FREQUENTLY ASKED QUESTIONS NURSE REGISTRIES

Remuneration and Marketing laws

Advertising

11.1 Does this law change prohibit my nurse registry from advertising?

No. There are no state laws that prohibit nurse registries from advertising in newspapers or other print media, television, radio or internet.

11.2 Marketing to physicians, their office staff & families

400.506(15), Florida Statutes:

(a) The agency may deny, suspend, or revoke the license of a nurse registry and shall impose a fine of $5,000 against a nurse registry that:

5. Gives remuneration to a physician, a member of the physician's office staff, or an immediate family member of the physician, and the nurse registry received a patient referral in the last 12 months from that physician or the physician's office staff. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.

400.462(27), Florida Statutes

“Remuneration”means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind. However, if the term is used in any provision of law relating to health care providers, the term does not apply to an item that has an individual value of up to $15, including, but not limited to, a plaque, a certificate, a trophy, or a novelty item that is intended solely for presentation or is customarily given away solely for promotional, recognition, or advertising purposes.

11.2(1) What is meant by the “Florida Medicaid program”?  Does it include the Medicaid Waivers?

The Florida Medicaid program includes all programs in Medicaid, including, but not limited to, all Medicaid Waivers and Medicaid HMO.

11.2(2) What is a “controlling interest”?

A “controlling interest” means: the applicant or license; or a person or entity that:

11.2 (3) Can I take a physician to lunch to update him on the patient he referred to our nurse registry?

Yes but only if your nurse registry does not:

(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

Here are some examples of billing the Medicaid program:  

(i) your nurse registry is enrolled as a Medicaid Waiver provider and bills on-line for services provided through the Aged & Disabled Medicaid Waiver;

(ii) your nurse registry bills Amerigroup or Eldercare for services provided under the Nursing Home Diversion Waiver program.

(b) bill the Medicare program

(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program as explained in (a) or the Medicare program.  “Controlling interest” is defined above in 11.2(2).

11.2(4) Can I take breakfast, or other food or beverages to a physician and his office staff that refers patients to our nurse registry? 

Yes but only if your nurse registry does not:

(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

(b) bill the Medicare program

(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program.  “Controlling interest” is defined above in 11.2(2).

11.2(5) I have a registered nurse on my staff who is married to a physician. The physician refers some patients to our nurse registry. Can I continue to employ the nurse?

Yes but only if your nurse registry does not:

(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

(b) bill the Medicare program

(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program.  “Controlling interest” is defined above in 11.2(2).

11.2(6) Can our nurse registry lease space from a referring physician or a physician group?

Yes but only if your nurse registry does not:

(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.

(b) bill the Medicare program

(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program.  “Controlling interest” is defined above in 11.2(2).

11.3 Marketing to discharge planners for hospitals, nursing homes, and other facilities

400.506(15), Florida Statutes:

(a) The agency may deny, suspend, or revoke the license of a nurse registry and shall impose a fine of $5,000 against a nurse registry that:

4. Gives remuneration to a case manager, discharge planner, facility-based staff member, or third-party vendor who is involved in the discharge planning process of a facility licensed under chapter 395 or this chapter and from whom the nurse registry receives referrals. A nurse registry is exempt from this subparagraph if it does not bill the Florida Medicaid program or the Medicare program or share a controlling interest with any entity licensed, registered, or certified under part II of chapter 408 that bills the Florida Medicaid program or the Medicare program.

400.462(27), Florida Statutes
“Remuneration” means any payment or other benefit made directly or indirectly, overtly or covertly, in cash or in kind. However, if the term is used in any provision of law relating to health care providers, the term does not apply to an item that has an individual value of up to $15, including, but not limited to, a plaque, a certificate, a trophy, or a novelty item that is intended solely for presentation or is customarily given away solely for promotional, recognition, or advertising purposes.

11.3(1) What are the facilities licensed under Chapter 395 and Chapter 400?

Chapter 395 facilities are hospitals, ambulatory surgical centers, and mobile surgical facilities. Chapter 400 facilities are skilled nursing facilities (SNFs), HHAs, nurse registries, hospices, intermediate care facilities (DD), home medical equipment providers, health care clinics, prescribed pediatric extended care centers, transitional living facilities, and health care service pools.

11.3(2) Can our nurse registry still provide promotional items as give-aways, such as pens, pads, and other office items with the company’s logo to the staff in the hospital discharge planning office?

Yes, but only if your nurse registry does not:
(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.
(b) bill the Medicare program
(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program. "Controlling interest" is defined above in 11.2(2).

11.3(3) Can our nurse registry still pay for the lunches or coffee and donuts during educational in-services to social workers who work at the hospital and in nursing homes?

Yes, but only if your nurse registry does not:
(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.
(b) bill the Medicare program
(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program. “Controlling interest” is defined above in 11.2(2).

11.3(4) Every year our nurse registry has a vendor table at the annual social worker recognition luncheon. It is an appreciation luncheon for social workers and case managers who work with seniors. We pay for the use of the table that helps covers the cost of the luncheon. The social workers attending work in a variety of places- hospitals, nursing homes, home health agencies, hospices and do case management for local community agencies who work with seniors. All professionals that work with seniors are invited. The lunch is free to social workers and case managers. Everyone else that comes has to pay. We give out educational materials and information about our nurse registry along with small items that have our agency name and phone number on them such as pens, pads, coffee cups, and candy. We contribute a raffle prize for the drawings at the end of the luncheon. Is this still allowable?

Yes, but only if your nurse registry does not:
(a) bill the FloridaMedicaid program (defined in 11.2(1) above) or bill another agency that receives funding from the Florida Medicaid program for the services your nurse registry is sending independent contractors to provide.
(b) bill the Medicare program
(c) share a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid Program or the Medicare program. "Controlling interest" is defined above in 11.2(2).

11.3(5) May a nurse registry have a booth at a Health Fair at a shopping mall or senior center & give out small items, such as pens, pads, and other items with the nurse registry’s name on it?

Yes. However the nurse registry cannot give out anything of value to a referral source specified in 400.506(15)(a) 4, F.S. if your nurse registry bills the Florida Medicaid Program, the Medicare program, or shares a controlling interest with any entity that is licensed, certified or registered by AHCA that bills the Florida Medicaid program or the Medicare program.  “Controlling interest” is defined above in 11.2(2).

NOTE: If you have the following or similar questions, your nurse registry will need to contact your attorney for legal advice:

  1. We have a booth at the guardianship association conference.  Are we permitted to offer give-aways to those who come to our both and provide a basket for the drawing?  Or, can we only give brochures and business cards?  Guardians do refer patients to our nurse registry.
  2. Is it a violation of state law for our nurse registry to serve as sponsor of the National Association for Continuing Education conference that has about 100 physicians in attendance? We pay to sponsor and put up an information board on their agency and its services.

11.4 Assisted Living Facilities and others

400.506(15), Florida Statutes:

(a) The agency may deny, suspend, or revoke the license of a nurse registry and shall impose a fine of $5,000 against a nurse registry that:
1. Provides services to residents in an assisted living facility for which the nurse registry does not receive fair market value remuneration.
2. Provides staffing to an assisted living facility for which the nurse registry does not receive fair market value remuneration.
3. Fails to provide the agency, upon request, with copies of all contracts with assisted living facilities which were executed within the last 5 years.
(b) The agency shall also impose an administrative fine of $15,000 if the nurse registry refers nurses, certified nursing assistants, home health aides, or other staff without charge to a facility licensed under chapter 429 in return for patient referrals from the facility.

11.4(1) In 400.506 (15)(a) 4, F.S., it refers to providing copies of contracts with ALFs that were executed within 5 years of the request by AHCA. Since the bill takes effect July 1, does this mean that 5 years back from the request if made this fall, for example? This would be prior to the effective date on the bill. Or, does the 5 years count forward from July 1, 2008?

Copies of contracts can be requested for July 1, 2008 on per this law. However, the Agency may request any documents pursuant to 408.811, F.S.

11.4(2) Re 400.506(15)(a) 4, F.S., our nurse registry does monthly blood pressure clinics in ALFs. Can we continue to do these if we charge a nominal fee?

No.

11.4(3) Can a nurse registry provide monthly educational programs for residents in an ALF and give pens, pads, and items with our name on it away?

Yes.

11.5 Making a Complaint

11.5(1) How do I make a complaint about a nurse registry that I know is violating the new laws?

Call the AHCA complaint call center at (888) 419-3456.