A Message of Change Agency for Health Care Administration

1
A Message of Change Agency for Health Care
Administration

• 2001 Legislation Affecting
• Florida Nursing Homes and
• Assisted Living Facilities

2
Senate Bill 1202 - Initiatives

• Quality Enhancements
• Enhanced Enforcement
• Tort Reform
• Signed May 15, 2001

3
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
4
Adverse Incident StatisticsAs of 8/24/01

• Total 2675 adverse incidents
• 1975 (74) nursing homes
• 700 (26) assisted living facilities
• 21 investigated

5
Increased MonitoringSB 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 Semi-annual Visits
• 107 Visits Conducted to Date

6
Liability InsuranceSB 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

7
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

8
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

9
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

10
NEWMedicaid 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

11
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

12
Electronic Monitoring Devices

• Joint Project Between AHCA and the Attorney
  Generals Office
• Initial Research Completed

• Public Meeting Scheduled in October

• Report Due January, 2002

13
Additional 2001 Legislation

• Immunization Requirements HB 1003

-Mailed to Nursing Homes 8/24/01

• Additional Funding for the Teaching Nursing Home

• - Geri U Web Site
• - Dementia Training Modules
• Center on Nursing

• DOEA Promulgating ALF Rules and Nursing Home
  Alzheimers Training
• AHCA Nursing Home Rule Revisions Workshop August
  17, 2001

14
Update on Legislation

• Medical Director Requirements 59A-4.1075,
  Effective August 2, 2001
• Nursing Home Gold Seal Rule 59A-4.200, Effective
  August 17, 2001
• Nursing Home Guide
• Beta Testing for Internet
• Consumer Satisfaction Survey

15
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

16
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

17
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
  Six-Months
• - Positive Current Ratio of At Least One
• - Positive Tangible Net Worth
• - Time Interest Earned Ratio of At Least 115

18
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

19
Gold Seal Award Criteria

• Outstanding Ombudsman Complaint History
• Evidence of Family And Community Involvement
• Targeted In-Service Training Programs

20
Gold Seal Review

• Governors Panel on Excellence in Long Term Care
  will Review Applications at Meetings (Locations
  Vary)
• Opportunity to Present Before the Governors
  Panel on Excellence in Long Term Care
• Facility Site Visit by Panel Members
• Recommendations to Governor

21
Gold Seal Application
22
Nursing Home Guide
23
Information

• AHCA Web Site www.fdhc.state.fl.us
• See Nursing Home Guide Button
• Elizabeth Dudek, Deputy Secretary
• Managed Care and Health Quality
• [phone]

24
Journey Through Chapter 400 Changes

• 2001 Senate Bill 1202
• Regulatory Impact on Florida Nursing Homes

25
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 [phone]

26
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

27
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

28
Risk ManagementSB 1202 pages 53 (section 24)

• Nursing Homes
• Risk Manager
• Program Committee
• Monthly Meetings
• Adverse Incident Investigation Report

29
AHCA Risk Management Forms

• 1-Day Adverse Incident Report
• 15-Day Adverse Incident Report
• Monthly Report of Liability Claim Information

30
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 facilitys
  risk management and quality assurance program.

31
Adverse Incident ReportsSB 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

32
Adverse Incidents DefinedFacility 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

33
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

34
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

35
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.

36
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.

37
Confidential Nursing Home Initial Adverse
Incident Report 1 Day
38
Confidential Nursing Home Complete Adverse
Incident Report 15 Day
39
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

40
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 off-site
  preparation

41
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

42
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

43
Nursing Home Monthly Liability Claim Information
44
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

45
Nursing Home StaffingSB 1202 page 72 (section
30)Hours of Direct Care per Resident per Day

• Certified Nursing Assistants
• 1/1/02 - 2.3 Hours Never Below 120
• 1/1/03 - 2.6 Hours
• 1/1/04 - 2.9 Hours

• Licensed Nurses
• Effective 1/1/02
• 1.0 Hours
• Never Below 140

Never Below 120 CNA and 140 Licensed Nurse is
an Alternative to Per Shift Ratios
46
Staff Counted Toward RatioSB 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

47
Report Staffing InformationSB 1202 page 50
(section 22)

• 400.141(15) Requires minimum of semi-annual
  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

48
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.

49
Moratorium for Insufficient StaffSB 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

50
Alzheimers Training Information for Nursing
HomesSB 1202 page 62 (section 26)

• Alzheimers 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

51
Alzheimers TrainingDirect 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
  residents 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.

52
Alzheimers TrainingDirect 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.

53
Efforts to Develop Training

• Department of Elder Affairs

Final Criteria Not Yet Approved

• Teaching Nursing Home
• Alzheimer's Resource Center

54
Alzheimers Training Affected Staff / CNA
Inservice

• Question - Are all existing direct care staff
  required to have 3 hours of Alzheimers 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 Alzheimers training
  requirement count toward the 18 hours of CNA
  training required annually?
• Answer Yes.

55
Certified Nursing AssistantsSB 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

56
Discharge TransferSB 1202 pages 36 (sections
13)

• Nursing Homes
• AHCA Notice only Required if Facility Initiated
• Notice Not Required if Initiated by Resident or
  Residents Physician

• Consistent with Federal Notice Requirements

57
Revised Discharge/Transfer FormsEnglish Spanish
58
Nursing Home Discharge Transfer

• Question If the residents physician signs for
  the residents 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 residents 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 residents physician.

59
Nursing Home Care Plan DefinitionSB 1202 page 14
(section 2)

• Director of Nursing
• Resident, Residents Designee or Residents Legal
  Representative

60
Nursing Home Care PlanDON 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.

61
Nursing Home Care PlanDON 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.
•  

62
Nursing Home Care PlanResident Signature

• Question What is the facilitys 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.

63
Referral for Evaluation of Dementia or Cognitive
ImpairmentSB 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.

64
Daily ADL ChartingSB 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.

65
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

66
Nursing Home Controlling InterestSB 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

67
Controlling Interest Disclosure Form
68
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 60-day period, OR
• Three or more substantiated complaints within a 6
  month period, each resulting in at least one
  Class I or II deficiency
• Seven facilities qualify as of 8/23/01

• Cited for last deficiency after 5/15/01

69
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

70
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

71
Scope of Deficiencies400.23(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.

72
Class IV Deficiency400.23(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

73
State Federal Correlation

• Class I
• Isolated J
• Pattern K
• Widespread L
• Class II
• Isolated G
• Pattern H
• Widespread I

• Class III
• Isolated D
• Pattern E
• Widespread F
• Class IV
• Isolated A
• Pattern B
• Widespread C

Conditional License Issued for Citation of a
Class I, Class II or Uncorrected Class III
74
Enforcement Matrix
75
LONG TERM CARE FACILITIES ENFORCEMENT MATRIX
76
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

77
Nursing Home Fine Amounts400.23(8) - SB 1202
page 77 (section 30)
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.

• 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

78
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

79
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

80
Nursing Homes Required Denial
Revocation400.121(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.

81
Enhanced Grounds for Action

• Nursing Home
• Unpaid Fines
• Alteration of Records

82
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

83
Additional Licensure Requirements in SB 1202

• Resident Grievance Procedure
• Post Watch List
• Dining Hospitality Attendant Program

84
Vacant Bed Reporting
85
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.

86
AHCA Duties Nursing Home Survey StaffSB 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

87
Resources Forms Information

• AHCA Web Site www.fdhc.state.fl.us
• Long-Term Care Unit [phone]

88
Presentation Materials

• This presentation was made during
• State-wide Provider
• Training September, 2001
• Material must be reviewed in conjunction with
  applicable statues and rules