S T A T E   O F   N E W   Y O R K
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                                 1417--A

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                               (PREFILED)

                             January 9, 2013
                               ___________

Introduced  by  Sens.  MONTGOMERY,  ADDABBO, GRISANTI, HOYLMAN, KRUEGER,
  PARKER -- read twice and ordered  printed,  and  when  printed  to  be
  committed to the Committee on Aging -- recommitted to the Committee on
  Aging   in  accordance  with  Senate  Rule  6,  sec.  8  --  committee
  discharged, bill amended, ordered reprinted as amended and recommitted
  to said committee

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
persons  in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY WILL
MEET THE REGISTERED NURSE STAFFING REQUIREMENT.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01611-03-4
              

S. 1417--A                          2

  (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
services law.  Provided, however, a resident may remain at the residence
if each of the following conditions are met:

S. 1417--A                          3

  (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.