The Home Care Association of Florida (HCAF) participated in the Agency for Health Care Administration’s (AHCA) formal rule workshop in Tallahassee on October 15 and submitted written comments on proposed changes to Rule 59G-4.130, Florida Administrative Code, and the accompanying Home Health Services Coverage Policy.

Drawing on member feedback, HCAF raised concerns about how the proposed language could affect nursing services, Family Home Health Aide (FHHA) program access, practitioner orders, reimbursement, and agency operations. Our participation brought the home care provider community’s practical experience directly into the rulemaking process.

HCAF supports clear coverage standards that help providers deliver safe, medically necessary care and enable eligible families to participate in the FHHA program. Our comments urge AHCA to resolve ambiguities before adoption and provide coordinated implementation guidance to prevent inconsistent authorizations, avoidable claim denials, duplicate documentation, and interruptions in care.

Clarifying the Role of Licensed Practical Nurses

A central concern is the proposed removal of licensed practical nurses (LPNs) from provisions addressing individual providers and independent nursing services. Without an explicit distinction, health plans and reviewers could interpret these deletions as also prohibiting nursing visits furnished by agency-employed LPNs.

HCAF requested clarification on whether agency-employed LPNs may continue providing covered nursing visits, whether the proposal changes LPN eligibility under the separate private duty nursing (PDN) benefit, and what enrollment, authorization, or billing changes would follow. We also requested a practical transition plan for recipients served by independent LPNs, particularly when another provider is unavailable.

Aligning Overlapping FHHA Requirements

The proposal adds FHHA requirements to a second coverage policy, creating questions about how those provisions interact with the existing PDN and FHHA policy.

HCAF urged AHCA to reconcile the policies and clearly identify which requirements govern eligibility, supervision, assessments, authorization, and reimbursement. We also requested clarification on whether the proposal contemplates payment per visit rather than hourly and whether agencies would need new enrollment categories, separate orders, additional authorizations, or duplicate assessments.

Providers need a clear explanation of what is changing and assurance that overlapping policies will not create unnecessary administrative barriers.

Recognizing Authorized Ordering Practitioners

Members raised concerns that physician-only language could be interpreted to exclude otherwise valid home health orders from advanced practice registered nurses (APRNs) and physician assistants (PAs).

HCAF requested explicit recognition of practitioners authorized to order services under applicable law and confirmation that qualifying APRN and PA orders will continue to be accepted. We also asked AHCA to clarify whether a separate physician relationship is required when an authorized APRN or PA manages the recipient’s care.

Protecting Families When Nursing Hours Cannot Be Staffed

The proposed reference to recipients “receiving PDN services” leaves an important question unanswered: Does FHHA eligibility depend on authorized nursing hours or on those hours actually being staffed?

HCAF asked AHCA to clarify whether otherwise eligible recipients may receive FHHA services when authorized PDN hours cannot be filled because a nurse is unavailable. Clear guidance is needed so workforce shortages do not become an additional barrier to family caregiver participation.

Clarifying Payment for Multiple Recipients

HCAF requested practical billing guidance for situations in which one worker serves multiple recipients, including siblings or individuals sharing a residence.

Our comments ask AHCA to distinguish shared care from a shared address, explain how overlapping hours and separate shifts affect payment, and reconcile the proposed adjustment with FHHA minimum-rate provisions and existing group-home exceptions. Providers need clear examples to bill accurately and avoid inappropriate payment reductions.

Defining Nursing Oversight and Managed Care Implementation

HCAF also requested clearer registered nurse (RN) oversight requirements, including visit frequency, documentation, qualifications, backup coverage, and restrictions involving family relationships.

Finally, we urged AHCA to distinguish fee-for-service requirements from those applicable to Medicaid managed care. Consistent guidance across agencies, health plans, reviewers, and claims administrators is essential to prevent conflicting interpretations of the same benefit.

Advocating for Clear Rules and Reliable Access

These concerns reflect the operational questions members face when translating policy into patient care. HCAF’s advocacy seeks to ensure that final requirements are clear, workable, and consistently applied.

We appreciate AHCA’s opportunity for stakeholder input and have offered additional operational feedback and proposed language as rulemaking continues. Members are encouraged to share examples of how the proposed changes could affect their agencies or patients to help inform HCAF’s continued advocacy.