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HB 391 Implementation Status: AHCA Updates on Home Health Aides for Medically Fragile Children Program

HB 391 Implementation Status: AHCA Updates on Home Health Aides for Medically Fragile Children Program

Medicaid Government Affairs & Advocacy

Leaders from the Florida Agency for Health Care Administration (AHCA) recently presented a comprehensive update on the implementation progress of the Home Health Aides for Medically Fragile Children program, established by HB 391 in 2023. The detailed presentation by Assistant Deputy Secretary of Medicaid Operations Austin Noll and Assistant Deputy Secretary of Health Care Policy & Oversight Kimberly Smoak occurred before the Florida House of Representatives Select Committee on Health Innovation on December 4, 2023. Watch the recording of the meeting here. This article highlights key points from their presentation and provides insights into the upcoming legislative session.

Key Elements of the Program

The Home Health Aide for Medically Fragile Children program aims to achieve several objectives, including reducing hospitalizations of medically fragile children, cutting state expenditures, and offering family caregivers the opportunity to serve as home health aides at a competitive rate of $25 per hour.

Eligibility criteria include employment by a licensed home health agency, age 18 or older, completion of an approved training program, and the ability to provide specific home health services to patients aged 21 or younger with qualifying conditions.

The program authorizes eligible relatives to provide trained nursing services as delegated by a registered nurse. The parent, guardian, or family member seeking the required training to become a home health aide for medically fragile children is not obligated to repay or reimburse the home health agency for the costs associated with the training program. HB 391 mandates the establishment of a new Medicaid fee schedule for a home health aide for medically fragile children, capped at $25 per hour for no more than eight (8) hours per day.

The legislation also includes a provision for AHCA to conduct an annual assessment of the program, focusing on hospitalization rates, caregiver satisfaction, and identifying additional support needs. Findings from the annual assessment must be reported to the Governor and legislative leaders annually, beginning January 1, 2025.

Implementation Status and Timeline

AHCA has presented a strategic timeline, outlining crucial steps for the implementation of the program. To achieve full implementation, AHCA, in collaboration with the Department of Health (DOH) Board of Nursing (BON), is currently in the process of adopting rules for the 85-hour training program. A draft of the rule has been developed and is slated for discussion with AHCA and the BON on December 15. Furthermore, a public rulemaking hearing on the program is anticipated in early January 2024.

Parallel to the training rulemaking process, AHCA is actively working on system updates designed to enable home health agencies to bill for services provided by home health aides for medically fragile children. Additionally, AHCA has drafted an amendment to the Medicaid State Plan, pending approval by the Centers for Medicare & Medicaid Services (CMS). The recruitment process for four (4) authorized full-time positions dedicated to implementing the program is currently underway. Finally, the updated fee schedule, reflecting the program’s associated $25 per hour reimbursement, is set to be promulgated once the licensure rulemaking process has concluded.

According to AHCA, 758 of the state's 2,423 licensed home health agencies would be eligible to participate in the program due to their skilled care designation. An analysis prepared by the Florida Legislature during the 2023 legislative session estimated that approximately 5,000 medically fragile children and their family members would be eligible to participate in the program.

2024 Florida Legislative Session Preview

Florida is gearing up for a pivotal 60-day legislative session set to commence on January 9, 2024, with a clear focus on addressing critical health care issues, including the workforce shortage.

Members can stay informed through HCAF's real-time legislative tracker at Active participation in the Home Care Day at the Capitol advocacy event on January 24-25, 2024, provides an opportunity for members to contribute to crucial health care policy discussions. For more information, visit

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