NURSING HOME ADMINISTRATOR LICENSURE
EXAM REVIEW COURSE
Florida Exam ◘ MODULE 6

referencsection

Ch. 400

Nursing Home Administration

 Speed Reader
Examination 1
Examination 2
Examination 3
Examination 4
Examination 5
Examination 6

Stan Mucinic, LNHA

LEGAL NOTICES

Students enrolled in the “Florida Nursing Home Administrator Licensing Course” are purchasing professional knowledge of the instructor to assist the student to prepare for the State Laws and Rules Exam administered by the National Association of Boards of Examiners (NAB).

This is a 3-week intensive independent study program designed to provide students a unique personalized and structured learning environment where progress is monitored by the instructor through email to help students maintain focus and complete scheduled assignments timely.

THE INSTRUCTOR MAKES NO EXPRESS OR IMPLIED WARRANTY OR REPRESENTATION OF ANY KIND THAT COMPLETION OF THIS OR ANY LICENSURE PREPARATION COURSE OFFERED BY INSTRUCTOR WILL GUARANTEE A PASSING SCORE ON ANY LICENSING EXAM.

An individual’s ultimate success in passing the licensure exam is dependent on an individual’s professional experience, academic preparation, and the time and energy the individual can commit to exam study and preparation. A student’s work schedule or other commitments may require more time to prepare for an exam than allotted by NAB or state licensing boards. The student is solely responsible for licensing exam registration/testing and retesting fees.

HOW TO USE THE STUDY GUIDES

Step 1 – VERY IMPORTANT - The personalized test organizer that comes with the program is the key to your success and sets this program apart from any other. It is critical you follow the instructions and score each exam, and file the completed exams into your binder. Try to keep to the schedule and email your test results to the instructor to stay focused.

Step 2. - Speed Reader – Read the speed reader for each module once or twice before taking the module exam(s). Read the speed reader over and over again until you familiarize yourself with its contents. THE MORE TIMES YOU LOOK IT THE MORE LIKELY YOU ARE TO REMEMBER IT.

Step 3 – Exam Packet - The exam packet contains questions designed to measure your comprehension and retention of the material you read. Take each exam over and over again until you score 100%. Make sure you score each exam and record the results in your organizer or you will not be able to gauge your progress.

The exam questions are cross referenced to the speed reader to allow you to quickly find and review material you missed on the exam as follows:

Thus, the specific material would be found on page 2 of the speed reader, section 1.8, subparagraph 13.

Contact Information

Email Stan Mucinic at with any questions and after you score each practice exam

SECTION 1 - intent

1.1 - INTENT

  1. The intent of Chapter 400 and Rule 59A-4 is to establish and enforce basic standards of treatment and care of residents in nursing facilities

SECTION 2 - Administration

2.1 - definitions

  1. “Administrator" is the licensed individual with day- to-day administrative charge of a facility
  2. "Agency" means the Agency for Health Care Administration (AHCA)
  3. “Department” means the Department of Health (licenses nursing homes)
  4. "Board" means the Board of Nursing Home Administrators
  5. "Controlling interest" means an officer, a director or person with 5 percent or greater ownership interest in a facility or management company that operates a facility
  6. "Facility" means any entity providing nursing, custodial or personal care exceeding 24-hours (in-patient care) for 3 or more persons, not related to the owner or manager by blood or marriage, and require nursing services due to illness, physical infirmity, or advanced age
  7. Nursing home bed" means an accommodation (including necessary equipment and furnishings) immediately available or can be ready for occupancy within 48 hours
  8. Nursing home facility" means any facility which provides nursing services
  9. “Voluntary board member" means a director of a not-for-profit corporation or organization serving in a voluntary capacity and does not receive any remuneration

2.2 - Licensed nursing home administrator required

  1. Every nursing home must be managed by a currently licensed nursing home administrator

2.3 – RESPONSIBILITIES OF LICENSEE

  1. The licensee (owner, corporate body) has full legal responsibility for operation of the facility
  2. Licensee must hire a licensed administrator to manage day-to-day operation of a facility
  3. The facility must be organized according to a written table of organization
  4. A vacant bed report must be submitted to AHCA monthly
  5. A nursing home staffing report must be submitted to AHCA quarterly

2.4- Long term care improvement fund

  1. The state’s Quality of Long-Term Care Facility Improvement Trust Fund supports activities and programs directly related to improving resident care (dementia training)

2.5 – LEvel 2 Background screening requirements

  1. Level 2 Screening

a)A level 2 background check involves an FBI fingerprint check

b)Fingerprints must be collected electronically and then submitted to the Florida Department of Law Enforcement (FDLE)

c)The FDLE submits the fingerprints to the FBI

  1. Who must have a Level 2 Background Screening
  1. The licensee, if an individual.
  2. The administrator or the person responsible for day-to-day operation of the facility
  3. The financial officer responsible for the financial operation of the facility
  4. Any person who is a controlling interest if the agency has reason to believe that such person has been convicted of any prohibited offense
  5. Any employee or contractor who will provide personal care or services directly to residents or have access to resident funds, personal property, or living areas
  1. Disqualifying Offenses/Convictions

  • Murder or homicide
/
  • Sexual misconduct

  • Assault or battery on elderly person/child
/
  • Prostitution or indecent exposure

  • Domestic Violence
/
  • Arson

  • Abuse of elderly adult or child
  • Theft or robberyMedicaid provider fraud.
  • Medicaid fraud.
  • Fraud in obtaining medicinal drugs
/
  • Fraudulent insurance claims

  • Kidnapping or false imprisonment

  1. Conditional Work Status
  1. An individual may start work before their background results are finalized but cannot have contact with residents.
  1. Re-Screening:

A) Each employee must be rescreened every 5 years to continue employment

2.6 – Accounting System

  1. The facility must maintain required fiscal records and make available for state/federal audit
  2. Must use either an accrual or cash system of accounting
  3. General ledgers and disbursement journals must be brought current no less than quarterly

2.7 - Resident Services Contract

  1. Each resident must receive, at the time of admission and as changes are made and upon request, in a language the resident or his representative understands:

a)The residents’ Bill of Rights

b)The facility’s admission and discharge policies; and

c)Information regarding advance directives

2.7 - Resident Services Contract

  1. Each resident must have a contract detailing services and charges, refund and bedhold policy
  2. Residents must be fully informed, both in writing and orally, prior to or upon admission, of all available services and charges covered and not covered by Medicaid and Medicare
  3. Contract must be retained 5 years
  4. A resident in continuing care community transferred from independent to skilled nursing does not need a new contract but an addendum must be attached describing additional costs
  5. Must provide interpreter if needed
  6. Need a new contract if payor source changes
  7. Each party to a contract is entitled to a copy of contract
  8. Facility must keep a copy of all contracts with resident
  9. Microfilmed records of original contracts can be retained in place of the original
  10. Must give resident both written and oral notice, 14 days in advance, of any changes to contract

2.8 – Resident Funds and property

  1. Resident has right to manage own financial affairs or delegate such responsibility to the facility (per written agreement to hold funds in trust)
  2. Cannot require residents to deposit personal funds with the facility.
  3. Facility must manage resident’s personal funds if requested by resident
  4. Facility must maintain a complete, and separate accounting of each resident’s personal funds
  5. Facility cannot commingle (mix) resident funds with facility funds
  6. Facility must provide resident or other party a quarterly accounting of all transactions in trust fund
  7. Facility may not charge resident for item or service paid for by Medicare or Medicaid
  8. Facility staff cannot be designated a legal representative of a resident or their property
  9. Facility must provide safekeeping of personal funds and property of resident
  10. Facility may require resident to remove valuables from the facility (jewels, etc.)
  11. Facility may require resident's to mark their personal property with the resident's name
  12. Any theft or loss of a resident's personal property must be documented by facility
  13. Must have policies to minimize theft or loss of resident personal property
  14. Policies must be provided to every employee and each resident within 30 days of admission
  15. Must include reporting theft or loss of resident's property to law enforcement and any facility waiver of liability for loss or theft
  16. The facility must post notice of policies in places accessible to residents
  17. Can impose a charge on resident funds for any item or service requested by resident

2.9 – Interest Bearing Acccount

  1. Medicaid Resident Trust Fund

a)Totaling more than $50 must be deposited in interest-bearing account

b)Totaling less than $50 can be deposited in non-interest bearing account

  1. Medicare Resident

A)Funds in excess of $100 must be deposited in Interest bearing account

2.10 – Deceased Resident Funds AND property

  1. Must refund all funds and provide a final accounting within 30 days of resident’s death to the personal representative (or spouse or next of kin named in beneficiary designation form)
  2. Must return all property of deceased resident (can deduct monies owed facility for services and charges not included in Medicare or Medicaid per diem date (newspaper delivery, private room rate)

  1. If there is no spouse or next of kin, must deposit in interest-bearing account until disbursed by a
probate court, or if not disbursed in 2 years then deposit in resident protection trust fund
  1. Must keep deceased resident’s property separate from the funds and property of other residents

5. Deceased Resident Funds – If no spouse or next of kin must deposit in bank as follows:
A. Under $100
1)Maintain one account for all deceased residents whose funds total less than $100
2)Maintain records to compile interest due each individual account
B. Over $100
  1. Maintain separate account for each deceased resident with more than $100
  2. Deposit funds in resident protection trust fund not disbursed within 2 years

2.11 – Resident Funds Surety Bond

  1. Must obtain surety bond equal to 2x average monthly balance in resident trust fund during prior fiscal year or $5,000, whichever is greater
  2. A licensee who owns more than one facility may purchase a single surety bond to cover resident funds held in homes located in same AHCA service district
  3. Surety must notify AHCA 30 days in advance if facility cancels bond
  4. Self-insurance pool – may self insure in lieu of surety bond by:

a)Pooling together with other facilities pooling to establish an interest bearing account that must be administered by an elected board of trustees

b)The board of trustees must be composed of one representative from each participating facility

c)Each member in pool must deposit 2x the average monthly balance of the trust fund account or $5,000.00 dollars, whichever is greater, in a separate account maintained by the board of trustees in the name of the self-insurance pool in a chartered commercial bank in the state of Florida

d)The self-insurance pool compensates any resident suffering financial loss as the result of misconduct by one or more of the member licensees

  1. If a facility does not have a surety bond or is not a member of a self insurance pool and is requested to hold funds in trust by a resident, the facility must notify AHCA, in writing, of the request, and make application for a surety bond or for participation in a self-insurance agreement within 7 days of the request, exclusive of weekends and holidays

2.12 – faciility policies

  1. Must have policies and procedures governing all services provided in the facility
  2. Policies and procedures Must be reviewed at least annually by the administrator, medical director, and DON
  3. Must maintain policies and procedures regarding the death of residents in the facility.

2.13 – Resident Screening, Admission and retention

  1. A resident with a communicable disease cannot be admitted or retained unless the medical director or attending physician certify adequate or appropriate isolation measures are available to control transmission of the disease
  2. Residents may not be retained in the facility who require services beyond the services the facility is licensed or has the functional ability to provide as determined by the medical director and the director of nursing in consultation with the facility administrator

2.14 – Resident Bedrooms

  1. Residents must be assigned to a bedroom area and cannot be assigned bedroom space in common areas except in an emergency
  2. Emergencies requiring residents to be located in common areas must be documented and for a limited period of time

2.15 - STAFF EDUCATION

  1. Must have a written staff education plan for all facility employees.
  2. The staff education plan must be reviewed annually by the quality assurance committee
  3. Must include both pre-service and in-service programs
  4. The staff education plan must ensure that education is conducted annually for all facility employees, at a minimum, in the following areas:

a)Prevention and control of infection

b)Fire prevention, life safety, and disaster preparedness

c)Accident prevention and safety awareness program

d)Resident’s rights

e)Florida “right to know” hazardous materials

f)HIV/aids (if employee does not have certificate of completion when hired, must have 2 hours within 6 months of employment or before they provides care to AIDS resident)

g)All employees must have a minimum of one hour of HIV/AIDS biennially

2.16 - ADVANCE DIRECTIVES.

  1. Must have written policies and procedures regarding advanced directives
  2. Cannot condition treatment or admission on execution of an advance directive
  3. Must provide on admission a copy of “health care advance directives”
  4. Must provide on admission and in writing the facilities policies on advance directives
  5. Must document the existence of an advance directive in the medical record
  6. Must place a copy of the advanced directive in the medical record

2.17 - employee union activity

  1. Participation by an employee in any activity that promotes or discourages union organizing is not allowed during time employee is counted in staffing calculations for minimum staffing standards
  2. Salaries or expenses paid by any health care provider to an employee for any activity that promotes or discourages union organizing is not allowable cost for Medicaid cost reporting purposes

2.18 - GENERAL and Professional Liability Insurance

  1. Must maintain general and professional liability insurance coverage in force at all times

2.19 – AHCA POster

  1. Must display AHCA poster in facility with contact information for AHCA, Ombudsman, advocacy groups and explanation of available services

2.20 - Volunteers

1. Facility is responsible for all the activities of volunteers and may require:
a)Volunteers sign in and out
b)Wear an identification badge
c)Participate in a facility orientation and training program.

2.21 – Resident Billing

  1. Initial Bill

a)Must contain statement of specific services received and expenses incurred
b)Must detail services received within each department with unit price data
2. Prohibited Billing Practices
a)Must not include charges of nursing home-based physicians if billed separately.
b)Must not include any generalized category of expenses such as "other" or "miscellaneous"
c)Must not refer to drug code numbers when referring to drugs of any sort.
d)Must not add any charges to services charged by a third party
3. Permitted Billing Practices
a)May list drugs by brand or generic name
b)May specifically identify therapy treatment by date, type, and length
c)May fully disclose each charge and service provided
d)May add handling charge for services performed by third party and billed through the facility
4. Discharge/Final Bill
a)Within 7 days after discharge or the cost of all goods or services are billed to the facility, the facility must send resident itemized statement with specific charges incurred by resident
5. Required Legend
a)Billing statement must have the words "A OR-PROFIT (or NOT-FOR-PROFIT or PUBLIC) NURSING HOME LICENSED BY THE STATE OF FLORIDA" or substantially similar words sufficient to identify ownership
2.22 – Limit to Adanced Payments
  1. Advanced payment for care may at no time exceed the cost of care for a 6-month period

2.23 – withholding CPR

  1. Staff may withhold cardiopulmonary resuscitation per order not to resuscitate

  1. Staff withholding CPR per DNRO are not subject to civil liability or criminal prosecution

  1. Absence of an order not to resuscitate does not preclude a physician from withholding or withdrawing cardiopulmonary resuscitation as otherwise permitted by law

2.24 – Medicaid up or out Program

  1. Purpose is to monitor Medicaid recipients in poor-performing nursing homes with numerous lawsuits to improve quality of care or revoke the facility’s license
  2. Trained medical staff must frequently visit these facilities, investigate complaints, and oversee care
  3. AHCA must assist residents in poor performing facilities who want to transfer to another facility

SECTION 3 – resident rights

3.1 - STATEMENT of resident rights

  1. Each facility must adopt and make public a statement of the residents’ rights and responsibilities in the facility and must treat residents in accord with those rights
  2. The statement of resident rights must be posted in the facility
  3. Must have a written plan and provide staff training to implement these rights
  4. The written statement of rights must include a statement that a resident may file a complaint with AHCA or the Ombudsman
  5. The statement must be in boldfaced type and must include the name, address, and telephone numbers of the local ombudsman council and central abuse hotline where complaints may be lodged.

3.2 - Civil and Religious freedoms