FREQUENTLY ASKED QUESTIONS
NURSE REGISTRIES
The frequently asked questions include the following:
What is a nurse registry: Section 1
How to apply for a nurse registry license: Section 2
Initial survey requirements: Section 3
Administrative and other staff requirements: Section 4
Independent Contractor requirements: Section 5
Background screening requirements: Section 6
Geographic service areas requirements: Section 7
Reporting changes to AHCA: Section 8
Emergency management plan: Section 9
Renewing nurse registry licenses: Section 10
State law changes: Section 11
Change 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.
· 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 II
d. 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 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.
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;
• 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?
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: