S T A T E   O F   N E W   Y O R K
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                                   2187
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 17, 2017
                                ___________
 
 Introduced  by M. of A. MORELLE -- read once and referred to the Commit-
   tee on Health
 
 AN ACT to amend the public health law, in relation to pediatric day-res-
   pite center
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1.  The  public health law is amended by adding a new section
 2803-ff to read as follows:
   § 2803-FF. PEDIATRIC DAY-RESPITE CENTER. 1.  IT IS THE INTENT  OF  THE
 LEGISLATURE  TO  AUTHORIZE DAYSTAR FOR MEDICALLY FRAGILE CHILDREN, INC.,
 LOCATED AT 700 LAC DE VILLE BOULEVARD, ROCHESTER, NY 14618, (HEREINAFTER
 REFERRED TO AS "DAYSTAR") TO BE LICENSED AS NEW YORK STATE'S  FIRST  AND
 ONLY  PEDIATRIC  DAY-RESPITE  CENTER,  DELIVERING  COMPREHENSIVE  FAMILY
 SUPPORT  SERVICES,  EDUCATIONAL   ENRICHMENT   PROGRAMS,   DEVELOPMENTAL
 SERVICES,  AND  PEDIATRIC  HEALTHCARE  SERVICES  TO  SERVE  THE NEEDS OF
 MEDICALLY FRAGILE AND TERMINALLY ILL CHILDREN AND THEIR FAMILIES.
   2. AS USED IN THIS SECTION, THE FOLLOWING DEFINITIONS SHALL  HAVE  THE
 FOLLOWING MEANINGS:
   (A)  "PEDIATRIC  DAY-RESPITE CENTER" OR "DAYSTAR" MEANS A CENTER-BASED
 PROGRAM DESIGNED ESPECIALLY TO  PROMOTE  THE  HEALTHCARE,  PSYCHOSOCIAL,
 DEVELOPMENTAL,  AND  EDUCATIONAL  GOALS  OF  MEDICALLY FRAGILE CHILDREN,
 PROVIDING A STRUCTURED DAY-PROGRAM OF THERAPEUTIC SOCIAL, DEVELOPMENTAL,
 AND EDUCATIONAL ACTIVITIES AND PROGRAMS, ONSITE HEALTHCARE SERVICES, AND
 DAY-RESPITE SERVICES UP TO TEN CONSECUTIVE HOURS PER  DAY  TO  MEDICALLY
 FRAGILE  CHILDREN  SIX WEEKS OLD TO AGE TWENTY-ONE, INCLUDING TERMINALLY
 ILL AND TECHNOLOGY DEPENDENT CHILDREN.
   (B) "MEDICALLY FRAGILE CHILD" MEANS AN INDIVIDUAL WHO IS  UNDER  TWEN-
 TY-ONE  YEARS  OF AGE AND HAS AN ACUTE OR CHRONIC DEBILITATING CONDITION
 AND/OR CONDITIONS, AND/OR WHO MEETS ANY OF THE FOLLOWING CRITERIA:
   (I) IS TECHNOLOGICALLY-DEPENDENT FOR LIFE OR  HEALTH-SUSTAINING  FUNC-
 TIONS;
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD00927-01-7

 A. 2187                             2
 
   (II) REQUIRES A COMPLEX MEDICATION REGIMEN OR MEDICAL INTERVENTIONS TO
 MAINTAIN OR TO IMPROVE THEIR HEALTH STATUS; AND
   (III)  IS  IN  NEED  OF  ONGOING ASSESSMENT OR INTERVENTION TO PREVENT
 SERIOUS DETERIORATION OF THEIR HEALTH STATUS  OR  MEDICAL  COMPLICATIONS
 THAT PLACE THEIR LIFE, HEALTH, OR DEVELOPMENT AT RISK.
   CHRONIC  DEBILITATING  MEDICAL CONDITIONS INCLUDE, BUT ARE NOT LIMITED
 TO BRONCHOPULMONARY  DYSPLASIA,  SPINA  BIFIDA,  CEREBRAL  PALSY,  HEART
 DISEASE,  MALIGNANCY, CYSTIC FIBROSIS, NEUROMUSCULAR DISEASE, ENCEPHALO-
 PATHIES, MUSCULAR DYSTROPHY,  AND  SEIZURE  DISORDERS.  INDIVIDUALS  WHO
 QUALIFY  FOR  CARE  AT  HOME I/II AND CARE AT HOME III, IV AND VI WAIVER
 PARTICIPANTS ARE ALSO ELIGIBLE FOR SERVICES AT DAYSTAR'S PEDIATRIC  DAY-
 RESPITE CENTER.
   (C)  "TECHNOLOGY-DEPENDENT  CHILD"  MEANS  A PERSON FROM BIRTH THROUGH
 TWENTY-ONE YEARS OF AGE WHO HAS A DISABILITY, REQUIRES THE  ROUTINE  USE
 OF A SPECIFIC MEDICAL DEVICE TO COMPENSATE FOR THE LOSS OF USE OF A LIFE
 SUSTAINING BODY FUNCTION, AND REQUIRES DAILY, ONGOING CARE OR MONITORING
 BY TRAINED PERSONNEL.
   (D)  "DAY-RESPITE  CARE"  MEANS DAY AND UP TO TEN CONSECUTIVE HOURS OF
 DAYTIME RELIEF FOR THE CHILD'S PARENT OR  GUARDIAN  AND  DEVELOPMENTALLY
 APPROPRIATE PROGRAMMING FOR THE CHILD AND INCLUDES BUT IS NOT LIMITED TO
 PEDIATRIC  NURSING  SERVICES  AND SUPERVISION, MEALS, SOCIAL ACTIVITIES,
 GROUP EDUCATIONAL ENRICHMENT PROGRAMS, AND OTHER DEVELOPMENTALLY  APPRO-
 PRIATE ACTIVITIES.
   (E)  "COMPREHENSIVE CASE MANAGEMENT" MEANS LOCATING, COORDINATING, AND
 MONITORING SERVICES FOR THE ELIGIBLE CLIENT POPULATION AND INCLUDES  ALL
 OF THE FOLLOWING:
   (I)  SCREENING  OF  CLIENT REFERRALS TO IDENTIFY THOSE PERSONS WHO CAN
 BENEFIT FROM THE AVAILABLE SERVICES;
   (II) COMPREHENSIVE CLIENT ASSESSMENT TO DETERMINE THE SERVICES NEEDED;
   (III) COORDINATING THE DEVELOPMENT OF AN INTERDISCIPLINARY  COMPREHEN-
 SIVE CARE PLAN;
   (IV) IDENTIFYING AND MAXIMIZING INFORMAL SOURCES OF CARE; AND
   (V)  ONGOING  MONITORING  OF SERVICE DELIVERY TO DETERMINE THE OPTIMUM
 TYPE, AMOUNT, AND DURATION OF SERVICES PROVIDED.
   (F) "LICENSE" MEANS A BASIC PERMIT TO OPERATE A PEDIATRIC  DAY-RESPITE
 CENTER.
   3.  (A)  DAYSTAR ENROLLEES MUST MEET THE FOLLOWING CRITERIA TO RECEIVE
 AUTHORIZATION  FOR  REIMBURSEMENT  FOR  PEDIATRIC   DAY-RESPITE   CENTER
 SERVICES:
   (I) BE MEDICAID ELIGIBLE;
   (II) DIAGNOSED WITH A MEDICALLY-COMPLEX OR MEDICALLY FRAGILE CONDITION
 AS DEFINED IN PARAGRAPH (B) OF SUBDIVISION TWO OF THIS SECTION;
   (III) BE BETWEEN SIX WEEKS OF AGE AND TWENTY-ONE YEARS OLD;
   (IV)  BE  MEDICALLY  STABLE  AND NOT PRESENT SIGNIFICANT RISK TO OTHER
 CHILDREN OR PERSONNEL AT THE CENTER; AND
   (V) REQUIRE SHORT-TERM, LONG-TERM OR INTERMITTENT CONTINUOUS THERAPEU-
 TIC INTERVENTIONS OR SKILLED NURSING  SUPERVISION  DUE  TO  A  MEDICALLY
 COMPLEX CONDITION.
   (B) SHORT-TERM PEDIATRIC DAY-RESPITE CENTER SERVICES AT DAYSTAR MAY BE
 REIMBURSED  BY  MEDICAID  IF THE SERVICES ARE DETERMINED TO BE MEDICALLY
 NECESSARY.
   (C) RECIPIENTS ENROLLED IN A MEDICAID HEALTH PLAN MAY RECEIVE SERVICES
 AT DAYSTAR.
   (D) MEDICAID REIMBURSES DAYSTAR FOR ITS BASIC SERVICES. BASIC SERVICES
 INCLUDES, BUT IS NOT LIMITED TO, THE  DEVELOPMENT,  IMPLEMENTATION,  AND
 MONITORING OF A COMPREHENSIVE PROTOCOL OF CARE, DEVELOPED IN CONJUNCTION

 A. 2187                             3
 
 WITH  THE  PARENT  OR GUARDIAN, WHICH SPECIFIES THE HEALTHCARE, NURSING,
 PSYCHOSOCIAL, EDUCATIONAL, AND DEVELOPMENTAL THERAPIES REQUIRED  BY  THE
 MEDICALLY FRAGILE OR TECHNOLOGICALLY DEPENDENT CHILD SERVED.
   (E)  MEDICAID REIMBURSEMENT FOR DAYSTAR'S PEDIATRIC DAY-RESPITE CENTER
 SERVICES IS LIMITED TO:
   (I) ONE UNIT OF SERVICE PER ENROLLEE PER DAY FOR A FULL DAY (PER  DIEM
 RATE); OR
   (II) FOUR HOURS OR LESS PER DAY (BILLED IN HOURLY UNITS) FOR A PARTIAL
 DAY.
   REIMBURSEMENT  CANNOT  BE  MADE FOR A FULL-DAY AND PARTIAL-DAY UNIT OF
 SERVICE ON THE SAME DATE OF SERVICE, FOR THE SAME RECIPIENT.
   (F) MEDICAID REIMBURSES DAYSTAR A FIXED RATE BASED ON  THE  NUMBER  OF
 HOURS PER DAY THE ENROLLEE ATTENDS THE PEDIATRIC DAY-RESPITE CENTER. (I)
 A  FULL  DAY  OF  SERVICE  IS MORE THAN FOUR HOURS BUT NOT TO EXCEED TEN
 HOURS. A PARTIAL DAY OF SERVICE IS FOUR HOURS  OR  LESS.  A  MINIMUM  OF
 FIFTEEN MINUTES OF SERVICE IS REQUIRED TO ROUND UP TO A FULL HOUR, AFTER
 THE  FIRST  HOUR. DAYSTAR SHALL KEEP TIME CARDS FOR EACH ENROLLEE, TO BE
 SIGNED BY EITHER THE PARENT OR GUARDIAN AT THE TIME OF DROP-OFF OR PICK-
 UP, OR BY AN AUTHORIZED  MEDICAID  TRANSPORTATION  DRIVER  AND/OR  OTHER
 ADULT, AUTHORIZED TO DROP-OFF OR PICK-UP THE CHILD.
   (II)  FULL-DAY  SERVICES SHALL BE REIMBURSED AT A PER DIEM RATE OF TWO
 HUNDRED FIFTY DOLLARS PER DAY. PARTIAL-DAY SERVICES SHALL BE  REIMBURSED
 AT  AN  HOURLY  RATE  OF  THIRTY-FIVE DOLLARS, WITH A MINIMUM OF FIFTEEN
 MINUTES OF SERVICE TO ROUND UP TO A FULL HOUR, AFTER THE FIRST HOUR.
   (G) THE MEDICAID PEDIATRIC DAY-RESPITE CENTER RATE EXCLUDES REIMBURSE-
 MENT FOR THE FOLLOWING SERVICES: (I) BABY FOOD OR FORMULAS;  (II)  TOTAL
 PARENTERAL  AND ENTERAL NUTRITION (TPN); (III) MENTAL HEALTH AND PSYCHI-
 ATRIC SERVICES; (IV) SUPPORTIVE OR  CONTRACTED  SERVICES  WHICH  INCLUDE
 THERAPIES  OUTLINED  AND/OR  CONTRACTED THROUGH EARLY INTERVENTION (EI).
 THESE SERVICES SHALL BE FUNDED THROUGH NEW  YORK  STATE'S  EARLY  INTER-
 VENTION  PROGRAM  AND SHALL BE CONTRACTED SEPARATELY; (V) FAMILY SUPPORT
 SERVICES CONTRACTS; AND (VI) PRESCHOOL PROGRAMS, INCLUDING SEIT SERVICES
 AUTHORIZED UNDER THE DEPARTMENT OF EDUCATION FOR  CHILDREN  AGES  THREE,
 FOUR AND FIVE.
   (H) PRIVATE DUTY NURSING MAY BE PROVIDED AS A WRAPAROUND SERVICE OR IF
 WARRANTED  BY  THE CHILD'S MEDICAL NEEDS WHICH FALL OUTSIDE THE SCOPE OF
 DAYSTAR'S APPROVED NURSING RATIOS AND SHALL BE BILLED SEPARATELY.
   (I) ALL OTHER MEDICAID SERVICES PROVIDED BY  DAYSTAR  WILL  BE  BILLED
 SEPARATELY  AND  DAYSTAR  WILL  FOLLOW THE REIMBURSEMENT REQUIREMENTS AS
 SPECIFIED IN THE PROVIDER HANDBOOK FOR EACH SERVICE.
   4. THE DEPARTMENT SHALL DEVELOP AND ADOPT RULES  AND  REGULATIONS  FOR
 THE  LICENSURE  OF,  AND  SHALL  LICENSE, PEDIATRIC DAY-RESPITE CENTERS.
 SUCH RULES AND REGULATIONS SHALL INCLUDE, BUT NOT  BE  LIMITED  TO,  THE
 FOLLOWING:
   (A)  ADEQUACY, SAFETY, AND SANITATION OF THE PHYSICAL PLANT AND EQUIP-
 MENT;
   (B) STAFFING WITH DULY QUALIFIED PERSONNEL;
   (C) TRAINING OF THE STAFF; AND
   (D) PROVIDING THE SERVICES OFFERED.
   5. (A) EACH PEDIATRIC DAY-RESPITE CENTER SHALL HAVE  WRITTEN  POLICIES
 AND PROCEDURES GOVERNING THE ADMISSION, TRANSFER, AND DISCHARGE OF CHIL-
 DREN.
   (B)  THE  ADMISSION  OF  EACH  CHILD TO A PEDIATRIC DAY-RESPITE CENTER
 SHALL BE UNDER THE SUPERVISION OF THE FACILITY ADMINISTRATOR  OR  DESIG-
 NEE,  AND  SHALL  BE IN ACCORDANCE WITH THE FACILITY'S CHILD SUPERVISION
 POLICIES AND PROCEDURES.

 A. 2187                             4
 
   (C) EACH CHILD ADMITTED TO A PEDIATRIC  DAY-RESPITE  CENTER  SHALL  BE
 ADMITTED  UPON  PRESCRIPTION  BY  A  LICENSED PHYSICIAN AND SHALL REMAIN
 UNDER THE CARE OF THE LICENSED PHYSICIAN FOR THE DURATION OF THE CHILD'S
 STAY IN THE FACILITY.
   (D)  EACH CHILD ADMITTED FOR SERVICE TO A PEDIATRIC DAY-RESPITE CENTER
 SHALL MEET AT LEAST THE FOLLOWING CRITERIA:
   (I) INFANTS AND CHILDREN CONSIDERED FOR  ADMISSION  TO  THE  PEDIATRIC
 DAY-RESPITE  CENTER  SHALL BE THOSE WHO ARE MEDICALLY OR TECHNOLOGICALLY
 DEPENDENT AND HAVE A PRESCRIPTION FROM A LICENSED PHYSICIAN.
   (II) THE INFANTS AND CHILDREN SHALL NOT, PRIOR TO  ADMISSION,  PRESENT
 SIGNIFICANT  RISK OF INFECTION TO OTHER CHILDREN OR PERSONNEL. THE CLIN-
 ICAL ADVISOR OR NURSING DIRECTORS SHALL REVIEW, ON A CASE-BY-CASE BASIS,
 ANY CHILD WITH A SUSPECTED INFECTIOUS DISEASE TO DETERMINE  APPROPRIATE-
 NESS OF ADMISSION.
   (III) THE CHILD SHALL BE MEDICALLY STABILIZED, REQUIRE SKILLED NURSING
 CARE, OR OTHER INTERVENTIONS, AND BE APPROPRIATE FOR OUTPATIENT CARE.
   (IV)  IF THE CHILD MEETS THE PRECEDING CRITERIA, THE CLINICAL DIRECTOR
 OR NURSING DIRECTOR OF THE PEDIATRIC DAY-RESPITE CENTER SHALL  IMPLEMENT
 A  PREADMISSION PLAN WHICH DELINEATES SERVICES TO BE PROVIDED AND APPRO-
 PRIATE SOURCES FOR SUCH SERVICES.
   (A) IF THE CHILD IS HOSPITALIZED AT THE TIME OF  REFERRAL,  PRE-ADMIS-
 SION  PLANNING SHALL INCLUDE THE PARENTS OR GUARDIANS, RELEVANT HOSPITAL
 MEDICAL, NURSING, SOCIAL SERVICES AND DEVELOPMENTAL STAFF TO ASSURE THAT
 THE HOSPITAL DISCHARGE PLANS SHALL BE IMPLEMENTED UPON ADMISSION TO  THE
 PEDIATRIC DAY-RESPITE CENTER.
   (B)  A  CONSENT  FORM OUTLINING THE PURPOSE OF A PEDIATRIC DAY-RESPITE
 CENTER, FAMILY RESPONSIBILITIES, AUTHORIZED  TREATMENT  AND  APPROPRIATE
 LIABILITY RELEASE, AND EMERGENCY DISPOSITION PLANS MUST BE SIGNED BY THE
 PARENTS  OR GUARDIANS AND WITNESSED PRIOR TO ADMISSION TO SUCH FACILITY.
 THE PARENTS OR GUARDIANS SHALL BE PROVIDED A COPY OF THE CONSENT FORM. A
 COPY OF THE SIGNED CONSENT FORM  SHALL  BE  MAINTAINED  IN  THE  CHILD'S
 MEDICAL  RECORD. CONFIDENTIALITY OF SUCH FACILITY RECORDS SHALL BE MAIN-
 TAINED IN ACCORDANCE WITH APPLICABLE STATE AND FEDERAL LAWS.
   6. (A) DAYSTAR SHALL DEVELOP, IMPLEMENT, AND MAINTAIN WRITTEN POLICIES
 AND PROCEDURES GOVERNING ALL SUPERVISION OF CHILDREN AND RELATED MEDICAL
 OR OTHER SERVICES PROVIDED.
   (B) POLICIES AND PROCEDURES SHALL BE DEVELOPED, MAINTAINED AND  IMPLE-
 MENTED  BY  A  GROUP  OF PROFESSIONAL PEDIATRIC DAY-RESPITE CENTER STAFF
 PERSONNEL COMPRISED OF AT LEAST THE CLINICAL ADVISOR OR MEDICAL CONSULT-
 ANT, THE FACILITY'S ADMINISTRATOR, AND THE DIRECTOR OF NURSING SERVICES.
 ALL POLICIES AND PROCEDURES SHALL BE  REVIEWED  AT  LEAST  ANNUALLY  AND
 REVISED AS NEEDED.
   (C)  THE POLICIES AND PROCEDURES DEVELOPED SHALL, AT A MINIMUM, ENSURE
 COMPLIANCE WITH THE PROVISIONS OF SECTION THREE HUNDRED  NINETY  OF  THE
 SOCIAL SERVICES LAW, AND THE STANDARDS CONTAINED IN THIS SECTION.
   7.    (A) DAYSTAR SHALL CREATE A MEDICAL ADVISORY BOARD WITH A MINIMUM
 OF FOUR ACTIVE MEMBERS, TO PROVIDE RELEVANT PROFESSIONAL  AND  TECHNICAL
 SUPPORT  TO  DAYSTAR  ON  ISSUES  RELATED TO THE PROVISION OF HEALTHCARE
 SERVICES TO  DAYSTAR'S  PROGRAM  PARTICIPANTS.  MEDICAL  ADVISORY  BOARD
 PARTICIPANTS  REFLECT A BROAD SPECTRUM OF PEDIATRIC EXPERIENCE AND OTHER
 RELEVANT  SUBSPECIALITIES,  AND  ARE  LICENSED  PROFESSIONALS  IN  THEIR
 RESPECTIVE FIELDS OF PRACTICE.
   (B)  SUCH BOARD SHALL MEET QUARTERLY OR AS NEEDED, TO PROVIDE GUIDANCE
 AND ADVICE TO DAYSTAR AS ISSUES EMERGE. PARTICIPANTS  MAY  BE  ASKED  TO
 PROVIDE  GUIDANCE ON INDIVIDUAL CASE STUDIES, AND/OR TO ASSIST IN RECOM-

 A. 2187                             5
 
 MENDING ADDITIONAL RESOURCES TO ADVISE DAYSTAR IN SPECIFIC CONTENT AREAS
 INCLUDING BUT NOT LIMITED TO:
   (I)  DEVELOP AND/OR ADAPT AN APPROPRIATE MEDICAL NEEDS ASSESSMENT TOOL
 TO BE IMPLEMENTED DURING THE INTAKE PROCESS TO  IDENTIFY  THE  LEVEL  OF
 NURSING  CARE  REQUIRED  AND  TO  MORE  CLOSELY  ALIGN DAYSTAR'S NURSING
 ASSIGNMENTS BASED ON INDIVIDUAL MEDICAL NEEDS, AND IN THE CONTEXT OF THE
 AGENCY'S OVERALL SERVICE CAPACITY;
   (II) RECOMMENDATIONS ON DAYSTAR'S NURSING  REQUIREMENTS  AND  CAPACITY
 BASED ON INTAKE ASSESSMENT AND BEST PRACTICES IN THE FIELD;
   (III) PROVIDE GUIDANCE ON THE DEVELOPMENT OF DAYSTAR'S PRACTICE GUIDE-
 LINES AND APPROPRIATE SCOPE OF WORK AS RELATES TO NURSING, MEDICAL CARE,
 AND SUPERVISION; AND
   (IV)  HELP  ADVANCE DAYSTAR'S MISSION AND RELATIONSHIPS IN THE MEDICAL
 COMMUNITY AND ADVISE AS NEEDED ON THE DEVELOPMENT OF ITS MEDICAL PROGRAM
 MODEL.
   8. (A) A PEDIATRIC NURSE PRACTITIONER MAY SERVE  AS  THE  DIRECTOR  OF
 NURSING. THE DIRECTOR OF NURSING SHALL HAVE AT LEAST THE FOLLOWING QUAL-
 IFICATIONS:
   (I) HOLDS A NURSE PRACTITIONER NATIONAL CERTIFICATION;
   (II)  HOLD  A  CURRENT  CERTIFICATION IN CARDIOPULMONARY RESUSCITATION
 (CPR); AND
   (III) HAVE A MINIMUM OF TWO YEARS GENERAL PEDIATRIC NURSING EXPERIENCE
 OF WHICH AT LEAST SIX MONTHS MUST HAVE BEEN SPENT CARING  FOR  MEDICALLY
 FRAGILE  INFANTS  OR  CHILDREN  IN  A PEDIATRIC INTENSIVE CARE, NEONATAL
 INTENSIVE CARE, PEDIATRIC DAY-RESPITE CENTER  OR  SIMILAR  CARE  SETTING
 DURING THE PREVIOUS FIVE YEARS.
   (B) THE DIRECTOR OF NURSING IS RESPONSIBLE FOR SUPERVISING THE MEDICAL
 PROGRAM.
   (C) REGISTERED NURSE STAFFING STANDARDS:
   (I)  THE  REGISTERED NURSE MUST HAVE AT LEAST THE FOLLOWING QUALIFICA-
 TIONS AND EXPERIENCE:
   (A) LICENSED AS A REGISTERED NURSE IN NEW YORK, AND TWO OR MORE  YEARS
 OF  PEDIATRIC EXPERIENCE, WITH AT LEAST SIX MONTHS EXPERIENCE CARING FOR
 MEDICALLY OR TECHNOLOGICALLY DEPENDENT CHILDREN.
   (B) CURRENT CERTIFICATION IN CPR.
   (C) PEDIATRIC NURSING EXPERIENCE, DEFINED AS BEING RESPONSIBLE FOR THE
 CARE OF ACUTELY ILL OR CHRONICALLY ILL  CHILDREN,  WITHIN  THE  PREVIOUS
 TWENTY-FOUR MONTHS.
   (II) THE REGISTERED NURSE STAFF MUST PROVIDE:
   (A)  NURSING  INTERVENTIONS;  EDUCATIONAL  SERVICES  TO  INCREASE  THE
 PARENT'S OR GUARDIAN'S CONFIDENCE AND COMPETENCE IN CARING FOR THE CHILD
 WITH SPECIAL NEEDS; ASSISTANCE TO FACILITATE COPING WITH THE EFFECTS  OF
 CHRONIC  ILLNESS ON THE CHILD AND FAMILY AND SUPPORT EFFECTIVE RELATION-
 SHIPS AMONG SIBLINGS AND THE ILL CHILD; INTERVENTIONS TO  FOSTER  NORMAL
 DEVELOPMENT AND PSYCHOSOCIAL ADAPTATION.
   (B)   INFORMATION  REGARDING  AVAILABILITY  AND  ACCESS  TO  COMMUNITY
 RESOURCES.
   (C) A COLLABORATIVE RELATIONSHIP  WITH  THE  INTERDISCIPLINARY  HEALTH
 TEAM.
   (D)  PROGRAM  STAFFING  STANDARDS.  FOR  THE PURPOSES OF THIS SECTION,
 OTHER PROGRAM STAFF INCLUDE:    NURSING  ASSISTANTS,  CERTIFIED  SPECIAL
 EDUCATION  AND/OR  CHILDHOOD  EDUCATION TEACHERS, TEACHER AIDES, MEDICAL
 ASSISTANTS, CHILD LIFE, SOCIAL SERVICES, AND/OR HAS  EXPERIENCE  WORKING
 WITH INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES.
   (I) THE AGENCY SHALL DETERMINE JOB REQUIREMENTS FOR PROGRAM STAFF.

 A. 2187                             6
 
   (II)  PROGRAM  STAFF  MUST WORK UNDER THE SUPERVISION OF THE EXECUTIVE
 DIRECTOR.
   9.  EACH  PEDIATRIC DAY-RESPITE CENTER SHALL DEVELOP STAFF, PARENT AND
 GUARDIAN TRAINING PROGRAMS.
   (A) STAFF TRAINING MUST INCLUDE:
   (I) QUARTERLY STAFF DEVELOPMENT PROGRAMS APPROPRIATE TO  THE  CATEGORY
 OF PERSONNEL.
   (II)  DOCUMENTATION  OF  ALL  STAFF DEVELOPMENT PROGRAMS, AND REQUIRED
 PARTICIPATION.
   (III) CURRENT CPR CERTIFICATION FOR ALL STAFF.
   (B) EACH NEW EMPLOYEE WILL PARTICIPATE IN ORIENTATION TO ACQUAINT  THE
 EMPLOYEE  WITH  THE  PHILOSOPHY,  ORGANIZATION,  PROGRAM, PRACTICES, AND
 GOALS OF THE PEDIATRIC DAY-RESPITE CENTER.
   (C) A COMPREHENSIVE ORIENTATION TO ACQUAINT  THE  PARENT  OR  GUARDIAN
 WITH  THE  PHILOSOPHY  AND  SERVICES WILL BE PROVIDED AT THE TIME OF THE
 CHILD'S ADMISSION TO THE PEDIATRIC DAY-HEALTH RESPITE CENTER.
   10.  (A) A MEDICAL RECORD SHALL BE DEVELOPED AT THE TIME OF ADMISSION,
 MUST BE MAINTAINED FOR EACH CHILD, SIGNED BY  AUTHORIZED  PERSONNEL  AND
 CONTAIN AT LEAST THE FOLLOWING:
   (I) A MEDICAL PLAN OF TREATMENT AND A NURSING PROTOCOL OF CARE.
   (II) ALL DETAILS OF THE REFERRAL, ADMISSION, CORRESPONDENCE AND PAPERS
 CONCERNING THE CHILD.
   (III) PHYSICIAN ORDERS.
   (IV) FLOW CHART OF MEDICATIONS AND TREATMENTS ADMINISTERED.
   (V)  CONCISE, ACCURATE INFORMATION AND INITIALED CASE NOTES REFLECTING
 PROGRESS TOWARD ACHIEVEMENT  OF  CARE  GOALS  OR  REASONS  FOR  LACK  OF
 PROGRESS.
   (VI)  DOCUMENTATION  OF  NUTRITIONAL  MANAGEMENT AND SPECIAL DIETS, AS
 APPROPRIATE.
   (VII)  DOCUMENTATION  OF  PHYSICAL,  OCCUPATIONAL,  SPEECH  AND  OTHER
 SPECIAL THERAPIES.
   (B) THE INDIVIDUALIZED NURSING CARE PROTOCOL SHALL BE DEVELOPED WITHIN
 TEN  WORKING  DAYS  OF ADMISSION. THE PROTOCOL SHALL BE REVIEWED MONTHLY
 AND REVISED QUARTERLY, AND INCLUDE ANY RECOMMENDATIONS AND REVISIONS  TO
 THE  PLAN BASED ON CONSULTATION WITH OTHER PROFESSIONALS INVOLVED IN THE
 CHILD'S CARE.
   (C) MEDICAL HISTORY, INCLUDING ALLERGIES AND SPECIAL PRECAUTIONS.
   (D) IMMUNIZATION RECORD.
   (E) A DISCHARGE ORDER WRITTEN BY THE PRIMARY PHYSICIAN WILL  BE  DOCU-
 MENTED  AND  ENTERED  IN  THE CHILD'S RECORD. A DISCHARGE SUMMARY, WHICH
 INCLUDES THE REASON FOR DISCHARGE, WILL ALSO BE INCLUDED.
   11. ALL PEDIATRIC DAY-RESPITE CENTERS SHALL HAVE A  QUALITY  ASSURANCE
 PROGRAM  AND MUST CONDUCT QUARTERLY REVIEWS OF THE PEDIATRIC DAY-RESPITE
 CENTER'S MEDICAL RECORDS FOR AT LEAST HALF OF THE CHILDREN SERVED BY THE
 PEDIATRIC DAY HEALTH AND RESPITE CARE FACILITY AT THE TIME OF THE QUALI-
 TY ASSURANCE REVIEW.  THE  QUARTERLY  REVIEW  SAMPLE  MUST  BE  RANDOMLY
 SELECTED  SO  EACH CHILD SERVED AT THE FACILITY HAS AN EQUAL OPPORTUNITY
 TO BE INCLUDED IN THE REVIEW.
   (A) THE QUALITY ASSURANCE COMMITTEE MUST INCLUDE  THE  FOLLOWING:  THE
 CLINICAL  ADVISOR,  ADMINISTRATOR,  DIRECTOR OF NURSING, AND THREE OTHER
 COMMITTEE MEMBERS AS DETERMINED BY EACH PEDIATRIC DAY-RESPITE CENTER.
   (B) THE QUALITY ASSURANCE REVIEW WILL BE CONDUCTED BY TWO  MEMBERS  OF
 THE  QUALITY  ASSURANCE  COMMITTEE.  WITHIN FIFTEEN CALENDAR DAYS OF ITS
 REVIEW, THE QUALITY ASSURANCE COMMITTEE  SHALL  FURNISH  COPIES  OF  ITS
 REPORT  TO THE PEDIATRIC DAY-RESPITE CENTER CLINICAL ADVISOR AND NURSING
 DIRECTOR.

 A. 2187                             7
 
   (C) EACH QUARTERLY QUALITY ASSURANCE REVIEW SHALL INCLUDE:
   (I) A REVIEW OF THE GOALS IN EACH CHILD'S NURSING PROTOCOL.
   (II)  A  REVIEW  OF  THE  STEPS, PROCESS, AND SUCCESS IN ACHIEVING THE
 GOALS.
   (III) IDENTIFICATION OF GOALS NOT BEING ACHIEVED AS EXPECTED,  REASONS
 FOR LACK OF ACHIEVEMENT AND PLANS TO PROMOTE GOAL ACHIEVEMENT.
   (IV)  EVIDENCE  THAT  THE PROTOCOL HAS BEEN REVISED TO ACCOMMODATE THE
 FINDINGS OF THE QUALITY ASSURANCE REPORT WILL BE FORWARDED TO THE QUALI-
 TY ASSURANCE COMMITTEE WITHIN TEN CALENDAR DAYS OF RECEIPT OF THE QUALI-
 TY ASSURANCE COMMITTEE REPORT.
   (V) IMPLEMENTATION OF REVISIONS TO THE PROTOCOL SHALL BE DOCUMENTED IN
 THE CHILD'S RECORD.
   (D) THE QUALITY ASSURANCE REVIEW WILL ALSO ASCERTAIN  AND  ASSURE  THE
 PRESENCE OF THE FOLLOWING DOCUMENTS IN EACH CHILD'S MEDICAL RECORD:
   (I) A PROPERLY EXECUTED CONSENT FORM.
   (II)  A MEDICAL HISTORY FOR THE CHILD, INCLUDING NOTATIONS FROM VISITS
 TO HEALTH CARE PROVIDERS.
   (III) AN IMMUNIZATION  RECORD  WITH  DOCUMENTATION  OF  ALLERGIES  AND
 SPECIAL PRECAUTIONS.
   12.  INFECTION  CONTROL REQUIREMENTS MUST INCLUDE AT LEAST THE FOLLOW-
 ING:
   (A) THE PEDIATRIC DAY-RESPITE CENTER SHALL HAVE AN ISOLATION ROOM WITH
 ONE LARGE GLASS AREA FOR OBSERVATION OF THE CHILD.
   (B) ISOLATION PROCEDURES MUST BE USED TO PREVENT CROSS-INFECTIONS.
   (C) ALL CRIBS AND BEDS MUST BE LABELED  WITH  THE  INDIVIDUAL  CHILD'S
 NAME.    LINENS  MUST  BE  REMOVED FROM THE CRIB FOR LAUNDERING PURPOSES
 ONLY.
   (D) BED LINENS MUST BE CHANGED WHEN SOILED AND AS NECESSARY,  BUT  NOT
 LESS THAN TWICE WEEKLY.
   (E)  ANTIMICROBIAL  SOAP  AND  DISPOSABLE PAPER TOWELS MUST BE AT EACH
 SINK.
   (F) STAFF MUST WASH THEIR HANDS AFTER DIRECT CONTACT WITH EACH  CHILD,
 USING  APPROPRIATE  HAND  WASHING  TECHNIQUES  TO  PREVENT THE SPREAD OF
 INFECTION FROM ONE CHILD TO ANOTHER.
   (G) CHILDREN SUSPECTED OF HAVING A COMMUNICABLE DISEASE, WHICH MAY  BE
 TRANSMITTED  THROUGH  CASUAL  CONTACT,  AS  DETERMINED BY THE FACILITY'S
 CLINICAL ADVISOR OR DIRECTOR OF NURSING, MUST BE ISOLATED;  THE  PARENTS
 OR  GUARDIANS  MUST  BE NOTIFIED OF THE CONDITION; AND THE CHILD MUST BE
 REMOVED FROM THE PEDIATRIC DAY-RESPITE CENTER AS SOON AS POSSIBLE.  WHEN
 THE COMMUNICABLE DISEASE IS NO LONGER PRESENT, AS EVIDENCED BY A WRITTEN
 PROVIDER'S STATEMENT, THE CHILD MAY RETURN TO THE PEDIATRIC  DAY-RESPITE
 CENTER.
   (H)  PEDIATRIC  DAY-RESPITE CENTER STAFF MEMBERS SUSPECTED OF HAVING A
 COMMUNICABLE DISEASE MUST NOT RETURN TO THE PEDIATRIC DAY-RESPITE CENTER
 UNTIL THE SIGNS AND SYMPTOMS RELATED TO THE COMMUNICABLE DISEASE ARE  NO
 LONGER PRESENT, AS EVIDENCED BY A WRITTEN PHYSICIAN'S STATEMENT.
   13. (A) PEDIATRIC DAY-RESPITE CENTERS MUST CONFORM TO STATE FIRE STAN-
 DARDS  AND MUST BE INSPECTED ANNUALLY. A COPY OF THE CURRENT ANNUAL FIRE
 INSPECTION REPORT, CONDUCTED BY THE LOCAL AUTHORITY HAVING  JURISDICTION
 OVER  FIRE  SAFETY  OR  THE  STATE  FIRE MARSHAL, MUST BE ON FILE AT THE
 PEDIATRIC DAY-RESPITE CENTER.   DOCUMENTATION  OF  A  SATISFACTORY  FIRE
 SAFETY INSPECTION SHALL BE PROVIDED AT THE TIME OF THE LICENSEE'S ANNUAL
 SURVEY.
   (B)  THERE  MUST BE A WORKING TELEPHONE, WHICH IS NEITHER LOCKED NOR A
 PAY STATION, IN THE PEDIATRIC DAY-RESPITE CENTER.

 A. 2187                             8
 
   (C) EMERGENCY TELEPHONE NUMBERS MUST BE POSTED ON OR IN THE  IMMEDIATE
 VICINITY OF ALL TELEPHONES.
   (D)  AN  EMERGENCY  GENERATOR  MUST  EXIST, WITH SUFFICIENT GENERATING
 POWER TO CONTINUE FUNCTION OF MEDICAL EQUIPMENT IN THE EVENT OF A  POWER
 FAILURE.  THE  EMERGENCY  GENERATOR MUST BE TESTED EVERY THIRTY DAYS AND
 SATISFACTORY MECHANICAL OPERATION MUST BE DOCUMENTED ON A  LOG  DESIGNED
 FOR THAT PURPOSE AND SIGNED BY THE PERSON CONDUCTING THE TEST.
   (E)  EMERGENCY  TRANSPORTATION  MUST BE PERFORMED BY A LICENSED E.M.S.
 PROVIDER.
   (F) THE PEDIATRIC DAY-RESPITE CENTER MUST HAVE AN EMERGENCY KIT AVAIL-
 ABLE TO PROVIDE BASIC FIRST AID AND CARDIOPULMONARY RESUSCITATION.
   § 2. This act shall take effect on the one hundred eightieth day after
 it shall have become a law.