The New York State Senate

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    108
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by M. of A. GUNTHER, CRUZ, GOTTFRIED, BARRETT, L. ROSENTHAL,
   SMITH, BRONSON, COLTON, MONTESANO,  BRABENEC,  BENEDETTO,  MAGNARELLI,
   SALKA,  DeSTEFANO, WEPRIN, SCHMITT, J. RIVERA, FALL, AUBRY, MORINELLO,
   OTIS, STECK,  B. MILLER,  ASHBY,  SANTABARBARA,  ZEBROWSKI,  ABINANTI,
   BARRON,    SEAWRIGHT,    WALKER,    BICHOTTE,   RICHARDSON,   HYNDMAN,
   PEOPLES-STOKES, PICHARDO, JOYNER,  JEAN-PIERRE,  ROZIC,  KIM,  HEVESI,
   O'DONNELL,   DILAN,   DAVILA,   HUNTER,  WILLIAMS,  CARROLL,  WOERNER,
   PHEFFER AMATO, JONES, VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE,
   REYES, STERN, SAYEGH, JACOBSON, McMAHON,  ABBATE,  CAHILL,  FERNANDEZ,
   FRONTUS, EPSTEIN, BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA,
   GRIFFIN,  QUART  --  Multi-Sponsored  by  --  M. of A. BARNWELL, COOK,
   CUSICK, CYMBROWITZ, ENGLEBRIGHT, FAHY, GALEF,  GLICK,  LUPARDO,  McDO-
   NOUGH,  MIKULIN,  PAULIN,  PERRY, PRETLOW -- read once and referred to
   the Committee on Health
 
 AN ACT to amend the public health law, in relation to enacting the "safe
   staffing for quality care act"
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "safe staffing for quality care act".
   § 2. Paragraphs (a) and (b) of subdivision 2 of section  2805  of  the
 public  health  law, paragraph (a) as amended by chapter 923 of the laws
 of 1973 and paragraph (b) as added by chapter 795 of the laws  of  1965,
 are amended to read as follows:
   (a)  Application  for an operating certificate for a hospital shall be
 made upon forms prescribed by  the  department.  The  application  shall
 [contain]  INCLUDE the name of the hospital, the kind or kinds of hospi-
 tal service to be provided, the location and physical description of the
 institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN  SECTION  TWENTY-

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

                                                            LBD02466-01-1

 A. 108                              2
 
 EIGHT HUNDRED TWENTY-NINE OF THIS ARTICLE, and such other information as
 the department may require.
   (b)  An  operating  certificate  shall not be issued by the department
 unless it finds that  the  premises,  equipment,  personnel,  DOCUMENTED
 STAFFING  PLAN, rules and by-laws, standards of medical care, and hospi-
 tal service are fit and adequate and that the hospital will be  operated
 in  the manner required by this article and rules and regulations there-
 under.
   § 3. The public health law is amended  by  adding  nine  new  sections
 2828,  2829,  2830,  2831,  2832,  2833,  2834, 2835 and 2836 to read as
 follows:
   § 2828. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL  OF
 THE FOLLOWING:
   1.  HEALTH  CARE  SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY
 DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
   2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE  STAFF-
 ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
   3.  TO  ENSURE  THE  ADEQUATE  PROTECTION  OF  PATIENTS IN HEALTH CARE
 SETTINGS, IT IS ESSENTIAL THAT QUALIFIED  REGISTERED  NURSES  AND  OTHER
 LICENSED  NURSES  BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE NEEDS OF
 PATIENTS; AND
   4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING  SHOULD
 BE  BASED  ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY OF CONDITION,
 SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
   § 2829. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS  AND  PHRASES,
 AS  USED  IN  THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE
 CONTEXT OTHERWISE PLAINLY REQUIRES:
   1. "ACUTE CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN  A  RESIDEN-
 TIAL  HEALTH  CARE  FACILITY  AND  SHALL  ALSO INCLUDE ANY FACILITY THAT
 PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW,  ARTI-
 CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
 ITY  IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR
 A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
   2. "ACUITY SYSTEM" SHALL MEAN AN  ESTABLISHED  MEASUREMENT  INSTRUMENT
 WHICH  (A)  PREDICTS  NURSING  CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS
 BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
 TECHNOLOGY,  INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND   THE
 COMPLEXITY  OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND
 EVALUATE THE PATIENT'S NURSING CARE PLAN;  (B)  DETAILS  THE  AMOUNT  OF
 NURSING  CARE  NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL
 MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
 A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN  TERMS  THAT  READILY
 CAN  BE  USED  AND  UNDERSTOOD  BY DIRECT-CARE NURSES. THE ACUITY SYSTEM
 SHALL TAKE INTO CONSIDERATION THE PATIENT  CARE  SERVICES  PROVIDED  NOT
 ONLY  BY  REGISTERED  PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL
 NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
   3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
 STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
 NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF  AN  ACUITY
 SYSTEM.
   4.  "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY
 NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY  OUT  MEDICAL
 REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
   5.  "DOCUMENTED  STAFFING  PLAN"  SHALL  MEAN  A DETAILED WRITTEN PLAN
 SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
 ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY

 A. 108                              3
 
 FOR A GIVEN YEAR, BASED  ON  REASONABLE  PROJECTIONS  DERIVED  FROM  THE
 PATIENT  CENSUS  AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT
 DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE  AND  GEOGRAPHY,  THE
 NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
 UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
   6.  "NURSE"  SHALL  MEAN  A  REGISTERED PROFESSIONAL NURSE OR LICENSED
 PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE  OF
 THE EDUCATION LAW.
   7.  "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
 OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
 THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE  RECOGNIZED  STAND-
 ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
 NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
   8.  "SAFE  STAFFING  REQUIREMENTS"  SHALL  MEAN THE PROVISIONS OF THIS
 SECTION AND  SECTIONS  TWENTY-EIGHT  HUNDRED  TWENTY-NINE,  TWENTY-EIGHT
 HUNDRED  THIRTY,  TWENTY-EIGHT  HUNDRED THIRTY-ONE, TWENTY-EIGHT HUNDRED
 THIRTY-TWO,  TWENTY-EIGHT  HUNDRED  THIRTY-THREE,  TWENTY-EIGHT  HUNDRED
 THIRTY-FOUR,  TWENTY-EIGHT  HUNDRED THIRTY-FIVE AND TWENTY-EIGHT HUNDRED
 THIRTY-SIX OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED  PURSU-
 ANT THERETO.
   9.  "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND
 EXPERIENCE AMONG DIRECT-CARE NURSES.
   10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO  PATIENT
 RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
   11.  "UNIT"  SHALL  MEAN  A  PATIENT CARE COMPONENT, AS DEFINED BY THE
 DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
   12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
 A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR  REGISTERED  UNDER  TITLE
 EIGHT  OF  THE  EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY
 OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT  ASSISTANCE
 IN THE DELIVERY OF PATIENT CARE.
   §  2830. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER
 SHALL:
   1. APPOINT AN ACUTE  CARE  FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN
 MEMBERS.  NO  LESS  THAN  SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL
 NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES,  THREE  OF
 WHOM  SHALL  BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINIS-
 TRATOR. NO LESS THAN TWO MEMBERS OF  THE  ACUTE  CARE  FACILITY  COUNCIL
 SHALL  BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAIN-
 ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
 REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A  NURS-
 ING  PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR
 CERTIFIED BARGAINING AGENT OF NURSES. THE ACUTE  CARE  FACILITY  COUNCIL
 SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD-
 ING  REGISTERED  PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND
 NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE  NOT  SPECIFIED
 IN  THIS  ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL
 BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL-
 UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
 ON APPROVAL OF STAFFING PLANS PRIOR TO  THE  GRANTING  OF  AN  OPERATING
 CERTIFICATE BY THE DEPARTMENT.
   2.  PROMULGATE,  AFTER CONSULTATION WITH THE ACUTE CARE FACILITY COUN-
 CIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE  PURPOSES  AND
 PROVISIONS  OF  THE  SAFE  STAFFING  REQUIREMENTS, INCLUDING REGULATIONS
 DEFINING TERMS, SETTING  FORTH  DIRECT-CARE  NURSE  TO  PATIENT  RATIOS,
 SETTING  FORTH  NON-NURSING  DIRECT-CARE  STAFF  TO  PATIENT  RATIOS AND

 A. 108                              4
 
 PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY  SYSTEMS;
 AND
   3.  ASSURE  THAT  THE  PROVISIONS  OF  SAFE  STAFFING REQUIREMENTS ARE
 ENFORCED, INCLUDING THE ISSUANCE  OF  REGULATIONS  WHICH  AT  A  MINIMUM
 PROVIDE  FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE
 TO COMPLY WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS  TO  INFORMATION
 REGARDING  REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
 PURSUANT TO SUCH REQUIREMENTS.
   § 2831. STAFFING REQUIREMENTS. 1. STAFFING  REQUIREMENTS.  EACH  ACUTE
 CARE  FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES
 SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN  EACH  DEPART-
 MENT  OR  UNIT  WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED
 CARE NEEDS OF THE PATIENTS THEREIN. AT A  MINIMUM,  EACH  SUCH  FACILITY
 SHALL  MEET  THE  REQUIREMENTS  OF  SUBDIVISIONS  TWO  AND THREE OF THIS
 SECTION.
   2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING  CERTIF-
 ICATE  TO  ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS
 TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
 THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE  ADEQUATE  AND
 APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
 YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
   (A)  MEET  THE  MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF
 THIS SECTION;
   (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY  OTHER
 LAWS, RULES OR REGULATIONS;
   (C)  EMPLOY  AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS
 IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS  REQUIRING
 INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
   (D)  FACTOR  IN  OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES,
 TRANSFERS AND ADMISSIONS, STAFF  BREAKS,  MEALS,  ROUTINE  AND  EXPECTED
 ABSENCES  FROM  THE  UNIT  AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE
 EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT  NURSING
 CARE;
   (E)  INCLUDE  A  PLAN  TO  MEET NECESSARY STAFFING LEVELS AND SERVICES
 PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE  NEEDS
 PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
 STAFFING  PLAN  SHALL  NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC-
 TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED  STANDARDS  OF
 PRACTICE  TO  BE  PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE
 PERFORMED BY OTHER PERSONNEL;
   (F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL  STAFFING
 ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
   (G)  INCLUDE  A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S
 STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
   (H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN  SUCH  PLAN
 TOGETHER  WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH
 SUCH CLASSIFICATION; AND
   (I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY  OF  THE  DIRECT-CARE
 NURSES  WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES-
 ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
 REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
 SUPPORTIVE AND ASSISTIVE STAFF.
   3. MINIMUM STAFFING REQUIREMENTS. (A)  THE  DOCUMENTED  STAFFING  PLAN
 SHALL  INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA-
 TIENT RATIOS:

 A. 108                              5
 
   (I) ONE NURSE TO ONE PATIENT:  OPERATING  ROOM  AND  TRAUMA  EMERGENCY
 UNITS  AND  MATERNAL/CHILD  CARE  UNITS FOR THE SECOND OR THIRD STAGE OF
 LABOR;
   (II)  ONE  NURSE  TO TWO PATIENTS:   MATERNAL/CHILD CARE UNITS FOR THE
 FIRST STAGE OF LABOR, AND ALL CRITICAL CARE  AREAS  INCLUDING  EMERGENCY
 CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
   (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
 TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
 DIATE CARE NURSERY UNITS;
   (IV) ONE NURSE TO THREE PATIENTS:    POSTPARTUM  MOTHER/BABY  COUPLETS
 (MAXIMUM SIX PATIENTS PER NURSE);
   (V)  ONE  NURSE  TO  FOUR  PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
 POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
 ATRIC UNITS;
   (VI) ONE NURSE TO FIVE PATIENTS:  REHABILITATION  UNITS  AND  SUBACUTE
 PATIENTS; AND
   (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
   FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
 TO,  PSYCHIATRIC  UNITS,  AND ACUTE CARE FACILITIES OPERATED PURSUANT TO
 THE MENTAL HYGIENE LAW OR  THE  CORRECTION  LAW,  THE  DEPARTMENT  SHALL
 ESTABLISH  BY  REGULATION  THE  APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT
 RATIO.
   (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN  PARAGRAPH  (A)  OF  THIS
 SUBDIVISION  SHALL  REFLECT  THE  MAXIMUM NUMBER OF PATIENTS THAT MAY BE
 ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
   (C) THERE SHALL BE NO AVERAGING OF THE  NUMBER  OF  PATIENTS  AND  THE
 TOTAL  NUMBER  OF  NURSES  ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY
 PERIOD OF TIME.
   (D) THE COMMISSIONER, IN CONSULTATION WITH  THE  ACUTE  CARE  FACILITY
 COUNCIL,  SHALL  ESTABLISH  REGULATIONS PROVIDING FOR THE MAINTENANCE OF
 MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
 DURING ROUTINE OR EXPECTED ABSENCES FROM THE  UNIT,  SUCH  AS  MEALS  OR
 BREAKS.
   4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
 TICAL  NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS
 ASSIGNED TO THE LICENSED PRACTICAL  NURSE  SHALL  ALSO  BE  INCLUDED  IN
 CALCULATING  THE  NUMBER  OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES-
 SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
 TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING  CARE  PROVIDED  BY  THE
 LICENSED PRACTICAL NURSE.
   5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
 ING  CARE  FUNCTIONS  REQUIRED  BY SECTION SIXTY-NINE HUNDRED TWO OF THE
 EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO  BE  PERFORMED  BY  A
 REGISTERED  PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI-
 CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE  FUNC-
 TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
 ACCEPTED  STANDARDS  OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL
 NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
   6. ADJUSTMENTS BY FACILITY.   THE  MINIMUM  STAFFING  REQUIREMENT  AND
 NURSE-TO-PATIENT  RATIO  SET  FORTH IN THIS SECTION SHALL BE ADJUSTED BY
 THE ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR  ADDITIONAL
 DIRECT-CARE  NURSES.    ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE
 WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN-
 ING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY  OF  THE  ILLNESS,
 THE  NEED  FOR  SPECIALIZED  EQUIPMENT AND TECHNOLOGY, THE COMPLEXITY OF
 CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE  THE  PATIENT

 A. 108                              6
 
 CARE  PLAN  AND  THE  ABILITY  FOR  SELF-CARE,  AND THE LICENSURE OF THE
 PERSONNEL REQUIRED FOR CARE.
   7.  COMMISSIONER  REGULATIONS.    THE  COMMISSIONER  MAY BY REGULATION
 REQUIRE A DOCUMENTED  STAFFING  PLAN  TO  HAVE  HIGHER  NURSE-TO-PATIENT
 RATIOS THAN THOSE SET FORTH IN THIS SECTION.
   8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
 TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
 RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
   §  2832.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
 ACUTE CARE FACILITY SHALL AT ALL TIMES  STAFF  IN  ACCORDANCE  WITH  ITS
 DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
 TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE; PROVIDED, HOWEVER, THAT
 NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY
 FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT  STAFFING  LEVELS,
 NOR  SHALL  THE  REQUIREMENTS  SET  FORTH  IN  SUCH SECTION TWENTY-EIGHT
 HUNDRED THIRTY-ONE OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
 HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
   2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
 STANDARDS  SET  FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS
 ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
 RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN  AN  ACUTE  CARE
 FACILITY  UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
 CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION  LAW,  HAS  RECEIVED  PRIOR
 ORIENTATION  IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
 ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND  HAS  DEMON-
 STRATED  CURRENT  COMPETENCE  IN PROVIDING CARE IN THAT UNIT OR CLINICAL
 AREA. ACUTE CARE FACILITIES  THAT  UTILIZE  TEMPORARY  NURSING  AGENCIES
 SHALL  HAVE  AND  ADHERE  TO  A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
 PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN-
 CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN
 EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD  TO
 UNSAFE  PATIENT  CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
 UNIT OR CLINICAL AREA, PROVIDED  THAT  SUCH  NURSES  SHALL  BE  ASSIGNED
 PATIENTS  APPROPRIATE  TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
 SHALL ESTABLISH A CONSISTENT  PLAN  FOR  ADDRESSING  EMERGENCY  STAFFING
 SITUATIONS  AND  MONITOR  OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL
 DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
 NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT  REGULARLY  OCCURRING
 WITHIN THE FACILITY.
   3.  EACH  ACUTE  CARE  FACILITY  SHALL MAINTAIN ACCURATE DAILY RECORDS
 SHOWING:
   (A) THE NUMBER OF PATIENTS ADMITTED,  RELEASED  AND  PRESENT  IN  EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
   (B)  THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS-
 ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
   (C) THE IDENTITY AND DUTY HOURS OF  EACH  DIRECT-CARE  NURSE  IN  EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
   4.  EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
 ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,  INFECTION,  ACCIDENT,
 INJURY AND MEDICAL ERRORS.
   5.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
 MAINTAINED FOR A PERIOD OF SEVEN YEARS.
   6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
 MADE  AVAILABLE  UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO THE PUBLIC;
 PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL  COMPLY
 WITH  THE  APPLICABLE  PATIENT  PRIVACY LAWS, RULES AND REGULATIONS, AND

 A. 108                              7

 THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE  IDENTITY
 AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.
   §  2833. WORK ASSIGNMENT POLICY. 1. GENERAL.  EACH ACUTE CARE FACILITY
 SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
 WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO
 AND  THREE  OF  THIS  SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
 DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
   2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY  SHALL
 PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
   (A)  FOR  WHICH  THE  NURSE  IS NOT PREPARED BY EDUCATION, TRAINING OR
 EXPERIENCE TO SAFELY FULFILL  THE  ASSIGNMENT  WITHOUT  COMPROMISING  OR
 JEOPARDIZING  PATIENT  SAFETY,  THE  NURSE'S ABILITY TO MEET FORESEEABLE
 PATIENT NEEDS OR THE NURSE'S LICENSE; OR
   (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
   3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY  SHALL
 CONTAIN PROCEDURES FOR THE FOLLOWING:
   (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
 REGARDING  THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED
 OF AN ASSIGNMENT OR CONTINUED DUTY;
   (B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR  TO  REVIEW  THE
 SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
 ER  TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR
 TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR  CONTIN-
 UED DUTY;
   (C)  A  PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE
 THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN  THE  SUPERVISOR  DENIES
 THE REQUEST TO BE RELIEVED IF:
   (I)  THE  SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR
 THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
   (II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY  AGENCY
 WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
   (III)  THE  EMPLOYEE  IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS
 CONDITIONS JUSTIFYING REFUSAL; AND
   (D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT  TO  A
 WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
 BY  REASON  THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION,
 PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW  RELATING  TO
 NURSING.
   §  2834.  PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY ACUTE CARE
 FACILITY SHALL:
   1. POST IN A CONSPICUOUS  PLACE  READILY  ACCESSIBLE  TO  THE  GENERAL
 PUBLIC  A  NOTICE  PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF
 THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
 INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF-
 ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
   2. UPON REQUEST, MAKE COPIES OF THE  DOCUMENTED  STAFFING  PLAN  FILED
 WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
   3.  UPON  REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A
 DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
   (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
   (B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED  TO  BE
 PRESENT  DURING  THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM,
 AND
   (C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE  NURSES  PRESENT
 DURING THE SHIFT.

 A. 108                              8
 
   §  2835.  ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE-
 GATE ITS RESPONSIBILITIES TO  ENFORCE  THE  SAFE  STAFFING  REQUIREMENTS
 PROMULGATED PURSUANT TO THIS ARTICLE.
   § 2836. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
 HUNDRED  THIRTY-THREE  OF  THIS  ARTICLE.   ANY ACUTE CARE FACILITY THAT
 VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED  WORK  ASSIGN-
 MENT  POLICY  UNDER  SECTION  TWENTY-EIGHT  HUNDRED THIRTY-THREE OF THIS
 ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION  BROUGHT  IN  A
 COURT  OF  COMPETENT  JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS
 MAY BE APPROPRIATE TO EFFECTUATE  THE  PURPOSES  OF  THE  SAFE  STAFFING
 REQUIREMENTS,  INCLUDING  BUT  NOT  LIMITED TO REINSTATEMENT, PROMOTION,
 LOST WAGES AND BENEFITS,  AND  COMPENSATORY  AND  CONSEQUENTIAL  DAMAGES
 RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
 DAMAGES.  THE  COURT  IN  SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT
 AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES  AND
 COSTS  OF  ACTION  TO  BE  PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO
 INSTITUTE A PRIVATE ACTION PURSUANT TO THIS  SUBDIVISION  SHALL  NOT  BE
 LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   §  4.  Section  2801-a of the public health law is amended by adding a
 new subdivision 3-b to read as follows:
   3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
 TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
 PLANNING COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR  FEDERAL
 RULES,  REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS,
 WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
 TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
 COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
 THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
   § 5. Section 2805 of the public health law is amended by adding a  new
 subdivision 3 to read as follows:
   3.  IN  DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE
 TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN  ACCORD-
 ANCE  WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY PAST
 VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR  STATUTES  RELATING
 TO  EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING
 OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS  OR  IMPERATIVES.  THE
 PUBLIC  HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT
 TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING  NURSE  STAFF
 AND SUPPORTIVE STAFF RATIOS.
   §  6.  The public health law is amended by adding a new section 2895-b
 to read as follows:
   § 2895-B. RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS.  1.  DEFI-
 NITIONS.  AS  USED  IN  THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
 FOLLOWING MEANINGS:
   (A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN  THE  RESIDEN-
 TIAL  HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION TWEN-
 TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
   (B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL  IN
 A  PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN
 A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
 THAT TIME.
   2. COMMISSIONER AND RESIDENTIAL HEALTH CARE FACILITY  COUNCIL;  POWERS
 AND  DUTIES.  THE  COMMISSIONER SHALL: APPOINT A RESIDENTIAL HEALTH CARE
 FACILITY COUNCIL CONSISTING  OF  THIRTEEN  MEMBERS.  NO  LESS  THAN  TWO
 MEMBERS  SHALL  BE DIRECT   CARE LICENSED PRACTICAL NURSES, NO LESS THAN
 TWO MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO  LESS

 A. 108                              9

 THAN    ONE MEMBER SHALL BE A DIRECT CARE REGISTERED PROFESSIONAL NURSE.
 THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE  EACH  OF
 RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS-
 ES,  OF  NON-REGISTERED  NURSE DIRECT CARE STAFF AND A REPRESENTATIVE OF
 NURSING PROFESSIONAL ASSOCIATIONS. THE COUNCIL  SHALL  ALSO  INCLUDE  NO
 LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA-
 TORS,  TWO  REPRESENTATIVES  OF  RESIDENTIAL  HEALTH CARE FACILITY NURSE
 ADMINISTRATORS AND ONE  REPRESENTATIVE  OF  CONSUMERS.  THE  RESIDENTIAL
 HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-
 OPMENT  OF  REGULATIONS  RELATING  TO  THE STAFFING STANDARDS UNDER THIS
 SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
 TURE, THE PUBLIC AND  THE  COMMISSIONER  ANY  RECOMMENDATIONS  REGARDING
 STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
   3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
 COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN-
 TIAL  HEALTH  CARE  FACILITY  MINIMUM STAFFING LEVELS TO MEET APPLICABLE
 STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
 TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
 ING OF EACH RESIDENT  OF  THE  FACILITY.  THE  COMMISSIONER  SHALL  ALSO
 REQUIRE  BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
 TAIN RECORDS ON ITS STAFFING LEVELS,  REPORT  ON  SUCH  RECORDS  TO  THE
 DEPARTMENT,  AND  MAKE  SUCH  RECORDS  AVAILABLE  FOR  INSPECTION BY THE
 DEPARTMENT.
   (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
   (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
   (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
 SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
 TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
 PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
   (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
 UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
 SUBDIVISION FOUR OF THIS SECTION.
   (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
 SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
 THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
 PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
 ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
   4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
 OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
 STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
   (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
   (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY  BY  A  LICENSED  PRACTICAL
 NURSE OR A REGISTERED NURSE;
   (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
 MINIMUM  OF  0.75  HOURS  OF  CARE PER RESIDENT PROVIDED BY A REGISTERED
 NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN  APPROPRIATE  LEVEL
 OF  REGISTERED  NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
 TO MEET RESIDENT NEEDS; AND
   (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
 SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PATIENT
 RATIO: ONE NURSE TO FIVE PATIENTS.
   5.    ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
 AN EMPLOYEE PURSUANT TO AN ADOPTED WORK  ASSIGNMENT  POLICY  UNDER  THIS
 SECTION  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
 COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
 MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING

 A. 108                             10
 
 REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
 LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
 RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
 DAMAGES.  THE  COURT  IN  SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT
 AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES  AND
 COSTS  OF  ACTION  TO  BE  PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO
 INSTITUTE A PRIVATE ACTION PURSUANT TO THIS  SUBDIVISION  SHALL  NOT  BE
 LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
 FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL-
 ITY  IS  REQUIRED  TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY-
 EIGHT HUNDRED FIVE-T OF THIS CHAPTER.  INFORMATION UNDER THIS  PARAGRAPH
 SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN
 A  MANNER  WHICH  IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES
 AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
   (B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A  SUMMARY  OF  THIS
 SECTION,  PROVIDED  BY  THE  DEPARTMENT,  IN  PROXIMITY  TO EACH POSTING
 REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
   § 7. If any provision of this act, or any application of any provision
 of this act, is held to be invalid, or ruled by any  federal  agency  to
 violate  or  be  inconsistent  with  any applicable federal law or regu-
 lation, that shall not affect the validity or effectiveness of any other
 provision of this act, or of any other application of any  provision  of
 this act.
   § 8. This act shall take effect on the one hundred eightieth day after
 it  shall have become a law. Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation of this act on its effective date are authorized to be  made  and
 completed on or before such effective date.

 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  108--A
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by  M.  of  A.  GUNTHER, GOTTFRIED, PEOPLES-STOKES, BARRETT,
   L. ROSENTHAL, BRONSON, COLTON, BENEDETTO,  CRUZ,  MAGNARELLI,  WEPRIN,
   J. RIVERA,  FALL, AUBRY, OTIS, STECK, SANTABARBARA, ZEBROWSKI, ABINAN-
   TI, BARRON, SEAWRIGHT, WALKER, BICHOTTE HERMELYN, RICHARDSON, HYNDMAN,
   PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI,  O'DONNELL,  DILAN,
   DAVILA,  HUNTER,  WILLIAMS,  CARROLL,  WOERNER,  PHEFFER AMATO, JONES,
   VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH,
   JACOBSON,  McMAHON,  ABBATE,  CAHILL,  FERNANDEZ,  FRONTUS,   EPSTEIN,
   BUTTENSCHON,  RAMOS,  DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART,
   McDONALD, ENGLEBRIGHT, GALLAGHER, BURKE,  KELLES,  CYMBROWITZ,  CLARK,
   MEEKS, BRABENEC, SMITH, MONTESANO, SALKA, SCHMITT, MORINELLO, B. MILL-
   ER,  ASHBY,  M. MILLER, DeSTEFANO, FORREST, GONZALEZ-ROJAS, BURDICK --
   Multi-Sponsored by -- M. of A. BARNWELL, COOK,  CUSICK,  FAHY,  GALEF,
   GLICK,  LUPARDO,  McDONOUGH,  MIKULIN,  PAULIN,  PERRY,  PRETLOW,  RA,
   D. ROSENTHAL, SIMON, SOLAGES, THIELE -- read once and referred to  the
   Committee  on  Health  --  committee discharged, bill amended, ordered
   reprinted as amended and recommitted to said committee
 
 AN ACT to amend the public health law, in relation to enacting the "safe
   staffing for quality care act"
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "safe staffing for quality care act".
   § 2. Paragraphs (a) and (b) of subdivision 2 of section  2805  of  the
 public  health  law, paragraph (a) as amended by chapter 923 of the laws
 of 1973 and paragraph (b) as added by chapter 795 of the laws  of  1965,
 are amended to read as follows:
   (a)  Application  for an operating certificate for a hospital shall be
 made upon forms prescribed by  the  department.  The  application  shall
 [contain]  INCLUDE the name of the hospital, the kind or kinds of hospi-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets

                       [ ] is old law to be omitted.
                                                            LBD02466-07-1

 A. 108--A                           2
 
 tal service to be provided, the location and physical description of the
 institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN  SECTION  TWENTY-
 EIGHT HUNDRED TWENTY-NINE OF THIS ARTICLE, and such other information as
 the department may require.
   (b)  An  operating  certificate  shall not be issued by the department
 unless it finds that  the  premises,  equipment,  personnel,  DOCUMENTED
 STAFFING  PLAN, rules and by-laws, standards of medical care, and hospi-
 tal service are fit and adequate and that the hospital will be  operated
 in  the manner required by this article and rules and regulations there-
 under.
   § 3. The public health law is amended  by  adding  nine  new  sections
 2828,  2829,  2830,  2831,  2832,  2833,  2834, 2835 and 2836 to read as
 follows:
   § 2828. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL  OF
 THE FOLLOWING:
   1.  HEALTH  CARE  SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY
 DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
   2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE  STAFF-
 ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
   3.  TO  ENSURE  THE  ADEQUATE  PROTECTION  OF  PATIENTS IN HEALTH CARE
 SETTINGS, IT IS ESSENTIAL THAT QUALIFIED  REGISTERED  NURSES  AND  OTHER
 LICENSED  NURSES  BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE NEEDS OF
 PATIENTS; AND
   4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING  SHOULD
 BE  BASED  ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY OF CONDITION,
 SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
   § 2829. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS  AND  PHRASES,
 AS  USED  IN  THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE
 CONTEXT OTHERWISE PLAINLY REQUIRES:
   1. "HOSPITAL" SHALL MEAN A GENERAL HOSPITAL  UNDER  THIS  ARTICLE  AND
 SHALL  ALSO  INCLUDE  ANY  FACILITY  THAT  PROVIDES HEALTH CARE SERVICES
 PURSUANT TO THE MENTAL HYGIENE LAW, ARTICLE NINETEEN-G OF THE  EXECUTIVE
 LAW OR THE CORRECTION LAW IF SUCH FACILITY IS OPERATED BY THE STATE OR A
 POLITICAL SUBDIVISION OF THE STATE OR A PUBLIC AUTHORITY OR PUBLIC BENE-
 FIT CORPORATION.
   2.  "ACUITY  SYSTEM"  SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT
 WHICH (A) PREDICTS NURSING CARE  REQUIREMENTS  FOR  INDIVIDUAL  PATIENTS
 BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
 TECHNOLOGY,   INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND  THE
 COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT  AND
 EVALUATE  THE  PATIENT'S  NURSING  CARE  PLAN; (B) DETAILS THE AMOUNT OF
 NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND  IN  SKILL
 MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
 A  NURSING  DEPARTMENT  OR UNIT; AND (C) IS STATED IN TERMS THAT READILY
 CAN BE USED AND UNDERSTOOD BY  DIRECT-CARE  NURSES.  THE  ACUITY  SYSTEM
 SHALL  TAKE  INTO  CONSIDERATION  THE PATIENT CARE SERVICES PROVIDED NOT
 ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO  BY  LICENSED  PRACTICAL
 NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
   3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
 STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
 NURSING  CARE  REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY
 SYSTEM.
   4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN  ANY
 NURSE  WHO  HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL
 REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.

 A. 108--A                           3
 
   5. "DOCUMENTED STAFFING PLAN"  SHALL  MEAN  A  DETAILED  WRITTEN  PLAN
 SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
 ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN A HOSPITAL FOR A GIVEN
 YEAR,  BASED  ON  REASONABLE PROJECTIONS DERIVED FROM THE PATIENT CENSUS
 AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT DURING THE PRIOR
 YEAR,  THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE NATURE OF SERVICES
 PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR UNIT SIZE OR FUNC-
 TION DURING THE CURRENT YEAR.
   6. "NURSE" SHALL MEAN A  REGISTERED  PROFESSIONAL  NURSE  OR  LICENSED
 PRACTICAL  NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF
 THE EDUCATION LAW.
   7. "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE  DEFINITION
 OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
 THE  EDUCATION  LAW, OR OTHERWISE ENCOMPASSED WITH THE RECOGNIZED STAND-
 ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
 NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
   8. "SAFE STAFFING REQUIREMENTS" SHALL  MEAN  THE  PROVISIONS  OF  THIS
 SECTION  AND  SECTIONS  TWENTY-EIGHT  HUNDRED  TWENTY-NINE, TWENTY-EIGHT
 HUNDRED THIRTY, TWENTY-EIGHT HUNDRED  THIRTY-ONE,  TWENTY-EIGHT  HUNDRED
 THIRTY-TWO,  TWENTY-EIGHT  HUNDRED  THIRTY-THREE,  TWENTY-EIGHT  HUNDRED
 THIRTY-FOUR, TWENTY-EIGHT HUNDRED THIRTY-FIVE AND  TWENTY-EIGHT  HUNDRED
 THIRTY-SIX  OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU-
 ANT THERETO.
   9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY  AND
 EXPERIENCE AMONG DIRECT-CARE NURSES.
   10.  "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT
 RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
   11. "UNIT" SHALL MEAN A PATIENT CARE  COMPONENT,  AS  DEFINED  BY  THE
 DEPARTMENT, WITHIN A HOSPITAL.
   12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
 A  NURSE  OR  OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE
 EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY  IS  TO  CARRY
 OUT  PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE
 IN THE DELIVERY OF PATIENT CARE.
   § 2830. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE  COMMISSIONER
 SHALL:
   1.  APPOINT A HOSPITAL COUNCIL CONSISTING OF THIRTEEN MEMBERS. NO LESS
 THAN SEVEN MEMBERS SHALL BE REGISTERED  PROFESSIONAL  NURSES,  THREE  OF
 WHOM  SHALL  BE  DIRECT  CARE  REGISTERED NURSES, THREE OF WHOM SHALL BE
 NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINISTRATOR.  NO  LESS
 THAN  TWO  MEMBERS  OF  THE HOSPITAL COUNCIL SHALL BE REPRESENTATIVES OF
 RECOGNIZED OR CERTIFIED  COLLECTIVE  BARGAINING  AGENTS  OF  NON-NURSING
 DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO REPRESENTATIVES OF HOSPI-
 TALS,  ONE REPRESENTATIVE OF A NURSING PROFESSIONAL ASSOCIATION, AND ONE
 REPRESENTATIVE OF A RECOGNIZED OR CERTIFIED BARGAINING AGENT OF  NURSES.
 THE HOSPITAL COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF
 REGULATIONS, INCLUDING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING
 REQUIREMENTS  AND  NON-NURSING  DIRECT-CARE STAFF TO PATIENT RATIOS THAT
 ARE NOT SPECIFIED IN  THIS  ARTICLE;  THE  EFFICACY  OF  ACUITY  SYSTEMS
 SUBMITTED  FOR  APPROVAL  BY  THE  COMMISSIONER;  THE  DEVELOPMENT OF AN
 ASSESSMENT TOOL USED TO EVALUATE THE EFFICACY  OF  ACUITY  SYSTEMS;  AND
 REVIEW  AND  MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO
 THE GRANTING OF AN OPERATING CERTIFICATE BY THE DEPARTMENT.
   2. PROMULGATE, AFTER CONSULTATION WITH THE HOSPITAL COUNCIL, THE RULES
 AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES  AND  PROVISIONS  OF
 THE  SAFE  STAFFING  REQUIREMENTS, INCLUDING REGULATIONS DEFINING TERMS,

 A. 108--A                           4
 
 SETTING FORTH DIRECT-CARE NURSE TO PATIENT RATIOS,  SETTING  FORTH  NON-
 NURSING  DIRECT-CARE STAFF TO PATIENT RATIOS AND PRESCRIBING THE PROCESS
 FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS; AND
   3.  ASSURE  THAT  THE  PROVISIONS  OF  SAFE  STAFFING REQUIREMENTS ARE
 ENFORCED, INCLUDING THE ISSUANCE  OF  REGULATIONS  WHICH  AT  A  MINIMUM
 PROVIDE  FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE
 TO COMPLY WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS  TO  INFORMATION
 REGARDING  REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
 PURSUANT TO SUCH REQUIREMENTS.
   § 2831. STAFFING REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH HOSPITAL
 SHALL ENSURE THAT IT IS STAFFED IN A MANNER  THAT  PROVIDES  SUFFICIENT,
 APPROPRIATELY  QUALIFIED  DIRECT-CARE  NURSES IN EACH DEPARTMENT OR UNIT
 WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED CARE  NEEDS  OF
 THE  PATIENTS  THEREIN.  AT A MINIMUM, EACH SUCH FACILITY SHALL MEET THE
 REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS SECTION.
   2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING  CERTIF-
 ICATE  TO  ANY  HOSPITAL  UNLESS  SUCH  FACILITY ANNUALLY SUBMITS TO THE
 DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN  CERTIFICATION  THAT
 THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND APPRO-
 PRIATE  DELIVERY  OF  HEALTH  CARE  SERVICES TO PATIENTS FOR THE ENSUING
 YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
   (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN  SUBDIVISION  THREE  OF
 THIS SECTION;
   (B)  BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER
 LAWS, RULES OR REGULATIONS;
   (C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR  ADDRESSING  FLUCTUATIONS
 IN  ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING
 INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
   (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY  SUCH  AS  DISCHARGES,
 TRANSFERS  AND  ADMISSIONS,  STAFF  BREAKS,  MEALS, ROUTINE AND EXPECTED
 ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND  SUPPORT  TASKS  THAT  ARE
 EXPECTED  TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING
 CARE;
   (E) INCLUDE A PLAN TO MEET  NECESSARY  STAFFING  LEVELS  AND  SERVICES
 PROVIDED  BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS
 PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
 STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT  NURSING  CARE  FUNC-
 TIONS  REQUIRED  BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF
 PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE  ARE  TO  BE
 PERFORMED BY OTHER PERSONNEL;
   (F)  IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
 ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
   (G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE  PRIOR  YEAR'S
 STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
   (H)  IDENTIFY  EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
 TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR  EACH
 SUCH CLASSIFICATION; AND
   (I)  BE  DEVELOPED  IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE
 NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE  REPRES-
 ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
 REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
 SUPPORTIVE AND ASSISTIVE STAFF.
   3.  MINIMUM  STAFFING  REQUIREMENTS.  (A) THE DOCUMENTED STAFFING PLAN
 SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PA-
 TIENT RATIOS:

 A. 108--A                           5
 
   (I)  ONE  NURSE  TO  ONE  PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
 UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND  OR  THIRD  STAGE  OF
 LABOR;
   (II)  ONE  NURSE  TO TWO PATIENTS:   MATERNAL/CHILD CARE UNITS FOR THE
 FIRST STAGE OF LABOR, AND ALL CRITICAL CARE  AREAS  INCLUDING  EMERGENCY
 CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
   (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
 TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
 DIATE CARE NURSERY UNITS;
   (IV) ONE NURSE TO THREE PATIENTS:    POSTPARTUM  MOTHER/BABY  COUPLETS
 (MAXIMUM SIX PATIENTS PER NURSE);
   (V)  ONE  NURSE  TO  FOUR  PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
 POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
 ATRIC UNITS;
   (VI) ONE NURSE TO FIVE PATIENTS:  REHABILITATION  UNITS  AND  SUBACUTE
 PATIENTS; AND
   (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
   FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
 TO,  PSYCHIATRIC  UNITS,  AND  HOSPITALS OPERATED PURSUANT TO THE MENTAL
 HYGIENE LAW OR THE CORRECTION LAW, THE  DEPARTMENT  SHALL  ESTABLISH  BY
 REGULATION THE APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT RATIO.
   (B)  THE  NURSE-TO-PATIENT  RATIOS  SET FORTH IN PARAGRAPH (A) OF THIS
 SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF  PATIENTS  THAT  MAY  BE
 ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
   (C)  THERE  SHALL  BE  NO  AVERAGING OF THE NUMBER OF PATIENTS AND THE
 TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE  SHIFT  NOR  OVER  ANY
 PERIOD OF TIME.
   (D) THE COMMISSIONER, IN CONSULTATION WITH THE HOSPITAL COUNCIL, SHALL
 ESTABLISH REGULATIONS PROVIDING FOR THE MAINTENANCE OF MINIMUM NURSE-TO-
 PATIENT  RATIOS,  AS SET FORTH IN THIS SECTION, INCLUDING DURING ROUTINE
 OR EXPECTED ABSENCES FROM THE UNIT, SUCH AS MEALS OR BREAKS.
   4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
 TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY  PATIENTS
 ASSIGNED  TO  THE  LICENSED  PRACTICAL  NURSE  SHALL ALSO BE INCLUDED IN
 CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO  ANY  REGISTERED  PROFES-
 SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
 TICE  TO  SUPERVISE  OR  OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE
 LICENSED PRACTICAL NURSE.
   5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
 ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE  HUNDRED  TWO  OF  THE
 EDUCATION  LAW  OR  ACCEPTED  STANDARDS OF PRACTICE TO BE PERFORMED BY A
 REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED  PRACTI-
 CAL  NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC-
 TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
 ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A  LICENSED  PRACTICAL
 NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
   6.  ADJUSTMENTS  BY  FACILITY.    THE MINIMUM STAFFING REQUIREMENT AND
 NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL  BE  ADJUSTED  BY
 THE HOSPITAL AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE
 NURSES.    ADDITIONAL  STAFF  SHALL  BE  ASSIGNED IN ACCORDANCE WITH THE
 APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMINING  NURS-
 ING  CARE  REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS, THE NEED
 FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY,  THE  COMPLEXITY  OF  CLINICAL
 JUDGMENT  NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT CARE PLAN
 AND THE ABILITY FOR  SELF-CARE,  AND  THE  LICENSURE  OF  THE  PERSONNEL
 REQUIRED FOR CARE.

 A. 108--A                           6
 
   7.  COMMISSIONER  REGULATIONS.    THE  COMMISSIONER  MAY BY REGULATION
 REQUIRE A DOCUMENTED  STAFFING  PLAN  TO  HAVE  HIGHER  NURSE-TO-PATIENT
 RATIOS THAN THOSE SET FORTH IN THIS SECTION.
   8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
 TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
 RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
   §  2832.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
 HOSPITAL SHALL AT ALL TIMES STAFF  IN  ACCORDANCE  WITH  ITS  DOCUMENTED
 STAFFING  PLAN  AND  THE STAFFING STANDARDS SET FORTH IN SECTION TWENTY-
 EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE; PROVIDED, HOWEVER, THAT  NOTH-
 ING  IN  THIS SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY FROM
 IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT  STAFFING  LEVELS,  NOR
 SHALL  THE  REQUIREMENTS  SET FORTH IN SUCH SECTION TWENTY-EIGHT HUNDRED
 THIRTY-ONE OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY  HIGHER
 REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
   2.  FOR  PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS
 STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE  OF  THIS
 ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
 RATIO  COUNT  IN  A  NURSING  UNIT  OR A CLINICAL AREA WITHIN A HOSPITAL
 UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE  PURSUANT  TO  ARTICLE  ONE
 HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR ORIENTATION
 IN  THAT  CLINICAL  AREA SUFFICIENT TO PROVIDE COMPETENT NURSING CARE TO
 THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMONSTRATED CURRENT
 COMPETENCE IN PROVIDING CARE IN THAT UNIT OR  CLINICAL  AREA.  HOSPITALS
 THAT UTILIZE TEMPORARY NURSING AGENCIES SHALL HAVE AND ADHERE TO A WRIT-
 TEN  PROCEDURE  TO  ORIENT  AND  EVALUATE PERSONNEL FROM SUCH SOURCES TO
 ENSURE ADEQUATE ORIENTATION AND COMPETENCY PRIOR  TO  INCLUSION  IN  THE
 NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN EMERGENCY STAFFING SITUATION
 IN  WHICH  INSUFFICIENT STAFFING MAY LEAD TO UNSAFE PATIENT CARE, NURSES
 MAY BE TEMPORARILY ASSIGNED  TO  A  DIFFERENT  UNIT  OR  CLINICAL  AREA,
 PROVIDED  THAT  SUCH  NURSES  SHALL  BE ASSIGNED PATIENTS APPROPRIATE TO
 THEIR SKILL  AND  COMPETENCY  LEVEL.  THE  HOSPITAL  SHALL  ESTABLISH  A
 CONSISTENT PLAN FOR ADDRESSING EMERGENCY STAFFING SITUATIONS AND MONITOR
 OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL DISASTERS, DECLARED EMER-
 GENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS NOT  REASONABLY  ANTIC-
 IPATED AND PLANNED FOR AND NOT REGULARLY OCCURRING WITHIN THE HOSPITAL.
   3. EACH HOSPITAL SHALL MAINTAIN ACCURATE DAILY RECORDS SHOWING:
   (A)  THE  NUMBER  OF  PATIENTS  ADMITTED, RELEASED AND PRESENT IN EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL;
   (B) THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH  NURS-
 ING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL; AND
   (C)  THE  IDENTITY  AND  DUTY  HOURS OF EACH DIRECT-CARE NURSE IN EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL.
   4. EACH HOSPITAL SHALL MAINTAIN DAILY STATISTICS, BY  NURSING  DEPART-
 MENT  AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJURY AND
 MEDICAL ERRORS.
   5. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
 MAINTAINED FOR A PERIOD OF SEVEN YEARS.
   6.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
 MADE AVAILABLE UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO  THE  PUBLIC;
 PROVIDED,  HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL COMPLY
 WITH THE APPLICABLE PATIENT PRIVACY LAWS,  RULES  AND  REGULATIONS,  AND
 THAT  IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE IDENTITY
 AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.
   § 2833. WORK ASSIGNMENT POLICY.  1.  GENERAL.    EACH  HOSPITAL  SHALL
 ADOPT,  DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN WORK

 A. 108--A                           7
 
 ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO  AND
 THREE  OF  THIS  SECTION,  DETAILING  THE  CIRCUMSTANCES  UNDER  WHICH A
 DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
   2.  MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
 PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
   (A) FOR WHICH THE NURSE IS NOT  PREPARED  BY  EDUCATION,  TRAINING  OR
 EXPERIENCE  TO  SAFELY  FULFILL  THE  ASSIGNMENT WITHOUT COMPROMISING OR
 JEOPARDIZING PATIENT SAFETY, THE NURSE'S  ABILITY  TO  MEET  FORESEEABLE
 PATIENT NEEDS OR THE NURSE'S LICENSE; OR
   (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
   3.  MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL
 CONTAIN PROCEDURES FOR THE FOLLOWING:
   (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
 REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING  RELIEVED
 OF AN ASSIGNMENT OR CONTINUED DUTY;
   (B)  WHERE  FEASIBLE,  AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE
 SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
 ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT,  OR
 TO  DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN-
 UED DUTY;
   (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT  TO  REFUSE
 THE  ASSIGNMENT  OR  CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES
 THE REQUEST TO BE RELIEVED IF:
   (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A  REMEDY  OR
 THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
   (II)  THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY
 WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
   (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT  THE  ASSIGNMENT  MEETS
 CONDITIONS JUSTIFYING REFUSAL; AND
   (D)  RECOGNITION  THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A
 WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
 BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR  INCOMPETENT  ACTION,
 PATIENT  ABANDONMENT,  OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO
 NURSING.
   § 2834. PUBLIC DISCLOSURE OF  STAFFING  REQUIREMENTS.  EVERY  HOSPITAL
 SHALL:
   1.  POST  IN  A  CONSPICUOUS  PLACE  READILY ACCESSIBLE TO THE GENERAL
 PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH  A  SUMMARY  OF
 THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT HOSPITAL TOGETHER WITH
 INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE HOSPITAL'S STAFF-
 ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
   2.  UPON  REQUEST,  MAKE  COPIES OF THE DOCUMENTED STAFFING PLAN FILED
 WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
   3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF  WITHIN  A
 DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
   (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
   (B)  DOCUMENTATION  OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE
 PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED  ACUITY  SYSTEM,
 AND
   (C)  DOCUMENTATION  OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT
 DURING THE SHIFT.
   § 2835. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL  NOT  DELE-
 GATE  ITS  RESPONSIBILITIES  TO  ENFORCE  THE SAFE STAFFING REQUIREMENTS
 PROMULGATED PURSUANT TO THIS ARTICLE.
   § 2836. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
 HUNDRED THIRTY-THREE OF THIS ARTICLE.   ANY HOSPITAL THAT  VIOLATES  THE

 A. 108--A                           8
 
 RIGHTS  OF  AN  EMPLOYEE  PURSUANT  TO AN ADOPTED WORK ASSIGNMENT POLICY
 UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-THREE OF THIS ARTICLE  MAY  BE
 HELD  LIABLE  TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT OF COMPE-
 TENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRI-
 ATE  TO  EFFECTUATE  THE  PURPOSES  OF  THE  SAFE STAFFING REQUIREMENTS,
 INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION,  LOST  WAGES  AND
 BENEFITS,  AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM THE
 VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT
 IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A  PREVAIL-
 ING  PLAINTIFF,  AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO
 BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT  TO  INSTITUTE  A  PRIVATE
 ACTION  PURSUANT  TO  THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER
 RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   § 4. Section 2801-a of the public health law is amended  by  adding  a
 new subdivision 3-b to read as follows:
   3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
 TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
 PLANNING  COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL
 RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE  RELATIONS,
 WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
 TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
 COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
 THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
   §  5. Section 2805 of the public health law is amended by adding a new
 subdivision 3 to read as follows:
   3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN  OPERATING  CERTIFICATE
 TO  AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD-
 ANCE WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY  PAST
 VIOLATIONS  OF  STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING
 TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE  BARGAINING
 OR  ANY  OTHER  LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE
 PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL  WEIGHT
 TO  VIOLATIONS  OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF
 AND SUPPORTIVE STAFF RATIOS.
   § 6. The public health law is amended by adding a new  section  2895-b
 to read as follows:
   §  2895-B.  NURSING  HOME  STAFFING LEVELS. 1. DEFINITIONS. AS USED IN
 THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
   (A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED  IN  THE  NURSING
 HOME  NURSE  AIDE  REGISTRY  PURSUANT  TO  SECTION  TWENTY-EIGHT HUNDRED
 THREE-J OF THIS CHAPTER.
   (B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL  IN
 A  PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN
 A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
 THAT TIME.
   2. COMMISSIONER AND NURSING  HOME  COUNCIL;  POWERS  AND  DUTIES.  THE
 COMMISSIONER  SHALL:  APPOINT A NURSING HOME COUNCIL CONSISTING OF THIR-
 TEEN MEMBERS. NO LESS THAN TWO MEMBERS SHALL BE DIRECT    CARE  LICENSED
 PRACTICAL  NURSES,  NO LESS THAN TWO MEMBERS SHALL BE DIRECT CARE CERTI-
 FIED NURSE ASSISTANTS AND NO LESS THAN   ONE MEMBER SHALL  BE  A  DIRECT
 CARE  REGISTERED  PROFESSIONAL NURSE.  THE COUNCIL SHALL ALSO INCLUDE NO
 LESS THAN ONE REPRESENTATIVE EACH OF RECOGNIZED OR CERTIFIED  COLLECTIVE
 BARGAINING  AGENTS  OF REGISTERED NURSES, OF NON-REGISTERED NURSE DIRECT
 CARE STAFF AND A REPRESENTATIVE OF  NURSING  PROFESSIONAL  ASSOCIATIONS.
 THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN TWO REPRESENTATIVES OF NURS-
 ING  HOME  OPERATORS, TWO REPRESENTATIVES OF NURSING HOME NURSE ADMINIS-

 A. 108--A                           9
 
 TRATORS AND ONE REPRESENTATIVE OF CONSUMERS. THE  NURSING  HOME  COUNCIL
 SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS RELATING
 TO THE STAFFING STANDARDS UNDER THIS SECTION; AND MAY FROM TIME TO TIME,
 REPORT TO THE GOVERNOR, THE LEGISLATURE, THE PUBLIC AND THE COMMISSIONER
 ANY RECOMMENDATIONS REGARDING STAFFING LEVELS IN NURSING HOMES.
   3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
 COUNCIL,  SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR NURSING
 HOME MINIMUM STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF SERVICE AND
 CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICA-
 BLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF  EACH  RESIDENT  OF
 THE  FACILITY.  THE  COMMISSIONER  SHALL ALSO REQUIRE BY REGULATION THAT
 EVERY NURSING HOME MAINTAIN RECORDS ON ITS STAFFING  LEVELS,  REPORT  ON
 SUCH  RECORDS  TO  THE  DEPARTMENT,  AND MAKE SUCH RECORDS AVAILABLE FOR
 INSPECTION BY THE DEPARTMENT.
   (B) EVERY NURSING HOME SHALL:
   (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
   (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
 SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
 TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
 PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
   (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
 UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
 SUBDIVISION FOUR OF THIS SECTION.
   (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
 SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
 THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
 PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
 ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
   4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
 OF THIS SECTION, EVERY NURSING HOME  SHALL  MAINTAIN  A  STAFFING  RATIO
 EQUAL TO AT LEAST THE FOLLOWING:
   (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
   (B)  1.3  HOURS  OF  CARE PER RESIDENT PER DAY BY A LICENSED PRACTICAL
 NURSE OR A REGISTERED NURSE;
   (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
 MINIMUM OF 0.75 HOURS OF CARE PER  RESIDENT  PROVIDED  BY  A  REGISTERED
 NURSE  SHALL  BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN APPROPRIATE LEVEL
 OF REGISTERED NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS  A  WEEK,
 TO MEET RESIDENT NEEDS; AND
   (D)  NURSING HOMES THAT CARE FOR SUBACUTE PATIENTS SHALL MAINTAIN AT A
 MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PATIENT RATIO: ONE NURSE  TO
 FIVE PATIENTS.
   5.   ANY NURSING HOME THAT VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT
 TO AN ADOPTED WORK ASSIGNMENT POLICY UNDER  THIS  SECTION  MAY  BE  HELD
 LIABLE  TO  SUCH  EMPLOYEE  IN AN ACTION BROUGHT IN A COURT OF COMPETENT
 JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRIATE TO
 EFFECTUATE THE PURPOSES OF THE SAFE STAFFING REQUIREMENTS, INCLUDING BUT
 NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES  AND  BENEFITS,  AND
 COMPENSATORY  AND  CONSEQUENTIAL  DAMAGES  RESULTING  FROM THE VIOLATION
 TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT  IN  SUCH
 ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A PREVAILING PLAIN-
 TIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO BE PAID BY
 THE  DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A PRIVATE ACTION PURSU-
 ANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER RIGHT  GRANTED
 BY THE SAFE STAFFING REQUIREMENTS.

 A. 108--A                          10
 
   6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A NURSING HOME SHALL POST
 INFORMATION  REGARDING  NURSE  STAFFING THAT THE FACILITY IS REQUIRED TO
 MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY-EIGHT  HUNDRED  FIVE-T
 OF THIS CHAPTER.  INFORMATION UNDER THIS PARAGRAPH SHALL BE DISPLAYED IN
 A  FORM  APPROVED  BY  THE DEPARTMENT AND BE POSTED IN A MANNER WHICH IS
 VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES AND  THE  STAFF,  AS
 REQUIRED BY THE COMMISSIONER.
   (B)  A  NURSING HOME SHALL POST A SUMMARY OF THIS SECTION, PROVIDED BY
 THE DEPARTMENT, IN PROXIMITY TO EACH POSTING REQUIRED BY  PARAGRAPH  (A)
 OF THIS SUBDIVISION.
   § 7. If any provision of this act, or any application of any provision
 of  this  act,  is held to be invalid, or ruled by any federal agency to
 violate or be inconsistent with any  applicable  federal  law  or  regu-
 lation, that shall not affect the validity or effectiveness of any other
 provision  of  this act, or of any other application of any provision of
 this act.
   § 8. This act shall take effect on the one hundred eightieth day after
 it shall have become a law. Effective immediately, the addition,  amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation  of  this act on its effective date are authorized to be made and
 completed on or before such effective date.