7.1 If my agency is only going to offer non-skilled services and is not Medicare or Medicaid certified, do I need to have a Director of Nursing?
No . Home health agencies that offer only home health aide and homemaker/companion services and do not offer nursing or other therapy services and are not Medicare or Medicaid certified do not require a Director of Nursing. They need, however, to have an RN on staff to supervise the care provided by home health aides and certified nursing assistants per Section 400.487 (3), Florida Statutes and Section 59A-8.0095 (3) (b), Florida Administrative Code. This individual does not have to be full time. Non-skilled agencies do not have to notify the Agency when the RN is terminated or replaced except at the time their license is renewed.
7.2 If my agency is only going to offer physical, occupational, or speech therapy and is not Medicare or Medicaid certified do I need to have a Director of Nursing?
Home health agencies that offer therapy services only do not have to have a director of nursing.
7.3 Our company has a licensed home health agency that provides nursing and other services. We would like to get a license to open a non-skilled home health agency. Can we have the office at the same address or in the same office building complex?
No. The state law (400.471 (7), Florida Statutes says: “The agency may not issue an initial license to an applicant for a home health agency license if the applicant shares common controlling interests with another licensed home health agency that is located within 10 miles of the applicant and is in the same county. The agency must return the application and fees to the applicant.”
7.4 Do we have to have a registered nurse for a non-skilled home health agency?
Yes, for the following reasons:
a. To provide supervision of home health aides and certified nursing assistants:
“A home health agency shall arrange for supervisory visits by a registered nurse to the home of a patient receiving home health aide services in accordance with the patient’s direction, approval, and agreement to pay the charge for the visits.” 400.487(3), Florida Statutes (F.S.) Note: Home health aide services are also provided by certified nursing assistants.
“A registered nurse may assign selected portions of patient care to licensed practical nurses and home health aides but always retains the full responsibility for the care given and for making supervisory visits to the patient’s home.” Note: Home health agencies must obtain the patient’s verbal permission to send an RN into the home to do supervisory visits. [59A-8.0095(3)(b) and (5)(b), Florida Administrative Code(FAC), and 400.487(3), F.S.]
There must be a supervisor available for the staff to call if needed during the hours of patient service. [59A-8.003(10)(d), FAC]
b. To review patient medications if a home health aide or certified nursing assistant is to assist the patient with self-administered medications – to make sure that the caregiver is able to provide assistance in accordance with their training and the medication prescription. [59A-8.0095(5)(m), FAC, and 400.488, F.S.]
Note: Filling pill boxes or other types of medication reminder systems is a nursing service and cannot be done by a non-skilled home health agency that does not provide nursing services.
7.5 For a new non-skilled home health agency license, do we have to complete all items on the application form?
All items on the application form must be completed or marked “Not Applicable” or NA. However, there are some differences for non-skilled agencies as listed below.
On the Home Health Agency Application Form (Recommended version):
Item 3.D. Administration – Do not submit a Director of Nursing or an Alternate Director of Nursing. Submit an RN.
Item 7. Federal Certification or other Federal Provider Numbers - The answers to the Medicare and Medicaid questions should be No. However, complete the “Other Medicaid Provider Numbers” with the type of Medicaid Waiver and number if you have any.
Item 9. Personnel - At least a part-time registered nurse is needed per question 7.4 above.
Item 12 – Accreditation/Deemed Status – write “Not Applicable “or NA on this item, unless you elect to become accredited. Accreditation is not required.
7.6 Our company got a license for a home health agency last year that will provide nursing and other skilled services as well as non-skilled services, got accredited, and applied for Medicare. We would like to give up our accreditation, withdraw our Medicare application and become a non-skilled home health agency. What do we need to do?
Submit the following to the AHCA Home Care Unit, 2727 Mahan Drive -Mail Stop 34, Tallahassee, FL 32308:
1. Prepare a cover letter that says your home health agency wants to only provide home health aide, certified nursing assistant, homemaker and companion services; is giving up its accreditation; and is withdrawing its Medicare application with CMS (if your agency has applied for Medicare).
2. Enclose the following items with the letter.
a. A copy of your letter to the accrediting organization telling them your agency is giving up its accreditation with an effective date.
b. If you have applied for Medicare, a copy of your letter to the Medicare Regional Home Health Fiscal Intermediary, Palmetto GBA that says you are withdrawing your agency’s CMS 855A Medicare application and a copy of the sections of the CMS 855A Medicare enrollment form (that are specified on page 6 of the form) that was sent with the letter to Palmetto GBA.
c. Revised Home Health Agency Licensure Application pages that show your agency no longer provides any skilled services. These pages are:(1) Page 4, item D, remove the Director of Nursing(DON) and Alternate DON, add an RN. This can be the RN that was your agency’s DON.
(2) Page 7, Federal Certification and Other Federal Provider numbers. If you checked Yes to Medicare, remove the Yes from Medicare. A non-skilled home health agency may be able to apply to provide personal care under a Medicaid Waiver program.
(3) Page 9, item 9 -Personnel. Show the RN that is from Page 4 under Nursing. Remove the other skilled services and include only the non-skilled services: home health aide, homemaker/companion, and CNAs. If the box in 9C for providing skilled services to children is checked “Yes”, change it to “No”.
(4) Page 10, item 11, uncheck the box regarding a 24 hour on-call system for skilled services and item 12, remove all items related to having accreditation.
d. An updated business plan for non-skilled services.
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