S T A T E   O F   N E W   Y O R K
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                                 7188--A
                                                        Cal. No. 272

                       2015-2016 Regular Sessions

                          I N  A S S E M B L Y

                             April 27, 2015
                               ___________

Introduced  by  M.  of  A. GLICK, WEINSTEIN, WEPRIN, GOTTFRIED, GUNTHER,
  McDONALD, SKOUFIS, BRONSON, MORELLE, LIFTON, FAHY,  STIRPE,  GALEF  --
  Multi-Sponsored by -- M. of A. MOSLEY -- read once and referred to the
  Committee  on Higher Education -- advanced to a third reading, amended
  and ordered reprinted, retaining its place on the order of third read-
  ing

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,  STERILE PROCEDURES, AND
CENTRAL LINE MAINTENANCE SHALL BE PROHIBITED.    PROVIDED  HOWEVER  SUCH
PROHIBITION  SHALL  NOT APPLY TO INJECTIONS OF INSULIN FOR DIABETES CARE
OR TO INJECTIONS OF LOW MOLECULAR WEIGHT HEPARIN FOR DIABETES CARE,  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
              

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD10526-03-6

A. 7188--A                          2

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
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 SECTION THIRTY-SIX HUNDRED THIRTEEN OF THE  PUBLIC
HEALTH  LAW AS HAVING SATISFIED ALL APPLICABLE TRAINING REQUIREMENTS AND
HAVING PASSED THE APPLICABLE COMPETENCY EXAMINATIONS 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  STANDARDS  OF  TRAINING  FOR THE
PERFORMANCE OF ADVANCED TASKS BY ADVANCED HOME HEALTH  AIDES,  INCLUDING
(A) DIDACTIC TRAINING, (B) CLINICAL TRAINING, AND (C) A SUPERVISED CLIN-
ICAL  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,

A. 7188--A                          3

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 ARTI-
CLE; (11) PROVIDE THAT AN ADVANCED HOME 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 SUBPARA-
GRAPH 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 PROFESSIONAL NURSE; (13) PROVIDE  THAT  AN
ADVANCED  HOME  HEALTH  AIDE SHALL DOCUMENT 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 PROVID-
ING  SUPERVISION  OR  ADVANCED  TASKS PURSUANT TO THIS SUBPARAGRAPH; AND
(16) PROVIDE THAT NO ADVANCED TASKS, OTHER THAN ADMINISTRATION OF  MEDI-
CATION, MAY BE PERFORMED PRIOR TO JANUARY FIRST, TWO THOUSAND SEVENTEEN;
PROVIDED  THAT  IN  DEVELOPING  SUCH REGULATIONS, THE COMMISSIONER SHALL
TAKE INTO ACCOUNT THE RECOMMENDATIONS OF  A  WORKGROUP  OF  STAKEHOLDERS
CONVENED  BY THE COMMISSIONER OF HEALTH IN CONSULTATION WITH THE COMMIS-
SIONER FOR THE PURPOSE OF PROVIDING GUIDANCE ON THE FOREGOING; OR
  S 2. Section 206 of the public health law is amended by adding  a  new
subdivision 30 to read as follows:
  30.    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

A. 7188--A                          4

LIMITATION OR REVOCATION OF THE ADVANCED  HOME  HEALTH  AIDE'S  AUTHORI-
ZATION ALSO SHALL BE INDICATED ON THE REGISTRY.
  S  5.  In  developing  regulations  required under subparagraph (v) of
paragraph a of subdivision 1 of section 6908 of the  education  law,  as
added  by  section  one of this act, the commissioner of education shall
take into consideration the recommendations of the workgroup  of  stake-
holders  convened  by  the commissioner of health to provide guidance on
the tasks which may be performed by advanced home health aides  pursuant
to  such  section  including, but not limited to, recommendations encom-
passing the following matters:
  (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  July  1,  2016,  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.
  S 6. On or before January 1, 2020, 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, 2017.   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; and
  b. this act shall expire and be deemed repealed June 30, 2020.