59A-8.0099. Minimum Training Requirements for Home Health Aides for Medically Fragile Children

(1) A licensed home health agency that provides skilled care and accepts Medicaid may train and employ any person 18 years of age or older as a home health aide for medically fragile children as defined in section 400.462, F.S., hereafter referred to as an “AMFC,” that meets the eligibility requirements of section 400.4765, F.S., and has successfully completed required training. (2) Home Health Agency Personnel. An AMFC is considered an employee of the home health agency pursuant to section 400.4765, F.S. An AMFC may only provide services to an eligible relative as defined in section 400.462, F.S., as assigned or delegated by, and under the supervision of, a registered nurse (RN). As an employee of the home health agency, the AFMC must complete a one-time educational course on HIV and AIDS, within 30 days of employment pursuant to section 381.0035, F.S. Additionally, the AFMC must obtain and maintain cardiopulmonary resuscitation (CPR) certification as described in paragraph 59A-8.0095(5)(k), F.A.C. (a) Prior to an AMFC providing services, the home health agency shall have on file documentation of the aide’s successful completion of an approved training program as outlined by this rule. (b) An AMFC shall provide services within the scope of their training as outlined by this rule and sections 400.4765 and 400.489, F.S., and may provide other services as taught by a licensed health professional employee or contractor of the home health agency for an eligible relative. A home health aide may be trained to become an AMFC provided they meet the requirements of sections 400.462 and 400.4765, F.S., and complete an approved training program as outlined by this rule. The home health agency must maintain policy and procedures regarding the services the AMFC may provide as taught and delegated by a RN per this rule and Rule 59A-8.0216, F.A.C. (c) An RN employed or contracted with the home health agency must conduct supervisory visits of the AMFC at least every 60 days, or more frequently for federally certified agencies as described in 42 C.F.R. ss. 484.80. The home health agency must maintain documentation of such visits. (d) Home health agencies that offer training in accordance with the minimum requirements outlined by this rule must document their course curriculum to be made available for review as requested by the Agency during an inspection. The training must be performed by an RN who possesses the qualifications as outlined by this rule and may not be performed by other staff under the general supervision of the RN. The training may be conducted in person, online, or through a hybrid program but must require the aide to demonstrate, in person, that he or she is able to perform the necessary skills associated with this rule and Rules 59A-8.0097, 59A-8.0216 and 59A-8.0219, F.A.C. (e) A Medicare or Medicaid certified home health agency that employs an AMFC may be required to provide evidence of additional training incorporated within the Medicare Conditions for Participation, 42 C.F.R., Part 484, and available at https://ecfr.io/Title-42/Part-484. (3) Approved AMFC Training Curriculum: Minimum Curriculum Requirements. The training curriculum must total at least 76 hours according to paragraphs (3)(a), (3)(b), and (3)(c) below. The home health agency shall be responsible for evaluating the AMFC’s competency and identifying any learning needs in accordance with the patient’s individualized plan of care. The home health agency must ensure that the aide receives sufficient training and instruction to address identified learning needs and to safely and effectively perform all tasks delegated under the plan of care. At minimum, the training curriculum must include the following sections: (a) A minimum of forty (40) hours of home health aide training described in section 400.497, F.S. and Rule 59A-8.0095, F.A.C. The AFMC must present documentation of successful completion of training in the subject areas listed in paragraph 59A-8.0095(5)(c) F.A.C. This section of training must be performed by or under the general supervision of a qualified RN with a minimum of two years nursing experience, with at least one year in home health care. Acceptable documentation of training must meet the requirements in subsection 59A-8.0095(5) F.A.C. The Home Health Aide Competency Test shall not be administered in lieu of, nor shall prior passage substitute for, any portion of the training outlined by this rule. (b) A minimum of twenty (20) hours of skills training in nursing specific to the care of the medically fragile pediatric patient as specified in the provider’s plan of care. This section of training must be conducted in person by a qualified RN with a minimum of two years nursing experience, with at least one year in pediatric nursing. The home health agency is responsible for determining that the skills training conforms to the delegable tasks under section 464.0156(1), F.S. This section of training may include the following as applicable to the child’s care needs per the individualized plan of care: 1. An overview of seizure disorders, epilepsy, seizure emergencies, and related first aid and rescue therapies. 2. Tracheostomy care including suctioning, regular cleaning or replacement of inner cannula, trach site care, dressing change, trach change and emergency management of desaturation, mucus plugging and dislodgement of trach tube. 3. Respiratory management including oxygen use and safety excluding the titration of the prescribed oxygen levels. 4. Enteral care and therapy. Instruction may cover different enteral feeding tubes specific to the child including nasogastric, nasoduodenal, nasojejunal, gastrostomy, jejunostomy, and gastrojejunal tubes, and gastronomy buttons. Instruction may cover related equipment, potential complications, and feeding methods to include: a. Administering enteral feedings: bolus intermittent, cyclic intermittent, intermittent drip, and continuous infusion. b. Equipment including syringes, feeding bags, and feeding pumps. c. Formula types and preparation. d. Complications including tube-related mechanical, infectious, gastrointestinal, aspiration pneumonia, and metabolic complications, and complications associated with tube placement. 5. Assisting with prescribed medical equipment, supplies and devices including oxygen, walkers, wheelchairs, hospital beds, ventilator, C-Pap and BiPap machines, peak flow meters, nebulizers, CPT vests, and apnea monitoring equipment, excluding the titration of the prescribed oxygen levels. 6. Skin care including pressure sore prevention and wound care. 7. Ostomies including ileostomies, colostomies and urostomies, maintaining a healthy stoma and emptying and changing the ostomy pouch or bag. Assisting with the placement and removal of colostomy bag, excluding the removal of the flange or manipulation of the stoma’s site. 8. Tasks associated with elimination and toileting, including assistance with the use of a bedpan, urinal and other non-invasive elimination devices. 9. Urinary catheter care including catheter position, hydration, hygiene, complications, emptying the bag, changing the catheter bag, removing and inserting a foley catheter. 10. End-of-life care and postmortem care. 11. Intravenous assistive care activities including care and maintenance of the device and signs and symptoms of complications, and assistance with total parenteral nutrition (TPN). 12. Measuring and preparing prescribed or special diets. 13. Measuring intake and output of fluids. 14. Performing simple urine tests for sugar, acetone, or albumin. 15. Observing appearance and reporting physical or behavioral changes in the patient or client to the registered nurse. 16. Recognition of emergencies and emergency procedures, including dialing 911. 17. Assisting with the use of a glucometer to perform blood glucose testing. 18. Basic restorative care and rehabilitation including the application of AFOs (ankle foot orthosis) and other orthopedic braces. 19. Keeping records of personal health care activities. (c) A minimum of sixteen (16) hours of clinical competency training and validation. Validation of medication routes pursuant to Rule 59A-8.0097, F.A.C., does not count toward the 16 hours required by this section. Validation must be conducted on site with an actual patient and supervised by a qualified RN with a minimum of two years nursing experience, with one year in pediatric nursing. Successful validation requires the AMFC to demonstrate, in person, the skills outlined in paragraph (3)(b) to include procedures for the following as applicable to the child per the individualized plan of care: 1. Skin care, pressure sore prevention, and wound care. 2. Tracheostomy care. 3. Enteral care and therapy. 4. Intravenous and TPN assistive care activities. 5. Urinary catheter care and foley catheterization. 6. Ostomy care and maintenance. 7. Appropriate use of prescribed medical equipment, supplies and devices. 8. Measuring intake and output of fluids. (4) Validation. An AMFC must be assessed and validated as competent to provide services by an RN after successfully completing required training. (a) An AMFC must achieve a score of 100% proficiency in validation of skills prior to providing services. (b) Validation must take place within 90 days of completing required training. (c) Validations expire 1 year from the effective date of the validation. An AMFC must be revalidated no more than within 60 days prior to the expiration of their validation to continue providing services. (5) Pursuant to section 400.4765, F.S., an AMFC that allows 24 consecutive months to pass without providing services to an eligible relative must complete an approved training program as outlined by this rule to resume providing services. (6) Pursuant to section 400.489, F.S., medication administration training may be provided in addition to the 76 hour curriculum outlined in subsection (3). An AMFC may administer medication as delegated by an RN in accordance with s. 464.0156, F.S. if they complete the basic medication administration training pursuant to Rule 59A-8.0097, F.A.C. and the requirements of Rules 59A-8.0219 and 59A-8.0216, F.A.C, are met. (a) To meet the needs of medically fragile pediatric patients, an AMFC may administer medications via additional routes with written instructions from the delegating RN as prescribed by the patient’s health care provider. The following routes require the AMFC to complete additional medication training specified in paragraph (3)(b): 1. Oral medications to be crushed, diluted, or mixed with foods or liquid. 2. Medications in a liquid form or pills crushed into a powder form via enteral feeding tube. 3. Medications by injection via subcutaneous, intra-dermal, or intra-muscular route. 4. Medication that is inserted rectally. 5. Inhaled medications administered via a tracheostomy tube with a metered-dose inhaler or nebulizer. (b) Medication Training for Additional Routes of Administration. In addition to the initial 6 hours of training required by Rule 59A-8.0097, F.A.C., the AMFC must complete an additional 4 hours of training to administer medications via the routes described in section (3)(a). The additional training must be provided by an RN with at least two years of experience and must cover the following: 1. Administration of medications utilizing standardized measuring devices for children including oral syringes, special medication dosing spoons, or medication cups. 2. Measuring liquid medication, including conversions of teaspoon/tablespoon to milliliter or cubic centimeter (cc). 3. Indications and procedures for oral medications to be diluted or mixed with foods or liquid. 4. Indications and contraindications to crushing oral medications. 5. Procedure to crush oral medications and mix with foods or liquid. 6. Procedures for medications administered via enteral feeding tubes. 7. Procedures for medications inserted rectally. 8. Procedure for the administration of inhaled medications via a tracheostomy tube utilizing a metered-dose inhaler or nebulizer. 9. Recognition of serious adverse reactions and how to handle the event. 10. Medication errors and reporting to the RN, including when the child does not take all of medication mixed with food or liquids. 11. Infection control measures for administration of medication to pediatric patients. (c) An AMFC that completes the training outlined in section (3)(b) must be validated in accordance with Rule 59A-8.0097, F.A.C. prior to administering medication via additional routes. (7) Adverse Incident Reporting. (a) An adverse incident, as defined in subsection 400.54(2), F.S., is an event over which home health agency personnel could exercise control and which is associated in whole or in part with medical intervention, rather than the patient's condition for which such intervention occurred, and results in the adverse incident. (b) Home health agencies must electronically submit adverse incident reports for incidents occurring under the care of a home health aide for medically fragile children to the Agency within 48 hours after the occurrence of the incident as required in section 400.54, F.S. The adverse incident must be reported on Home Health Agency Adverse Incident Report, AHCA Form 3110-0011 OL, August 2025, which is hereby incorporated by reference and available at: https://www.flrules.org/Gateway/reference.asp?No=Ref-19116, and through the Agency’s adverse incident reporting system which can only be accessed through the Agency’s Single Sign On Portal located at: https://apps.ahca.myflorida.com/SingleSignOnPortal.