New York State Assembly

 
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A10707 Summary:

A10707 Actions:

A10707 Committee Votes:

Committee:CODES   Chair:Lentol      
DATE:06/15/2016AYE/NAY:22/0  Action: Favorable refer to committee Rules        
Lentol
Aye
Graf
Aye
Schimminger
Aye
Giglio
Aye
Weinstein
Aye
McKevitt
Aye
Hevesi
Aye
Montesano
Aye
Wright
Aye
Ra
Aye
Pretlow
Aye
Tenney
Aye
Cook
Aye
Cymbrowitz
Aye
Titus
Aye
O'Donnell
Aye
Lavine
Aye
Perry
Aye
Zebrowski
Aye
Abinanti
Aye
Weprin
Aye
Mosley
Aye

Committee:RULES   Chair:Heastie      
DATE:06/16/2016AYE/NAY:28/0  Action: Favorable         
Heastie
Aye
Kolb
Aye
Gottfried
Aye
Tedisco
Aye
Lentol
Aye
Oaks
Aye
Farrell
Aye
Butler
Aye
Gantt
Aye
Crouch
Aye
Nolan
Aye
Finch
Excused
Weinstein
Aye
Barclay
Aye
Hooper
Aye
Raia
Aye
Ortiz
Aye
Duprey
Aye
Pretlow
Aye
Cook
Aye
Glick
Aye
Morelle
Aye
Aubry
Aye
Englebright
Aye
Wright
Excused
Dinowitz
Aye
Colton
Aye
Magnarelli
Aye
Perry
Aye
Markey
Aye

A10707 Floor Votes:

A10707 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A10707
 
SPONSOR: Rules (Glick)

 
TITLE OF BILL:  An act to amend the education law and the public
health law, in relation to authorizing certain advanced home health
aides to perform certain advanced tasks; and providing for the repeal of
such provisions upon expiration thereof
 
 
PURPOSE OF BILL:
 
This bill would amend the Nurse Practice Act to authorize advanced home
health aides to perform advanced tasks with appropriate training and
supervision.
 
 
SUMMARY OF PROVISIONS:
 
Section 1 of the bill would add a new Educ. L. § 6908(2) to exempt from
the Nurse Practice Act (NPA), advanced tasks to be performed by advanced
home health aides in conformance with regulations issued by the State
Education Department ("SED") in consultation with the Department of
Health ("DOW). Such regulations would specify the types of advanced
tasks that could be performed by advanced home health aides, which would
include administering routine or prefilled medications, and would set
forth the qualifications, training and competency requirements for
advanced home health aides.
 
The regulations also would state that advanced tasks may be performed
only in accordance with and pursuant to an authorized health practition-
er's ordered care and only under the direct supervision of a licensed
registered professional nurse employed by a home care services agency, a
hospice program or an enhanced assisted living residence. In developing
such regulations, SED would be required to take into account the recom-
mendations of a workgroup of stakeholders convened by DOH for the
purpose of providing guidance on these issues.
 
Section 2 of the bill would add a new Educ. L. § 6908(8) to specify
provisions for registered professional nurses who assign tasks to and
supervise advanced home health aides, consistent with the new Educ.  L.
§ 6908(2).
 
Section 3 of the bill would add a new Educ. L. § 6906(9) to require
licensed practical nurses to indicate, upon registration or re-registra-
tion with SED, if they have previously been authorized as an advanced
home health aide. SED would provide such information to DOH for purposes
of including it in the report required under § 10 of the bill.
 
Section 4 of the bill would add a new Public Health Law (PHL) § 206(30)
to require DOH to refer to SED any instance in which a registered
professional nurse engages in improper behavior while supervising an
advanced home health aide.

Section 5 of the bill would add a new PHL § 3602(17) to define advanced
home health aides as home health aides who are authorized to perform
advanced tasks as set forth in Educ. L. § 6908(1)(a)(v) and regulations
issued thereto. In addition, DOH would be required to issue regulations
regarding advanced home health aides related to the advanced home health
aide's authorization to perform advanced tasks in appropriate cases.
 
 
Section 6 of the bill would amend PHL § 3613(1)(a) to include hospice
programs and enhanced assisted living residences in the definition of
"home care services entity" for purposes of the Home Care Services Work-
er Registry.
 
Section 7 of the bill would renumber existing PHL§ 3613(9) as subdivi-
sion 10 and add a new subdivision 9 to provide that DOH will indicate
within the Home Care Services Worker Registry when a home health aide is
qualified to serve as an advanced home health aide because he or she has
satisfied all applicable training and competency requirements.
 
Sections 8 and 9 of the bill would amend PHL §§ 2899(6) and 2899-a(9) to
provide for criminal history information checks for hospice workers
serving individuals at home for purposes of the Home Care Services Work-
er Registry.
 
Section 10 of the bill would require DOH, in consultation with SED, to
report by September 1, 2016 on the recommendations of the workgroup
convened for the purpose of - providing input on the tasks that could be
performed by advanced home health aides and the qualifications and
supervision of such aides.
 
Section 11 of the bill would require DOH, in consultation with SED, to
issue a report by October 1, 2022, describing the implementation of the
advanced home health aide initiative and setting forth any recommenda-
tions in connection therewith. The report would include information such
as the number of advanced home health aides, the types of tasks they
perform, the number of home health and personal care aides who became
advanced home health aides, and the number of advanced home health aides
who became licensed practical nurses.
 
Section 12 of the bill provides that the bill would take effect 18
months after enactment and expire on March 31, 2023.
 
 
EXISTING LAW:
 
The Nurse Practice Act, set forth in Educ. L. Art. 139, generally limits
the provision of nursing care to licensed nurses, with certain
exemptions identified in Educ. L. § 6908. For example, Education Law §
6908(1)(a) permits persons who are not licensed as nurses to provide
care to friends and family members with disabilities or illness, or to
pay another individual to provide such services.
 
PHL § 3602 defines terms relevant to home care. In particular, PHL §
3602(4) defines "home health aide services" as meaning "simple health
care tasks, personal hygiene services, housekeeping tasks essential to
the patient's health and other related supportive services." PHL §
3602(5) defines "personal care services" as meaning "services to assist
with personal hygiene, dressing, feeding and household tasks essential
to the patient's health."
 
PHL § 3613 requires DOH to establish the Home Care Services Worker
Registry, identifying home care services workers - meaning individuals
that provide home health aide services as defined in PHL § 3602(4) or
personal care services as defined in PHL § 3062(5) - who have success-
fully completed a state-approved education or training program for home
care services workers.
 
 
STATEMENT IN SUPPORT:
 
In 2011, the Workforce Flexibility and Change of Scope of Practice Work
Group convened by the Medicaid Redesign Team ("MRT") recommended, among
other things: (1) authorizing home health aides to assist with the
administration of routine, pre-poured medications; and (2) creating a
certification for advanced home care aides who could carry out an
expanded range of tasks to be developed through a stakeholder process
established by DOH. These proposals were intended to increase access and
quality of care, and to help reduce disparities for consumers of home
and community based services in the Medicaid program.
 
This bill would authorize advanced home health aides to perform advanced
tasks under the supervision of a registered professional nurse employed
by a home care services agency, a hospice program or an enhanced
assisted living residence. To serve as an advanced home health aide, a
certified home health aide with at least one year of experience provid-
ing either home health or personal care services, or a combination ther-
eof, would be required to meet appropriate training and competency stan-
dards, as detailed in regulations issued by SED in consultation with DOH
and taking into consideration the guidance of a workgroup of stakehold-
ers convened by DOH. The tasks which could be performed by advanced home
health aides also would be identified in regulation, again taking into
consideration the workgroup's recommendations.
 
This bill would enable more people to live in home and community based
settings, and further supports the State's efforts to ensure that care
is provided in the most integrated settings as required by Olmstead v.
L.C., 527 U.S. 581 (1999) and as emphasized in Exec.  Order No. 84.
 
 
BUDGET IMPLICATIONS:
 
None.
 
 
EFFECTIVE DATE:
This bill would take effect 18 months after enactment, except that §§ 8
and 9 related to criminal history information checks for hospice
programs would take effect April 1, 2018 and apply only to prospective
employees. SED would be authorized to issue regulations and take other
necessary steps within the 18 month period; however, no advanced tasks
could be provided by advanced home health aides until such regulations
are adopted. The new provisions would expire and be repealed March 31,
2023 unless extended.

A10707 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          10707
 
                   IN ASSEMBLY
 
                                      June 13, 2016
                                       ___________
 
        Introduced  by  COMMITTEE  ON RULES -- (at request of M. of A. Glick) --
          (at request of the Governor) -- read once and referred to the  Commit-
          tee on Codes
 
        AN ACT to amend the education law and the public health law, in relation
          to  authorizing  certain advanced home health aides to perform certain
          advanced tasks; and providing for the repeal of such  provisions  upon
          expiration thereof

          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:
 
     1    Section 1. Section 6908 of the education law is amended  by  adding  a
     2  new subdivision 2 to read as follows:
     3    2.  This  article shall not be construed as prohibiting advanced tasks
     4  provided by an advanced home health aide in accordance with  regulations
     5  developed  by the commissioner, in consultation with the commissioner of
     6  health.  At a minimum, such regulations shall:
     7    a. specify the advanced tasks that may be performed by  advanced  home
     8  health  aides pursuant to this subdivision. Such tasks shall include the
     9  administration of medications which are routine and prefilled or  other-
    10  wise packaged in a manner that promotes relative ease of administration,
    11  provided that administration of medications by injection, sterile proce-
    12  dures,  and  central  line  maintenance  shall  be prohibited. Provided,
    13  however, such prohibition shall not apply to injections  of  insulin  or
    14  other  injections  for  diabetes  care,  to  injections of low molecular
    15  weight heparin,  and  to  pre-filled  auto-injections  of  naloxone  and
    16  epinephrine for emergency purposes, and provided, further, that entities
    17  employing  advanced home health aides pursuant to this subdivision shall
    18  establish a systematic approach to address drug diversion;
    19    b. provide that advanced tasks performed by advanced home health aides
    20  may be performed only under  the  direct  supervision  of  a  registered
    21  professional  nurse  licensed  in  New  York state, as set forth in this
    22  subdivision and subdivision eight of section sixty-nine hundred nine  of
    23  this article, where such nurse is employed by a home care services agen-
    24  cy  licensed  or  certified pursuant to article thirty-six of the public
    25  health law, a hospice program certified pursuant to article forty of the
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD12075-01-6
        A. 10707                            2

     1  public health law, or an enhanced  assisted  living  residence  licensed
     2  pursuant  to  article  seven  of  the  social services law and certified
     3  pursuant to article forty-six-B of the public health law.  Such  nursing
     4  supervision shall:
     5    (i)  include  training  and  periodic assessment of the performance of
     6  advanced tasks;
     7    (ii) be determined by the registered  professional  nurse  responsible
     8  for  supervising  such  advanced tasks based upon the complexity of such
     9  advanced tasks, the skill and experience of  the  advanced  home  health
    10  aide,  and  the  health  status of the individual for whom such advanced
    11  tasks are being performed;
    12    (iii) include a comprehensive initial and thereafter regular and ongo-
    13  ing assessment of the individual's needs;
    14    (iv) include as a requirement that the supervising registered  profes-
    15  sional  nurse shall visit individuals receiving services for the purpose
    16  of supervising the services provided by advanced home  health  aides  no
    17  less  than  once  every  two  weeks  and include as a requirement that a
    18  registered professional nurse shall be available  by  telephone  to  the
    19  advanced  home  health  aide twenty-four hours a day, seven days a week,
    20  provided that a registered professional  nurse  shall  be  available  to
    21  visit  an  individual  receiving  services  as  necessary to protect the
    22  health and safety of such individual; and
    23    (v) as shall be specified by the commissioner, be provided in a manner
    24  that takes into account individual care needs, case mix  complexity  and
    25  geographic  considerations  and  provide  that the number of individuals
    26  served by a supervising registered professional nurse is reasonable  and
    27  prudent.
    28    c.  establish  a  process by which a registered professional nurse may
    29  assign advanced tasks to an advanced  home  health  aide.  Such  process
    30  shall include, but not be limited to:
    31    (i)  allowing  assignment of advanced tasks to an advanced home health
    32  aide only where such advanced home health aide has demonstrated  to  the
    33  satisfaction of the supervising registered professional nurse competency
    34  in every advanced task that such advanced home health aide is authorized
    35  to perform, a willingness to perform such advanced tasks, and the abili-
    36  ty  to  effectively  and  efficiently  communicate  with  the individual
    37  receiving services and understand such individual's needs;
    38    (ii) prohibiting assignment of advanced  tasks  to  an  advanced  home
    39  health  aide  if the individual receiving services declines to be served
    40  by an advanced home health aide;
    41    (iii) authorizing the supervising  registered  professional  nurse  to
    42  revoke  any assigned advanced task from an advanced home health aide for
    43  any reason; and
    44    (iv) authorizing multiple registered professional  nurses  to  jointly
    45  agree to assign advanced tasks to an advanced home health aide, provided
    46  further that only one registered professional nurse shall be required to
    47  determine  if  the advanced home health aide has demonstrated competency
    48  in the advanced task to be performed;
    49    d. provide that advanced tasks may be  performed  only  in  accordance
    50  with and pursuant to an authorized health practitioner's ordered care;
    51    e. provide that only a certified home health aide may perform advanced
    52  tasks as an advanced home health aide when such aide has:
    53    (i)  at  least  one year of experience providing either home health or
    54  personal care services, or a combination of the same;
        A. 10707                            3
 
     1    (ii) completed the requisite training and demonstrated competencies of
     2  an advanced home health  aide  as  determined  by  the  commissioner  in
     3  consultation with the commissioner of health;
     4    (iii)  successfully  completed competency examinations satisfactory to
     5  the commissioner in consultation with the commissioner of health; and
     6    (iv) meets other  appropriate  qualifications  as  determined  by  the
     7  commissioner in consultation with the commissioner of health;
     8    f.  provide  that  only  an  individual who is listed in the home care
     9  services registry maintained by the department  of  health  pursuant  to
    10  section  thirty-six  hundred thirteen of the public health law as having
    11  satisfied all applicable training requirements  and  having  passed  the
    12  applicable  competency  examinations and who meets other requirements as
    13  set forth in regulations issued by the commissioner of  health  pursuant
    14  to subdivision seventeen of section thirty-six hundred two of the public
    15  health  law  may perform advanced tasks pursuant to this subdivision and
    16  may hold himself or herself out as an advanced home health aide;
    17    g. establish minimum standards of  training  for  the  performance  of
    18  advanced  tasks by advanced home health aides, including didactic train-
    19  ing, clinical training, and a supervised clinical practicum with  stand-
    20  ards set forth by the commissioner of health;
    21    h. provide that advanced home health aides shall receive case-specific
    22  training  on the advanced tasks to be assigned by the supervising nurse,
    23  provided that additional training shall take place  whenever  additional
    24  advanced tasks are assigned;
    25    i.  prohibit  an  advanced  home  health  aide from holding himself or
    26  herself out, or accepting employment as, a person licensed  to  practice
    27  nursing under the provisions of this article;
    28    j.  provide  that  an  advanced  home  health aide is not required nor
    29  permitted to assess the medication or medical needs of an individual;
    30    k. provide that an advanced home health aide shall not  be  authorized
    31  to perform any advanced tasks or activities pursuant to this subdivision
    32  that  are outside the scope of practice of a licensed practical nurse or
    33  any advanced tasks that have not  been  appropriately  assigned  by  the
    34  supervising registered professional nurse;
    35    l.  provide  that  an  advanced  home  health  aide shall document all
    36  advanced tasks provided to an individual, including medication  adminis-
    37  tration  to  each  individual  through  the use of a medication adminis-
    38  tration record; and
    39    m. provide that the supervising registered  professional  nurse  shall
    40  retain  the  discretion  to  decide  whether to assign advanced tasks to
    41  advanced home health aides under this program and shall not  be  subject
    42  to  coercion,  retaliation,  or the threat of retaliation; in developing
    43  such regulations, the commissioner shall take into account the recommen-
    44  dations of a workgroup of stakeholders convened by the  commissioner  of
    45  health  in consultation with the commissioner for the purpose of provid-
    46  ing guidance on the foregoing.
    47    § 2. Section 6909 of the education law is  amended  by  adding  a  new
    48  subdivision 8 to read as follows:
    49    8.  A  registered  professional  nurse,  while working for a home care
    50  services agency licensed or certified pursuant to article thirty-six  of
    51  the  public  health law, a hospice program certified pursuant to article
    52  forty of the public health law, or an enhanced assisted living residence
    53  licensed pursuant to article seven of the social services law and certi-
    54  fied pursuant to article forty-six-B of the public health  law  may,  in
    55  accordance  with  this subdivision, assign advanced home health aides to
    56  perform advanced tasks for individuals pursuant  to  the  provisions  of
        A. 10707                            4
 
     1  subdivision  two of section sixty-nine hundred eight of this article and
     2  supervise advanced home  health  aides  who  perform  assigned  advanced
     3  tasks.
     4    (a)  Prior  to  assigning  or  modifying  an  assignment to perform an
     5  advanced task, the registered professional nurse shall:
     6    (i) complete a nursing assessment to ascertain  the  client's  current
     7  health status and care needs; and
     8    (ii) provide to the advanced home health aide written, individual-spe-
     9  cific  instructions  for  performing  the advanced task and criteria for
    10  identifying, reporting and responding to problems or complications.
    11    (b) The registered professional nurse shall  not  assign  an  advanced
    12  task unless:
    13    (i)  the advanced task to be assigned is consistent with an authorized
    14  health practitioner's ordered care;
    15    (ii) the registered professional nurse provides case specific training
    16  to the advanced home  health  aide  and  personally  verifies  that  the
    17  advanced  home  health  aide  can  safely  and  competently  perform the
    18  advanced task;
    19    (iii) the registered professional nurse determines that  the  advanced
    20  home health aide is willing to perform such advanced task; and
    21    (iv)  the  registered  professional nurse determines that the advanced
    22  home health aide is able to effectively and efficiently communicate with
    23  the individual  receiving  services  and  understand  such  individual's
    24  needs.
    25    (c) The supervising registered professional nurse shall:
    26    (i)  visit individuals receiving services for the purpose of supervis-
    27  ing the services provided by advanced home health  aides  no  less  than
    28  once every two weeks; and
    29    (ii) conduct regular and ongoing assessment of the individual's needs.
    30    §  3.  Section  6906  of  the education law is amended by adding a new
    31  subdivision 9 to read as follows:
    32    (9) In conjunction with and as a condition of each triennial registra-
    33  tion, the department shall ask and  a  licensed  practical  nurse  shall
    34  indicate  whether the licensed practical nurse is or has previously been
    35  authorized as an advanced home health aide pursuant to  subdivision  two
    36  of  section  sixty-nine  hundred  eight  of this article. The department
    37  shall provide responses to the department of health and  the  department
    38  of  health shall include such information in reports related to advanced
    39  home health aides.
    40    § 4. Section 206 of the public health law is amended by adding  a  new
    41  subdivision 30 to read as follows:
    42    30. The commissioner shall notify the commissioner of education in any
    43  instance  in  which  a registered professional nurse engages in improper
    44  behavior while supervising an advanced  home  health  aide  pursuant  to
    45  subdivision  two  of  section  sixty-nine hundred eight of the education
    46  law.
    47    § 5. Section 3602 of the public health law is amended by adding a  new
    48  subdivision 17 to read as follows:
    49    17.  "Advanced  home  health  aides"  means  home health aides who are
    50  authorized to perform advanced tasks as delineated in subdivision two of
    51  section sixty-nine hundred eight of the education  law  and  regulations
    52  issued  by  the  commissioner of education relating thereto. The commis-
    53  sioner shall promulgate regulations regarding such  aides,  which  shall
    54  include  a process for the limitation or revocation of the advanced home
    55  health aide's authorization to perform  advanced  tasks  in  appropriate
    56  cases.
        A. 10707                            5
 
     1    §  6.  Paragraph  (a)  of  subdivision 1 of section 3613 of the public
     2  health law, as added by chapter 594 of the laws of 2008, is  amended  to
     3  read as follows:
     4    (a)  "Home  care services entity" means a home care services agency or
     5  other entity providing home care services subject  to  this  article  or
     6  exempt  under  section  thirty-six  hundred  nineteen of this article, a
     7  hospice program certified pursuant to  article  forty  of  this  chapter
     8  providing routine care at home under the hospice benefit, or an enhanced
     9  assisted  living  residence  licensed  under article seven of the social
    10  services law and certified under article  forty-six-B  of  this  chapter
    11  providing enhanced assisted living services.
    12    §  7. Subdivision 9 of section 3613 of the public health law is renum-
    13  bered subdivision 10 and a  new  subdivision  9  is  added  to  read  as
    14  follows:
    15    9.  The department shall indicate within the home care services worker
    16  registry when a home health aide has satisfied all  applicable  training
    17  and recertification requirements and has passed the applicable competen-
    18  cy examinations necessary to perform advanced tasks pursuant to subdivi-
    19  sion  two  of  section sixty-nine hundred eight of the education law and
    20  regulations issued thereto. Any limitation or revocation of the advanced
    21  home health aide's authorization also shall be indicated on  the  regis-
    22  try.
    23    §  8.  Subdivision  6  of  section  2899  of the public health law, as
    24  amended by chapter 94 of the  laws  of  2014,  is  amended  to  read  as
    25  follows:
    26    6. "Provider" shall mean any residential health care facility licensed
    27  under article twenty-eight of this chapter; or any certified home health
    28  agency, licensed home care services agency or long term home health care
    29  program  certified under article thirty-six of this chapter; any hospice
    30  program certified pursuant to article forty  of  this  chapter;  or  any
    31  adult  home,  enriched  housing program or residence for adults licensed
    32  under article seven of the social services law.
    33    § 9. Paragraph (a) of subdivision 9 of section 2899-a  of  the  public
    34  health law, as amended by section 23 of part A of chapter 60 of the laws
    35  of 2014, is amended to read as follows:
    36    (a)  In the event that funds are appropriated in any given fiscal year
    37  for the reimbursement for the costs of providing such  criminal  history
    38  information,  reimbursement  shall be made available in an equitable and
    39  direct manner for the projected cost of the fee established pursuant  to
    40  law by the division of criminal justice services for processing a crimi-
    41  nal  history information check, the fee imposed by the federal bureau of
    42  investigation for a national criminal history check, and  costs  associ-
    43  ated  with obtaining the fingerprints to all providers licensed, but not
    44  certified under article thirty-six of this chapter, providers  certified
    45  under  article  forty  of  this  chapter,  and all adult care facilities
    46  licensed under article seven of the social services law, including those
    47  that are subject to  this  article  and  are  unable  to  access  direct
    48  reimbursement from state and/or federal funded health programs.
    49    §  10.  On  or  before  September  1, 2016, the commissioner of health
    50  shall, in consultation with  the  commissioner  of  education,  issue  a
    51  report  to the governor and the chairs of the senate and assembly health
    52  and higher education committees setting forth the recommendations of the
    53  workgroup convened by the commissioner of  health  for  the  purpose  of
    54  providing  guidance  on  the  performance of advanced tasks which may be
    55  performed by advanced home health aides.
        A. 10707                            6
 
     1    § 11. On or before October 1, 2022, the commissioner of health  shall,
     2  in  consultation  with  the commissioner of education, issue a report on
     3  the implementation of advanced home health  aides  in  the  state.  Such
     4  report shall include the number of advanced home health aides authorized
     5  pursuant  to this act; the number of home health aides and personal care
     6  aides that became authorized to perform advanced tasks;  the  number  of
     7  advanced  home health aides that became registered as licensed practical
     8  nurses; the types of advanced tasks that advanced home health aides  are
     9  performing;  the number of complaints pertaining to services provided by
    10  advanced home health aides that  were  reported  to  the  department  of
    11  health;  and  the  number  of  advanced  home health aides who had their
    12  authorization limited or revoked. Such report shall provide  recommenda-
    13  tions  to  the governor and the chairs of the senate and assembly health
    14  and higher education committees regarding  the  implementation  of  home
    15  health aides pursuant to this act, and any recommendations related ther-
    16  eto.
    17    § 12. This act shall take effect immediately; provided that:
    18    a.  sections  one  and  three  of  this act shall take effect eighteen
    19  months after this act shall have become a  law.  Effective  immediately,
    20  the  commissioner  of  education  is  authorized to adopt or amend regu-
    21  lations and take such other actions as are necessary  to  implement  the
    22  provisions  of sections one and two of this act on or before such effec-
    23  tive date; provided, further, that no advanced tasks shall be  performed
    24  pursuant  to  the  provisions  of subdivision two of section 6908 of the
    25  education law, as added by section one of this act, on  or  before  such
    26  effective  date;  provided  further,  that  no  advanced  tasks shall be
    27  performed pursuant to such provisions until such regulations are adopted
    28  and except in conformance with such regulations including in conformance
    29  with the provisions of such regulations related  to  the  completion  of
    30  advanced  home  health  aide training and the satisfaction of competency
    31  examination requirements; and provided, further, that sections eight and
    32  nine of this act shall take effect April 1, 2018 and shall apply only to
    33  prospective employees.
    34    b. this act shall expire and be deemed repealed March 31, 2023.