BILL NUMBER:S2943

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

PURPOSE:  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 Education Law § 6908(1)(iii), 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:  The current exemption in the Nurse Practice Act origi-
nates from Chapter 795 of 1992. 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 involved tasks crossing into "the practice of nursing"
(e.g. suctioning, medication administration). Patients without family
members thus faced sole reliance on nurses to provide such care in the
              

home. In the absence of nurses or family to provide this such care,
these individuals faced institutionalization or other extreme limita-
tions. 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 regarding patient access and the need for effi-
cient use of nursing resources, 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.

LEGISLATIVE HISTORY:  2012: S.5048 reported to Finance 2011: S.5048 died
in Health
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 S20 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.