S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  11015

                          I N  A S S E M B L Y

                              May 10, 2010
                               ___________

Introduced  by  M. of A. GOTTFRIED, GUNTHER, MILLMAN, JACOBS, BENEDETTO,
  REILLY, GABRYSZAK, JOHN, LANCMAN, PHEFFER, ESPAILLAT,  CLARK,  MARKEY,
  SCHROEDER,  HOYT,  FIELDS,  ROSENTHAL,  DESTITO,  JAFFEE,  MAGNARELLI,
  PEOPLES-STOKES -- Multi-Sponsored by  --  M.  of  A.  ALESSI,  ALFANO,
  ARROYO, BARRA, BARRON, BENJAMIN, BING, BRENNAN, BRODSKY, BROOK-KRASNY,
  BURLING,  CAHILL,  CAMARA,  CHRISTENSEN, COLTON, COOK, CRESPO, CUSICK,
  CYMBROWITZ, DelMONTE, DINOWITZ, ENGLEBRIGHT, GLICK,  HEASTIE,  HOOPER,
  HYER-SPENCER,  KELLNER,  LATIMER,  LAVINE,  LIFTON,  LUPARDO,  MAISEL,
  MAYERSOHN, McDONOUGH, McENENY, McKEVITT, MENG,  J. MILLER,  MONTESANO,
  ORTIZ,  PAULIN,  PERRY,  POWELL,  PRETLOW,  RABBITT, RAMOS, J. RIVERA,
  P. RIVERA, ROBINSON, RUSSELL, SALADINO, SCARBOROUGH, SCHIMEL,  SKARTA-
  DOS,  SPANO, STIRPE, SWEENEY, THIELE, TITONE, TITUS, TOWNS, WEINSTEIN,
  WEISENBERG, WRIGHT -- 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" and to amend the state finance law, in
  relation to moneys deposited into the  improving  quality  of  patient
  care fund

  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".
  S  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-EIGHT HUNDRED TWENTY OF THIS ARTICLE, and such other  information
as the department may require.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD17038-01-0
              

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  (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.
  S 3. The public health law is amended  by  adding  nine  new  sections
2823,  2824,  2825,  2826,  2827,  2828,  2829, 2830 and 2831 to read as
follows:
  S 2823. 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.
  S 2824. 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 GENERAL HOSPITAL, AND SHALL ALSO
INCLUDE ANY CHRONIC DISEASE  HOSPITAL,  MATERNITY  HOSPITAL,  OUTPATIENT
DEPARTMENT,  EMERGENCY CENTER OR SURGICAL CENTER, 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 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
FOR A GIVEN YEAR, BASED  ON  REASONABLE  PROJECTIONS  DERIVED  FROM  THE

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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 SECTIONS
TWENTY-EIGHT   HUNDRED   TWENTY-THREE   THROUGH   TWENTY-EIGHT   HUNDRED
THIRTY-ONE  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.
  S 2825. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE  COMMISSIONER
SHALL:
  1.  PROMULGATE,  AFTER  CONSULTATION  WITH  THE COUNCIL, 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 PRESCRIBING THE
PROCESS FOR APPROVING ACUITY SYSTEMS, WHICH MAY  INCLUDE  A  SYSTEM  FOR
CLASS APPROVAL OF ACUITY SYSTEMS; AND
  2.  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.
  3. ESTABLISH A COMMITTEE TO ADVISE 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 SPECI-
FIED IN THIS ARTICLE.  THE COMMITTEE SHALL ADVISE  THE  COMMISSIONER  ON
THE  EFFICACY  OF  ACUITY SYSTEMS SUBMITTED FOR APPROVAL, AND REVIEW AND
MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING
OF AN OPERATING CERTIFICATE BY THE DEPARTMENT. THE COMMITTEE SHALL  HAVE
THIRTEEN  MEMBERS.  NO  LESS  THAN  SIXTY  PERCENT OF THE MEMBERS OF THE
COMMITTEE SHALL BE REGISTERED PROFESSIONAL NURSES. THE  COMMITTEE  SHALL
INCLUDE  REGISTERED  PROFESSIONAL NURSE DIRECT CARE PROVIDERS, REPRESEN-
TATIVES OF ACUTE CARE FACILITIES, AND REPRESENTATIVES OF NURSING PROFES-
SIONAL ASSOCIATIONS AND RECOGNIZED OR  CERTIFIED  COLLECTIVE  BARGAINING
REPRESENTATIVE  OF  NURSES  AND  OF  NON-NURSING  DIRECT-CARE STAFF. THE
GOVERNOR SHALL APPOINT THE CHAIR AND  SIX  OTHER  MEMBERS,  TWO  MEMBERS

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SHALL  BE  APPOINTED BY THE SPEAKER OF THE ASSEMBLY, ONE MEMBER SHALL BE
APPOINTED BY THE MINORITY LEADER OF THE ASSEMBLY, TWO MEMBERS  SHALL  BE
APPOINTED  BY THE TEMPORARY PRESIDENT OF THE SENATE AND ONE MEMBER SHALL
BE APPOINTED BY THE MINORITY LEADER OF THE SENATE.
  S  2826.  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 APPROVED ACUITY SYSTEM FOR ADDRESSING FLUC-
TUATIONS 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, AND ADMINISTRATIVE AND SUPPORT TASKS THAT IS
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 ASSESSMENT TOOL USED TO VALIDATE  THE  ACUITY  SYSTEM
RELIED ON IN THE PLAN;
  (G)  IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING
ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
  (H) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE  PRIOR  YEAR'S
STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
  (I)  IDENTIFY  EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN
TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR  EACH
SUCH CLASSIFICATION; AND
  (J)  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:
  (I)  ONE  NURSE  TO  ONE  PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY
UNITS AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY CRITICAL CARE  AND

A. 11015                            5

ALL INTENSIVE CARE 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 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,  AND
MEDICAL/SURGICAL AND ACUTE CARE PSYCHIATRIC UNITS;
  (VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS; AND
  (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
  FOR  ANY  UNITS  NOT  LISTED  IN THIS PARAGRAPH, INCLUDING 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 DURING ONE SHIFT. A NURSE,
INCLUDING A NURSE ADMINISTRATOR OR SUPERVISOR, WHO DOES NOT HAVE PRINCI-
PAL RESPONSIBILITY AS A DIRECT-CARE NURSE FOR A SPECIFIC  PATIENT  SHALL
NOT BE INCLUDED IN THE CALCULATION OF THE NURSE-TO-PATIENT RATIO.
  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. THE MINIMUM STAFFING REQUIREMENT AND  NURSE-TO-PATIENT
RATIO  SET  FORTH  IN  THIS  SECTION  SHALL  BE ADJUSTED AS NECESSARY TO
REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE NURSES NECESSARY  TO  ENSURE
ADEQUATE STAFFING OF EACH NURSING DEPARTMENT OR UNIT, IN ACCORDANCE WITH
AN APPROVED ACUITY SYSTEM.
  7.  DEPARTMENT REGULATIONS. NOTHING IN THIS SECTION SHALL BE DEEMED TO
PRECLUDE THE DEPARTMENT BY RULE  OR  REGULATION  FROM  ESTABLISHING  AND
REQUIRING  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 BE DEEMED TO ALTER,  AFFECT
THE  VALIDITY OF, MODIFY THE TERMS OF, OR IMPAIR ANY COLLECTIVE BARGAIN-
ING AGREEMENT.
  S 2827. COMPLIANCE WITH STAFFING  PLAN  AND  RECORDKEEPING.  1.  AS  A
CONDITION  FOR  THE  MAINTENANCE OF AN OPERATING CERTIFICATE, 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 TWENTY-SIX OF THIS ARTICLE; PROVIDED, HOWEVER, THAT
NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY

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FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT  STAFFING  LEVELS,
NOR  SHALL  THE  REQUIREMENTS  SET  FORTH  IN  SUCH SECTION TWENTY-EIGHT
HUNDRED TWENTY-SIX OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
HIGHER  REQUIREMENTS  OTHERWISE  MANDATED  BY  LAW,  RULE, REGULATION OR
CONTRACT.
  2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
STANDARDS  SET  FORTH IN SECTION TWENTY-EIGHT HUNDRED TWENTY-SIX 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.  AS  A  CONDITION  FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE,
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.  AS  A  CONDITION  FOR THE MAINTENANCE OF AN OPERATING CERTIFICATE,
EACH ACUTE CARE FACILITY SHALL MAINTAIN  DAILY  STATISTICS,  BY  NURSING
DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJU-
RY 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.
  S  2828.  WORK  ASSIGNMENT  POLICY. 1. GENERAL. AS A CONDITION FOR THE
MAINTENANCE OF AN OPERATING CERTIFICATE, 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. 11015                            7

  (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.
  S 2829. 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.
  S 2830. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL  NOT  DELE-
GATE  ITS  RESPONSIBILITIES  TO  ENFORCE  THE SAFE STAFFING REQUIREMENTS
PROMULGATED PURSUANT TO THIS ARTICLE.
  S 2831. ENFORCEMENT AND  PENALTIES.  1.  CIVIL  PENALTY.  ANY  PERSON,
REGARDLESS  OF  WHETHER  THAT PERSON POSSESSES AN OPERATING CERTIFICATE,
WHO HAS COMMITTED A VIOLATION OF ANY  OF  THE  PROVISIONS  OF  THE  SAFE
STAFFING  REQUIREMENTS, INCLUDING FAILURE TO CORRECT A SERIOUS VIOLATION
(AS DEFINED BY REGULATION) WITHIN THE TIME  SPECIFIED  IN  A  DEFICIENCY
CITATION,  MAY BE ASSESSED A CIVIL PENALTY BY ORDER OF THE DEPARTMENT OF
UP TO FIVE HUNDRED DOLLARS FOR EACH DEFICIENCY FOR EACH  DAY  THAT  EACH

A. 11015                            8

DEFICIENCY  CONTINUES;  PROVIDED,  HOWEVER,  THAT  AN  ACUTE HEALTH CARE
FACILITY  THAT  FAILS  TO  COMPLY  WITH  THE  REQUIREMENTS  OF   SECTION
TWENTY-EIGHT  HUNDRED TWENTY-SIX OF THIS ARTICLE MAY BE ASSESSED A CIVIL
PENALTY  BY  ORDER  OF  THE DEPARTMENT OF UP TO TEN THOUSAND DOLLARS FOR
EACH DAY OF NON-COMPLIANCE. CIVIL PENALTIES SHALL BE COLLECTED FROM  THE
DATE  SUCH  FACILITY  RECEIVES  NOTICE  OF VIOLATION UNTIL THE DATE SUCH
VIOLATION IS CORRECTED.
  2. CIVIL PENALTY FOR  INTERFERENCE  WITH  REPORTING  OBLIGATIONS.  ANY
PERSON OR ACUTE CARE FACILITY THAT FAILS TO REPORT OR FALSIFIES INFORMA-
TION, OR COERCES, THREATENS, INTIMIDATES OR OTHERWISE INFLUENCES  ANOTH-
ER  PERSON  TO  FAIL  TO REPORT OR TO FALSIFY INFORMATION REQUIRED TO BE
REPORTED UNDER THE SAFE STAFFING REQUIREMENTS, MAY BE ASSESSED  A  CIVIL
PENALTY OF UP TO TEN THOUSAND DOLLARS FOR EACH SUCH INCIDENT.
  3.  PRIVATE  RIGHT  OF  ACTION  FOR VIOLATIONS OF SECTION TWENTY-EIGHT
HUNDRED TWENTY-EIGHT 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  TWENTY-EIGHT  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.
  S 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 COUNCIL
SHALL CONSIDER ANY PAST VIOLATIONS OF  STATE  OR  FEDERAL  RULES,  REGU-
LATIONS  OR  STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE
SAFETY, COLLECTIVE BARGAINING OR  ANY  OTHER  LABOR  RELATED  PRACTICES,
OBLIGATIONS  OR  IMPERATIVES.  THE  PUBLIC  HEALTH  COUNCIL  SHALL  GIVE
SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE  PUBLIC  HEALTH  LAW  PROVISIONS
CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
  S  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 COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE
PUBLIC HEALTH LAW PROVISIONS CONCERNING NURSE STAFF AND SUPPORTIVE STAFF
RATIOS.
  S 6. Subdivisions 2 and 4 of section 97-aaaa of the state finance law,
as added by chapter 24 of the laws of  2002,  are  amended  to  read  as
follows:
  2. Such fund shall consist of all moneys received from civil penalties
assessed  in  actions commenced pursuant to section seven hundred forty-
one of the labor law AND CIVIL PENALTIES ASSESSED  PURSUANT  TO  SECTION
TWENTY-EIGHT HUNDRED THIRTY-ONE OF THE PUBLIC HEALTH LAW.

A. 11015                            9

  4.  Moneys in the account, following appropriation by the legislature,
shall be expended by the department of health for the purpose of improv-
ing the direct treatment and care of patients  in  facilities  providing
health  care services that are licensed pursuant to article twenty-eight
or  thirty-six  of  the  public  health law or which operate and provide
health care services under the mental hygiene law, the education law, or
the correction law. THE DEPARTMENT  SHALL  GIVE  SUBSTANTIAL  WEIGHT  TO
FUNDING INITIATIVES TO IMPROVE STAFFING RATIOS IN HEALTH CARE FACILITIES
OR TO REDUCE THE USE OF EXCESSIVE OVERTIME AMONG NURSING STAFF.
  S  7.  The public health law is amended by adding a new section 2895-b
to read as follows:
  S 2895-B. NURSING HOME STAFFING LEVELS. 1.  DEFINITIONS.  AS  USED  IN
THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  (A)  "ADVISORY  COUNCIL"  MEANS  THE  ADVISORY COUNCIL ON NURSING HOME
STAFFING CREATED IN SUBDIVISION TWO OF THIS SECTION.
  (B) "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.
  (C) "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. ADVISORY COUNCIL ON NURSING HOME STAFFING. THERE IS HEREBY  CREATED
IN  THE DEPARTMENT AN ADVISORY COUNCIL ON NURSING HOME STAFFING TO STUDY
AND MAKE RECOMMENDATIONS RELATING TO THE STAFFING STANDARDS  UNDER  THIS
SECTION. THE ADVISORY COUNCIL SHALL BE APPOINTED BY THE COMMISSIONER AND
SHALL  BE COMPOSED OF REPRESENTATIVES OF NURSING HOME OPERATORS, CONSUM-
ERS, AND NON-ADMINISTRATIVE NURSING HOME EMPLOYEES AND THE PUBLIC.   THE
ADVISORY  COUNCIL  SHALL, FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE
LEGISLATURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARD-
ING STAFFING LEVELS IN NURSING HOMES.
  3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
ADVISORY 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 HIGH-
EST  PRACTICABLE  PHYSICAL,  MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH
RESIDENT OF THE NURSING HOME. 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 NURSING HOME.
  (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.

A. 11015                           10

  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)  FROM 2.4 TO 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED
NURSE AIDE;
  (B) FROM 1.15 TO 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A  LICENSED
PRACTICAL NURSE OR A REGISTERED NURSE; AND
  (C)  FROM  0.55 TO 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGIS-
TERED NURSE.
  5. PHASE-IN. (A) THE COMMISSIONER SHALL  MAKE  THE  FIRST  REGULATIONS
UNDER  SUBDIVISION  THREE  OF  THIS  SECTION  WITHIN ONE YEAR AFTER THIS
SECTION BECOMES A LAW.
  (B) IF THE COMMISSIONER DETERMINES THAT COMPLIANCE WITH THE  STATUTORY
STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION IS NOT REASONABLY FEASI-
BLE  FOR  NURSING  HOMES  BY THE TIME SPECIFIED IN THAT SUBDIVISION, THE
COMMISSIONER MAY DELAY THE IMPLEMENTATION OF THAT STAFFING STANDARD  FOR
A  PHASE-IN PERIOD NOT TO EXCEED FIVE YEARS AFTER THIS SECTION BECOMES A
LAW. IF THE COMMISSIONER DELAYS IMPLEMENTATION OF THAT  STAFFING  STAND-
ARD,  THE COMMISSIONER SHALL PHASE IN, OVER THE PHASE-IN PERIOD,  STAFF-
ING STANDARDS THAT GRADUALLY INCREASE  IN  EACH  OF  THE  YEARS  OF  THE
PHASE-IN PERIOD UNTIL THE STAFFING STANDARD MEETS AT LEAST THE STATUTORY
STANDARD UNDER SUBDIVISION FOUR OF THIS SECTION.
  6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A NURSING HOME SHALL POST
INFORMATION  REGARDING  NURSE STAFFING THAT THE NURSING HOME 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 CLOSE PROXIMITY TO EACH POSTING REQUIRED BY PARAGRAPH
(A) OF THIS SUBDIVISION.
  S 8. 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.
  S 9. This act shall take effect on the one hundred eightieth day after
it shall have become a law, provided that any rules and regulations, and
any  other  actions necessary to implement the provisions of this act on
its effective date are authorized and directed to  be  completed  on  or
before such date.