S T A T E   O F   N E W   Y O R K
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                                 5168--A
                                                        Cal. No. 806

                       2013-2014 Regular Sessions

                          I N  A S S E M B L Y

                            February 20, 2013
                               ___________

Introduced  by M. of A. GOTTFRIED, GUNTHER, JAFFEE, LIFTON, ENGLEBRIGHT,
  ROBINSON, MILLMAN, ORTIZ, HOOPER, ROSENTHAL -- Multi-Sponsored  by  --
  M.  of  A.    ARROYO,  BRENNAN, BROOK-KRASNY, CLARK, COLTON, DINOWITZ,
  HEASTIE, JACOBS, MARKEY, McDONOUGH, MONTESANO, PAULIN, PERRY,  TITONE,
  WEISENBERG  --  read  once  and referred to the Committee on Health --
  recommitted to the Committee on Health  in  accordance  with  Assembly
  Rule  3,  sec. 2 -- reported from committee, advanced to a third read-
  ing, amended and ordered reprinted, retaining its place on  the  order
  of third reading

AN ACT to amend the public health law, in relation to requiring a regis-
  tered  nurse  on  staff  at facilities certified for enhanced assisted
  living or special needs assisted living

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Section 4655 of the public health law, as added by chapter
2 of the laws of 2004, is amended to read as follows:
  S 4655. Certification procedures and requirements. 1.  Notwithstanding
any other provision of law, an assisted living operator may apply to the
department to obtain an enhanced assisted living certificate pursuant to
this section.
  (a) Such application shall be on a form approved by the department.
  (b)  An  assisted living operator may apply for such a certificate for
the entire facility or any number of beds at the facility.
  (c) To obtain an enhanced assisted living certificate,  the  applicant
must  submit  a  plan to the department setting forth how the additional
needs of residents will be safely and appropriately met  at  such  resi-
dence.  Such  plan  shall include, but need not be limited to, a written
description of services, staffing levels, staff education and  training,
work experience, and any environmental modifications that have been made
or  will  be  made  to  protect  the  health, safety and welfare of such

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01611-02-4
              

A. 5168--A                          2

persons in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY  WILL
MEET THE REGISTERED NURSE STAFFING REQUIREMENT.
  (d) In addition to any other requirements of assisted living, an oper-
ator  of  enhanced assisted living may hire care staff directly pursuant
to standards developed by the department or contract with  a  home  care
services  agency  which has been approved to operate pursuant to article
thirty-six of this chapter.
  (e) No assisted  living  residence  shall  be  certified  as  enhanced
assisted  living  unless  and  until  the  applicant obtains the written
approval of the department.
  (F) (I) TO OBTAIN OR RENEW AN ENHANCED  ASSISTED  LIVING  CERTIFICATE,
THE  APPLICANT  SHALL  BE  REQUIRED TO HAVE A REGISTERED NURSE ONSITE TO
ASSESS AND MONITOR THE CONDITION OF RESIDENTS.
  (II) THE REGISTERED NURSE SHALL BE AT THE FACILITY A  MINIMUM  OF  ONE
SHIFT  PER  DAY,  FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES OF THE REGIS-
TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI-
DENT ASSESSMENT AND MONITORING, AND  ENSURING  THAT  ALL  RESIDENTS  ARE
RECEIVING APPROPRIATE CARE.
  (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE
MONITORING  OR  OVERSIGHT  SERVICES OF A REGISTERED NURSE ON A FULL TIME
BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER
CAPACITY, AS APPROPRIATE FOR  THE  FACILITY.  FACILITIES  CHOOSING  THIS
OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT
AND MONITORING.
  (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO
FURNISH  PROOF  OF COMPLIANCE WITH THIS PARAGRAPH NO LATER THAN EIGHTEEN
MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW.
  2. No resident shall be permitted to continue to age  in  place  under
the  terms  of an enhanced assisted living certificate unless the opera-
tor, the resident's physician, THE FACILITY'S  STAFF  REGISTERED  NURSE,
and, if applicable, the resident's licensed or certified home care agen-
cy,  agree  that  the additional needs of the resident can be safely and
appropriately met at the residence. A  resident  eligible  for  enhanced
assisted  living  or his or her representative shall submit to the resi-
dence a written report from a physician, which report shall state that:
  (a) the physician has physically examined the resident within the last
month; and
  (b) the resident is not in need of twenty-four  hour  skilled  nursing
care  or  medical  care  which  would require placement in a hospital or
residential health care facility.
  3. The residence must notify a resident that, while the residence will
make reasonable efforts to facilitate the resident's ability to  age  in
place  pursuant  to an individualized service plan, there may be a point
reached where the needs of the resident cannot be safely or appropriate-
ly met at the residence, requiring the transfer of  the  resident  to  a
more  appropriate  facility  in  accordance  with the provisions of this
article.
  4. If a resident reaches the point where he or she is in need of twen-
ty-four hour skilled  nursing  care  or  medical  care  required  to  be
provided by facilities licensed pursuant to article twenty-eight of this
chapter  or  article  nineteen,  thirty-one  or thirty-two of the mental
hygiene law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE  FACILITY'S
STAFF  RESIDENT  NURSE,  then  the  resident must be discharged from the
residence and the operator shall initiate  proceedings  for  the  termi-
nation  of  the  residency agreement of such resident in accordance with
the provisions  of  section  four  hundred  sixty-one-h  of  the  social

A. 5168--A                          3

services law.  Provided, however, a resident may remain at the residence
if each of the following conditions are met:
  (a)  a  resident  in  need of twenty-four hour skilled nursing care or
medical care hires appropriate nursing, medical or hospice staff to care
for his or her increased needs;
  (b) the resident's physician [and], home care services  agency  [both]
AND  THE  FACILITY'S  STAFF  REGISTERED NURSE ALL determine and document
that, with the provision of such additional nursing, medical or  hospice
care,  the  resident can be safely cared for in the residence, and would
not require placement in a hospital,  nursing  home  or  other  facility
licensed under article twenty-eight of this chapter or article nineteen,
thirty-one or thirty-two of the mental hygiene law;
  (c)  the  operator agrees to retain the resident and to coordinate the
care provided by the operator and the  additional  nursing,  medical  or
hospice staff; and
  (d) the resident is otherwise eligible to reside at the residence.
  5. In addition to the requirements otherwise required for licensure as
assisted  living,  any  residence  that  advertises or markets itself as
serving individuals with special needs, including, but not  limited  to,
individuals  with  dementia  or  cognitive  impairments,  must  submit a
special needs plan to the department setting forth how the special needs
of such residents will be safely and appropriately  met  at  such  resi-
dence.  Such  plan  shall include, but need not be limited to, a written
description of specialized services, staffing  levels,  staff  education
and  training,  work  experience,  professional  affiliations or special
characteristics relevant to serving persons with special needs, and  any
environmental  modifications  that  have  been  made  or will be made to
protect the health, safety and welfare of such persons in the residence.
In approving an application for special needs certification, the depart-
ment shall develop standards to ensure adequate staffing and training in
order to safely meet the needs of the resident. The standards  shall  be
based upon recommendations of the task force established by section five
of  [the] chapter TWO of the laws of two thousand four [which added this
section]. IN ADDITION TO ANY OTHER STANDARDS WHICH  THE  DEPARTMENT  MAY
DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL
BE  SUBJECT  TO THE SAME REGISTERED NURSE STAFFING REQUIREMENTS DETAILED
IN PARAGRAPHS (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION.  No  resi-
dence shall market [themselves] ITSELF as providing specialized services
unless  and  until  the  department  has  approved  such applicant for a
special  needs  assisted  living  certificate.  EXISTING  SPECIAL  NEEDS
ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI-
ANCE  WITH  THE  NEW STAFFING REQUIREMENTS NO LATER THAN EIGHTEEN MONTHS
AFTER THIS SENTENCE SHALL HAVE BECOME A LAW.
  6. An enhanced assisted living certificate shall not be required of an
adult care facility, or part thereof, which has obtained approval by the
department to operate an assisted living  program  pursuant  to  section
four  hundred sixty-one-l of the social services law. Provided, however,
such exemption shall only apply to those beds at the facility which  are
subject to the assisted living program.
  S  2.  This  act shall take effect on the ninetieth 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.