NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A909
SPONSOR: Gray TITLE OF BILL:
An act to amend the education law and the public health law, in relation
to authorizing certain nursing home medication aides to perform certain
advanced tasks; and providing for the repeal of such provisions upon
expiration thereof
PURPOSE OR GENERAL IDEA OF BILL:
This bill would allow nursing home-medication aides in St. Lawrence
County to administer medications in residential health care facilities
with training specified under the act and while under the supervision of
a registered nurse.
SUMMARY OF PROVISIONS:
Section 1 adds new subdivision 3 to section 6908 of the education law,
to permit administration of certain medication by nursing home medica-
tion aide in the county of Saint Lawrence certified under the public
health law, pursuant to the minimum regulations directed under this new
subdivision. Among the minimum regulations, administration of medica-
tions by nursing home medication aides will be under the direct super-
vision of a registered professional nurse licensed in the state of New
York.
Section 2 adds new subdivision 9 to section 6909 of the education law,
permitting registered professional nurses to assign nursing home medica-
tion aides to perform medication administration under the registered
professional nurse's supervision pursuant to new subdivision 3 of
section 6908, subject to the requirements of this new subdivision 9.
Section 3 adds new subdivision 10 to section 6906 of the education law,
relating to information the commissioner of education must gather and
Report.
Section 4 adds new subdivision 31 to section 206 of the public health
law, requiring that the commissioner of health notify the commissioner
of education of any improper behavior of registered professional nurses
while supervising a nursing home medication aide pursuant to new subdi-
vision 3 of section 6908 of the education law.
Section 5 adds new subdivision 12 to section 2801 of the public health
law, defining nursing home medication aides, and requiring the commis-
sioner of health to promulgate regulations for such aides.
Section 6 adds new subdivision 5 to section 2803-j of the public health
law, requiring the department of health to indicate within the nursing
home nurse aide registry when a nursing home nurse aide has satisfied
all requirements necessary to perform medication administration pursuant
to new subdivision 3 of section 6908 of the education law and regu-
lations issued thereto.
Section 7 directs the commissioner of health, in consultation with the
commissioner of education, to issue a report on the implementation of
nursing home medication aides in the state, and details the information
required in such report.
Section 8 provides the effective date, including specific effective
dates for sections 1 and 3 of this act, and provides an expiration date
for this act.
JUSTIFICATION:
At least 28 states have authorized the use of medication aides in nurs-
ing homes and/or assisted living facilities. In New York, there is an
exemption to the Nurse Practice Act for direct care staff employed in
residences certified by the Department of Mental Hygiene. This exemption
allows registered nurses to delegate nursing functions, including medi-
cation administration, to direct care staff provided there is adequate
medical and nursing supervision. A registered nurse (RN) must train the
direct care staff in any delegated nursing function, including medica-
tion administration. In the case of medication administration, the
direct care staff member must complete a four-day course in medication
administration, pass the final exam with a minimum grade of 80 and also
pass a clinical practicum. If the direct care staff person passes the
training, he or she is certified to administer medication for one year
and must be recertified each year. The RN is responsible for providing
ongoing supervision of the direct care staff and is responsible for
ensuring that all of the provisions of the medication administration
regulations are carried out. Reports indicate a very high success rate
for this program. Studies have shown an actual decrease in medication
errors with administration performed by medication technicians.
St. Lawrence County is facing a significant nursing shortage, and many
nurses express dissatisfaction with the repetitive task of routine medi-
cation administration consuming most of their time, leaving little time
for direct care. Meanwhile, aide-level workers are leaving health care
to pursue other jobs due to wage restrictions and job satisfaction.
Allowing these additional responsibilities can provide increased job
satisfaction, allow for wage increases and promote staff retention.
Since routine nursing supervision is still required, this program does
not replace a licensed nurse with a nursing home medication aide, but
instead uses the aide to assist the nurse, allowing more time for the
nurse to supervise and provide direct care, overall providing for a more
efficient and productive use of licensed nursing skills.
PRIOR LEGISLATIVE HISTORY:
2019 referred to higher education
2020 referred to higher education
2020 held for consideration in higher education
2022 referred to higher education
2023 referred to higher education
2024 referred to higher education
FISCAL IMPLICATIONS FOR STATE AND LOCAL GOVERNMENTS:
To be determined.
EFFECTIVE DATE:
This act shall take effect immediately; shall expire and be deemed
repealed on March 31, 2032
STATE OF NEW YORK
________________________________________________________________________
909
2025-2026 Regular Sessions
IN ASSEMBLY(Prefiled)
January 8, 2025
___________
Introduced by M. of A. GRAY, BLANKENBUSH, BENDETT, DeSTEFANO -- 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 nursing home medication aides to perform
certain advanced tasks; and providing for the repeal of such
provisions upon expiration thereof
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Section 6908 of the education law is amended by adding a
2 new subdivision 3 to read as follows:
3 3. This article shall not be construed as prohibiting the adminis-
4 tration of medication by a nursing home medication aide certified pursu-
5 ant to section twenty-eight hundred three-j of the public health law as
6 added by chapter seven hundred seventeen of the laws of nineteen hundred
7 eighty-nine in residential health care facilities, as defined in article
8 twenty-eight of the public health law, in the county of St. Lawrence, in
9 accordance with regulations developed by the commissioner, in consulta-
10 tion with the commissioner of health. At a minimum, such regulations
11 shall:
12 a. authorize the administration of medications which are routine and
13 prefilled or otherwise packaged in a manner that promotes relative ease
14 of administration, provided that administration of medications by
15 injection shall be prohibited. Provided, however, such prohibition shall
16 not apply to injections of insulin or other injections for diabetes
17 care, to injections of low molecular weight heparin, and to pre-filled
18 auto-injections of epinephrine for emergency purposes, and provided,
19 further, that entities employing nursing home medication aides pursuant
20 to this subdivision shall establish a systematic approach to address
21 drug diversion;
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD00113-01-5
A. 909 2
1 b. provide that medication administration by nursing home medication
2 aides may be performed only under the direct supervision of a registered
3 professional nurse licensed in New York state, as set forth in this
4 subdivision and subdivision eight of section sixty-nine hundred nine of
5 this article, where such nurse is employed by a residential health care
6 facility licensed or certified pursuant to the public health law. Such
7 nursing supervision shall:
8 (i) include training and periodic assessment of the performance of
9 medication administration;
10 (ii) be determined by the registered professional nurse responsible
11 for supervising such medication administration based upon the complexity
12 of such medication administration, the skill and experience of the nurs-
13 ing home medication aide, and the health status of the individual for
14 whom such medication administration is being performed;
15 (iii) include a comprehensive initial and thereafter regular and ongo-
16 ing assessment of the individual's needs;
17 (iv) include as a requirement that the supervising registered profes-
18 sional nurse shall visit individuals receiving medication for the
19 purpose of supervising the medication administration provided by nursing
20 home medication aides and include as a requirement that a registered
21 professional nurse shall be available to the nursing home medication
22 aide twenty-four hours a day, seven days a week, provided that a regis-
23 tered professional nurse shall be available to visit an individual
24 receiving medication as necessary to protect the health and safety of
25 such individual; and
26 (v) as shall be specified by the commissioner, be provided in a manner
27 that takes into account individual care needs and case mix complexity
28 and provide that the number of individuals served by a supervising
29 registered professional nurse is reasonable and prudent;
30 c. establish a process by which a registered professional nurse may
31 assign medication administration to a nursing home medication aide. Such
32 process shall include, but not be limited to:
33 (i) allowing assignment of medication administration to a nursing home
34 medication aide only where such nursing home medication aide has demon-
35 strated to the satisfaction of the supervising registered professional
36 nurse competency in medication administration that such nursing home
37 medication aide is authorized to perform, a willingness to perform such
38 medication administration, and the ability to effectively and efficient-
39 ly communicate with the individual receiving medication and understand
40 such individual's needs;
41 (ii) prohibiting assignment of medication administration to a nursing
42 home medication aide if the individual receiving services declines to be
43 served by a nursing home medication aide;
44 (iii) authorizing the supervising registered professional nurse to
45 revoke any assigned medication administration from a nursing home medi-
46 cation aide for any reason; and
47 (iv) authorizing multiple registered professional nurses to jointly
48 agree to assign medication administration to a nursing home medication
49 aide, provided further that only one registered professional nurse shall
50 be required to determine if the nursing home medication aide has demon-
51 strated competency in the medication administration to be performed;
52 d. provide that medication administration may be performed only in
53 accordance with and pursuant to an authorized health practitioner's
54 ordered care;
A. 909 3
1 e. provide that only a certified nursing home medication aide may
2 perform medication administration as a nursing home medication aide when
3 such aide has:
4 (i) at least one year of experience providing residential health care
5 services;
6 (ii) completed the requisite training and demonstrated competencies of
7 a nursing home medication aide as determined by the commissioner in
8 consultation with the commissioner of health;
9 (iii) successfully completed competency examinations satisfactory to
10 the commissioner in consultation with the commissioner of health; and
11 (iv) meets other appropriate qualifications as determined by the
12 commissioner in consultation with the commissioner of health;
13 f. provide that only an individual who has satisfied all applicable
14 training requirements and having passed the applicable competency exam-
15 inations and who meets other requirements as set forth in regulations
16 issued by the commissioner of health pursuant to the public health law
17 may perform medication administration pursuant to this subdivision and
18 may hold themself out as a nursing home medication aide;
19 g. establish minimum standards of training for the performance of
20 medication administration by nursing home medication aides, including
21 didactic training, clinical training, and a supervised clinical practi-
22 cum with standards set forth by the commissioner of health;
23 h. provide that nursing home medication aides shall receive case-spe-
24 cific training on the medication administration to be assigned by the
25 supervising nurse, provided that additional training shall take place
26 whenever additional medication administration is assigned;
27 i. prohibit a nursing home medication aide from holding themself out,
28 or accepting employment as, a person licensed to practice nursing under
29 the provisions of this article;
30 j. provide that a nursing home medication aide is not required nor
31 permitted to assess the medication or medical needs of an individual;
32 k. provide that a nursing home medication aide shall not be authorized
33 to perform any activities pursuant to this subdivision that are outside
34 the scope of practice of a licensed practical nurse or that have not
35 been appropriately assigned by the supervising registered professional
36 nurse;
37 l. provide that a nursing home medication aide shall document all
38 medication administration to each individual through the use of a medi-
39 cation administration record; and
40 m. provide that the supervising registered professional nurse shall
41 retain the discretion to decide whether to assign medication adminis-
42 tration to nursing home medication aides under this program and shall
43 not be subject to coercion, retaliation, or the threat of retaliation.
44 § 2. Section 6909 of the education law is amended by adding a new
45 subdivision 12 to read as follows:
46 12. A registered professional nurse, while working for a residential
47 health care facility licensed or certified pursuant to the public health
48 law, may, in accordance with this subdivision, assign nursing home medi-
49 cation aides to perform medication administration for individuals pursu-
50 ant to the provisions of subdivision three of section sixty-nine hundred
51 eight of this article and supervise nursing home medication aides who
52 perform assigned medication administration.
53 (a) Prior to assigning or modifying an assignment to perform medica-
54 tion administration, the registered professional nurse shall:
55 (i) complete a nursing assessment to ascertain the client's current
56 health status and care needs; and
A. 909 4
1 (ii) provide to the nursing home medication aide written, individual-
2 specific instructions for performing the medication administration and
3 criteria for identifying, reporting and responding to problems or
4 complications.
5 (b) The registered professional nurse shall not assign medication
6 administration unless:
7 (i) the medication administration to be assigned is consistent with an
8 authorized health practitioner's ordered care;
9 (ii) the registered professional nurse provides case specific training
10 to the nursing home medication aide and personally verifies that the
11 nursing home medication aide can safely and competently perform the
12 medication administration;
13 (iii) the registered professional nurse determines that the nursing
14 home medication aide is willing to perform such medication adminis-
15 tration; and
16 (iv) the registered professional nurse determines that the nursing
17 home medication aide is able to effectively and efficiently communicate
18 with the individual receiving services and understand such individual's
19 needs.
20 (c) The supervising registered professional nurse shall:
21 (i) visit individuals receiving medication for the purpose of super-
22 vising the medication administration provided by nursing home medication
23 aides; and
24 (ii) conduct regular and ongoing assessment of the individual's needs.
25 § 3. Section 6906 of the education law is amended by adding a new
26 subdivision 10 to read as follows:
27 (10) In conjunction with and as a condition of each triennial regis-
28 tration, the department shall ask and a licensed practical nurse shall
29 indicate whether the licensed practical nurse is or has previously been
30 authorized as a nursing home medication aide pursuant to subdivision
31 three of section sixty-nine hundred eight of this article. The depart-
32 ment shall provide responses to the department of health and the depart-
33 ment of health shall include such information in reports related to
34 nursing home medication aides.
35 § 4. Section 206 of the public health law is amended by adding a new
36 subdivision 32 to read as follows:
37 32. The commissioner shall notify the commissioner of education in any
38 instance in which a registered professional nurse engages in improper
39 behavior while supervising a nursing home medication aide pursuant to
40 subdivision three of section sixty-nine hundred eight of the education
41 law.
42 § 5. Section 2801 of the public health law is amended by adding a new
43 subdivision 15 to read as follows:
44 15. "Nursing home medication aides" means nursing home aides who are
45 authorized to perform medication administration as delineated in subdi-
46 vision three of section sixty-nine hundred eight of the education law
47 and regulations issued by the commissioner of education relating there-
48 to. The commissioner shall promulgate regulations regarding such aides,
49 which shall include a process for the limitation or revocation of the
50 nursing home medication aide's authorization to perform medication
51 administration in appropriate cases.
52 § 6. Section 2803-j of the public health law, as added by chapter 717
53 of the laws of 1989, is amended by adding a new subdivision 5 to read as
54 follows:
55 5. The department shall indicate within the nursing home nurse aide
56 registry when a nursing home nurse aide has satisfied all applicable
A. 909 5
1 training and recertification requirements and has passed the applicable
2 competency examinations necessary to perform medication administration
3 pursuant to subdivision three of section sixty-nine hundred eight of the
4 education law and regulations issued thereto. Any limitation or revoca-
5 tion of the nursing home medication aide's authorization also shall be
6 indicated on the registry.
7 § 7. On or before October 1, 2031, the commissioner of health shall,
8 in consultation with the commissioner of education, issue a report on
9 the implementation of nursing home medication aides in the state. Such
10 report shall include the number of nursing home medication aides author-
11 ized pursuant to this act; the number of nursing home nurse aides that
12 became authorized to perform medication administration; the number of
13 nursing home medication aides that became registered as licensed practi-
14 cal nurses; the types of medication that nursing home medication aides
15 are administering; the number of complaints pertaining to medication
16 administration provided by nursing home medication aides that were
17 reported to the department of health; and the number of nursing home
18 medication aides who had their authorization limited or revoked. Such
19 report shall provide recommendations to the governor and the chairs of
20 the senate and assembly health and higher education committees regarding
21 the implementation of nursing home medication aides pursuant to this
22 act, and any recommendations related thereto.
23 § 8. This act shall take effect immediately; provided that:
24 a. sections one and three of this act shall take effect two years
25 after this act shall have become a law. Effective immediately, the
26 commissioner of education is authorized to adopt or amend regulations
27 and take such other actions as are necessary to implement the provisions
28 of sections one and two of this act on or before such effective date;
29 provided, further, that no medication administration shall be performed
30 pursuant to the provisions of subdivision three of section 6908 of the
31 education law, as added by section one of this act, on or before such
32 effective date; provided further, that no medication administration
33 shall be performed pursuant to such provisions until such regulations
34 are adopted and except in conformance with such regulations including in
35 conformance with the provisions of such regulations related to the
36 completion of nursing home medication aide training and the satisfaction
37 of competency examination requirements.
38 b. this act shall expire and be deemed repealed March 31, 2032.
