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FREQUENTLY ASKED QUESTIONS NURSE REGISTRIES

The frequently asked questions include the following:

What is a nurse registry: Section 1How to apply for a nurse registry license: Section 2Initial survey requirements: Section 3Administrative and other staff requirements: Section 4Independent Contractor requirements: Section 5Background screening requirements: Section 6Geographic service areas requirements: Section 7Reporting changes to AHCA: Section 8Emergency management plan: Section 9Renewing nurse registry licenses: Section 10State law changes: Section 11Change of ownership Section 12

Section 1: What is a nurse registry

1.1 What is a Nurse Registry and how does it differ from a Home Health Agency, and a Health Care Services Pool?

A nurse registry as defined in 400.462, Florida Statutes (F.S.). is an agency that offers health-care-related contracts for registered nurses, licensed practical nurses, certified nursing assistants, home health aides, companions or homemakers who are paid by fees as independent contractors. The agency is required to be licensed as a nurse registry in order to offer the contracts. Some of the differences between a nurse registry and other types of health related providers are included below:

A nurse registry and a home health agency may provide services that are privately paid for by insurance or other means to patients in their home or place of residence and provide staff to health care facilities, schools, or other business entities on a temporary or school year basis.

A health care services pool may hire or contract with individuals and assign them to health care facilities to support or supplement the facilities’ work force in temporary work situations such as employee absences, temporary skill shortages, seasonal workloads, and special assignments and projects but cannot provide private duty staffing or enter into direct contracts with individuals to provide services.

A nurse registry and a health care services pool do not qualify for Medicare reimbursements; a home health agency does.

A nurse registry cannot have any employees except for the administrator, alternate administrator and office staff – all individuals who enter the home of patients to provide direct care must be independent contractors.

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A home health agency and a health care services pool may hire employees or contract with independent contractors to provide staffing. However, a home health agency must provide at least one service directly.

A nurse registry is limited to contracting with only registered nurses, licensed practical nurses, certified nursing assistants, home health aides, homemakers, and companions.

These are only a few of the differences. For more information, please review the Florida Statutes and the Florida Administrative Code (State Rules) with each of these programs at this web site.

Section 2: How to apply for a nurse registry license:

2.1 What laws and rules should I be familiar with in order to open and operate a nurse registry? New applicants should read the following found on or linked to the AHCA website under Nurse Registry:

a. Florida Statutes Chapter 400 Part III b. Florida Administrative Code 59A-18 c. Florida Statutes Chapter 408 Part IId. Florida Administrative Code 59A-35

Part II of Chapter 408 is the referred to as the Health Care Licensing Procedures Act and applies to all programs licensed by the Agency for Health Care Administration. Information on the legislation can be found at the Agency web site http://ahca.myflorida.com/MCHQ/Corebill/index.shtml. These Frequently Asked Questions contain updated information as a result of the passage of the legislation. The Web site also contains the new forms needed to comply with the reporting requirements of Chapter 408, Part II, and Initial Application Instructions to help applicants prepare their paperwork for licensure as a nurse registry.

Note: Always check the AHCA website for updates to frequently asked questions, the law, rules, survey standards, emergency management contacts & other information.

2.2 How much does it cost and how long is the license issued for? The application fee is $2,000. Licenses are issued for two (2) years. The licensure fee is non-refundable.

2.3 How long does it take to receive my license after submitting my application to the Home Care Unit?

a) The entire application and initial survey process may take from 3 to 4 months, at a minimum. Field offices must conduct an initial licensure survey once the application has been found to be complete by the Home Care Unit in Tallahassee.

b) Your initial application will be reviewed within thirty days of receipt. If there are omissions, a letter will be sent to you. You will have one opportunity to respond

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http://ahca.myflorida.com/MCHQ/Corebill/index.shtml

to the items in the omission letter within 21 days of receipt of the omission letter. The responses are sent to the Specialist who signed the omission letter at the Home Care Unit. . c) An applicant is prohibited from operating as a nurse registry until such time as the license has been issued in accordance with state law. Within 60 days after the receipt of a complete application, which includes having passed a survey, the agency shall approve or deny the application

2.4 What paperwork must be provided to the Home Care Unit to obtain the license?

The following forms are used for initial, renewal and change of ownership (CHOW) licensure:

a. AHCA Form 3110-7004 Nurse Registry Application b. AHCA Form 3110-7004A Financial Schedules (Initials and CHOW’s only)c. Health Care Licensing Application Addendum,d. Affidavit of Compliance with Background Screening

AHCA Form 3100-0008, August 2010 if proof of level 2 screening was done by another authorized agency such as Agency for Persons with Disabilities, Department of Children and Families and Department of Health.

e. Results from a Level 2 screening for both the Administrator and Financial Officer

If the administrator or financial officer has not had a background screen conducted within 5 years prior to the application for licensure see question # 18 for how to obtain a level 2 background screening.

All of the information is sent to the Agency for Health Care Administration, Home Care Unit, Mail Stop # 34, 2727 Mahan Drive, Tallahassee, Fl. 32308.

2.5 Can I operate from my home? A nurse registry is not a home-based business due to the traffic with contract personnel coming in and out of the office and the unannounced inspections by AHCA. However, if you have a copy of evidence of compliance with the local zoning authorities to operate this kind of business from your home, you are not prohibited from doing so. The Agency would also want evidence that your homeowner association does not prohibit businesses run out of the home. In addition to zoning, you must have a fire inspection for your office site. Please note that your office location can be inspected at any time during the work day by the AHCA field office surveyors as permitted by state law and your office address will appear at the AHCA web site, www.floridahealthfinder.gov once licensed.

2.6 How much money is required to be in a financial institution that will establish proof of financial ability to operate for the applicant? There is no set amount specified. It will depend upon your business plan. The applicant must have assets in the company name and provide evidence that all required application items have been budgeted such as the required personnel and start up costs. You must follow the instructions with the financial schedules in the application and complete all financial schedules, providing current evidence of sufficient assets, credit and projected revenues to cover liabilities and expenses for the first year of operation and a balance sheet.

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http://www.floridahealthfinder.gov/

2.7 Where can I obtain an application packet? The application, laws, and rules, and surveyor guidelines can all be downloaded from our web site at http://ahca.myflorida.com / homecare and click on “Nurse Registries.” To download the application, click on the forms listed under “Licensure Application and Forms for Initial, Renewal and Change of Ownership applications.”

Section 3: Initial survey requirements:

3.1 What is an initial licensure survey and what are they looking for? The surveyors conducting the initial announced licensure survey will be reviewing your policies and procedures and readiness to operate a nurse registry. If the applicant is not available when an inspection is attempted, the application will be denied and the fees forfeited.

You are required to have policies and procedures in place for the following Florida Administrative Code rules (F.A.C.) and Florida Statutes (F.S.) We also recommend that you view “Nurse Registry update preparing for a survey” at this web page” (the 6th bullet).

The survey tag numbers are shown after the F.S. and/or F.A.C. cites. The survey tags can be accessed at the web site under State Regulation Set used by surveyors.

a. The selection, documentation, screening and verification of credentials for each independent contractor referred by the registry. 59A-18.005(2), FAC (G 251)

b. Providing notice to patients of the 3 toll-free numbers for reporting abuse, neglect, exploitation; complaints; and Medicaid fraud. 408.810(5), F.S. (G 192)

c. Availability of a Nurse • 24 hour availability to a nurse by active patients who are receiving skilled care

from licensed nurses referred by the nurse registry. Describe the on-call system whereby designated nursing staff will be available to directly communicate with the patient. For registries which refer only CNAs or home health aides, written policies & procedures must address the availability of an on-call nurse, during hours of patient service.

• 59A-18.004 (9), F.A.C. (G 188)

d. Acceptance of patients & termination of services• No patient or client shall be refused service because of age, race, color, sex or

national origin• When a patient or client is accepted for referrals of independent contractors,

there shall be a reasonable expectation that the requested services can be provided adequately & safely in their residence. The registry must refer independent contractors capable of delivering services as defined in a specific medical plan of treatment for a patient or services requested by a client, including all visits;

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• When medical treatments or medications are administered, physician, ARNP or PA orders in writing that are signed & dated shall be included in the clinical record; and

• When services are to be terminated, the patient or client, or the caregiver shall be notified of the date of termination & the reason for termination, & these shall be documented in the patient or client's record.

• 59A-18.010, F.A.C. (G 180)

e. Procedures on the administration of drugs & biologicals f. 59A-18.013, F.A.C. (G 225)

g. Procedures for informing patients of the special needs registry at intake & assisting in their registration & annual review of registered patients – including registration procedures from each county emergency management office. 400.506 (15), F.S. (G290)

h. Emergency Management Plan 400.506 (16), F.S. and 59A-18.018, F.A.C. (G 291)

Approved applicants awaiting initial surveys should be familiar with and develop appropriate policies and procedures for the following Florida Administrative Codes (F.A.C.) and Florida Statutes (F.S.)

59A-18.004, 59A-18.005, 59A-18.006, 59A-18.007, 59A-18.0081. 59A-18.009, 59A-18.010, 59A-18.011, 59A-18.012, 59A-18.013 and 59A-18.018, F.A.C.and 408.810 (5) F.S.

The Home Care Unit does not have a sample Policies & Procedures Manual. You must create your own. Please review the State Regulation Set under Nurse Registry at the web site to see the standards that the surveyor will use to conduct your survey. See also, Update How to Prepare for a Nurse Registry Survey at this web page.

Section 4: Administrative and other staff requirements:

4.1 What are the qualifications for the administrator? You must have a administrator that meets one of the following criteria:

(1) licensed physician; (2) registered nurse or (3) individual with training and experience in health service administration and at least one year of supervisory or administrative experience in the health care field.

Every nurse registry must also have an alternate administrator (available in the absence of the administrator) that meets the same qualifications. The alternate administrator can be part-time.

4.2 What is the difference between "... an individual with training and experience in health services administration" and "at least one year of supervisory or administrative experience in the healthcare field?

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The requirement is a minimum of one year of supervisory or administrative experience in health care. AHCA would consider the following as examples of health care experience: hospital, nursing home, assisted living facilities, home health agencies, nurse registries, ambulatory surgical centers, and hospice. The individual automatically qualifies if he or she is an RN or Physician. Any other type of experience or qualifications as mentioned above would have to be evaluated at the time the application was sent to AHCA. Alternate administrators must meet the same qualifications as the administrator.

4.3 Can I be the administrator of more than one nurse registry? Beginning July 1, 2012, yes. An administrator may manage up to five registries if all five registries have identical controlling interests as defined in F.S. 408.803 and are located within one agency (AHCA) geographic service area or within an immediately contiguous county.

Identical controlling interests is defined as nurse registries that share the same legal entity (EIN); have the exact same people or entities with the exact same percentage of ownership; have the exact same board of directors (if applicable) and have the exact same people or entities with the exact same percentage of ownership in the management company (if applicable).

Immediately contiguous county means the borders of the counties touch each other and there has to be a licensed nurse registry office in each of the counties that touch.

4.4 Do I have to have a registered nurse? Yes. Section 400.506(10)(c) F.S., requires every nurse registry that provides home health aides or certified nursing assistants to have a registered nurse available to make visits to the patient’s home if requested. The nurse registry must advise the patient or the patient’s representative at the time of contract that RNs are available for visits for an additional cost. The nurse registry is not required to charge for the RN visits but may do so if they deem it necessary. The RN does not have to be a direct employee of the nurse registry.

Section 5: Independent Contractor requirements:

5.1 Who can be independent contractors for a nurse registry? Registered nurses, licensed practical nurses, certified nursing assistants, home health aides, homemakers, and companions all of which must be independent contractors for a nurse registry. Each of the above must provide evidence of their license or certification and training as applicable prior to having any patients referred to them by the nurse registry. A nurse registry cannot have any direct employees providing services to patients. Each nurse registry shall in its contracts with independent contractors provide instructions as to the responsibility for the payment of self-employment estimated taxes.

5.2 Do nurse registries have to have documentation that independent contractors have HIV training? YES. The state law regarding HIV training was changed in 2008 to require certified nursing assistants and home health aides that apply for contracts with

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nurse registries to have a one time HIV course. Professional independent contractors, such as RN’s and LPN’s are governed by their board with regard to training requirements, including HIV.

5.3 Do independent contractors have to provide a health statement to show he or she is free of communicable diseases? In accordance with Rule 59A-18.005(6), F.A.C., prior to contact with patients, an independent contractor must provide a health statement, based upon an examination within the last six months that the contractor is free from communicable disease, from a physician licensed under Chapter 458 or 459, F.S., a physician's assistant, or an advanced registered nurse practitioner (ARNP), or a registered nurse licensed under Chapter 464, F.S. under the supervision of a licensed physician, or acting pursuant to an established protocol signed by a licensed physician. Rule 59A-18.005(6), F.A.C. does not require health physicals to be performed yearly or every two years. It requires a health statement be obtained, within the last six months, prior to contact with patients. If the administrator of the nurse registry suspects that the individual contractor appears to have a communicable disease, the administrator would then require the contractor to have a statement from a health care professional that such condition no longer exists before they could be referred to patients again.

5.4 Can a nurse registry train its own home health aides? No. Nurse registries cannot train home health aides. If the nurse registry is interested in becoming a non-public, postsecondary, educational institution that trains home health aides, then the nurse registry may call toll free 1-888-224-6684 and ask for the Commission for Independent Education or, visit their web site at www.firn.edu/doe/cie for information on the requirements.

Also, a nurse registry cannot give a competency exam to a person that has not been through the minimum training required in state rule (59A-18.0081) and put the person to work as a home health aide. A competency exam by a home health agency in lieu of training cannot be used by the nurse registry either. If the home health aide has already had at least the minimum training required in the nurse registry rule, this response does not prohibit the nurse registry from screening or testing the aide.

5.5 If a C.N.A. has completed a CNA training course through the adult vocation school or a licensed career education school, can they work as an home health aide until they take the state test?

Yes, if you have documentation that the person meets the 40 hour training requirements listed in the state rule [59A-18.0081(8), Florida Administrative Code] that is quoted in survey standard G 271. Unless the state rule is changed to allow what you are requesting or it is put in law, the state rule 59A-18.0081(8) is all that we have for home health aide qualifications.

5.6 If a CNA lets their certification lapse, can she or he work as home health aide?

Yes, if you have documentation that the person meets the 40 hour training requirements listed in the state rule [59A-18.0081(8), Florida Administrative Code]

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that is quoted in survey standard G 271. Please note that persons can take the C.N.A test and become certified without having any training according to the Dept of Health (http://www.doh.state.fl.us/mqa/cna/cna-faqs.htm#Certification ).

Section 6: Background screening requirements:

6.1 What are the background screening requirements for required personnel positions of administrator and chief financial officer?

If the individuals have not had a level 2 (FDLE and FBI screening) background screen conducted, then those individuals must have their fingerprints scanned at a LiveScan vendor site. Applicants for new licenses will get a letter that gives the AHCA number to be used for background screening after the application is received at AHCA.

If the individuals have had a background screen within the previous 5 years to meet any provider or professional licensure requirements of the Department of Health, the Agency for Persons with Disabilities, Department of Elder Affairs or the Department of Children and Family Services satisfies the requirements of subsection 408. 809, F.S. provided that the proof is accompanied, under penalty of perjury, by an Affidavit of Compliance with Background Screening AHCA Form 3100-0008, November 2006. The form is at the web site.

If screening results are over five years old, or if the administrator or financial officer does not have a level 2 background screening clearance, then fingerprinting will be done through scanning. See the Background Screening page of the Agency’s web site for information:

http://ahca.myflorida.com/backgroundscreening

6.2 What are the background screening requirements for independent contractors?

Effective August 1, 2010 there are new requirements – see Section 11.6 of the Frequently Asked Questions and the Background Screening page of the Agency’s web site for information:


Section 7: Geographic service areas:

7.1 What counties can I serve with my nurse registry license? All nurse registries must apply for counties contained in a single geographic service area. Nurse registries may apply for one or all of the counties (Except Broward County which is a single county geographic service area) within the specific Agency for Health Care Administration (AHCA) area boundaries:

Area 1 Escambia, Walton, Santa Rosa and OkaloosaArea 2 Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and WashingtonArea 3 Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union

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http://www.doh.state.fl.us/mqa/cna/cna-faqs.htm#Certification

Area 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns and VolusiaArea 5 Pasco and PinellasArea 6 Hardee, Highlands, Hillsborough, Manatee and PolkArea 7 Brevard, Orange, Osceola and SeminoleArea 8 Charlotte, Collier, Desoto, Glades, Hendry, Lee and SarasotaArea 9 Indian River, Martin, Okeechobee, Palm Beach and St. LucieArea 10 BrowardArea 11 Dade and Monroe

7.2 Where are the Agency field offices located and what areas do they cover:

There are eight Agency for Health Care Administration field offices. These are the offices that send out surveyors to nurse registries to conduct surveys or investigate complaints. Program related questions need to be directed to the Home Care Unit in Tallahassee (850) 412-4403. The field offices include the following locations:

Field Office Geographic Service Area(s) Phone

Tallahassee Areas 1 and 2 (850) 412-4540

Alachua Area 3 (386) 462-6201

Jacksonville Area 4 (904) 798-4201

St Petersburg Areas 5 and 6 (727) 552-2000

Orlando Area 7 (407) 420-2502

Fort Myers Area 8 (239) 335-1315

Delray Beach Areas 9 and 10 (561) 381-5840

Miami Area 11 (305) 593-3100

7.3 Can I open one or more nurse registries in a geographic service area?If the nurse registry wants to open a separate office location in a different county within the AHCA geographic service area an initial application must be submitted to the AHCA Home Care Unit. Each operational site must be licensed, unless there is more than one site within a county. If there is more than one site within a county, only one license per county is required.

7.4 Can I operate a drop site for independent contractors to use to drop off paperwork and contact existing patients? NO. Drop sites are not allowed under nurse registry laws and rules. Any additional site(s) outside the county where the nurse registry is located must be separately licensed.

Section 8: Reporting changes to AHCA:

8.1 How do I report a change in the administrator or alternate administrator? Send the application sections 1, 3D and 11 to the Home Care Unit indicating the name of the new personnel and what their position (administrator, alternate administrator) will be in your agency. If the new individual is an administrator or a chief financial officer and they have not had a level 2 background screening,

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please go to the link below to find out how to obtain a level 2 screening and the required costs. http://ahca.myflorida.com/MCHQ/Long_Term_Care/Background_Screening/index.shtml

8.2 How do I report a change in address? Effective July 14, 2010 you need to complete sections of the Nurse Registry AHCA Form 7004 (See Section D Change During Licensure Period on the Checklist) and send it along with a $25 processing fee 21 days in advance of your change of address. Include the effective date of the new address and a copy of evidence of compliance with local zoning codes and fire inspection authorities for the new location. Once all of the documentation is received your new license certificate will be issued. A nurse registry cannot move their agency to another geographic service area unless they submit an initial application for the new location. Initial licenses are issued for a specific geographic service area and cannot be moved to another area.

8.3 How do I report a change in the name of the registry? Effective July 14, 2010 you need to complete sections of the Nurse Registry AHCA Form 7004 (See Section D Change During Licensure Period on the Checklist) and send it along with a $25 processing fee for your name change and new certificate. A copy of the affidavit of a fictitious name is required if a nurse registry chooses to operate under a name other than the name of the partnership or corporation. An individually owned nurse registry must submit a copy of the document from the Divisions of Corporations that shows the name has been officially changed as well as submit amended articles of incorporation showing the name change. Please note that a name change is not the same as a change in the corporation or partnership.

8.4 How do I do a change of ownership of a nurse registry?

A change of ownership as defined in Chapter 408, Part II, Florida Statutes is “An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or an event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned.” This does not apply to a licensee that is publicly traded on a recognized stock exchange. The definition of “licensee” now includes all legal entities.

A change of ownership application must be completed and sent to the Home Care Unit 60 days prior to the change in ownership. Nurse registries use the AHCA Form 3110-7004 August 2010 recommended including the financial schedules AHCA Form 3110-7004A July 2009 and the other application forms listed at the web site. In addition the new owner needs to supply the following:

Signed and dated closing document and/or bill of sale showing date of transfer of ownership

Signed and dated asset purchase agreement indicating change of ownership is pending

Corporate and IRS paperwork showing new owner status and EIN #.

See Section 12 for more questions and answers on Change of Ownership

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http://ahca.myflorida.com/MCHQ/Long_Term_Care/Background_Screening/index.shtml

8.5 What must I do to notify AHCA & others when I discontinue the operation of my nurse registry?

The registry must inform the Home Care Unit 30 days prior to the discontinuance of the agency and include the date the registry will no longer be in operation. The license must be surrendered to the Home Care Unit. The registry must also inform patients or their legal representatives in writing of the closure date and provide options for obtaining or forwarding copies of records as per the wishes of the patient. A copy of the notice in a newspaper can also suffice for written notification to patients.

Section 9: Emergency management plan:

9.1 Is my nurse registry required to have an emergency management plan? All nurse registries are required to have a current emergency management plan. The required contents of the plan are outlined in 400.506 (16) (a) through (f), Florida Statutes and 59A-18.018 Florida Administrative Code, revised March 15, 2007. The new emergency management form is “Comprehensive Emergency Management Plan for Nurse Registries,” AHCA Form 3110-1017 Dec 06, and can be obtained from the web site. If the nurse registry used AHCA Form 3110-1016, check to be sure the information on providing the same type and quantity of services to special needs patients is included. The only change to the form in Dec 06 was the Form number.

Each nurse registry should begin to use the Plan format found at the website. The form is designed to be e-mailed, attached as a word document, to the reviewer. The Plan is subject to review and approval by the county health departments as per s. 400.506(16) (e). Also at the web site is a listing of all of the county health department contacts. Emergency management plans must be sent to each county health department for each of the counties on the nurse registry license. Since funding was not allocated to the county health departments for reviewers of the plans, some counties have elected not to review plans. However, it is the nurse registry’s responsibility to contact the county health department of each of the counties listed on the provider’s license to determine and document whether the Comprehensive Emergency Management Plans should be submitted to that county and, if submission is required, whether the county health department will be reviewing the plan for compliance with Florida Statues and rules.

Surveyors will ask to see your plan during an initial survey and your approval letter(s) from the county(s). If you don’t have your approval at the time of your initial survey, be sure you have a receipt that you sent the plan to the appropriate reviewer for each county.

9.2 We are supposed to review our emergency management plan every year and update it as needed. Are we supposed to send our updated plans for review by each county contact?

No. Nurse registries are only required to submit changes in telephone numbers and names of staff who lead the nurse registry’s emergency response.

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Section 10: Renewing nurse registry licenses:

10.1 How is the license renewed? Licenses are issued for two years. The renewal application must be received in the Home Care Unit at least sixty (60) days prior to the expiration date. Renewal reminder postcards will be sent by the Agency for Health Care Administration 90 days in advance of the expiration date of the license beginning October 1, 2006. There is a penalty imposed of $50/per day for each day the application is late – up to a maximum of $500.00. If the application is received after the required filing date and exhibits a hand-cancelled postmark obtained from the US post office dated on or before the required filing date, no fine will be levied. If the application for renewal is received prior to the expiration date, the license will not be deemed to have expired if the license expiration date occurs during the agency’s review of the renewal application.

Failure to renew the nurse registry license prior to the expiration date will require the nurse registry to reapply using the initial application forms. The nurse registry cannot continue to serve patients if their license expires. The forms for renewal of the nurse registry license are:

AHCA Form 3110-7004 Nurse Registry Application Health Care Licensing Application Addendum

Section 11: State Law Changes

11.1 Advertising (1) Does this law change prohibit my nurse registry from advertising? No. There are no state laws that prohibit nurse registries from advertising in newspapers or other print media, television, radio or internet.

11.2 Marketing to physicians, their office staff & families

400.506(15), Florida Statutes:

(a) The agency may deny, suspend, or revoke the license of a nurse registry and shall impose a fine of $5,000 against a nurse registry that:

5. Gives remuneration to a physician, a member of the physician's office staff, or an immediate family member of the physician, and the nurse registry received a patient referral in the last 12 months from that physician or the physician's office staff. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.

400.462(27), Florida Statutes

“Remuneration” means any payment or other benefit made directlyor indirectly, overtly or covertly, in cash or in kind. However, if the term isused in any provision of law relating to health care providers, the term does

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not apply to an item that has an individual value of up to $15, including, butnot limited to, a plaque, a certificate, a trophy, or a novelty item that isintended solely for presentation or is customarily given away solely forpromotional, recognition, or advertising purposes.

11.2 (1) What is meant by the “Florida Medicaid program”? Does it include the Medicaid Waivers?

The Florida Medicaid program includes all programs in Medicaid, including, but not limited to, all Medicaid Waivers and Medicaid HMO.

11.2(2) What is a “controlling interest”?

A “controlling interest” means: the applicant or license; or a person or entity that:

Serves as an officer of, Is on the board of directors of [does not include a voluntary board

member of a not-for-profit] or Has a 5% or more interest in the applicant or licensee or in the

management company of other entity that the Nurse Registry contracts with to manage the business.

11.2 (3) Can I take a physician to lunch to update him on the patient he referred to our nurse registry?Yes but only if your nurse registry does not:

(a) bill the Florida Medicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide. Here are some examples of billing the Medicaid program:

(i) your nurse registry is enrolled as a Medicaid Waiver provider and bills on-line for services provided through the Aged & Disabled Medicaid Waiver;

(ii) your nurse registry bills Amerigroup or Eldercare for services provided under the Nursing Home Diversion Waiver program.

(b) bill the Medicare program(c.) share a controlling interest with any entity that is licensed, certified or

registered by AHCA that bills the Florida Medicaid Program as explained in (a) or the Medicare program. “Controlling interest” is defined above in 11.2(2).

11.2 (4) Can I take breakfast, or other food or beverages to a physician and his office staff that refers patients to our nurse registry? Yes but only if your nurse registry does not:

(a) bill the Florida Medicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

(b) bill the Medicare program

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(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program. “Controlling interest” is defined above in 11.2(2).

11.2 (5) I have a registered nurse on my staff who is married to a physician. The physician refers some patients to our nurse registry. Can I continue to employ the nurse?Yes but only if your nurse registry does not:

(d) bill the Florida Medicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

(e) bill the Medicare program(f) share a controlling interest with any entity that is licensed, certified or

registered by AHCA that bills the Florida Medicaid Program or the Medicare program. “Controlling interest” is defined above in 11.2(2).

11.2 (6) Can our nurse registry lease space from a referring physician or a physician group?Yes but only if your nurse registry does not:


(b) bill the Medicare program(c) share a controlling interest with any entity that is licensed, certified or


11.3 Marketing to discharge planners for hospitals, nursing homes, and other facilities



4. Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395 or this chapter and from whom the nurse registry receives referrals. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.

400.462(27), Florida Statutes

“Remuneration” means any payment or other benefit made directlyor indirectly, overtly or covertly, in cash or in kind. However, if the term isused in any provision of law relating to health care providers, the term does

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not apply to an item that has an individual value of up to $15, including, butnot limited to, a plaque, a certificate, a trophy, or a novelty item that isintended solely for presentation or is customarily given away solely forpromotional, recognition, or advertising purposes.

11.3 (1) What are the facilities licensed under Chapter 395 and Chapter 400?Chapter 395 facilities are hospitals, ambulatory surgical centers, and mobile surgical facilities. Chapter 400 facilities are skilled nursing facilities (SNFs), HHAs, nurse registries, hospices, intermediate care facilities (DD), home medical equipment providers, health care clinics, prescribed pediatric extended care centers, transitional living facilities, and health care service pools.

11.3 (2) Can our nurse registry still provide promotional items as give-aways, such as pens, pads, and other office items with the company’s logo to the staff in the hospital discharge planning office?Yes but only if your nurse registry does not:


(b) bill the Medicare program(c.) share a controlling interest with any entity that is licensed, certified or


11.3 (3) Can our nurse registry still pay for the lunches or coffee and donuts during educational in-services to social workers who work at the hospital and in nursing homes?Yes but only if your nurse registry does not:




11.3 (4) Every year our nurse registry has a vendor table at the annual social worker recognition luncheon. It is an appreciation luncheon for social workers and case managers who work with seniors. We pay for the use of the table that helps covers the cost of the luncheon. The social workers attending work in a variety of places- hospitals, nursing homes, home health agencies, hospices and do case management for local community agencies who work with seniors. All professionals that work with seniors are invited. The lunch is free to social workers and case managers. Everyone else that comes has to pay. We give out educational materials and information about our nurse registry along with small items that have our agency name and phone number on them such as pens, pads, coffee cups, and candy. We contribute a raffle prize for the drawings at the end of the luncheon. Is this still allowable?Yes but only if your nurse registry does not:

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11.3 (5) May a nurse registry have a booth at a Health Fair at a shopping mall or senior center & give out small items, such as pens, pads, and other items with the nurse registry’s name on it?Yes. However the nurse registry cannot give out anything of value to a referral source specified in 400.506(15)(a) 4, F.S. if your nurse registry bills the Florida Medicaid Program, the Medicare program, or shares a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid program or the Medicare program. “Controlling interest” is defined above in 11.2(2).

NOTE: If you have the following or similar questions, your nurse registry will need to contact your attorney for legal advice:

1. We have a booth at the guardianship association conference. Are we permitted to offer give-aways to those who come to our both and provide a basket for the drawing? Or, can we only give brochures and business cards? Guardians do refer patients to our nurse registry.

2. Is it a violation of state law for our nurse registry to serve as sponsor of the National Association for Continuing Education conference that has about 100 physicians in attendance? We pay to sponsor and put up an information board on their agency and its services.

11.4 Assisted Living Facilities and others



1. Provides services to residents in an assisted living facility for which the nurse registry does not receive fair market value remuneration.

2. Provides staffing to an assisted living facility for which the nurse registry does not receive fair market value remuneration.

3. Fails to provide the agency, upon request, with copies of all contracts with assisted living facilities which were executed within the last 5 years.

(b) The agency shall also impose an administrative fine of $15,000 if the nurse registry refers nurses, certified nursing assistants, home health aides, or other

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staff without charge to a facility licensed under chapter 429 in return for patient referrals from the facility.

11.4 (1) In 400.506 (15)(a) 4, F.S., it refers to providing copies of contracts with ALFs that were executed within 5 years of the request by AHCA. Since the bill takes effect July 1, does this mean that 5 years back from the request if made this fall, for example? This would be prior to the effective date on the bill. Or, does the 5 years count forward from July 1, 2008?Copies of contracts can be requested for July 1, 2008 on per this law. However, the Agency may request any documents pursuant to 408.811, F.S.

11.4 (2) Re 400.506(15)(a) 4, F.S., our nurse registry does monthly blood pressure clinics in ALFs. Can we continue to do these if we charge a nominal fee?No.

11.4 (3) Can a nurse registry provide monthly educational programs for residents in an ALF and give pens, pads, and items with our name on it away?Yes.

11.5 Making a Complaint11.5 (1) How do I make a complaint about a nurse registry that I know is violating the new laws?Call the AHCA complaint call center at (888) 419-3456.

11.6 Background Screening 2010 and 2012 law changes

There is information on the 2010 and 2012 law changes at the Background Screening page of the AHCA web site: http://ahca.myflorida.com/backgroundscreening See also the May 17, 2012 Regulatory Update at the Nurse Registry page of the AHCA web site http://ahca.myflorida.com/homecare - click on “Nurse Registry”.

11.6 (1) Our nurse registry has some independent contractors that started with us prior to the 2010 law changes and had level 1 (FDLE) background screening. Do they still have until July 31, 2015 to get level 2 screening (fingerprints)?

It depends on when they were last screened. There is now a staggered screening schedule for getting level 2 screening from the 2012 law changes. The schedule is as follows:– Individuals for whom the last screening was conducted on or before

December 31, 2004, must be rescreened by July 31, 2013. – Individuals last screened between January 1, 2005 and December 31, 2008,

must be rescreened by July 31, 2014. – Individuals last screened between January 1, 2009 and July 31, 2011, must

be rescreened by July 31, 2015.

11.6 (2) How long will the LiveScan background screening take -- from the

scan to when the person’s results are known?

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http://ahca.myflorida.com/homecare


It is estimated that it will take 8 work days. The results are immediately available when posted at the Background Screening web site.

11.6 (3) If the fingerprints are rejected who pays for the scanning of the prints again? Or do they not have to pay the 2 nd time? Aren’t there supposed to be fewer rejects with scanning?

AHCA will receive information on the rejected fingerprints and will notify the individual whose prints were rejected. The individual can go to the same vendor to have his or her fingerprints scanned again at no charge. There should be fewer rejections with the scanned fingerprints. If the fingerprints are rejected a second time, the FBI will do a criminal history check.

Section 12: Change of Ownership process

12.1 Who should submit the Change of Ownership application?The Buyer is the applicant.

12.2 How soon may the Buyer operate the registry?The Change of Ownership is an initial licensure application. The Seller is responsible for the operation of the registry until the license is transferred to the Buyer. The Buyer must submit the application at least 60 days prior to the actual transfer of ownership. Once the application is received, it will be reviewed within the first 30 days. If it is incomplete, a letter will be sent detailing the omissions. The Buyer then has 21 days from their receipt of the letter in which to respond with the items or clarifications requested. The Agency for Health Care Administration [AHCA] will not issue the license to the Buyer until the legal documents transferring ownership have been received. When the license is issued, the effective date will be backdated to the date of the actual transfer of ownership indicated in the ownership transfer documents.

12.3 Can the date of ownership transfer be stated as the day AHCA approves the change of ownership application?No. A change of ownership application must include the effective date of the change of ownership. The effective date of the change of ownership shall not be extended more than 60 days from the effective date reported on the application; written notification of a change in the effective date must be received by the AHCA prior to the originally reported effective date. The AHCA will deem the application withdrawn if the change of ownership does not occur within 60 days of the reported effective date.

12.4 How long does it take to change the ownership of a home health agency license?The average processing time, from beginning to end, is 90-120 days.

12.5 Is it faster to apply for an initial license?The average processing time for an initial license, from beginning to end, is also 90-120 days.

12.6 Do Nurse Registries need to be accredited?Nurse Registries do not need to become accredited.

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12.7 How do I know if the change we are planning is a change of ownership?The current definition of Change of Ownership can be found at Florida Statutes 408.803(5)“Change of ownership” means:(a) An event in which the licensee sells or otherwise transfers its ownership to a different individual or entity as evidenced by a change in federal employer identification number or taxpayer identification number; or(b) An event in which 51 percent or more of the ownership, shares, membership, or controlling interest of a licensee is in any manner transferred or otherwise assigned. This paragraph does not apply to a licensee that is publicly traded on a recognized stock exchange.A change solely in the management company or board of directors is not a change of ownership.

Updated: 11/10/2012

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