Bill Text: NY A00921 | 2011-2012 | General Assembly | Introduced
Bill Title: Enacts the "safe staffing for quality care act" to require acute care facilities and nursing homes to implement certain direct-care nurse to patient ratios in all nursing units; sets minimum staffing requirements; requires every such facility to submit a documented staffing plan to the department on an annual basis and upon application for an operating certificate; requires acute care facilities to maintain staffing records during all shifts; authorizes nurses to refuse work assignments if the assignment exceeds the nurse's abilities or if minimum staffing is not present; requires public access to documented staffing plans; imposes civil penalties for violations of such provisions; establishes private right of action for nurses discriminated against for refusing any illegal work assignment.
Spectrum: Moderate Partisan Bill (Democrat 72-16)
Status: (Introduced - Dead) 2012-01-04 - referred to health [A00921 Detail]
Download: New_York-2011-A00921-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 921 2011-2012 Regular Sessions I N A S S E M B L Y (PREFILED) January 5, 2011 ___________ Introduced by M. of A. GOTTFRIED, GUNTHER, MILLMAN, JACOBS, PHEFFER, CLARK, DESTITO, PEOPLES-STOKES, MAGNARELLI, MARKEY, HOYT, ROSENTHAL, JAFFEE, COLTON, BENEDETTO, REILLY, GABRYSZAK, LANCMAN, SCHROEDER -- Multi-Sponsored by -- M. of A. ARROYO, BARRON, BING, BRENNAN, BROOK-KRASNY, BURLING, CAHILL, CAMARA, COOK, CRESPO, CUSICK, CYMBROW- ITZ, DINOWITZ, ENGLEBRIGHT, GLICK, HEASTIE, HOOPER, KELLNER, LATIMER, LAVINE, LIFTON, LUPARDO, MAISEL, MAYERSOHN, McDONOUGH, McENENY, McKEV- ITT, MENG, J. MILLER, MONTESANO, ORTIZ, PAULIN, PERRY, PRETLOW, RABBITT, RAMOS, J. RIVERA, P. RIVERA, ROBINSON, RUSSELL, SALADINO, SCARBOROUGH, SCHIMEL, SPANO, SWEENEY, THIELE, TITONE, TITUS, TOWNS, WEISENBERG, WRIGHT -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to enacting the "safe staffing for quality care act" and to amend the state finance law, in relation to moneys deposited into the improving quality of patient care fund THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Short title. This act shall be known and may be cited as 2 the "safe staffing for quality care act". 3 S 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the 4 public health law, paragraph (a) as amended by chapter 923 of the laws 5 of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965, 6 are amended to read as follows: 7 (a) Application for an operating certificate for a hospital shall be 8 made upon forms prescribed by the department. The application shall 9 [contain] INCLUDE the name of the hospital, the kind or kinds of hospi- 10 tal service to be provided, the location and physical description of the 11 institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN SECTION EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD02400-01-1 A. 921 2 1 TWENTY-EIGHT HUNDRED TWENTY-FOUR OF THIS ARTICLE, and such other infor- 2 mation as the department may require. 3 (b) An operating certificate shall not be issued by the department 4 unless it finds that the premises, equipment, personnel, DOCUMENTED 5 STAFFING PLAN, rules and by-laws, standards of medical care, and hospi- 6 tal service are fit and adequate and that the hospital will be operated 7 in the manner required by this article and rules and regulations there- 8 under. 9 S 3. The public health law is amended by adding nine new sections 10 2823, 2824, 2825, 2826, 2827, 2828, 2829, 2830 and 2831 to read as 11 follows: 12 S 2823. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF 13 THE FOLLOWING: 14 1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY 15 DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES; 16 2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFF- 17 ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES; 18 3. TO ENSURE THE ADEQUATE PROTECTION OF PATIENTS IN HEALTH CARE 19 SETTINGS, IT IS ESSENTIAL THAT QUALIFIED REGISTERED NURSES AND OTHER 20 LICENSED NURSES BE ACCESSIBLE AND AVAILABLE TO MEET THE NEEDS OF 21 PATIENTS; AND 22 4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD 23 BE BASED ON THE PATIENT'S CARE NEEDS, THE SEVERITY OF CONDITION, 24 SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES. 25 S 2824. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES, 26 AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE 27 CONTEXT OTHERWISE PLAINLY REQUIRES: 28 1. "ACUTE CARE FACILITY" SHALL MEAN A GENERAL HOSPITAL, AND SHALL ALSO 29 INCLUDE ANY CHRONIC DISEASE HOSPITAL, MATERNITY HOSPITAL, OUTPATIENT 30 DEPARTMENT, EMERGENCY CENTER OR SURGICAL CENTER, AND SHALL ALSO INCLUDE 31 ANY FACILITY THAT PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL 32 HYGIENE LAW, ARTICLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION 33 LAW IF SUCH FACILITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION 34 OF THE STATE OR A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION. 35 2. "ACUITY SYSTEM" SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT 36 WHICH (A) PREDICTS NURSING CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS 37 BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND 38 TECHNOLOGY, INTENSITY OF NURSING INTERVENTIONS REQUIRED, AND THE 39 COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND 40 EVALUATE THE PATIENT'S NURSING CARE PLAN; (B) DETAILS THE AMOUNT OF 41 NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL 42 MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN 43 A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN TERMS THAT READILY 44 CAN BE USED AND UNDERSTOOD BY DIRECT-CARE NURSES. THE ACUITY SYSTEM 45 SHALL TAKE INTO CONSIDERATION THE PATIENT CARE SERVICES PROVIDED NOT 46 ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL 47 NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL. 48 3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE 49 STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT 50 NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY 51 SYSTEM. 52 4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY 53 NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL 54 REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS. 55 5. "DOCUMENTED STAFFING PLAN" SHALL MEAN A DETAILED WRITTEN PLAN 56 SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS- A. 921 3 1 ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY 2 FOR A GIVEN YEAR, BASED ON REASONABLE PROJECTIONS DERIVED FROM THE 3 PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT 4 DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE 5 NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR 6 UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR. 7 6. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE OR LICENSED 8 PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF 9 THE EDUCATION LAW. 10 7. "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION 11 OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF 12 THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE RECOGNIZED STAND- 13 ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN- 14 NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY. 15 8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF SECTIONS 16 TWENTY-EIGHT HUNDRED TWENTY-THREE THROUGH TWENTY-EIGHT HUNDRED 17 THIRTY-ONE OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU- 18 ANT THERETO. 19 9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND 20 EXPERIENCE AMONG DIRECT-CARE NURSES. 21 10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT 22 RATIO WITHIN A NURSING DEPARTMENT OR UNIT. 23 11. "UNIT" SHALL MEAN A PATIENT CARE COMPONENT, AS DEFINED BY THE 24 DEPARTMENT, WITHIN AN ACUTE CARE FACILITY. 25 12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT 26 A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE 27 EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY 28 OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE 29 IN THE DELIVERY OF PATIENT CARE. 30 S 2825. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER 31 SHALL: 32 1. PROMULGATE, AFTER CONSULTATION WITH THE COUNCIL, THE RULES AND 33 REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND PROVISIONS OF THE 34 SAFE STAFFING REQUIREMENTS, INCLUDING REGULATIONS DEFINING TERMS, 35 SETTING FORTH DIRECT-CARE NURSE TO PATIENT RATIOS, SETTING FORTH 36 NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS AND PRESCRIBING THE 37 PROCESS FOR APPROVING ACUITY SYSTEMS, WHICH MAY INCLUDE A SYSTEM FOR 38 CLASS APPROVAL OF ACUITY SYSTEMS; AND 39 2. ASSURE THAT THE PROVISIONS OF SAFE STAFFING REQUIREMENTS ARE 40 ENFORCED, INCLUDING THE ISSUANCE OF REGULATIONS WHICH AT A MINIMUM 41 PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE 42 TO COMPLY WITH SUCH REQUIREMENTS AND PUBLIC ACCESS TO INFORMATION 43 REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS 44 PURSUANT TO SUCH REQUIREMENTS. 45 3. ESTABLISH A COMMITTEE TO ADVISE IN THE DEVELOPMENT OF REGULATIONS, 46 INCLUDING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS 47 AND NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE NOT SPECI- 48 FIED IN THIS ARTICLE. THE COMMITTEE SHALL ADVISE THE COMMISSIONER ON 49 THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL, AND REVIEW AND 50 MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING 51 OF AN OPERATING CERTIFICATE BY THE DEPARTMENT. THE COMMITTEE SHALL HAVE 52 THIRTEEN MEMBERS. NO LESS THAN SIXTY PERCENT OF THE MEMBERS OF THE 53 COMMITTEE SHALL BE REGISTERED PROFESSIONAL NURSES. THE COMMITTEE SHALL 54 INCLUDE REGISTERED PROFESSIONAL NURSE DIRECT CARE PROVIDERS, REPRESEN- 55 TATIVES OF ACUTE CARE FACILITIES, AND REPRESENTATIVES OF NURSING PROFES- 56 SIONAL ASSOCIATIONS AND RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING A. 921 4 1 REPRESENTATIVE OF NURSES AND OF NON-NURSING DIRECT-CARE STAFF. THE 2 GOVERNOR SHALL APPOINT THE CHAIR AND SIX OTHER MEMBERS, TWO MEMBERS 3 SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY, ONE MEMBER SHALL BE 4 APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY, TWO MEMBERS SHALL BE 5 APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE AND ONE MEMBER SHALL 6 BE APPOINTED BY THE MINORITY LEADER OF THE SENATE. 7 S 2826. STAFFING REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH ACUTE 8 CARE FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES 9 SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN EACH DEPART- 10 MENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED 11 CARE NEEDS OF THE PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY 12 SHALL MEET THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS 13 SECTION. 14 2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF- 15 ICATE TO ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS 16 TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION 17 THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND 18 APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING 19 YEAR. THE DOCUMENTED STAFFING PLAN SHALL: 20 (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF 21 THIS SECTION; 22 (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER 23 LAWS, RULES OR REGULATIONS; 24 (C) EMPLOY AND IDENTIFY AN APPROVED ACUITY SYSTEM FOR ADDRESSING FLUC- 25 TUATIONS IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS 26 REQUIRING INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE 27 PLAN; 28 (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES, 29 TRANSFERS AND ADMISSIONS, AND ADMINISTRATIVE AND SUPPORT TASKS THAT IS 30 EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING 31 CARE; 32 (E) INCLUDE A PLAN TO MEET NECESSARY STAFFING LEVELS AND SERVICES 33 PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS 34 PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE 35 STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC- 36 TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF 37 PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE 38 PERFORMED BY OTHER PERSONNEL; 39 (F) IDENTIFY THE ASSESSMENT TOOL USED TO VALIDATE THE ACUITY SYSTEM 40 RELIED ON IN THE PLAN; 41 (G) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING 42 ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT; 43 (H) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S 44 STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS; 45 (I) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN 46 TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH 47 SUCH CLASSIFICATION; AND 48 (J) BE DEVELOPED IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE 49 NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES- 50 ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING 51 REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER 52 SUPPORTIVE AND ASSISTIVE STAFF. 53 3. MINIMUM STAFFING REQUIREMENTS. (A) THE DOCUMENTED STAFFING PLAN 54 SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA- 55 TIENT RATIOS: A. 921 5 1 (I) ONE NURSE TO ONE PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY 2 UNITS AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY CRITICAL CARE AND 3 ALL INTENSIVE CARE UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND OR 4 THIRD STAGE OF LABOR; 5 (II) ONE NURSE TO TWO PATIENTS: MATERNAL/CHILD CARE UNITS FOR THE 6 FIRST STAGE OF LABOR, AND POSTANESTHESIA UNITS; 7 (III) ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA- 8 TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME- 9 DIATE CARE NURSERY UNITS; 10 (IV) ONE NURSE TO THREE PATIENTS: POSTPARTUM MOTHER/BABY COUPLETS 11 (MAXIMUM SIX PATIENTS PER NURSE); 12 (V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS, AND 13 MEDICAL/SURGICAL AND ACUTE CARE PSYCHIATRIC UNITS; 14 (VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS; AND 15 (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS. 16 FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING PSYCHIATRIC 17 UNITS, AND ACUTE CARE FACILITIES OPERATED PURSUANT TO THE MENTAL HYGIENE 18 LAW OR THE CORRECTION LAW, THE DEPARTMENT SHALL ESTABLISH BY REGULATION 19 THE APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT RATIO. 20 (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN PARAGRAPH (A) OF THIS 21 SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF PATIENTS THAT MAY BE 22 ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT DURING ONE SHIFT. A NURSE, 23 INCLUDING A NURSE ADMINISTRATOR OR SUPERVISOR, WHO DOES NOT HAVE PRINCI- 24 PAL RESPONSIBILITY AS A DIRECT-CARE NURSE FOR A SPECIFIC PATIENT SHALL 25 NOT BE INCLUDED IN THE CALCULATION OF THE NURSE-TO-PATIENT RATIO. 26 4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC- 27 TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS 28 ASSIGNED TO THE LICENSED PRACTICAL NURSE SHALL ALSO BE INCLUDED IN 29 CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES- 30 SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC- 31 TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE 32 LICENSED PRACTICAL NURSE. 33 5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS- 34 ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE 35 EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A 36 REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI- 37 CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC- 38 TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR 39 ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL 40 NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL. 41 6. ADJUSTMENTS. THE MINIMUM STAFFING REQUIREMENT AND NURSE-TO-PATIENT 42 RATIO SET FORTH IN THIS SECTION SHALL BE ADJUSTED AS NECESSARY TO 43 REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE NURSES NECESSARY TO ENSURE 44 ADEQUATE STAFFING OF EACH NURSING DEPARTMENT OR UNIT, IN ACCORDANCE WITH 45 AN APPROVED ACUITY SYSTEM. 46 7. DEPARTMENT REGULATIONS. NOTHING IN THIS SECTION SHALL BE DEEMED TO 47 PRECLUDE THE DEPARTMENT BY RULE OR REGULATION FROM ESTABLISHING AND 48 REQUIRING A DOCUMENTED STAFFING PLAN TO HAVE HIGHER NURSE-TO-PATIENT 49 RATIOS THAN THOSE SET FORTH IN THIS SECTION. 50 8. NOTHING CONTAINED IN THIS SECTION SHALL BE DEEMED TO ALTER, AFFECT 51 THE VALIDITY OF, MODIFY THE TERMS OF, OR IMPAIR ANY COLLECTIVE BARGAIN- 52 ING AGREEMENT. 53 S 2827. COMPLIANCE WITH STAFFING PLAN AND RECORDKEEPING. 1. AS A 54 CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE, EACH ACUTE 55 CARE FACILITY SHALL AT ALL TIMES STAFF IN ACCORDANCE WITH ITS DOCUMENTED 56 STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION A. 921 6 1 TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS ARTICLE; PROVIDED, HOWEVER, THAT 2 NOTHING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY 3 FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS, 4 NOR SHALL THE REQUIREMENTS SET FORTH IN SUCH SECTION TWENTY-EIGHT 5 HUNDRED TWENTY-SIX OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY 6 HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, RULE, REGULATION OR 7 CONTRACT. 8 2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS 9 STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS 10 ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT 11 RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN AN ACUTE CARE 12 FACILITY UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI- 13 CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR 14 ORIENTATION IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS- 15 ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMON- 16 STRATED CURRENT COMPETENCE IN PROVIDING CARE IN THAT UNIT OR CLINICAL 17 AREA. ACUTE CARE FACILITIES THAT UTILIZE TEMPORARY NURSING AGENCIES 18 SHALL HAVE AND ADHERE TO A WRITTEN PROCEDURE TO ORIENT AND EVALUATE 19 PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN- 20 CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO. IN THE EVENT OF AN 21 EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD TO 22 UNSAFE PATIENT CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT 23 UNIT OR CLINICAL AREA, PROVIDED THAT SUCH NURSES SHALL BE ASSIGNED 24 PATIENTS APPROPRIATE TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY 25 SHALL ESTABLISH A CONSISTENT PLAN FOR ADDRESSING EMERGENCY STAFFING 26 SITUATIONS AND MONITOR OUTCOMES. EMERGENCIES ARE DEFINED AS NATURAL 27 DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS 28 NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT REGULARLY OCCURRING 29 WITHIN THE FACILITY. 30 3. AS A CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE, 31 EACH ACUTE CARE FACILITY SHALL MAINTAIN ACCURATE DAILY RECORDS SHOWING: 32 (A) THE NUMBER OF PATIENTS ADMITTED, RELEASED AND PRESENT IN EACH 33 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; 34 (B) THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS- 35 ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND 36 (C) THE IDENTITY AND DUTY HOURS OF EACH DIRECT-CARE NURSE IN EACH 37 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY. 38 4. AS A CONDITION FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE, 39 EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURSING 40 DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJU- 41 RY AND MEDICAL ERRORS. 42 5. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE 43 MAINTAINED FOR A PERIOD OF SEVEN YEARS. 44 6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE 45 MADE AVAILABLE UPON REQUEST TO THE DEPARTMENT AND TO THE PUBLIC; 46 PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL COMPLY 47 WITH THE APPLICABLE PATIENT PRIVACY LAWS, RULES AND REGULATIONS, AND 48 THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE IDENTITY 49 AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC. 50 S 2828. WORK ASSIGNMENT POLICY. 1. GENERAL. AS A CONDITION FOR THE 51 MAINTENANCE OF AN OPERATING CERTIFICATE, EACH ACUTE CARE FACILITY SHALL 52 ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN WORK 53 ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS TWO AND 54 THREE OF THIS SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A 55 DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT. A. 921 7 1 2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL 2 PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT: 3 (A) FOR WHICH THE NURSE IS NOT PREPARED BY EDUCATION, TRAINING OR 4 EXPERIENCE TO SAFELY FULFILL THE ASSIGNMENT WITHOUT COMPROMISING OR 5 JEOPARDIZING PATIENT SAFETY, THE NURSE'S ABILITY TO MEET FORESEEABLE 6 PATIENT NEEDS OR THE NURSE'S LICENSE; OR 7 (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS. 8 3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL 9 CONTAIN PROCEDURES FOR THE FOLLOWING: 10 (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR 11 REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED 12 OF AN ASSIGNMENT OR CONTINUED DUTY; 13 (B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE 14 SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH- 15 ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR 16 TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN- 17 UED DUTY; 18 (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE 19 THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES 20 THE REQUEST TO BE RELIEVED IF: 21 (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR 22 THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY, 23 (II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY 24 WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND 25 (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS 26 CONDITIONS JUSTIFYING REFUSAL; AND 27 (D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A 28 WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED, 29 BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION, 30 PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO 31 NURSING. 32 S 2829. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY ACUTE CARE 33 FACILITY SHALL: 34 1. POST IN A CONSPICUOUS PLACE READILY ACCESSIBLE TO THE GENERAL 35 PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF 36 THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH 37 INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF- 38 ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED; 39 2. UPON REQUEST, MAKE COPIES OF THE DOCUMENTED STAFFING PLAN FILED 40 WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND 41 3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A 42 DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION: 43 (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT, 44 (B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE 45 PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM, 46 AND 47 (C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT 48 DURING THE SHIFT. 49 S 2830. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE- 50 GATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS 51 PROMULGATED PURSUANT TO THIS ARTICLE. 52 S 2831. ENFORCEMENT AND PENALTIES. 1. CIVIL PENALTY. ANY PERSON, 53 REGARDLESS OF WHETHER THAT PERSON POSSESSES AN OPERATING CERTIFICATE, 54 WHO HAS COMMITTED A VIOLATION OF ANY OF THE PROVISIONS OF THE SAFE 55 STAFFING REQUIREMENTS, INCLUDING FAILURE TO CORRECT A SERIOUS VIOLATION 56 (AS DEFINED BY REGULATION) WITHIN THE TIME SPECIFIED IN A DEFICIENCY A. 921 8 1 CITATION, MAY BE ASSESSED A CIVIL PENALTY BY ORDER OF THE DEPARTMENT OF 2 UP TO FIVE HUNDRED DOLLARS FOR EACH DEFICIENCY FOR EACH DAY THAT EACH 3 DEFICIENCY CONTINUES; PROVIDED, HOWEVER, THAT AN ACUTE HEALTH CARE 4 FACILITY THAT FAILS TO COMPLY WITH THE REQUIREMENTS OF SECTION 5 TWENTY-EIGHT HUNDRED TWENTY-SIX OF THIS ARTICLE MAY BE ASSESSED A CIVIL 6 PENALTY BY ORDER OF THE DEPARTMENT OF UP TO TEN THOUSAND DOLLARS FOR 7 EACH DAY OF NON-COMPLIANCE. CIVIL PENALTIES SHALL BE COLLECTED FROM THE 8 DATE SUCH FACILITY RECEIVES NOTICE OF VIOLATION UNTIL THE DATE SUCH 9 VIOLATION IS CORRECTED. 10 2. CIVIL PENALTY FOR INTERFERENCE WITH REPORTING OBLIGATIONS. ANY 11 PERSON OR ACUTE CARE FACILITY THAT FAILS TO REPORT OR FALSIFIES INFORMA- 12 TION, OR COERCES, THREATENS, INTIMIDATES OR OTHERWISE INFLUENCES ANOTH- 13 ER PERSON TO FAIL TO REPORT OR TO FALSIFY INFORMATION REQUIRED TO BE 14 REPORTED UNDER THE SAFE STAFFING REQUIREMENTS, MAY BE ASSESSED A CIVIL 15 PENALTY OF UP TO TEN THOUSAND DOLLARS FOR EACH SUCH INCIDENT. 16 3. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT 17 HUNDRED TWENTY-EIGHT OF THIS ARTICLE. ANY ACUTE CARE FACILITY THAT 18 VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGN- 19 MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED TWENTY-EIGHT OF THIS 20 ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A 21 COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS 22 MAY BE APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING 23 REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, 24 LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES 25 RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED 26 DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT 27 AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND 28 COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO 29 INSTITUTE A PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE 30 LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS. 31 S 4. Section 2801-a of the public health law is amended by adding a 32 new subdivision 3-b to read as follows: 33 3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI- 34 TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH COUNCIL 35 SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGU- 36 LATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE 37 SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRACTICES, 38 OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH COUNCIL SHALL GIVE 39 SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PUBLIC HEALTH LAW PROVISIONS 40 CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS. 41 S 5. Section 2805 of the public health law is amended by adding a new 42 subdivision 3 to read as follows: 43 3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE 44 TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD- 45 ANCE WITH THIS ARTICLE, THE COMMISSIONER SHALL CONSIDER ANY PAST 46 VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING 47 TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING 48 OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE 49 PUBLIC HEALTH COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE 50 PUBLIC HEALTH LAW PROVISIONS CONCERNING NURSE STAFF AND SUPPORTIVE STAFF 51 RATIOS. 52 S 6. Subdivisions 2 and 4 of section 97-aaaa of the state finance law, 53 as added by chapter 24 of the laws of 2002, are amended to read as 54 follows: 55 2. Such fund shall consist of all moneys received from civil penalties 56 assessed in actions commenced pursuant to section seven hundred forty- A. 921 9 1 one of the labor law AND CIVIL PENALTIES ASSESSED PURSUANT TO SECTION 2 TWENTY-EIGHT HUNDRED THIRTY-ONE OF THE PUBLIC HEALTH LAW. 3 4. Moneys in the account, following appropriation by the legislature, 4 shall be expended by the department of health for the purpose of improv- 5 ing the direct treatment and care of patients in facilities providing 6 health care services that are licensed pursuant to article twenty-eight 7 or thirty-six of the public health law or which operate and provide 8 health care services under the mental hygiene law, the education law, or 9 the correction law. THE DEPARTMENT SHALL GIVE SUBSTANTIAL WEIGHT TO 10 FUNDING INITIATIVES TO IMPROVE STAFFING RATIOS IN HEALTH CARE FACILITIES 11 OR TO REDUCE THE USE OF EXCESSIVE OVERTIME AMONG NURSING STAFF. 12 S 7. The public health law is amended by adding a new section 2895-b 13 to read as follows: 14 S 2895-B. NURSING HOME STAFFING LEVELS. 1. DEFINITIONS. AS USED IN 15 THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: 16 (A) "ADVISORY COUNCIL" MEANS THE ADVISORY COUNCIL ON NURSING HOME 17 STAFFING CREATED IN SUBDIVISION TWO OF THIS SECTION. 18 (B) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE NURSING 19 HOME NURSE AIDE REGISTRY PURSUANT TO SECTION TWENTY-EIGHT HUNDRED 20 THREE-J OF THIS CHAPTER. 21 (C) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN 22 A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN 23 A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT 24 THAT TIME. 25 2. ADVISORY COUNCIL ON NURSING HOME STAFFING. THERE IS HEREBY CREATED 26 IN THE DEPARTMENT AN ADVISORY COUNCIL ON NURSING HOME STAFFING TO STUDY 27 AND MAKE RECOMMENDATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS 28 SECTION. THE ADVISORY COUNCIL SHALL BE APPOINTED BY THE COMMISSIONER AND 29 SHALL BE COMPOSED OF REPRESENTATIVES OF NURSING HOME OPERATORS, CONSUM- 30 ERS, AND NON-ADMINISTRATIVE NURSING HOME EMPLOYEES AND THE PUBLIC. THE 31 ADVISORY COUNCIL SHALL, FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE 32 LEGISLATURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARD- 33 ING STAFFING LEVELS IN NURSING HOMES. 34 3. STAFFING STANDARDS. (A) THE COMMISSIONER, IN CONSULTATION WITH THE 35 ADVISORY COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR 36 NURSING HOME MINIMUM STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF 37 SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGH- 38 EST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH 39 RESIDENT OF THE NURSING HOME. THE COMMISSIONER SHALL ALSO REQUIRE BY 40 REGULATION THAT EVERY NURSING HOME MAINTAIN RECORDS ON ITS STAFFING 41 LEVELS, REPORT ON SUCH RECORDS TO THE DEPARTMENT, AND MAKE SUCH RECORDS 42 AVAILABLE FOR INSPECTION BY THE DEPARTMENT. 43 (B) EVERY NURSING HOME SHALL: 44 (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND 45 (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF 46 SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES 47 TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND 48 PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE NURSING HOME. 49 (C) SUBJECT TO SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS 50 UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS UNDER 51 SUBDIVISION FOUR OF THIS SECTION. 52 (D) IN DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS 53 SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED WHILE PERFORMING SERVICES 54 THAT ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD 55 PREPARATION, HOUSEKEEPING, LAUNDRY, MAINTENANCE SERVICES, OR OTHER 56 ACTIVITIES THAT ARE NOT DIRECT NURSING CARE. A. 921 10 1 4. STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE 2 OF THIS SECTION, EVERY NURSING HOME SHALL MAINTAIN A STAFFING RATIO 3 EQUAL TO AT LEAST THE FOLLOWING: 4 (A) FROM 2.4 TO 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED 5 NURSE AIDE; 6 (B) FROM 1.15 TO 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A LICENSED 7 PRACTICAL NURSE OR A REGISTERED NURSE; AND 8 (C) FROM 0.55 TO 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGIS- 9 TERED NURSE. 10 5. PHASE-IN. (A) THE COMMISSIONER SHALL MAKE THE FIRST REGULATIONS 11 UNDER SUBDIVISION THREE OF THIS SECTION WITHIN ONE YEAR AFTER THIS 12 SECTION BECOMES A LAW. 13 (B) IF THE COMMISSIONER DETERMINES THAT COMPLIANCE WITH THE STATUTORY 14 STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION IS NOT REASONABLY FEASI- 15 BLE FOR NURSING HOMES BY THE TIME SPECIFIED IN THAT SUBDIVISION, THE 16 COMMISSIONER MAY DELAY THE IMPLEMENTATION OF THAT STAFFING STANDARD FOR 17 A PHASE-IN PERIOD NOT TO EXCEED FIVE YEARS AFTER THIS SECTION BECOMES A 18 LAW. IF THE COMMISSIONER DELAYS IMPLEMENTATION OF THAT STAFFING STAND- 19 ARD, THE COMMISSIONER SHALL PHASE IN, OVER THE PHASE-IN PERIOD, STAFF- 20 ING STANDARDS THAT GRADUALLY INCREASE IN EACH OF THE YEARS OF THE 21 PHASE-IN PERIOD UNTIL THE STAFFING STANDARD MEETS AT LEAST THE STATUTORY 22 STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION. 23 6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A NURSING HOME SHALL POST 24 INFORMATION REGARDING NURSE STAFFING THAT THE NURSING HOME IS REQUIRED 25 TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY-EIGHT HUNDRED 26 FIVE-T OF THIS CHAPTER. INFORMATION UNDER THIS PARAGRAPH SHALL BE 27 DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN A MANNER 28 WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES AND THE 29 STAFF, AS REQUIRED BY THE COMMISSIONER. 30 (B) A NURSING HOME SHALL POST A SUMMARY OF THIS SECTION, PROVIDED BY 31 THE DEPARTMENT, IN CLOSE PROXIMITY TO EACH POSTING REQUIRED BY PARAGRAPH 32 (A) OF THIS SUBDIVISION. 33 S 8. If any provision of this act, or any application of any provision 34 of this act, is held to be invalid, or ruled by any federal agency to 35 violate or be inconsistent with any applicable federal law or regu- 36 lation, that shall not affect the validity or effectiveness of any other 37 provision of this act, or of any other application of any provision of 38 this act. 39 S 9. This act shall take effect on the one hundred eightieth day after 40 it shall have become a law, provided that any rules and regulations, and 41 any other actions necessary to implement the provisions of this act on 42 its effective date are authorized and directed to be completed on or 43 before such date.