NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A10137
SPONSOR: Rules (Glick) TITLE OF BILL: An act to amend the education law and the public
health law, in relation to authorizing certain advanced home health
aides to perform certain advanced tasks; and providing for the repeal of
such provisions upon expiration thereof
PURPOSE OR GENERAL IDEA OF BILL: This bill would provide an exemption
to the Nurse Practice Act to establish a program for "advanced home
health aides" who would be authorized to perform advanced tasks, includ-
ing the administration of medications, under the direct supervision of a
registered professional nurse.
SUMMARY OF SPECIFIC PROVISIONS:
Section 1 of the bill would add an exemption to the Nurse Practice Act
to allow advanced home health aides, in accordance with regulations
developed by the Commissioner of Education in consultation with the
Commissioner of Health, to perform advanced tasks under the direct
supervision of a registered professional nurse. Such regulations shall
take into account the recommendations of a workgroup of stakeholders
convened by the Commissioner of Health, in consultation with the Commis-
sioner of Education.
Section 2 of the bill would require the Commissioner of Health to notify
the Commissioner of Education in any instance in which a registered
professional nurse engages in improper behavior while supervising an
advanced home health.
Section 3 of the bill would add a definition of "advanced home health
aide" to the Public Health Law and allow the Commissioner of Health to
promulgate regulations regarding such aides.
Section 4 of the bill would require the Department of Health to indicate
on the home care services worker registry when a home health aide has
satisfied all applicable training and recertification requirements and
has passed the applicable competency examinations necessary to perform
advanced tasks. Any limitation or revocation of the advanced home health
aide's authorization would also be indicated on the registry.
Section 5 of the bill would direct the Commissioner of Health, in
consultation with the Commissioner of Education, to convene a workgroup
of stakeholders to provide guidance on the advanced tasks which may be
performed by advanced home health aides. A report would be issued to the
Governor and the Legislature setting forth the recommendations of the
workgroup.
Section 6 of the bill would direct the Commissioner of Health, in
consultation with the Commissioner of Education, to issue a report on or
before January 1, 2019 on the implementation of advanced home health
aides in the State.
Section 7 is the effective date and expiration date of the bill.
JUSTIFICATION: This legislation will help individuals with disabili-
ties to transition from institutional settings to home environments
since such individuals will have access to more affordable and addi-
tional home care options. This legislation will also help the State draw
down federal funds under the Community First Choice Option under the
Affordable Care Act.
PRIOR LEGISLATIVE HISTORY: New Bill.
FISCAL IMPLICATIONS: Unknown at this time.
EFFECTIVE DATE: Immediately.
STATE OF NEW YORK
________________________________________________________________________
10137
IN ASSEMBLY
June 16, 2014
___________
Introduced by COMMITTEE ON RULES -- (at request of M. of A. Glick, Wein-
stein, Morelle, Gunther, Weprin, Gottfried) -- read once and referred
to the Committee on Higher Education
AN ACT to amend the education law and the public health law, in relation
to authorizing certain advanced home health aides to perform certain
advanced tasks; and providing for the repeal of such provisions upon
expiration thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Subparagraph (v) of paragraph a of subdivision 1 of section
2 6908 of the education law is renumbered subparagraph (vi) and a new
3 subparagraph (v) is added to read as follows:
4 (v) advanced tasks provided by an advanced home health aide in accord-
5 ance with regulations developed by the commissioner, in consultation
6 with the commissioner of health which, at a minimum, shall: (1) specify
7 the advanced tasks that may be performed by advanced home health aides
8 pursuant to this subparagraph, which shall include the administration of
9 medications which are routine and prefilled or otherwise packaged in a
10 manner that promotes relative ease of administration, provided that
11 administration of medications by injection other than insulin for
12 diabetes care, sterile procedures, and central line maintenance shall be
13 prohibited, and provided further that a system shall be established that
14 addresses drug diversion; (2) specify that participation in this program
15 shall be voluntary and such advanced tasks provided by an advanced home
16 health aide shall be at the option of the individual; (3) provide that
17 advanced tasks performed by advanced home health aides may be performed
18 only under the direct supervision of a registered professional nurse
19 licensed in New York state and employed by a home care services agency
20 licensed or certified pursuant to article thirty-six or hospice program
21 certified pursuant to article forty of the public health law, where such
22 nursing supervision (A) includes training and periodic assessment of the
23 performance of advanced tasks, (B) shall be determined by the registered
24 professional nurse responsible for supervising such advanced tasks based
25 upon the complexity of such advanced tasks, the skill and experience of
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD15582-03-4
A. 10137 2
1 the advanced home health aide, and the health status of the individual
2 for whom such advanced tasks are being performed, and (C) includes a
3 comprehensive initial and thereafter regular and ongoing assessment of
4 the individual's needs; provided that the registered professional nurse
5 responsible for supervising such advanced tasks shall visit individuals
6 receiving acute services no less than once per month and individuals
7 receiving maintenance care no less than once every six months and
8 provided further that a registered professional nurse shall be available
9 by telephone to the advanced home health aide twenty-four hours a day,
10 seven days a week; the commissioner of health shall, in consultation
11 with the commissioner, determine appropriate staffing ratios to ensure
12 adequate nursing supervision that shall not exceed one full time equiv-
13 alent of a registered professional nurse to fifty individuals receiving
14 services; (4) establish a process by which a registered professional
15 nurse may delegate advanced tasks to an advanced home health aide
16 provided that such process shall include, but not be limited to (A)
17 allowing delegation of advanced tasks to an advanced home health aide
18 only where such advanced home health aide has demonstrated to the satis-
19 faction of the supervising registered professional nurse competency in
20 every advanced task that such advanced home health aide is authorized to
21 perform, (B) authorizing the supervising registered professional nurse
22 to revoke any delegated advanced task from an advanced home health aide
23 for any reason, and (C) authorizing multiple registered professional
24 nurses to jointly agree to delegate advanced tasks to an advanced home
25 health aide, provided further that only one registered professional
26 nurse shall be required to determine the advanced home health aide has
27 demonstrated competency in the advanced task to be performed; (5)
28 provide that advanced tasks may be performed only in accordance with and
29 pursuant to an authorized practitioner's ordered care; (6) provide that
30 only a home health aide who has at least one year of experience as a
31 certified home health aide, has completed the requisite training and
32 demonstrated competencies of an advanced home health aide as determined
33 by the commissioner of health, has successfully completed competency
34 examinations satisfactory to and developed or approved by the commis-
35 sioner of health and meets other appropriate qualifications as deter-
36 mined by the commissioner of health may perform advanced tasks as an
37 advanced home health aide; (7) provide that only an individual who is
38 listed in the home care services registry maintained by the department
39 of health pursuant to subdivision nine of section thirty-six hundred
40 thirteen of the public health law as having satisfied all applicable
41 training requirements and having passed the applicable competency exam-
42 inations and who meets other requirements as set forth in regulations
43 issued by the commissioner of health pursuant to subdivision seventeen
44 of section thirty-six hundred two of the public health law may perform
45 advanced tasks pursuant to this subparagraph and may hold himself or
46 herself out as an advanced home health aide; (8) establish minimum stan-
47 dards of training for the performance of advanced tasks by advanced home
48 health aides, including (A) didactic training, (B) clinical training,
49 and (C) a supervised clinical practicum with standards set forth by the
50 commissioner of health; (9) provide that advanced home health aides
51 shall receive case-specific training on the advanced tasks to be
52 assigned by the supervising nurse, provided that additional training
53 shall take place whenever additional advanced tasks are assigned; (10)
54 prohibit an advanced home health aide from holding himself or herself
55 out, or accepting employment as, a person licensed to practice nursing
56 under the provisions of this article; (11) provide that an advanced home
A. 10137 3
1 health aide is not required nor permitted to assess the medication or
2 medical needs of an individual; (12) provide that an advanced home
3 health aide shall not be authorized to perform any advanced tasks or
4 activities pursuant to this subparagraph that are outside the scope of
5 practice of a licensed practical nurse or any advanced tasks that have
6 not been appropriately delegated by the supervising registered profes-
7 sional nurse; (13) provide that an advanced home health aide shall docu-
8 ment medication administration to each individual through the use of a
9 medication administration record; (14) provide that the supervising
10 registered professional nurse shall retain the discretion to decide
11 whether to assign advanced tasks to advanced home health aides under
12 this program and the advanced home health aide shall retain the
13 discretion to refuse a delegated advanced task and shall not be subject
14 to coercion or the threat of retaliation; (15) notwithstanding any
15 provisions of sections seven hundred forty and seven hundred forty-one
16 of the labor law to the contrary, the protections provided in such
17 sections shall apply to individuals providing supervision or advanced
18 tasks pursuant to this subparagraph; and (16) provide that no advanced
19 tasks, other than administration of medication, may be performed prior
20 to January first, two thousand seventeen; provided that in developing
21 such regulations, the commissioner shall take into account the recommen-
22 dations of a workgroup of stakeholders convened by the commissioner of
23 health in consultation with the commissioner for the purpose of provid-
24 ing guidance on the foregoing; or
25 § 2. Section 206 of the public health law is amended by adding a new
26 subdivision 29 to read as follows:
27 29. The commissioner shall notify the commissioner of education in
28 any instance in which a registered professional nurse engages in improp-
29 er behavior while supervising an advanced home health aide pursuant to
30 subparagraph (v) of paragraph a of subdivision one of section sixty-nine
31 hundred eight of the education law.
32 § 3. Section 3602 of the public health law is amended by adding a new
33 subdivision 17 to read as follows:
34 17. "Advanced home health aides" means home health aides who are
35 authorized to perform advanced tasks as delineated in subparagraph (v)
36 of paragraph a of subdivision one of section sixty-nine hundred eight of
37 the education law and regulations issued by the commissioner of educa-
38 tion relating thereto. The commissioner shall promulgate regulations
39 regarding such aides, which shall include training, demonstrated compe-
40 tencies, competency examinations, and other appropriate qualifications,
41 as well as a process for the limitation or revocation of the advanced
42 home health aide's authorization to perform advanced tasks in appropri-
43 ate cases.
44 § 4. Subdivision 9 of section 3613 of the public health law is renum-
45 bered subdivision 10 and a new subdivision 9 is added to read as
46 follows:
47 9. The department shall indicate within the home care services worker
48 registry when a home health aide has satisfied all applicable training
49 and recertification requirements and has passed the applicable competen-
50 cy examinations necessary to perform advanced tasks pursuant to subpara-
51 graph (v) of paragraph a of subdivision one of section sixty-nine
52 hundred eight of the education law and regulations issued thereto. Any
53 limitation or revocation of the advanced home health aide's authori-
54 zation also shall be indicated on the registry.
55 § 5. The commissioner of health, in consultation with the commissioner
56 of education, shall convene a workgroup of stakeholders to provide guid-
A. 10137 4
1 ance on the advanced tasks which may be performed by advanced home
2 health aides pursuant to subparagraph (v) of paragraph a of subdivision
3 1 of section 6908 of the education law, which shall encompass matters
4 including but not limited to:
5 (a) the advanced tasks that appropriately could be performed by
6 advanced home health aides with appropriate training and supervision;
7 (b) the types of medications that advanced home health aides should be
8 authorized to administer, including whether controlled substances should
9 be authorized;
10 (c) qualifications that must be satisfied by advanced home health
11 aides to perform such advanced tasks, including those related to experi-
12 ence, training, moral character, and examination requirements;
13 (d) minimum training and education standards; and
14 (e) adequate levels of supervision to be provided by nurses, including
15 adherence to existing requirements for comprehensive assessment and any
16 additional assessment that should be required, including when the indi-
17 vidual receiving advanced tasks performed by an advanced home health
18 aide experiences a significant change in condition.
19 On or before March 1, 2015, the commissioner of health shall, in
20 consultation with the commissioner of education, issue a report to the
21 governor and the chairs of the senate and assembly health and higher
22 education committees setting forth the recommendations of the workgroup.
23 The members of such workgroup shall include individuals from academic
24 institutions with relevant expertise, representatives of home care
25 providers, hospice providers, nurses, nurse educators, home health aides
26 and pharmacists, representatives of individuals who may be eligible for
27 advanced tasks performed by advanced home health aides pursuant to such
28 statute, and other relevant stakeholders.
29 § 6. On or before January 1, 2019, the commissioner of health shall,
30 in consultation with the commissioner of education, issue a report on
31 the implementation of advanced home health aides in the state. Such
32 report shall include the number of advanced home health aides authorized
33 pursuant to this act; the types of advanced tasks that advanced home
34 health aides are performing; the number of individuals who were moved
35 out of institutionalized settings as a direct result of this act; the
36 extent to which advanced home health aides contributed to the improve-
37 ment of quality care of these individuals; the number of adverse
38 outcomes, including medication errors, that were reported to the depart-
39 ment of health; any reports of or issues with drug diversion; and the
40 number of advanced home health aides who had their authorization limited
41 or revoked. Such report shall provide recommendations to the governor
42 and the chairs of the senate and assembly health and higher education
43 committees regarding the extension and/or alteration of these provisions
44 and make any other recommendations related to the implementation of
45 advanced home health aides pursuant to this act.
46 § 7. This act shall take effect immediately; provided that:
47 a. section one of this act shall take effect January 1, 2016. Effec-
48 tive immediately, the commissioner of education is authorized to adopt
49 or amend regulations necessary to implement the provisions of section
50 one of this act on or before such effective date; provided, further,
51 that no advanced tasks shall be performed pursuant to the provisions of
52 subparagraph (v) of paragraph a of subdivision 1 of section 6908 of the
53 education law, as added by section one of this act, until such regu-
54 lations are adopted and except in conformance with such regulations;
55 b. section five of this act shall expire and be deemed repealed March
56 31, 2015;
A. 10137 5
1 c. the commissioner of health shall convene the workgroup of stake-
2 holders established pursuant to section five of this act as soon as
3 practicable; and
4 d. this act shall expire and be deemed repealed June 30, 2019.
