S T A T E   O F   N E W   Y O R K
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                                  7164--A
     Cal. No. 378
 
                             I N  S E N A T E
 
                                (PREFILED)
 
                              January 3, 2018
                                ___________
 
 Introduced  by  Sen. RITCHIE -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health -- reported favora-
   bly from said committee, ordered to first and second  report,  ordered
   to  a  third  reading, passed by Senate and delivered to the Assembly,
   recalled, vote reconsidered, restored to third  reading,  amended  and
   ordered reprinted, retaining its place in the order of third reading
 
 AN ACT to amend the education law and the public health law, in relation
   to  authorizing  certain  nursing  home  medication  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. Section 6908 of the education law is amended  by  adding  a
 new subdivision 3 to read as follows:
   3.  THIS  ARTICLE  SHALL  NOT BE CONSTRUED AS PROHIBITING THE ADMINIS-
 TRATION OF MEDICATION BY A NURSING HOME MEDICATION AIDE CERTIFIED PURSU-
 ANT TO SECTION TWENTY-EIGHT HUNDRED THREE-J OF THE PUBLIC HEALTH LAW  AS
 ADDED BY CHAPTER SEVEN HUNDRED SEVENTEEN OF THE LAWS OF NINETEEN HUNDRED
 EIGHTY-NINE IN RESIDENTIAL HEALTH CARE FACILITIES, AS DEFINED IN ARTICLE
 TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, IN THE COUNTY OF ST. LAWRENCE, IN
 ACCORDANCE  WITH REGULATIONS DEVELOPED BY THE COMMISSIONER, IN CONSULTA-
 TION WITH THE COMMISSIONER OF HEALTH.   AT A MINIMUM,  SUCH  REGULATIONS
 SHALL:
   A.  AUTHORIZE  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 SHALL BE PROHIBITED. PROVIDED, HOWEVER, SUCH PROHIBITION SHALL
 NOT APPLY TO INJECTIONS OF INSULIN  OR  OTHER  INJECTIONS  FOR  DIABETES
 CARE,  TO  INJECTIONS OF LOW MOLECULAR WEIGHT HEPARIN, AND TO PRE-FILLED
 AUTO-INJECTIONS OF EPINEPHRINE FOR  EMERGENCY  PURPOSES,  AND  PROVIDED,
 FURTHER,  THAT ENTITIES EMPLOYING NURSING HOME MEDICATION AIDES PURSUANT
 TO THIS SUBDIVISION SHALL ESTABLISH A  SYSTEMATIC  APPROACH  TO  ADDRESS
 DRUG DIVERSION;
              

 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD10807-07-8

 S. 7164--A                          2
 
   B.  PROVIDE  THAT MEDICATION ADMINISTRATION BY NURSING HOME MEDICATION
 AIDES MAY BE PERFORMED ONLY UNDER THE DIRECT SUPERVISION OF A REGISTERED
 PROFESSIONAL NURSE LICENSED IN NEW YORK STATE,  AS  SET  FORTH  IN  THIS
 SUBDIVISION  AND SUBDIVISION EIGHT OF SECTION SIXTY-NINE HUNDRED NINE OF
 THIS  ARTICLE, WHERE SUCH NURSE IS EMPLOYED BY A RESIDENTIAL HEALTH CARE
 FACILITY LICENSED OR CERTIFIED PURSUANT TO THE PUBLIC HEALTH  LAW.  SUCH
 NURSING SUPERVISION SHALL:
   (I)  INCLUDE  TRAINING  AND  PERIODIC ASSESSMENT OF THE PERFORMANCE OF
 MEDICATION ADMINISTRATION;
   (II) BE DETERMINED BY THE REGISTERED  PROFESSIONAL  NURSE  RESPONSIBLE
 FOR SUPERVISING SUCH MEDICATION ADMINISTRATION BASED UPON THE COMPLEXITY
 OF SUCH MEDICATION ADMINISTRATION, THE SKILL AND EXPERIENCE OF THE NURS-
 ING  HOME  MEDICATION  AIDE, AND THE HEALTH STATUS OF THE INDIVIDUAL FOR
 WHOM SUCH MEDICATION ADMINISTRATION IS BEING PERFORMED;
   (III) INCLUDE A COMPREHENSIVE INITIAL AND THEREAFTER REGULAR AND ONGO-
 ING ASSESSMENT OF THE INDIVIDUAL'S NEEDS;
   (IV) INCLUDE AS A REQUIREMENT THAT THE SUPERVISING REGISTERED  PROFES-
 SIONAL  NURSE  SHALL  VISIT  INDIVIDUALS  RECEIVING  MEDICATION  FOR THE
 PURPOSE OF SUPERVISING THE MEDICATION ADMINISTRATION PROVIDED BY NURSING
 HOME MEDICATION AIDES AND INCLUDE AS A  REQUIREMENT  THAT  A  REGISTERED
 PROFESSIONAL  NURSE  SHALL  BE  AVAILABLE TO THE NURSING HOME MEDICATION
 AIDE TWENTY-FOUR HOURS A DAY, SEVEN DAYS A WEEK, PROVIDED THAT A  REGIS-
 TERED  PROFESSIONAL  NURSE  SHALL  BE  AVAILABLE  TO VISIT AN INDIVIDUAL
 RECEIVING MEDICATION AS NECESSARY TO PROTECT THE HEALTH  AND  SAFETY  OF
 SUCH INDIVIDUAL; AND
   (V) AS SHALL BE SPECIFIED BY THE COMMISSIONER, BE PROVIDED IN A MANNER
 THAT  TAKES  INTO  ACCOUNT INDIVIDUAL CARE NEEDS AND CASE MIX COMPLEXITY
 AND PROVIDE THAT THE NUMBER  OF  INDIVIDUALS  SERVED  BY  A  SUPERVISING
 REGISTERED PROFESSIONAL NURSE IS REASONABLE AND PRUDENT;
   C.  ESTABLISH  A  PROCESS BY WHICH A REGISTERED PROFESSIONAL NURSE MAY
 ASSIGN MEDICATION ADMINISTRATION TO A NURSING HOME MEDICATION AIDE. SUCH
 PROCESS SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (I) ALLOWING ASSIGNMENT OF MEDICATION ADMINISTRATION TO A NURSING HOME
 MEDICATION AIDE ONLY WHERE SUCH NURSING HOME MEDICATION AIDE HAS  DEMON-
 STRATED  TO  THE SATISFACTION OF THE SUPERVISING REGISTERED PROFESSIONAL
 NURSE COMPETENCY IN MEDICATION ADMINISTRATION  THAT  SUCH  NURSING  HOME
 MEDICATION  AIDE IS AUTHORIZED TO PERFORM, A WILLINGNESS TO PERFORM SUCH
 MEDICATION ADMINISTRATION, AND THE ABILITY TO EFFECTIVELY AND EFFICIENT-
 LY COMMUNICATE WITH THE INDIVIDUAL RECEIVING MEDICATION  AND  UNDERSTAND
 SUCH INDIVIDUAL'S NEEDS;
   (II)  PROHIBITING ASSIGNMENT OF MEDICATION ADMINISTRATION TO A NURSING
 HOME MEDICATION AIDE IF THE INDIVIDUAL RECEIVING SERVICES DECLINES TO BE
 SERVED BY A NURSING HOME MEDICATION AIDE;
   (III) AUTHORIZING THE SUPERVISING  REGISTERED  PROFESSIONAL  NURSE  TO
 REVOKE  ANY ASSIGNED MEDICATION ADMINISTRATION FROM A NURSING HOME MEDI-
 CATION AIDE FOR ANY REASON; AND
   (IV) AUTHORIZING MULTIPLE REGISTERED PROFESSIONAL  NURSES  TO  JOINTLY
 AGREE  TO  ASSIGN MEDICATION ADMINISTRATION TO A NURSING HOME MEDICATION
 AIDE, PROVIDED FURTHER THAT ONLY ONE REGISTERED PROFESSIONAL NURSE SHALL
 BE REQUIRED TO DETERMINE IF THE NURSING HOME MEDICATION AIDE HAS  DEMON-
 STRATED COMPETENCY IN THE MEDICATION ADMINISTRATION TO BE PERFORMED;
   D.  PROVIDE  THAT  MEDICATION  ADMINISTRATION MAY BE PERFORMED ONLY IN
 ACCORDANCE WITH AND PURSUANT  TO  AN  AUTHORIZED  HEALTH  PRACTITIONER'S
 ORDERED CARE;

 S. 7164--A                          3
 
   E.  PROVIDE  THAT  ONLY  A  CERTIFIED NURSING HOME MEDICATION AIDE MAY
 PERFORM MEDICATION ADMINISTRATION AS A NURSING HOME MEDICATION AIDE WHEN
 SUCH AIDE HAS:
   (I)  AT LEAST ONE YEAR OF EXPERIENCE PROVIDING RESIDENTIAL HEALTH CARE
 SERVICES;
   (II) COMPLETED THE REQUISITE TRAINING AND DEMONSTRATED COMPETENCIES OF
 A NURSING HOME MEDICATION AIDE AS  DETERMINED  BY  THE  COMMISSIONER  IN
 CONSULTATION WITH THE COMMISSIONER OF HEALTH;
   (III)  SUCCESSFULLY  COMPLETED COMPETENCY EXAMINATIONS SATISFACTORY TO
 THE COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER OF HEALTH; AND
   (IV) MEETS OTHER  APPROPRIATE  QUALIFICATIONS  AS  DETERMINED  BY  THE
 COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER OF HEALTH;
   F.  PROVIDE  THAT  ONLY AN INDIVIDUAL WHO HAS 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 THE PUBLIC  HEALTH  LAW
 MAY  PERFORM  MEDICATION ADMINISTRATION PURSUANT TO THIS SUBDIVISION AND
 MAY HOLD HIMSELF OR HERSELF OUT AS A NURSING HOME MEDICATION AIDE;
   G. ESTABLISH MINIMUM STANDARDS OF  TRAINING  FOR  THE  PERFORMANCE  OF
 MEDICATION  ADMINISTRATION  BY  NURSING HOME MEDICATION AIDES, INCLUDING
 DIDACTIC TRAINING, CLINICAL TRAINING, AND A SUPERVISED CLINICAL  PRACTI-
 CUM WITH STANDARDS SET FORTH BY THE COMMISSIONER OF HEALTH;
   H.  PROVIDE THAT NURSING HOME MEDICATION AIDES SHALL RECEIVE CASE-SPE-
 CIFIC TRAINING ON THE MEDICATION ADMINISTRATION TO BE  ASSIGNED  BY  THE
 SUPERVISING  NURSE,  PROVIDED  THAT ADDITIONAL TRAINING SHALL TAKE PLACE
 WHENEVER ADDITIONAL MEDICATION ADMINISTRATION IS ASSIGNED;
   I. PROHIBIT A NURSING HOME MEDICATION AIDE  FROM  HOLDING  HIMSELF  OR
 HERSELF  OUT,  OR ACCEPTING EMPLOYMENT AS, A PERSON LICENSED TO PRACTICE
 NURSING UNDER THE PROVISIONS OF THIS ARTICLE;
   J. PROVIDE THAT A NURSING HOME MEDICATION AIDE  IS  NOT  REQUIRED  NOR
 PERMITTED TO ASSESS THE MEDICATION OR MEDICAL NEEDS OF AN INDIVIDUAL;
   K. PROVIDE THAT A NURSING HOME MEDICATION AIDE SHALL NOT BE AUTHORIZED
 TO  PERFORM ANY ACTIVITIES PURSUANT TO THIS SUBDIVISION THAT ARE OUTSIDE
 THE SCOPE OF PRACTICE OF A LICENSED PRACTICAL NURSE  OR  THAT  HAVE  NOT
 BEEN  APPROPRIATELY  ASSIGNED BY THE SUPERVISING REGISTERED PROFESSIONAL
 NURSE;
   L. PROVIDE THAT A NURSING HOME  MEDICATION  AIDE  SHALL  DOCUMENT  ALL
 MEDICATION  ADMINISTRATION TO EACH INDIVIDUAL THROUGH THE USE OF A MEDI-
 CATION ADMINISTRATION RECORD; AND
   M. PROVIDE THAT THE SUPERVISING REGISTERED  PROFESSIONAL  NURSE  SHALL
 RETAIN  THE  DISCRETION  TO DECIDE WHETHER TO ASSIGN MEDICATION ADMINIS-
 TRATION TO NURSING HOME MEDICATION AIDES UNDER THIS  PROGRAM  AND  SHALL
 NOT BE SUBJECT TO COERCION, RETALIATION, OR THE THREAT OF RETALIATION.
   §  2.  Section  6909  of  the education law is amended by adding a new
 subdivision 9 to read as follows:
   9. A REGISTERED PROFESSIONAL NURSE, WHILE WORKING  FOR  A  RESIDENTIAL
 HEALTH CARE FACILITY LICENSED OR CERTIFIED PURSUANT TO THE PUBLIC HEALTH
 LAW, MAY, IN ACCORDANCE WITH THIS SUBDIVISION, ASSIGN NURSING HOME MEDI-
 CATION AIDES TO PERFORM MEDICATION ADMINISTRATION FOR INDIVIDUALS PURSU-
 ANT TO THE PROVISIONS OF SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED
 EIGHT  OF  THIS  ARTICLE AND SUPERVISE NURSING HOME MEDICATION AIDES WHO
 PERFORM ASSIGNED MEDICATION ADMINISTRATION.
   (A) PRIOR TO ASSIGNING OR MODIFYING AN ASSIGNMENT TO  PERFORM  MEDICA-
 TION ADMINISTRATION, THE REGISTERED PROFESSIONAL NURSE SHALL:
   (I)  COMPLETE  A  NURSING ASSESSMENT TO ASCERTAIN THE CLIENT'S CURRENT
 HEALTH STATUS AND CARE NEEDS; AND

 S. 7164--A                          4

   (II) PROVIDE TO THE NURSING HOME MEDICATION AIDE WRITTEN,  INDIVIDUAL-
 SPECIFIC  INSTRUCTIONS  FOR PERFORMING THE MEDICATION ADMINISTRATION AND
 CRITERIA FOR  IDENTIFYING,  REPORTING  AND  RESPONDING  TO  PROBLEMS  OR
 COMPLICATIONS.
   (B)  THE  REGISTERED  PROFESSIONAL  NURSE  SHALL NOT ASSIGN MEDICATION
 ADMINISTRATION UNLESS:
   (I) THE MEDICATION ADMINISTRATION TO BE ASSIGNED IS CONSISTENT WITH AN
 AUTHORIZED HEALTH PRACTITIONER'S ORDERED CARE;
   (II) THE REGISTERED PROFESSIONAL NURSE PROVIDES CASE SPECIFIC TRAINING
 TO THE NURSING HOME MEDICATION AIDE AND  PERSONALLY  VERIFIES  THAT  THE
 NURSING  HOME  MEDICATION  AIDE  CAN  SAFELY AND COMPETENTLY PERFORM THE
 MEDICATION ADMINISTRATION;
   (III) THE REGISTERED PROFESSIONAL NURSE DETERMINES  THAT  THE  NURSING
 HOME  MEDICATION  AIDE  IS  WILLING  TO PERFORM SUCH MEDICATION ADMINIS-
 TRATION; AND
   (IV) THE REGISTERED PROFESSIONAL NURSE  DETERMINES  THAT  THE  NURSING
 HOME  MEDICATION AIDE IS ABLE TO EFFECTIVELY AND EFFICIENTLY COMMUNICATE
 WITH THE INDIVIDUAL RECEIVING SERVICES AND UNDERSTAND SUCH  INDIVIDUAL'S
 NEEDS.
   (C) THE SUPERVISING REGISTERED PROFESSIONAL NURSE SHALL:
   (I)  VISIT  INDIVIDUALS RECEIVING MEDICATION FOR THE PURPOSE OF SUPER-
 VISING THE MEDICATION ADMINISTRATION PROVIDED BY NURSING HOME MEDICATION
 AIDES; AND
   (II) CONDUCT REGULAR AND ONGOING ASSESSMENT OF THE INDIVIDUAL'S NEEDS.
   § 3. Section 6906 of the education law is  amended  by  adding  a  new
 subdivision 10 to read as follows:
   (10)  IN  CONJUNCTION WITH AND AS A CONDITION OF EACH TRIENNIAL REGIS-
 TRATION, THE DEPARTMENT SHALL ASK AND A LICENSED PRACTICAL  NURSE  SHALL
 INDICATE  WHETHER THE LICENSED PRACTICAL NURSE IS OR HAS PREVIOUSLY BEEN
 AUTHORIZED AS A NURSING HOME MEDICATION  AIDE  PURSUANT  TO  SUBDIVISION
 THREE  OF  SECTION SIXTY-NINE HUNDRED EIGHT OF THIS ARTICLE. THE DEPART-
 MENT SHALL PROVIDE RESPONSES TO THE DEPARTMENT OF HEALTH AND THE DEPART-
 MENT OF HEALTH SHALL INCLUDE SUCH  INFORMATION  IN  REPORTS  RELATED  TO
 NURSING HOME MEDICATION AIDES.
   §  4.  Section 206 of the public health law is amended by adding a new
 subdivision 31 to read as follows:
   31. THE COMMISSIONER SHALL NOTIFY THE COMMISSIONER OF EDUCATION IN ANY
 INSTANCE IN WHICH A REGISTERED PROFESSIONAL NURSE  ENGAGES  IN  IMPROPER
 BEHAVIOR  WHILE  SUPERVISING  A NURSING HOME MEDICATION AIDE PURSUANT TO
 SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF  THE  EDUCATION
 LAW.
   §  5. Section 2801 of the public health law is amended by adding a new
 subdivision 12 to read as follows:
   12. "NURSING HOME MEDICATION AIDES" MEANS NURSING HOME AIDES  WHO  ARE
 AUTHORIZED  TO PERFORM MEDICATION ADMINISTRATION AS DELINEATED IN SUBDI-
 VISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF  THE  EDUCATION  LAW
 AND  REGULATIONS ISSUED BY THE COMMISSIONER OF EDUCATION RELATING THERE-
 TO. THE COMMISSIONER SHALL PROMULGATE REGULATIONS REGARDING SUCH  AIDES,
 WHICH  SHALL  INCLUDE  A PROCESS FOR THE LIMITATION OR REVOCATION OF THE
 NURSING HOME  MEDICATION  AIDE'S  AUTHORIZATION  TO  PERFORM  MEDICATION
 ADMINISTRATION IN APPROPRIATE CASES.
   §  6. Section 2803-j of the public health law, as added by chapter 717
 of the laws of 1989, is amended by adding a new subdivision 5 to read as
 follows:
   5. THE DEPARTMENT SHALL INDICATE WITHIN THE NURSING  HOME  NURSE  AIDE
 REGISTRY  WHEN  A  NURSING  HOME NURSE AIDE HAS SATISFIED ALL APPLICABLE

 S. 7164--A                          5
 
 TRAINING AND RECERTIFICATION REQUIREMENTS AND HAS PASSED THE  APPLICABLE
 COMPETENCY  EXAMINATIONS  NECESSARY TO PERFORM MEDICATION ADMINISTRATION
 PURSUANT TO SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF THE
 EDUCATION  LAW AND REGULATIONS ISSUED THERETO. ANY LIMITATION OR REVOCA-
 TION OF THE NURSING HOME MEDICATION AIDE'S AUTHORIZATION ALSO  SHALL  BE
 INDICATED ON THE REGISTRY.
   §  7.  On or before October 1, 2024, the commissioner of health shall,
 in consultation with the commissioner of education, issue  a  report  on
 the  implementation  of nursing home medication aides in the state. Such
 report shall include the number of nursing home medication aides author-
 ized pursuant to this act; the number of nursing home nurse  aides  that
 became  authorized  to  perform medication administration; the number of
 nursing home medication aides that became registered as licensed practi-
 cal nurses; the types of medication that nursing home  medication  aides
 are  administering;  the  number of complaints pertaining to  medication
 administration provided by  nursing  home  medication  aides  that  were
 reported  to  the  department  of health; and the number of nursing home
 medication 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 implementation of nursing home medication  aides  pursuant  to  this
 act, and any recommendations related thereto.
   § 8. This act shall take effect immediately; provided that:
   a.  sections  one  and  three  of this act shall take effect two years
 after this act shall have  become  a  law.  Effective  immediately,  the
 commissioner  of  education  is authorized to adopt or amend regulations
 and take such other actions as are necessary to implement the provisions
 of sections one and two of this act on or before  such  effective  date;
 provided,  further, that no medication administration shall be performed
 pursuant to the provisions of subdivision three of section 6908  of  the
 education  law,  as  added by section one of this act, on or before such
 effective date; provided further, that  no    medication  administration
 shall  be  performed  pursuant to such provisions until such regulations
 are adopted and except in conformance with such regulations including in
 conformance with the provisions  of  such  regulations  related  to  the
 completion of nursing home medication aide training and the satisfaction
 of competency examination requirements.
   b. this act shall expire and be deemed repealed March 31, 2025.