S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    171
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of A. GOTTFRIED, GUNTHER, ENGLEBRIGHT, L. ROSENTHAL,
   ABINANTI, SEAWRIGHT, GALEF, SOLAGES, SAYEGH -- Multi-Sponsored  by  --
   M.  of A.  CARROLL, COLTON, DeSTEFANO, DINOWITZ, McDONOUGH, MONTESANO,
   PAULIN, PERRY, SIMON -- read once and referred  to  the  Committee  on
   Health

 AN ACT to amend the public health law, in relation to requiring a regis-
   tered  nurse  on  staff  at facilities certified for enhanced assisted
   living or special needs assisted living
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1. Section 4655 of the public health law, as added by chapter
 2 of the laws of 2004, is amended to read as follows:
   § 4655. Certification procedures and requirements. 1.  Notwithstanding
 any other provision of law, an assisted living operator may apply to the
 department to obtain an enhanced assisted living certificate pursuant to
 this section.
   (a) Such application shall be on a form approved by the department.
   (b)  An  assisted living operator may apply for such a certificate for
 the entire facility or any number of beds at the facility.
   (c) To obtain an enhanced assisted living certificate,  the  applicant
 must  submit  a  plan to the department setting forth how the additional
 needs of residents will be safely and appropriately met  at  such  resi-
 dence.  Such  plan  shall include, but need not be limited to, a written
 description of services, staffing levels, staff education and  training,
 work experience, and any environmental modifications that have been made
 or  will  be  made  to  protect  the  health, safety and welfare of such
 persons in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY  WILL
 MEET THE REGISTERED NURSE STAFFING REQUIREMENT.
   (d) In addition to any other requirements of assisted living, an oper-
 ator  of  enhanced assisted living may hire care staff directly pursuant
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
              

                       [ ] is old law to be omitted.
                                                            LBD00141-01-1

 A. 171                              2
 
 to standards developed by the department or contract with  a  home  care
 services  agency  which has been approved to operate pursuant to article
 thirty-six of this chapter.
   (e)  No  assisted  living  residence  shall  be  certified as enhanced
 assisted living unless and  until  the  applicant  obtains  the  written
 approval of the department.
   (F)  (I)  TO  OBTAIN OR RENEW AN ENHANCED ASSISTED LIVING CERTIFICATE,
 THE APPLICANT SHALL BE REQUIRED TO HAVE A  REGISTERED  NURSE  ONSITE  TO
 ASSESS AND MONITOR THE CONDITION OF RESIDENTS.
   (II)  THE  REGISTERED  NURSE SHALL BE AT THE FACILITY A MINIMUM OF ONE
 SHIFT PER DAY, FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES  OF  THE  REGIS-
 TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI-
 DENT  ASSESSMENT  AND  MONITORING,  AND  ENSURING THAT ALL RESIDENTS ARE
 RECEIVING APPROPRIATE CARE.
   (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE
 MONITORING OR OVERSIGHT SERVICES OF A REGISTERED NURSE ON  A  FULL  TIME
 BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER
 CAPACITY,  AS  APPROPRIATE  FOR  THE  FACILITY. FACILITIES CHOOSING THIS
 OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT
 AND MONITORING.
   (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO
 FURNISH PROOF OF COMPLIANCE WITH THIS PARAGRAPH NO LATER  THAN  EIGHTEEN
 MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW.
   2.  No  resident  shall be permitted to continue to age in place under
 the terms of an enhanced assisted living certificate unless  the  opera-
 tor,  the  resident's  physician, THE FACILITY'S STAFF REGISTERED NURSE,
 and, if applicable, the resident's licensed or certified home care agen-
 cy, agree that the additional needs of the resident can  be  safely  and
 appropriately  met  at  the  residence. A resident eligible for enhanced
 assisted living or his or her representative shall submit to  the  resi-
 dence a written report from a physician, which report shall state that:
   (a) the physician has physically examined the resident within the last
 month; and
   (b)  the  resident  is not in need of twenty-four hour skilled nursing
 care or medical care which would require  placement  in  a  hospital  or
 residential health care facility.
   3. The residence must notify a resident that, while the residence will
 make  reasonable  efforts to facilitate the resident's ability to age in
 place pursuant to an individualized service plan, there may be  a  point
 reached where the needs of the resident cannot be safely or appropriate-
 ly  met  at  the  residence, requiring the transfer of the resident to a
 more appropriate facility in accordance  with  the  provisions  of  this
 article.
   4. If a resident reaches the point where he or she is in need of twen-
 ty-four  hour  skilled  nursing  care  or  medical  care  required to be
 provided by facilities licensed pursuant to article twenty-eight of this
 chapter or article nineteen, thirty-one  or  thirty-two  of  the  mental
 hygiene  law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE FACILITY'S
 STAFF RESIDENT NURSE, then the resident  must  be  discharged  from  the
 residence  and  the  operator  shall initiate proceedings for the termi-
 nation of the residency agreement of such resident  in  accordance  with
 the  provisions  of  section  four  hundred  sixty-one-h  of  the social
 services law.  Provided, however, a resident may remain at the residence
 if each of the following conditions are met:

 A. 171                              3
 
   (a) a resident in need of twenty-four hour  skilled  nursing  care  or
 medical care hires appropriate nursing, medical or hospice staff to care
 for his or her increased needs;
   (b)  the  resident's physician [and], home care services agency [both]
 AND THE FACILITY'S STAFF REGISTERED NURSE  ALL  determine  and  document
 that,  with the provision of such additional nursing, medical or hospice
 care, the resident can be safely cared for in the residence,  and  would
 not  require  placement  in  a  hospital, nursing home or other facility
 licensed under article twenty-eight of this chapter or article nineteen,
 thirty-one or thirty-two of the mental hygiene law;
   (c) the operator agrees to retain the resident and to  coordinate  the
 care  provided  by  the  operator and the additional nursing, medical or
 hospice staff; and
   (d) the resident is otherwise eligible to reside at the residence.
   5. In addition to the requirements otherwise required for licensure as
 assisted living, any residence that  advertises  or  markets  itself  as
 serving  individuals  with special needs, including, but not limited to,
 individuals with  dementia  or  cognitive  impairments,  must  submit  a
 special needs plan to the department setting forth how the special needs
 of  such  residents  will  be safely and appropriately met at such resi-
 dence. Such plan shall include, but need not be limited  to,  a  written
 description  of  specialized  services, staffing levels, staff education
 and training, work  experience,  professional  affiliations  or  special
 characteristics  relevant to serving persons with special needs, and any
 environmental modifications that have been  made  or  will  be  made  to
 protect the health, safety and welfare of such persons in the residence.
 In approving an application for special needs certification, the depart-
 ment shall develop standards to ensure adequate staffing and training in
 order  to  safely meet the needs of the resident. The standards shall be
 based upon recommendations of the task force established by section five
 of [the] chapter TWO of the laws of two thousand four [which added  this
 section].  IN  ADDITION  TO ANY OTHER STANDARDS WHICH THE DEPARTMENT MAY
 DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL
 BE SUBJECT TO THE SAME REGISTERED NURSE STAFFING  REQUIREMENTS  DETAILED
 IN  PARAGRAPHS  (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION. No resi-
 dence shall market [themselves] ITSELF as providing specialized services
 unless and until the  department  has  approved  such  applicant  for  a
 special  needs  assisted  living  certificate.  EXISTING  SPECIAL  NEEDS
 ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI-
 ANCE WITH THE NEW STAFFING REQUIREMENTS NO LATER  THAN  EIGHTEEN  MONTHS
 AFTER THIS SENTENCE SHALL HAVE BECOME A LAW.
   6. An enhanced assisted living certificate shall not be required of an
 adult care facility, or part thereof, which has obtained approval by the
 department  to  operate  an  assisted living program pursuant to section
 four hundred sixty-one-l of the social services law. Provided,  however,
 such  exemption shall only apply to those beds at the facility which are
 subject to the assisted living program.
   § 2. This act shall take effect on the ninetieth day  after  it  shall
 have  become  a  law;  provided  that any rules and regulations, and any
 other actions necessary to implement the provisions of this act  on  its
 effective  date are authorized and directed to be completed on or before
 such date.