Legal State and Federal Activities

1. Organizational Purpose

   The Nurse Registry coordinates and refers independent healthcare professionals to provide non-institutional home and community-based services to clients in their place of residence or other authorized settings.

   The registry does not directly employ caregivers; services are delivered by contracted, self-directed independent practitioners.

   The Nurse Registry operates in compliance with:

   • State laws and AHCA regulations for Nurse Registries
   • HIPAA privacy and confidentiality standards
   • Medicare / Medicaid and managed care contract rules (when applicable)

2. Types of Professionals Referred

   The Nurse Registry may coordinate services provided by:

   • Registered Nurses (RN)
   • Licensed Practical Nurses (LPN)
   • Certified Nursing Assistants (CNA)
   • Home Health Aides (HHA)
   • Companions / Homemakers (when permitted)

   All independent contractors must:

   • Hold current professional licensure or certification
   • Maintain liability insurance (when required)
   • Pass level-2 background screening
   • Maintain CPR and competency documentation
   • Meet continuing education and compliance standards

3. Scope of Services That May Be Referred

   1. Skilled Nursing Services (RN/LPN)

      When ordered by a physician and within license scope:

      • Medication administration & education
      • Wound care and dressing changes
      • Diabetic management / insulin administration
      • Foley catheter care
      • Tube feeding
      • Vital signs monitoring & symptom observation
      • Disease process teaching
      • Post-operative care
      • Ostomy care
      • Pain management support
      • Skilled nursing assessments

   2. Personal Care Services (CNA/HHA)

      • Activities of Daily Living (ADLs)
        • Bathing, grooming, dressing, toileting, transfers, ambulation
      • Assistance with mobility and safety
      • Skin Care/Hygiene (Non-skilled)
      • Assistance with self-administered medications
      • Light meal preparation, hydration reminders
      • Basic household support directly related to patient care

   3. Companion / Homemaker Services

      (Where permitted — non-hands-on, non-clinical)

      • Supervision for safety and companionship
      • Light housekeeping tasks
      • Errands/Grocery Assistance
      • Meal Preparation
      • Social Engagement Activities
      • Transportation Assistance (If Authorized)

      No personal care or hands-on care is provided in this category.

4. Services Not Provided/Limitations

   A Nurse Registry:

   • Does not directly supervise clinical practice
   • Does not employ caregivers
   • Does not provide case management
   • Does not guarantee hours or assignments
   • Does not control clinical judgment
   • Does not bill Medicare directly unless contracted to do so

   Independent contractors are responsible for:

   • Accepting or declining referrals
   • Providing care within licensure scope
   • Documenting services rendered
   • Maintaining professional standards

5. Referral & Coordination Responsibilities

   The Nurse Registry is responsible for:

   • Verifying credentials and eligibility of contractors
   • Matching client needs with an appropriate professional
   • Providing client condition and service expectations at referral
   • Notifying contractors of assignment details
   • Documenting referral activities
   • Maintaining client and contractor records

   Clients and families retain the right to:

   • Select or refuse any caregiver
   • Change assigned caregivers
   • Direct care preferences
   • Terminate services

6. Plan of Care & Orders (When Applicable)

   For skilled nursing services:

   • Services are delivered under a physician’s order
   • A service plan is developed with the client and/or family
   • Care is provided only within ordered scope
   • Contractors must notify physician and registry of:
     
     • Change in condition
     • Safety risk
     • Refusal of care
     • Hospitalization or discontinuation of service

7. Documentation Requirements

   Independent contractors must maintain:

   • Visit Notes/Clinical Documentation
   • Progress notes and observations
   • Incident or Injury Reports
   • Communication with Physician/Client/Family
   • Proof of services rendered (for Billing and Audit Compliance)

   The Nurse Registry maintains:

   • Client referral records
   • Contractor credentials
   • Service coordination records
   • Complaint and incident logs

8. Quality, Safety & Compliance

   The Nurse Registry maintains:

   • Continuous quality improvement activities
   • Complaint resolution process
   • Risk management and incident reporting system
   • Infection control standards
   • Patient rights and grievance policy
   • Emergency and disaster coordination plan

   Contractors must:

   • Practice within ethical and legal standards
   • Report suspected abuse, neglect, or exploitation
   • Ensure client safety and dignity
   • Maintain professional competence

9. Termination or Discontinuation of Services

   Services may be discontinued when:

   • The client no longer requires services
   • The physician discontinues orders
   • Safety risks prevent continued care
   • The client or caregiver terminates services
   • Lack of payment or coverage applies

Required notices (such as NOMNC or non-coverage forms) are issued when applicable.

Here are the specific Florida laws and administrative rules that support and define the Scope of Action for a Nurse Registry, including what services may be referred, contractor limitations, required procedures, and compliance obligations.

Where possible, I cite the exact statute or regulation so you can reference it in policies, manuals, or compliance documents.

1. Florida Statute — Nurse Registry Licensure & Scope (F.S. § 400.506)

   1. Licensing and Definition

      1. A Nurse Registry must be licensed with the Florida Agency for Health Care Administration (AHCA). It is not a home health agency but must have its own license. Legislation Florida

      2. A “Nurse Registry” is legally defined as a person/entity that procures or secures contracts for healthcare workers — including RNs, LPNs, CNAs, HHAs, companions, or homemakers — as independent contractors for private residences or or staffing services. Legislation Florida

   2. Who Can Be Referred

      A licensed nurse registry may only refer:

      • Registered Nurses (RN)
      • Licensed Practical Nurses (LPN)
      • Certified Nursing Assistants (CNA)
      • Home Health Aides trained per AHCA rules
      • Companions or Homemakers

      for services authorized under Section 400.509(1). FindLaw Codes

   3. Independent Contractor Status

      Contractors referred by a nurse registry are legally independent contractors, not employees, regardless of obligations imposed by law. The registry may not supervise, manage, or train them. FindLaw Codes+1

   4. Services Allowed for CNA/HHA

      A CNA or HHA may be referred to provide care only if the patient is under physician care. FindLaw Codes

      The care for CNAs/HHAs in private residences is limited to:

      • Bathing, dressing, toileting, grooming, eating
      • Physical transfers and ambulation
      • Normal daily routines the patient could perform if not physically incapable they may not perform skilled or licensed-only services. FindLaw Codes

      This statutory limitation effectively defines the scope of personal care services allowed for direct care contractors.

   5. Written Physician Notification

      The registry must obtain the name and address of the attending physician and send written notice within 48 hours of the CNA or HHA contract. FindLaw Codes

   6. Credential Requirements

      Every person referred must:

      • Provide current proof of communicable disease status
      • Provide training proof for HHAs per AHCA rules
      • Be certified/licensed for the services they perform

      This is required for all independent contractors referred by the registry. FindLaw Codes

   7. Documentation & Recordkeeping

      The nurse registry must maintain:

      • Contract applications
      • Patient/client names and addresses
      • Fees received
      • Credential documentation

      Records must be available for AHCA inspection and kept for 3 years after last entry. FindLaw Codes

   8. Emergency Preparedness

      The registry must prepare and maintain a comprehensive emergency management plan consistent with statutory requirements. FindLaw Codes

   9. Penalties & Compliance

      Operating an unlicensed nurse registry after notification is a misdemeanor and can result in fines. Legislation Florida

      AHCA may deny, suspend, or revoke a registry’s license for violations — including inappropriate services or improper financial arrangements. FindLaw Codes

2. Florida Administrative Code — Supporting Regulations (59A-18)

   1. Registration & Contractor Verification (Rule 59A-18.005)

      Each registry must:

      • Disseminate applicable rules/statutes to contractors
      • Verify identities, credentials, and licenses
      • Confirm background screenings
      • Maintain complaint recording systems
      • Ensure health verification prior to patient contact
      • Maintain contractor files that meet F.S. § 400.506 requirements Legal Information Institute

      This rule supports the regulatory foundation for safe and compliant referrals.

   2. Administrator Qualifications (Rule 59A-18.006)

      Registry administrators must be:

      • Licensed physician, APRN, RN, OR
      • Qualified administrator with healthcare experience

      And be knowledgeable about AHCA rules and responsible for total registry operation. Justia

   3. Operational Policies (Rule 59A-18.004)

      Operational rules require:

      • Administrator availability during business hours
      • Staff or designated person to answer phones and contact administrator
      • Access to records during AHCA surveys
      • Patient contact numbers for emergencies and replacement caregivers Legal Information Institute

      These administrative standards reinforce compliance and quality operations.

   4. Emergency Management (Rule 59A-18.018)

      Detailed requirements for emergency planning include:

      • Written comprehensive emergency plan
      • Annual review of the plan
      • Communication contingencies
      • Assistance with special needs registries
      • Documentation of emergency services continuity Legal Information Institute

      This regulation ensures that nurse registries are prepared for disasters and continuity of care.

3. Definitions (Supporting the Scope)

   1. “Personal Care” Defined

      Under statute, personal care means:

      • Assistance with dressing, bathing, eating, hygiene
      • Physical transfer and ambulation
      • Assisting with medication administration as permitted by rule The Florida Senate

      This statutory definition supports what CNAs/HHAs can provide when referred.