S T A T E O F N E W Y O R K
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10137
I N A S S E M B L Y
June 16, 2014
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Introduced by COMMITTEE ON RULES -- (at request of M. of A. Glick, Wein-
stein, Morelle, Gunther, Weprin, Gottfried) -- read once and referred
to the Committee on Higher Education
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:
Section 1. Subparagraph (v) of paragraph a of subdivision 1 of section
6908 of the education law is renumbered subparagraph (vi) and a new
subparagraph (v) is added to read as follows:
(V) ADVANCED TASKS PROVIDED BY AN ADVANCED HOME HEALTH AIDE IN ACCORD-
ANCE WITH REGULATIONS DEVELOPED BY THE COMMISSIONER, IN CONSULTATION
WITH THE COMMISSIONER OF HEALTH WHICH, AT A MINIMUM, SHALL: (1) SPECIFY
THE ADVANCED TASKS THAT MAY BE PERFORMED BY ADVANCED HOME HEALTH AIDES
PURSUANT TO THIS SUBPARAGRAPH, WHICH SHALL INCLUDE THE ADMINISTRATION OF
MEDICATIONS WHICH ARE ROUTINE AND PREFILLED OR OTHERWISE PACKAGED IN A
MANNER THAT PROMOTES RELATIVE EASE OF ADMINISTRATION, PROVIDED THAT
ADMINISTRATION OF MEDICATIONS BY INJECTION OTHER THAN INSULIN FOR
DIABETES CARE, STERILE PROCEDURES, AND CENTRAL LINE MAINTENANCE SHALL BE
PROHIBITED, AND PROVIDED FURTHER THAT A SYSTEM SHALL BE ESTABLISHED THAT
ADDRESSES DRUG DIVERSION; (2) SPECIFY THAT PARTICIPATION IN THIS PROGRAM
SHALL BE VOLUNTARY AND SUCH ADVANCED TASKS PROVIDED BY AN ADVANCED HOME
HEALTH AIDE SHALL BE AT THE OPTION OF THE INDIVIDUAL; (3) PROVIDE THAT
ADVANCED TASKS PERFORMED BY ADVANCED HOME HEALTH AIDES MAY BE PERFORMED
ONLY UNDER THE DIRECT SUPERVISION OF A REGISTERED PROFESSIONAL NURSE
LICENSED IN NEW YORK STATE AND EMPLOYED BY A HOME CARE SERVICES AGENCY
LICENSED OR CERTIFIED PURSUANT TO ARTICLE THIRTY-SIX OR HOSPICE PROGRAM
CERTIFIED PURSUANT TO ARTICLE FORTY OF THE PUBLIC HEALTH LAW, WHERE SUCH
NURSING SUPERVISION (A) INCLUDES TRAINING AND PERIODIC ASSESSMENT OF THE
PERFORMANCE OF ADVANCED TASKS, (B) SHALL BE DETERMINED BY THE REGISTERED
PROFESSIONAL NURSE RESPONSIBLE FOR SUPERVISING SUCH ADVANCED TASKS BASED
UPON THE COMPLEXITY OF SUCH ADVANCED TASKS, THE SKILL AND EXPERIENCE OF
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD15582-03-4
A. 10137 2
THE ADVANCED HOME HEALTH AIDE, AND THE HEALTH STATUS OF THE INDIVIDUAL
FOR WHOM SUCH ADVANCED TASKS ARE BEING PERFORMED, AND (C) INCLUDES A
COMPREHENSIVE INITIAL AND THEREAFTER REGULAR AND ONGOING ASSESSMENT OF
THE INDIVIDUAL'S NEEDS; PROVIDED THAT THE REGISTERED PROFESSIONAL NURSE
RESPONSIBLE FOR SUPERVISING SUCH ADVANCED TASKS SHALL VISIT INDIVIDUALS
RECEIVING ACUTE SERVICES NO LESS THAN ONCE PER MONTH AND INDIVIDUALS
RECEIVING MAINTENANCE CARE NO LESS THAN ONCE EVERY SIX MONTHS AND
PROVIDED FURTHER THAT A REGISTERED PROFESSIONAL NURSE SHALL BE AVAILABLE
BY TELEPHONE TO THE ADVANCED HOME HEALTH AIDE TWENTY-FOUR HOURS A DAY,
SEVEN DAYS A WEEK; THE COMMISSIONER OF HEALTH SHALL, IN CONSULTATION
WITH THE COMMISSIONER, DETERMINE APPROPRIATE STAFFING RATIOS TO ENSURE
ADEQUATE NURSING SUPERVISION THAT SHALL NOT EXCEED ONE FULL TIME EQUIV-
ALENT OF A REGISTERED PROFESSIONAL NURSE TO FIFTY INDIVIDUALS RECEIVING
SERVICES; (4) ESTABLISH A PROCESS BY WHICH A REGISTERED PROFESSIONAL
NURSE MAY DELEGATE ADVANCED TASKS TO AN ADVANCED HOME HEALTH AIDE
PROVIDED THAT SUCH PROCESS SHALL INCLUDE, BUT NOT BE LIMITED TO (A)
ALLOWING DELEGATION OF ADVANCED TASKS TO AN ADVANCED HOME HEALTH AIDE
ONLY WHERE SUCH ADVANCED HOME HEALTH AIDE HAS DEMONSTRATED TO THE SATIS-
FACTION OF THE SUPERVISING REGISTERED PROFESSIONAL NURSE COMPETENCY IN
EVERY ADVANCED TASK THAT SUCH ADVANCED HOME HEALTH AIDE IS AUTHORIZED TO
PERFORM, (B) AUTHORIZING THE SUPERVISING REGISTERED PROFESSIONAL NURSE
TO REVOKE ANY DELEGATED ADVANCED TASK FROM AN ADVANCED HOME HEALTH AIDE
FOR ANY REASON, AND (C) AUTHORIZING MULTIPLE REGISTERED PROFESSIONAL
NURSES TO JOINTLY AGREE TO DELEGATE ADVANCED TASKS TO AN ADVANCED HOME
HEALTH AIDE, PROVIDED FURTHER THAT ONLY ONE REGISTERED PROFESSIONAL
NURSE SHALL BE REQUIRED TO DETERMINE THE ADVANCED HOME HEALTH AIDE HAS
DEMONSTRATED COMPETENCY IN THE ADVANCED TASK TO BE PERFORMED; (5)
PROVIDE THAT ADVANCED TASKS MAY BE PERFORMED ONLY IN ACCORDANCE WITH AND
PURSUANT TO AN AUTHORIZED PRACTITIONER'S ORDERED CARE; (6) PROVIDE THAT
ONLY A HOME HEALTH AIDE WHO HAS AT LEAST ONE YEAR OF EXPERIENCE AS A
CERTIFIED HOME HEALTH AIDE, HAS COMPLETED THE REQUISITE TRAINING AND
DEMONSTRATED COMPETENCIES OF AN ADVANCED HOME HEALTH AIDE AS DETERMINED
BY THE COMMISSIONER OF HEALTH, HAS SUCCESSFULLY COMPLETED COMPETENCY
EXAMINATIONS SATISFACTORY TO AND DEVELOPED OR APPROVED BY THE COMMIS-
SIONER OF HEALTH AND MEETS OTHER APPROPRIATE QUALIFICATIONS AS DETER-
MINED BY THE COMMISSIONER OF HEALTH MAY PERFORM ADVANCED TASKS AS AN
ADVANCED HOME HEALTH AIDE; (7) PROVIDE THAT ONLY AN INDIVIDUAL WHO IS
LISTED IN THE HOME CARE SERVICES REGISTRY MAINTAINED BY THE DEPARTMENT
OF HEALTH PURSUANT TO SUBDIVISION NINE OF SECTION THIRTY-SIX HUNDRED
THIRTEEN OF THE PUBLIC HEALTH LAW AS HAVING SATISFIED ALL APPLICABLE
TRAINING REQUIREMENTS AND HAVING PASSED THE APPLICABLE COMPETENCY EXAM-
INATIONS AND WHO MEETS OTHER REQUIREMENTS AS SET FORTH IN REGULATIONS
ISSUED BY THE COMMISSIONER OF HEALTH PURSUANT TO SUBDIVISION SEVENTEEN
OF SECTION THIRTY-SIX HUNDRED TWO OF THE PUBLIC HEALTH LAW MAY PERFORM
ADVANCED TASKS PURSUANT TO THIS SUBPARAGRAPH AND MAY HOLD HIMSELF OR
HERSELF OUT AS AN ADVANCED HOME HEALTH AIDE; (8) ESTABLISH MINIMUM STAN-
DARDS OF TRAINING FOR THE PERFORMANCE OF ADVANCED TASKS BY ADVANCED HOME
HEALTH AIDES, INCLUDING (A) DIDACTIC TRAINING, (B) CLINICAL TRAINING,
AND (C) A SUPERVISED CLINICAL PRACTICUM WITH STANDARDS SET FORTH BY THE
COMMISSIONER OF HEALTH; (9) PROVIDE THAT ADVANCED HOME HEALTH AIDES
SHALL RECEIVE CASE-SPECIFIC TRAINING ON THE ADVANCED TASKS TO BE
ASSIGNED BY THE SUPERVISING NURSE, PROVIDED THAT ADDITIONAL TRAINING
SHALL TAKE PLACE WHENEVER ADDITIONAL ADVANCED TASKS ARE ASSIGNED; (10)
PROHIBIT AN ADVANCED HOME HEALTH AIDE FROM HOLDING HIMSELF OR HERSELF
OUT, OR ACCEPTING EMPLOYMENT AS, A PERSON LICENSED TO PRACTICE NURSING
UNDER THE PROVISIONS OF THIS ARTICLE; (11) PROVIDE THAT AN ADVANCED HOME
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HEALTH AIDE IS NOT REQUIRED NOR PERMITTED TO ASSESS THE MEDICATION OR
MEDICAL NEEDS OF AN INDIVIDUAL; (12) PROVIDE THAT AN ADVANCED HOME
HEALTH AIDE SHALL NOT BE AUTHORIZED TO PERFORM ANY ADVANCED TASKS OR
ACTIVITIES PURSUANT TO THIS SUBPARAGRAPH THAT ARE OUTSIDE THE SCOPE OF
PRACTICE OF A LICENSED PRACTICAL NURSE OR ANY ADVANCED TASKS THAT HAVE
NOT BEEN APPROPRIATELY DELEGATED BY THE SUPERVISING REGISTERED PROFES-
SIONAL NURSE; (13) PROVIDE THAT AN ADVANCED HOME HEALTH AIDE SHALL DOCU-
MENT MEDICATION ADMINISTRATION TO EACH INDIVIDUAL THROUGH THE USE OF A
MEDICATION ADMINISTRATION RECORD; (14) PROVIDE THAT THE SUPERVISING
REGISTERED PROFESSIONAL NURSE SHALL RETAIN THE DISCRETION TO DECIDE
WHETHER TO ASSIGN ADVANCED TASKS TO ADVANCED HOME HEALTH AIDES UNDER
THIS PROGRAM AND THE ADVANCED HOME HEALTH AIDE SHALL RETAIN THE
DISCRETION TO REFUSE A DELEGATED ADVANCED TASK AND SHALL NOT BE SUBJECT
TO COERCION OR THE THREAT OF RETALIATION; (15) NOTWITHSTANDING ANY
PROVISIONS OF SECTIONS SEVEN HUNDRED FORTY AND SEVEN HUNDRED FORTY-ONE
OF THE LABOR LAW TO THE CONTRARY, THE PROTECTIONS PROVIDED IN SUCH
SECTIONS SHALL APPLY TO INDIVIDUALS PROVIDING SUPERVISION OR ADVANCED
TASKS PURSUANT TO THIS SUBPARAGRAPH; AND (16) PROVIDE THAT NO ADVANCED
TASKS, OTHER THAN ADMINISTRATION OF MEDICATION, MAY BE PERFORMED PRIOR
TO JANUARY FIRST, TWO THOUSAND SEVENTEEN; PROVIDED THAT IN DEVELOPING
SUCH REGULATIONS, THE COMMISSIONER SHALL TAKE INTO ACCOUNT THE RECOMMEN-
DATIONS OF A WORKGROUP OF STAKEHOLDERS CONVENED BY THE COMMISSIONER OF
HEALTH IN CONSULTATION WITH THE COMMISSIONER FOR THE PURPOSE OF PROVID-
ING GUIDANCE ON THE FOREGOING; OR
S 2. Section 206 of the public health law is amended by adding a new
subdivision 29 to read as follows:
29. THE COMMISSIONER SHALL NOTIFY THE COMMISSIONER OF EDUCATION IN
ANY INSTANCE IN WHICH A REGISTERED PROFESSIONAL NURSE ENGAGES IN IMPROP-
ER BEHAVIOR WHILE SUPERVISING AN ADVANCED HOME HEALTH AIDE PURSUANT TO
SUBPARAGRAPH (V) OF PARAGRAPH A OF SUBDIVISION ONE OF SECTION SIXTY-NINE
HUNDRED EIGHT OF THE EDUCATION LAW.
S 3. Section 3602 of the public health law is amended by adding a new
subdivision 17 to read as follows:
17. "ADVANCED HOME HEALTH AIDES" MEANS HOME HEALTH AIDES WHO ARE
AUTHORIZED TO PERFORM ADVANCED TASKS AS DELINEATED IN SUBPARAGRAPH (V)
OF PARAGRAPH A OF SUBDIVISION ONE OF SECTION SIXTY-NINE HUNDRED EIGHT OF
THE EDUCATION LAW AND REGULATIONS ISSUED BY THE COMMISSIONER OF EDUCA-
TION RELATING THERETO. THE COMMISSIONER SHALL PROMULGATE REGULATIONS
REGARDING SUCH AIDES, WHICH SHALL INCLUDE TRAINING, DEMONSTRATED COMPE-
TENCIES, COMPETENCY EXAMINATIONS, AND OTHER APPROPRIATE QUALIFICATIONS,
AS WELL AS A PROCESS FOR THE LIMITATION OR REVOCATION OF THE ADVANCED
HOME HEALTH AIDE'S AUTHORIZATION TO PERFORM ADVANCED TASKS IN APPROPRI-
ATE CASES.
S 4. Subdivision 9 of section 3613 of the public health law is renum-
bered subdivision 10 and a new subdivision 9 is added to read as
follows:
9. THE DEPARTMENT SHALL INDICATE WITHIN THE HOME CARE SERVICES WORKER
REGISTRY WHEN A HOME HEALTH AIDE HAS SATISFIED ALL APPLICABLE TRAINING
AND RECERTIFICATION REQUIREMENTS AND HAS PASSED THE APPLICABLE COMPETEN-
CY EXAMINATIONS NECESSARY TO PERFORM ADVANCED TASKS PURSUANT TO SUBPARA-
GRAPH (V) OF PARAGRAPH A OF SUBDIVISION ONE OF SECTION SIXTY-NINE
HUNDRED EIGHT OF THE EDUCATION LAW AND REGULATIONS ISSUED THERETO. ANY
LIMITATION OR REVOCATION OF THE ADVANCED HOME HEALTH AIDE'S AUTHORI-
ZATION ALSO SHALL BE INDICATED ON THE REGISTRY.
S 5. The commissioner of health, in consultation with the commissioner
of education, shall convene a workgroup of stakeholders to provide guid-
A. 10137 4
ance on the advanced tasks which may be performed by advanced home
health aides pursuant to subparagraph (v) of paragraph a of subdivision
1 of section 6908 of the education law, which shall encompass matters
including but not limited to:
(a) the advanced tasks that appropriately could be performed by
advanced home health aides with appropriate training and supervision;
(b) the types of medications that advanced home health aides should be
authorized to administer, including whether controlled substances should
be authorized;
(c) qualifications that must be satisfied by advanced home health
aides to perform such advanced tasks, including those related to experi-
ence, training, moral character, and examination requirements;
(d) minimum training and education standards; and
(e) adequate levels of supervision to be provided by nurses, including
adherence to existing requirements for comprehensive assessment and any
additional assessment that should be required, including when the indi-
vidual receiving advanced tasks performed by an advanced home health
aide experiences a significant change in condition.
On or before March 1, 2015, the commissioner of health shall, in
consultation with the commissioner of education, issue a report to the
governor and the chairs of the senate and assembly health and higher
education committees setting forth the recommendations of the workgroup.
The members of such workgroup shall include individuals from academic
institutions with relevant expertise, representatives of home care
providers, hospice providers, nurses, nurse educators, home health aides
and pharmacists, representatives of individuals who may be eligible for
advanced tasks performed by advanced home health aides pursuant to such
statute, and other relevant stakeholders.
S 6. On or before January 1, 2019, the commissioner of health shall,
in consultation with the commissioner of education, issue a report on
the implementation of advanced home health aides in the state. Such
report shall include the number of advanced home health aides authorized
pursuant to this act; the types of advanced tasks that advanced home
health aides are performing; the number of individuals who were moved
out of institutionalized settings as a direct result of this act; the
extent to which advanced home health aides contributed to the improve-
ment of quality care of these individuals; the number of adverse
outcomes, including medication errors, that were reported to the depart-
ment of health; any reports of or issues with drug diversion; and the
number of advanced home health aides who had their authorization limited
or revoked. Such report shall provide recommendations to the governor
and the chairs of the senate and assembly health and higher education
committees regarding the extension and/or alteration of these provisions
and make any other recommendations related to the implementation of
advanced home health aides pursuant to this act.
S 7. This act shall take effect immediately; provided that:
a. section one of this act shall take effect January 1, 2016. Effec-
tive immediately, the commissioner of education is authorized to adopt
or amend regulations necessary to implement the provisions of section
one of this act on or before such effective date; provided, further,
that no advanced tasks shall be performed pursuant to the provisions of
subparagraph (v) of paragraph a of subdivision 1 of section 6908 of the
education law, as added by section one of this act, until such regu-
lations are adopted and except in conformance with such regulations;
b. section five of this act shall expire and be deemed repealed March
31, 2015;
A. 10137 5
c. the commissioner of health shall convene the workgroup of stake-
holders established pursuant to section five of this act as soon as
practicable; and
d. this act shall expire and be deemed repealed June 30, 2019.