Requires 18 Hours of In-service Each
Calendar Year
Discharge & Transfer
SB 1202 pages 36 (sections 13)
Nursing Homes
• AHCA Notice only Required if Facility
Initiated
• Notice Not Required if Initiated by
Resident or Resident’s Physician
• Consistent with Federal Notice
Requirements
Revised Discharge/Transfer Forms
English & Spanish
Nursing Home
Discharge & Transfer
Question – If the resident’s physician signs for the
resident’s discharge is the AHCA Discharge
and Transfer Notice required?
Answer – 400.0255 requires the notice only for
discharge initiated by the facility, not the
resident or resident’s physician.
Question – Does a Baker Act transfer require use
of the AHCA Discharge and Transfer Notice?
Answer – 400.0255 requires the notice only for
discharge initiated by the facility, not the
resident or resident’s physician.
Nursing Home Care Plan Definition
SB 1202 page 14 (section 2)
• Director of Nursing
• Resident, Resident’s Designee or
Resident’s Legal Representative
Nursing Home Care Plan
DON Signature Delegation
Question - Can anyone else sign care
plans in case of DON incapacity or
unavailability?
Answer – Guidance to Surveyors (N0076)
details delegation of the DON signature
to the Assistant DON in accordance
with 59A-4.108(1) or to another nurse
(registered) through formal delegation
of institutional responsibilities
demonstrates compliance. Such
delegation should be documented and
remain on file.
Nursing Home Care Plan
DON Signature
Question – How often must the Director of Nursing (DON)
sign the care plan?
Answer – The care plan must be signed by the DON each
time it is completed, i.e. quarterly or when a
significant change has occurred.
Question - Where does the DON sign the care plan?
Answer - The law does not specify where the DON should
sign on the actual care plan. Each facility should
develop a policy and procedure on the signature
requirement.
Question – By what date must the DON must sign the
care plan?
Answer – Guidance to Surveyors (N0076) indicates
signature within 7 days of the comprehensive
assessment as the care plans must be completed
within 7 days.
Nursing Home Care Plan
Resident Signature
Question – What is the facility’s responsibility if
the resident or resident representative will not
sign the care plan?
Answer – The facility staff should document and
retain on file, efforts to obtain the resident
signature.
Referral for Evaluation of Dementia or Cognitive
Impairment
SB 1202 pages 51 (sections 22)
Nursing Homes
Question - When a facility notifies a physician that a
resident exhibits signs of dementia or cognitive
impairment, what is the facility responsibility after
that notification?
Answer - Facilities already have the obligation to
implement appropriate interventions for a change
in condition.
Daily ADL Charting
SB 1202 page 50 (section 22) 400.141(21)
• Resident medical record must include a daily
chart of certified nursing assistant services.
• The certified nursing assistant who is caring for
the resident must complete this record by the
end of his or her shift.
• This record must indicate assistance with
activities of daily living, assistance with eating,
and assistance with drinking, and must record
each offering of nutrition and hydration for
those residents whose plan of care or
assessment indicates a risk for malnutrition or
dehydration.
Enhanced Enforcement
• Controlling Interest Information
Disclosure
• Six-Month Survey Cycle for Nursing
Homes
• Classification of Deficiencies
• Fines for Violations
• Enhanced Grounds for Agency Action
• Required Nursing Home Revocation or
Denial for Certain Violations
Nursing Home Controlling Interest
SB 1202 page 12 (section 2)
AHCA May Deny Application Based on Adverse
Action
Defined as:
• Applicant
• Licensee
• Management
Company
• Interest in Above:
- 5% or Greater
Ownership Interest
- Officer
- Board of Directors
(Excludes
Voluntary
Board Members)
Disclosure Required at:
• Initial Application
• Change of Licensed
Operator (CHOW)
• Renewal Application
• Change in
Management
Company
AHCA Form for
Required Disclosure
Controlling Interest Disclosure Form
Six-Month Survey Cycle
400.19 - SB 1202 page 65 (section 27)
Requires 6-month survey cycle for 2
years for a nursing home that has
• been:
Cited for a Class I deficiency,
• Cited for two or more Class II
deficiencies arising from separate
surveys or investigations within a 60day period, OR
• Three or more substantiated
complaints within a 6 month period,
each resulting in at least one Class I or
II deficiency
• Cited for last deficiency after 5/15/01
• Seven facilities qualify as of 8/23/01
Six-Month Survey Fine
• $6,000 fines for the 2-year period
($3,000 per extra survey)
• Half ($3,000) paid at the completion
of each survey
• Agency may adjust the fine by
consumer price index
• Fine to be assessed by
administrative complaint
Deficiencies
SB 1202 pages 77 (sections 30)
Nursing Homes
• Create Definition of “Scope” in State
Law
• Create Class IV
• Align State Classification with Federal
Assignment of Scope and Severity
Scope of Deficiencies
400.23(8) SB 1202 page 76 (section 33)
The scope shall be cited as isolated, patterned, or
widespread. An isolated deficiency is a deficiency
affecting one or a very limited number of residents,
or involving one or a very limited number of staff, or
a situation that occurred only occasionally or in a
very limited number of locations. A patterned
deficiency is a deficiency where more than a very
limited number of residents are affected, or more
than a very limited number of staff are involved, or
the situation has occurred in several locations, or
the same resident or residents have been affected by
repeated occurrences of the same deficient practice
but the effect of the deficient practice is not found to
be pervasive throughout the facility. A widespread
deficiency is a deficiency in which the problems
causing the deficiency are pervasive in the facility or
represent systemic failure that has affected or has
the potential to affect a large portion of the facility's
residents.
Class IV Deficiency
400.23(8)(d) SB 1202 page 79 (section 33)
• A deficiency that the agency
determines has the potential for
causing no more than a minor
negative impact on the resident.
• If the Class IV deficiency is isolated,
no plan of correction is required.
• Correlates to A, B, or C level
deficiency
State & Federal Correlation
Class I
Isolated = J
Pattern = K
Widespread = L
Class III
Isolated = D
Pattern = E
Widespread = F
Class II
Isolated = G
Pattern = H
Widespread = I
Class IV
Isolated = A
Pattern = B
Widespread = C
Conditional License Issued for Citation of a Class I, Class II
or Uncorrected Class III
Enforcement Matrix
LONG TERM CARE FACILITIES ENFORCEMENT MATRIX
SEVERITY
Immediate Jeopardy to
Resident Health or
Safety
Actual Harm that is not
Immediate Jeopardy
No Actual Harm with
Potential for More than
Minimal Harm that is
not Immediate Jeopardy
No Actual Harm with
Potential for Minimal
Harm
SCOPE
POC
POC
POC
Required: Cat. 3
Optional: Cat. 1
Optional: Cat. 2
Class I
J
POC
Required: Cat. 3
Optional: Cat. 1
Optional: Cat. 2
Class I
K
POC
Required: Cat. 3
Optional: Cat. 2
Optional: Cat. 1
Class I
L
POC
Required* Cat. 2
Optional: Cat. 1
Required* Cat. 2
Optional: Cat. 1
Class II
G
POC
Class II
H
POC
Required* Cat. 2
Optional: Cat. 1
Optional:
Temporary Mgmt.
Class II
I
POC
Required* Cat. 1
Optional: Cat. 2
Class III
D
No POC
No Remedies
Commitment to Correct
Not on HCFA-2567
ClassIV
A
Required* Cat. 1
Optional: Cat. 2
Class III
E
Required* Cat. 2
Optional: Cat. 1
Class III
F
POC
POC
Class IV
B
Class IV
C
Isolated
Pattern
Widespread
Fines
SB 1202 pages 77 (sections 30)
Nursing Homes
• Required Fine Amounts
• Fines for Class II Regardless of
Correction
• Based on Classification and Scope of
Deficiency
• Effect for Surveys Completed 5/16/01
• Six-month Survey Fine
Nursing Home Fine Amounts
400.23(8) - SB 1202 page 77
(section 30)
Class I
Isolated (J) 10,000 / 20,000*
Pattern (K) 12,500 / 25,000*
Widespread (L) 15,000 / 30,000*
Class II
Isolated (G) 2,500 / 5,000*
Pattern (H) 5,000 / 10,000*
Widespread (I) 7,500 / 15,000*
Class III (uncorrected)
Isolated (D) 1,000 / 2,000*
Pattern (E) 2,000 / 4,000*
Widespread (F) 3,000 / 6,000*
* The fine amount
shall be doubled
for each
deficiency if the
facility was
previously cited
for one or more
class I or class II
deficiencies
during the last
annual
inspection or any
inspection or
complaint
investigation
since the last
annual
inspection.
Nursing Home Fines
• Uncorrected deficiencies are finable as
independent deficiencies
• If a deficiency is uncorrected upon
revisit as Class III, it is finable as an
uncorrected Class III even if it was
previously cited at a higher level (Class
I or II)
• No fine is imposed for a Class IV
deficiency
Fine Process
• Initial Notice by:
Administrative Complaint
(Deficiencies) or
Intent to Impose Letter (Late
Application Fines)
- Elect to Pay or Challenge
- 21 Days to Request Hearing
• Final Order Imposes Fine with 30
Days to Pay
• If Not Paid, License May be
Denied or Revoked
Nursing Homes
Required Denial & Revocation
400.121(3) SB 1202 page 45
(section 20)
• The Agency shall revoke or deny a nursing
home license if the licensee or controlling
interest operates a facility in the state that has:
• Two moratoria for substandard quality of care
in a 30 month period,
• Conditional license for 180 consecutive days,
• Two class I deficiencies on separate surveys in
a 30 month period, OR
• Two class I deficiencies on same survey for
unrelated circumstances.
• Licensee may present factors in mitigation of
the action.
Enhanced Grounds for Action
Nursing Home
• Unpaid Fines
• Alteration of Records
Additional Licensure Requirements
in SB 1202
Nursing Homes
• Report Management Company
Renewal and Change
• Vacant Bed Reporting
• Report Bankruptcy, Corporate
Reorganization, or Transfer of
Assets
Additional Licensure Requirements
in SB 1202
• Resident Grievance Procedure
• Post Watch List
• Dining & Hospitality Attendant
Program
Vacant Bed Reporting
Assistance with Eating
Question – Who can assist a resident with eating?
Answer – The Health Care Financing Administration
(now CMS) defines assistance with eating, such as
feeding a resident, as a nursing related service. The
only staff who can provide nursing and nursing related
services are nurses aides, licensed health
professionals, registered dietitians or licensed
dietitian/nutritionists and volunteers.
Licensed health professionals are defined [42 CFR
483.75(e)(1)] as a physician, physician assistant, nurse
practitioner, physical therapist, speech therapist,
occupational therapist, physical or occupational
therapy assistant, registered professional nurse,
license practical nurse or licensed or certified social
worker.
Accompanying a resident during meal-time or queuing
a resident to eat are not considered nursing related
services.
Feeding or hand-over-hand assistance are nursing
related services.
AHCA Duties
Nursing Home Survey Staff
SB 1202 page 80 (section 32)
• New Surveyors Spend Two Days in a
Nursing Home
• Joint Training for Surveyors and
Providers
• 50% of Surveyor Training in Geriatric
Care
• Geriatric Experienced Physician or
Nurse Participation in Informal Dispute
Resolution for Substandard Quality of
Care
Resources * Forms * Information
AHCA Web Site: www.fdhc.state.fl.us
Long-Term Care Unit (850) 488-5861
Presentation Materials
This presentation was made during
State-wide Provider
Training September, 2001
Material must be reviewed in conjunction
with applicable statues and rules