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A02360 Summary:

BILL NOA02360
 
SAME ASNo Same As
 
SPONSORGottfried
 
COSPNSRGunther, Jaffee, Lifton, Englebright, Rosenthal L, Ortiz, Hooper, Abinanti, Seawright, Sepulveda, Crespo, D'Urso, Galef, Solages
 
MLTSPNSRArroyo, Carroll, Colton, Dinowitz, McDonough, Montesano, Paulin, Perry, Simon, Titone
 
Amd 4655, Pub Health L
 
Relates to requiring a registered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living.
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A02360 Actions:

BILL NOA02360
 
01/18/2017referred to health
04/25/2017reported
04/27/2017advanced to third reading cal.187
01/03/2018ordered to third reading cal.178
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A02360 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A2360
 
SPONSOR: Gottfried (MS)
  TITLE OF BILL: An act to amend the public health law, in relation to requiring a regis- tered nurse on staff at facilities certified for enhanced assisted living or special needs assisted living   PURPOSE OR GENERAL IDEA OF BILL: To require that a registered nurse be on staff five days a week to assure adequate assessment and monitoring of resident care in certain adult care facilities.   SUMMARY OF SPECIFIC PROVISIONS: Amends Public Health Law section 4655 to require that adult care facili- ties pursuing new or renewing enhanced assisted living certificates include a registered nurse (RN) on staff a minimum of one shift per day, five days a week. Facilities with resident populations that do not require full time over- sight by the RN may employ the individual for administrative or other purposes, as well. Determination of a resident's need for 24 hour skilled nursing care must be made by both the resident's physician and the facility's RN. Exist- ing facilities are given an additional 18 months to comply with the RN staffing requirement.   JUSTIFICATION: "Enhanced assisted living residences" (EALR) and "special needs assisted living residences" (SNALR) are categories of assisted living residences that are authorized to house residents who need a higher level of care, such as those who are chronically chair-fast and unable to transfer, or suffering from significant dementia. These individuals are inherently more fragile and more likely to be or become unstable and need full-time assistance than the general popu- lation of assisted living residents. Although under current regulatory requirements registered nurses are available on call, there is no system in place for residents to receive ongoing, in-person, professional moni- toring or assessment. This type of ongoing evaluation is essential to helping residents age in place safely. This requirement had been adopted by DOH, but a court decision held that it required statutory authority, which this bill would provide. The bill would update the requirements for obtaining or renewing certif- ication as an EALR or SNALR to include having a full-time registered nurse on-site at the facility, employed primarily to coordinate and monitor resident care. To minimize the burden on smaller facilities, with the department's permission, the staff registered nurse may also be employed in an administrative or other capacity.   PRIOR LEGISLATIVE HISTORY: 2011-2012: A.8870 - referred to Health committee 2013-2014: A.5168-A - advanced to third reading 2015-2016: A.2141 - advanced to third reading   FISCAL IMPLICATIONS: None to the state   EFFECTIVE DATE: Ninety days after becoming law
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A02360 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          2360
 
                               2017-2018 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 18, 2017
                                       ___________
 
        Introduced  by M. of A. GOTTFRIED, GUNTHER, JAFFEE, LIFTON, ENGLEBRIGHT,
          ROSENTHAL, ORTIZ, HOOPER, ABINANTI, SEAWRIGHT,  SEPULVEDA,  CRESPO  --
          Multi-Sponsored  by  --  M.  of  A. ARROYO, CARROLL, COLTON, DINOWITZ,
          McDONOUGH, MONTESANO, PAULIN, PERRY, SIMON, TITONE --  read  once  and
          referred to the Committee on Health

        AN ACT to amend the public health law, in relation to requiring a regis-
          tered  nurse  on  staff  at facilities certified for enhanced assisted
          living or special needs assisted living
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Section 4655 of the public health law, as added by chapter
     2  2 of the laws of 2004, is amended to read as follows:
     3    § 4655. Certification procedures and requirements. 1.  Notwithstanding
     4  any other provision of law, an assisted living operator may apply to the
     5  department to obtain an enhanced assisted living certificate pursuant to
     6  this section.
     7    (a) Such application shall be on a form approved by the department.
     8    (b)  An  assisted living operator may apply for such a certificate for
     9  the entire facility or any number of beds at the facility.
    10    (c) To obtain an enhanced assisted living certificate,  the  applicant
    11  must  submit  a  plan to the department setting forth how the additional
    12  needs of residents will be safely and appropriately met  at  such  resi-
    13  dence.  Such  plan  shall include, but need not be limited to, a written
    14  description of services, staffing levels, staff education and  training,
    15  work experience, and any environmental modifications that have been made
    16  or  will  be  made  to  protect  the  health, safety and welfare of such
    17  persons in the residence. The plan shall describe how the facility  will
    18  meet the registered nurse staffing requirement.
    19    (d) In addition to any other requirements of assisted living, an oper-
    20  ator  of  enhanced assisted living may hire care staff directly pursuant
    21  to standards developed by the department or contract with  a  home  care

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD02263-01-7

        A. 2360                             2
 
     1  services  agency  which has been approved to operate pursuant to article
     2  thirty-six of this chapter.
     3    (e)  No  assisted  living  residence  shall  be  certified as enhanced
     4  assisted living unless and  until  the  applicant  obtains  the  written
     5  approval of the department.
     6    (f)  (i)  To  obtain or renew an enhanced assisted living certificate,
     7  the applicant shall be required to have a  registered  nurse  onsite  to
     8  assess and monitor the condition of residents.
     9    (ii)  The  registered  nurse shall be at the facility a minimum of one
    10  shift per day, five days per week. The principal duties  of  the  regis-
    11  tered nurse shall be coordinating resident care, providing ongoing resi-
    12  dent  assessment  and  monitoring,  and  ensuring that all residents are
    13  receiving appropriate care.
    14    (iii) Facilities with resident populations that do not necessitate the
    15  monitoring or oversight services of a registered nurse on  a  full  time
    16  basis may also employ the registered nurse in an administrative or other
    17  capacity,  as  appropriate  for  the  facility. Facilities choosing this
    18  option must demonstrate that residents are receiving adequate assessment
    19  and monitoring.
    20    (iv) Existing enhanced assisted living residences shall be required to
    21  furnish proof of compliance with this paragraph no later  than  eighteen
    22  months after this paragraph shall have become a law.
    23    2.  No  resident  shall be permitted to continue to age in place under
    24  the terms of an enhanced assisted living certificate unless  the  opera-
    25  tor,  the  resident's  physician, the facility's staff registered nurse,
    26  and, if applicable, the resident's licensed or certified home care agen-
    27  cy, agree that the additional needs of the resident can  be  safely  and
    28  appropriately  met  at  the  residence. A resident eligible for enhanced
    29  assisted living or his or her representative shall submit to  the  resi-
    30  dence a written report from a physician, which report shall state that:
    31    (a) the physician has physically examined the resident within the last
    32  month; and
    33    (b)  the  resident  is not in need of twenty-four hour skilled nursing
    34  care or medical care which would require  placement  in  a  hospital  or
    35  residential health care facility.
    36    3. The residence must notify a resident that, while the residence will
    37  make  reasonable  efforts to facilitate the resident's ability to age in
    38  place pursuant to an individualized service plan, there may be  a  point
    39  reached where the needs of the resident cannot be safely or appropriate-
    40  ly  met  at  the  residence, requiring the transfer of the resident to a
    41  more appropriate facility in accordance  with  the  provisions  of  this
    42  article.
    43    4. If a resident reaches the point where he or she is in need of twen-
    44  ty-four  hour  skilled  nursing  care  or  medical  care  required to be
    45  provided by facilities licensed pursuant to article twenty-eight of this
    46  chapter or article nineteen, thirty-one  or  thirty-two  of  the  mental
    47  hygiene  law, as determined by the patient's physician or the facility's
    48  staff resident nurse, then the resident  must  be  discharged  from  the
    49  residence  and  the  operator  shall initiate proceedings for the termi-
    50  nation of the residency agreement of such resident  in  accordance  with
    51  the  provisions  of  section  four  hundred  sixty-one-h  of  the social
    52  services law.  Provided, however, a resident may remain at the residence
    53  if each of the following conditions are met:
    54    (a) a resident in need of twenty-four hour  skilled  nursing  care  or
    55  medical care hires appropriate nursing, medical or hospice staff to care
    56  for his or her increased needs;

        A. 2360                             3
 
     1    (b)  the  resident's physician [and], home care services agency [both]
     2  and the facility's staff registered nurse  all  determine  and  document
     3  that,  with the provision of such additional nursing, medical or hospice
     4  care, the resident can be safely cared for in the residence,  and  would
     5  not  require  placement  in  a  hospital, nursing home or other facility
     6  licensed under article twenty-eight of this chapter or article nineteen,
     7  thirty-one or thirty-two of the mental hygiene law;
     8    (c) the operator agrees to retain the resident and to  coordinate  the
     9  care  provided  by  the  operator and the additional nursing, medical or
    10  hospice staff; and
    11    (d) the resident is otherwise eligible to reside at the residence.
    12    5. In addition to the requirements otherwise required for licensure as
    13  assisted living, any residence that  advertises  or  markets  itself  as
    14  serving  individuals  with special needs, including, but not limited to,
    15  individuals with  dementia  or  cognitive  impairments,  must  submit  a
    16  special needs plan to the department setting forth how the special needs
    17  of  such  residents  will  be safely and appropriately met at such resi-
    18  dence. Such plan shall include, but need not be limited  to,  a  written
    19  description  of  specialized  services, staffing levels, staff education
    20  and training, work  experience,  professional  affiliations  or  special
    21  characteristics  relevant to serving persons with special needs, and any
    22  environmental modifications that have been  made  or  will  be  made  to
    23  protect the health, safety and welfare of such persons in the residence.
    24  In approving an application for special needs certification, the depart-
    25  ment shall develop standards to ensure adequate staffing and training in
    26  order  to  safely meet the needs of the resident. The standards shall be
    27  based upon recommendations of the task force established by section five
    28  of [the] chapter two of the laws of two thousand four [which added  this
    29  section].  In  addition  to any other standards which the department may
    30  develop, applicants for special needs assisted living certificates shall
    31  be subject to the same registered nurse staffing  requirements  detailed
    32  in  paragraphs  (c) and (f) of subdivision one of this section. No resi-
    33  dence shall market [themselves] itself as providing specialized services
    34  unless and until the  department  has  approved  such  applicant  for  a
    35  special  needs  assisted  living  certificate.  Existing  special  needs
    36  assisted living residences shall be required to furnish proof of compli-
    37  ance with the new staffing requirements no later  than  eighteen  months
    38  after this sentence shall have become a law.
    39    6. An enhanced assisted living certificate shall not be required of an
    40  adult care facility, or part thereof, which has obtained approval by the
    41  department  to  operate  an  assisted living program pursuant to section
    42  four hundred sixty-one-l of the social services law. Provided,  however,
    43  such  exemption shall only apply to those beds at the facility which are
    44  subject to the assisted living program.
    45    § 2. This act shall take effect on the ninetieth day  after  it  shall
    46  have  become  a  law;  provided  that any rules and regulations, and any
    47  other actions necessary to implement the provisions of this act  on  its
    48  effective  date are authorized and directed to be completed on or before
    49  such date.
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