BILL NUMBER:S5048

TITLE OF BILL:
An act
to amend the education law, in relation to the provision of nursing
level care under a registered nurse's supervision

PURPOSE OR GENERAL IDEA OF BILL:
To permit nurses and patients in state-regulated (Public health law
article 36) home care agencies to be able to exercise the authority
under the existing nurse practice act for the provision of care at home.

SUMMARY OF PROVISIONS:
Amends clause (iii) of paragraph a of subdivision 1 of section 6908 of
the education law, which is the current nurse practice act exemption
that permits nurses and patients/family members to instruct home care
aides in certain programs to provide care that would otherwise be
permissible for family members under the scope of nursing. The proposed
amendment would allow the exemption to apply to nurses/patients in
Article 36 home care agencies as well.

JUSTIFICATION:
This current exemption in the nurse practice act originates from a 1992
chapter of law (chapter 795). Prior to that chapter, for a patient
receiving home care, only a nurse or a family member (acting under an
existing exemption to the nurse practice act) could provide care to the
              

patient that would involve tasks that crossover into "the practice of
nursing" (e.g., suctioning, medication administration). Patients without
family members thus faced sole reliance on nurses providing such care in
the home (i.e., including reliance on nurses for care which could be
provided by family) and, in the absence of nurses (or family), faced
institutionalization or other extreme limitations. With the severe and
growing shortage of nurses, patients faced growing access problems as
well as limitations in community living that could be addressed with the
proper ability to instruct aides to provide services under nurse/patient
instruction in the absence of family. Patients urged the Legislature to
provide a solution.

Recognizing the issues with regard to patient access, need for efficient
use of nursing resources and exorbitant cost, and with the direct
involvement of consumers and representatives of the State Nurses
Association, the statute was amended to provide for the current
exemption. While the legislative proposal sought to address all home
care settings, in its final version, the exemption was set forth on an
initial conservative basis (with services reimbursable through the
Consumer Directed program), which is its form in the present law.

The flexibility that would be accorded nurses and patients under this
bill is of core importance to the patients, the nurses, the system and
the added efficiency of the Medicaid Program. It is a practical reform
with innumerable benefits.

This proposal provides for a long-needed, major improvement in service
access, flexibility and efficiency. It's benefits include:

* Enhanced access to and flexibility of care for consumers.


* Enhanced care planning and arrangement flexibility by nurses.

* Opportunity for more efficient deployment of nursing and other agency
resources.

* Cost savings to the Medicaid program.

PRIOR LEGISLATIVE HISTORY:
New standalone bill. The bill is an amendment to chapter 795 of 1992.
This amendment was recently also introduced as part of the comprehensive
legislation known as the "Home Care Accessibility and Efficiency
Improvement Act, S.5179 of 2009-10, portions of which were enacted as
part of the State Deficit Reduction Act of 2009 and the State
Health/Medicaid Budget of 2010-11.

FISCAL IMPLICATIONS:
It is projected that this legislation would result in over $20 Million
in anticipated state-share Medicaid savings through the increased
capability of nurses and patients to more efficiently deploy both aide
and nursing services in the absence of family members.

EFFECTIVE DATE:
This act takes effect immediately.