Following the Agency for Health Care Administration’s (AHCA) Notice of Proposed Rule regarding Rule 59A-8.0099 — Minimum Training Requirements for Home Health Aides for Medically Fragile Children — the Home Care Association of Florida (HCAF) submitted formal comments to ensure the rule is clear, consistent with Florida law, and operationally feasible for licensed home health agencies.

HCAF strongly supports maintaining rigorous standards for children with complex medical needs. However, as drafted, several provisions of the proposed rule raise concerns related to statutory consistency, registered nurse (RN) delegation authority, workforce availability, and survey enforcement implications. Below is a summary of the key recommendations and requests for clarification submitted to AHCA.

1. Alignment With Statutory Competency Test Provisions

The proposed rule states that the Home Health Aide Competency Test may not substitute for any portion of the required training hours. However, section 400.497, Florida Statutes, expressly permits successful completion of the competency test to substitute for required home health aide training.

• HCAF Recommendation: Revise the rule to clarify that the 40-hour home health aide training component may be satisfied consistent with statute, while preserving additional pediatric-specific training requirements. Alignment with statute is necessary to avoid enforcement inconsistencies and potential legal conflict.

2. RN Qualification Requirements and Workforce Burden

The rule requires that:

• The 40-hour training be conducted by an RN with at least two years of nursing experience, including one year in home health care; and
• The 30-hour skills training and 16-hour clinical competency validation be conducted in person by an RN with at least two years of nursing experience, including one year in pediatric nursing.

As drafted, agencies may be required to retain two separate RNs to complete all training components. In rural and underserved areas, RNs with pediatric experience are already in limited supply.

• HCAF Recommendation: Permit an RN who meets the pediatric experience requirement to conduct all portions of the training and validation process, or clarify that the pediatric-qualified RN satisfies all instructor criteria. This would reduce duplicative staffing requirements while maintaining clinical integrity.

3. Delegation and Scope of Practice Concerns

Several tasks listed in the proposed curriculum raise potential conflicts with section 464.0156, Florida Statutes, governing RN delegation. These include:

• Foley catheter insertion and removal (a sterile, non-delegable procedure)
• Peripheral intravenous-related tasks that may involve sterile dressing changes
• Language suggesting aides may independently assess behavioral changes
• Glucometer assistance where the child cannot self-administer
• Ambiguity regarding ostomy and colostomy task parameters

Without clarification, agencies risk inconsistent survey findings and citations for tasks that exceed lawful delegation authority.

HCAF Recommendations:

• Remove or revise language suggesting delegation of sterile or otherwise non-delegable nursing functions.
• Explicitly state that all services must comply with section 464.0156, Florida Statutes, and existing RN delegation standards.
• Clarify that aides may report observations but may not perform independent assessments.

4. Clinical Competency Validation Requirements

The rule requires 16 hours of on-site clinical competency validation with an actual patient.

Agencies raised concerns that:

• Not every medically fragile child will exhibit each condition included in the curriculum.
• Requiring on-site validation for every listed procedure may create access barriers and delay service delivery.

HCAF Recommendations:

• Clarify that competency validation applies only to tasks required under the child’s individualized plan of care.
• Expand permissible use of simulation or pseudo-patient models where clinically appropriate.

5. Data and Adverse Incident Reporting

The proposed revisions reference electronic adverse incident reporting and annual data submission requirements.

HCAF Requested Clarification:

• Expand permissible use of simulation or pseudo-patient models where clinically appropriate.
• Confirm agencies must report only adverse incidents occurring during the period in which the aide is actively providing care.
• Clarify how the new reporting requirements interact with existing home health adverse incident reporting obligations to prevent duplicative reporting.

6. Survey and Enforcement Considerations

Agencies expressed concern that detailed curriculum requirements may create citation risk if surveyors determine an agency’s training materials do not precisely align with the rule’s structure.

HCAF Recommendations:

• Issue written interpretive guidance outlining compliance expectations.
• Provide a reasonable implementation period prior to enforcement to allow agencies to revise curricula and training processes.

Moving Forward

HCAF emphasized that strong safeguards for medically fragile children must remain paramount. However, clarifying delegation boundaries, ensuring statutory consistency, and addressing operational realities will strengthen implementation while avoiding unintended workforce barriers.

HCAF remains committed to working collaboratively with AHCA to refine the rule language and ensure patient safety, regulatory clarity, and continued access to high-quality in-home care for Florida’s medically fragile children.

Members will be kept informed as AHCA reviews stakeholder comments and determines next steps in the rulemaking process.