S T A T E O F N E W Y O R K
________________________________________________________________________
108--B
2021-2022 Regular Sessions
I N A S S E M B L Y
(PREFILED)
January 6, 2021
___________
Introduced by M. of A. GUNTHER, GOTTFRIED, PEOPLES-STOKES, BARRETT,
L. ROSENTHAL, BRONSON, COLTON, BENEDETTO, CRUZ, MAGNARELLI, WEPRIN,
J. RIVERA, FALL, AUBRY, OTIS, STECK, SANTABARBARA, ZEBROWSKI, ABINAN-
TI, BARRON, SEAWRIGHT, WALKER, BICHOTTE HERMELYN, RICHARDSON, HYNDMAN,
PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI, O'DONNELL, DILAN,
DAVILA, HUNTER, WILLIAMS, CARROLL, WOERNER, PHEFFER AMATO, JONES,
VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH,
JACOBSON, McMAHON, ABBATE, CAHILL, FERNANDEZ, FRONTUS, EPSTEIN,
BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART,
McDONALD, ENGLEBRIGHT, GALLAGHER, BURKE, KELLES, CYMBROWITZ, CLARK,
MEEKS, BRABENEC, SMITH, MONTESANO, SALKA, SCHMITT, MORINELLO, B. MILL-
ER, ASHBY, M. MILLER, DeSTEFANO, FORREST, GONZALEZ-ROJAS, BURDICK,
MAMDANI, MITAYNES, CONRAD, CUSICK, ANDERSON, ZINERMAN, LAWLER --
Multi-Sponsored by -- M. of A. BARNWELL, COOK, FAHY, GALEF, GLICK,
LUPARDO, McDONOUGH, MIKULIN, PAULIN, PERRY, PRETLOW, RA, D. ROSENTHAL,
SIMON, SOLAGES, THIELE -- read once and referred to the Committee on
Health -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee -- reported and referred to
the Committee on Ways and Means -- committee discharged, bill amended,
ordered reprinted as amended and recommitted to said committee
AN ACT to amend the public health law, in relation to establishing clin-
ical staffing committees
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Section 2805-t of the public health law, as added by chap-
ter 422 of the laws of 2009, is amended to read as follows:
§ 2805-t. [Disclosure] CLINICAL STAFFING COMMITTEES AND DISCLOSURE of
nursing quality indicators. 1. LEGISLATIVE INTENT. THE LEGISLATURE
HEREBY FINDS AND DECLARES:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02466-12-1
A. 108--B 2
(A) RESEARCH DEMONSTRATES THAT NURSES PLAY A CRITICAL ROLE IN IMPROV-
ING PATIENT SAFETY AND QUALITY OF CARE;
(B) APPROPRIATE STAFFING OF GENERAL HOSPITAL PERSONNEL, INCLUDING
REGISTERED NURSES AVAILABLE FOR PATIENT CARE, ASSISTS IN REDUCING
ERRORS, COMPLICATIONS AND ADVERSE PATIENT CARE EVENTS, IMPROVES STAFF
SAFETY AND SATISFACTION, AND REDUCES INCIDENCES OF WORKPLACE INJURIES;
(C) HEALTH CARE PROFESSIONAL, TECHNICAL, AND SUPPORT STAFF COMPRISE
VITAL COMPONENTS OF THE PATIENT CARE TEAM, BRINGING THEIR PARTICULAR
SKILLS AND SERVICES TO ENSURING QUALITY PATIENT CARE;
(D) ENSURING SUFFICIENT STAFFING OF GENERAL HOSPITAL PERSONNEL,
INCLUDING REGISTERED NURSES, IS AN URGENT PUBLIC POLICY PRIORITY IN
ORDER TO PROTECT PATIENTS AND SUPPORT GREATER RETENTION OF REGISTERED
NURSES AND SAFER WORKING CONDITIONS; AND
(E) IT IS THE PUBLIC POLICY OF THE STATE TO PROMOTE EVIDENCE-BASED
NURSE STAFFING STANDARDS AND INCREASE TRANSPARENCY OF HEALTH CARE DATA
AND DECISION MAKING BASED ON THE DATA.
2. CLINICAL STAFFING COMMITTEE. (A) EACH GENERAL HOSPITAL LICENSED
PURSUANT TO THIS ARTICLE SHALL ESTABLISH AND MAINTAIN A CLINICAL STAFF-
ING COMMITTEE, EITHER BY CREATING A NEW COMMITTEE OR ASSIGNING THE FUNC-
TIONS OF THE CLINICAL STAFFING COMMITTEE TO AN EXISTING COMMITTEE, NO
LATER THAN JANUARY FIRST, TWO THOUSAND TWENTY-TWO.
(B) WHERE A COLLECTIVE BARGAINING AGREEMENT PROVIDES FOR A STAFFING
COMMITTEE, THE REQUIRED FUNCTIONS OF THE CLINICAL STAFFING COMMITTEE
ESTABLISHED PURSUANT TO THIS SECTION SHALL BE INCORPORATED INTO THAT
COMMITTEE. ANY STAFFING OR NON-STAFFING COMMITTEES ESTABLISHED BY A
COLLECTIVE BARGAINING AGREEMENT, SHALL CONTINUE TO FUNCTION IN ACCORD-
ANCE WITH THE TERMS OF THE AGREEMENT, AND THE CLINICAL STAFFING COMMIT-
TEE ESTABLISHED BY THIS SECTION SHALL NOT LIMIT OR OTHERWISE SUPPLANT
THE COLLECTIVE BARGAINING AGREEMENT.
(C) AT LEAST ONE-HALF OF THE MEMBERS OF THE CLINICAL STAFFING COMMIT-
TEE SHALL BE REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY
MEMBERS OF THE FRONTLINE TEAM CURRENTLY PROVIDING OR SUPPORTING DIRECT
PATIENT CARE AND UP TO ONE-HALF OF THE MEMBERS SHALL BE SELECTED BY THE
GENERAL HOSPITAL ADMINISTRATION AND SHALL INCLUDE BUT NOT BE LIMITED TO
THE CHIEF FINANCIAL OFFICER, THE CHIEF NURSING OFFICER, AND PATIENT CARE
UNIT DIRECTORS OR MANAGERS OR THEIR DESIGNEES. THE SELECTION OF THE
REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY FRONTLINE
TEAM MEMBERS OF THE COMMITTEE SHALL BE ACCORDING TO THEIR RESPECTIVE
COLLECTIVE BARGAINING AGREEMENTS IF THERE IS ONE IN EFFECT AT THE GENER-
AL HOSPITAL FOR THEIR BARGAINING UNIT. IF THERE IS NO APPLICABLE COLLEC-
TIVE BARGAINING AGREEMENT, THE MEMBERS OF THE CLINICAL STAFFING COMMIT-
TEE WHO ARE REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY
MEMBERS PROVIDING DIRECT PATIENT CARE SHALL BE SELECTED BY THEIR PEERS.
ANCILLARY MEMBERS OF THE FRONTLINE TEAM ON THE COMMITTEE SHALL INCLUDE
BUT ARE NOT LIMITED TO PATIENT CARE TECHNICIANS, CERTIFIED NURSING
ASSISTANTS, OTHER NON-LICENSED STAFF ASSISTING WITH NURSING OR CLERICAL
TASKS, AND UNIT CLERKS.
3. EMPLOYEE PARTICIPATION. PARTICIPATION IN THE CLINICAL STAFFING
COMMITTEE BY A GENERAL HOSPITAL EMPLOYEE SHALL BE ON SCHEDULED WORK TIME
AND COMPENSATED AT THE APPROPRIATE RATE OF PAY. CLINICAL STAFFING
COMMITTEE MEMBERS SHALL BE FULLY RELIEVED OF ALL OTHER WORK DUTIES
DURING MEETINGS OF THE COMMITTEE AND SHALL NOT HAVE WORK DUTIES ADDED OR
DISPLACED TO OTHER TIMES AS A RESULT OF THEIR COMMITTEE RESPONSIBIL-
ITIES.
4. PRIMARY RESPONSIBILITIES. PRIMARY RESPONSIBILITIES OF THE CLINICAL
STAFFING COMMITTEE SHALL INCLUDE THE FOLLOWING FUNCTIONS:
A. 108--B 3
(A) DEVELOPMENT AND OVERSIGHT OF IMPLEMENTATION OF AN ANNUAL CLINICAL
STAFFING PLAN. THE CLINICAL STAFFING PLAN SHALL INCLUDE SPECIFIC STAFF-
ING FOR EACH PATIENT CARE UNIT AND WORK SHIFT AND SHALL BE BASED ON THE
NEEDS OF PATIENTS. STAFFING PLANS SHALL INCLUDE SPECIFIC GUIDELINES OR
RATIOS, MATRICES, OR GRIDS INDICATING HOW MANY PATIENTS ARE ASSIGNED TO
EACH REGISTERED NURSE AND THE NUMBER OF NURSES AND ANCILLARY STAFF TO BE
PRESENT ON EACH UNIT AND SHIFT AND SHALL BE USED AS THE PRIMARY COMPO-
NENT OF THE GENERAL HOSPITAL STAFFING BUDGET.
(B) FACTORS TO BE CONSIDERED AND INCORPORATED IN THE DEVELOPMENT OF
THE PLAN SHALL INCLUDE, BUT ARE NOT LIMITED TO:
(I) CENSUS, INCLUDING TOTAL NUMBERS OF PATIENTS ON THE UNIT ON EACH
SHIFT AND ACTIVITY SUCH AS PATIENT DISCHARGES, ADMISSIONS, AND TRANS-
FERS;
(II) MEASURES OF ACUITY AND INTENSITY OF ALL PATIENTS AND NATURE OF
THE CARE TO BE DELIVERED ON EACH UNIT AND SHIFT;
(III) SKILL MIX;
(IV) THE AVAILABILITY, LEVEL OF EXPERIENCE, AND SPECIALTY CERTIF-
ICATION OR TRAINING OF NURSING PERSONNEL PROVIDING PATIENT CARE, INCLUD-
ING CHARGE NURSES, ON EACH UNIT AND SHIFT;
(V) THE NEED FOR SPECIALIZED OR INTENSIVE EQUIPMENT;
(VI) THE ARCHITECTURE AND GEOGRAPHY OF THE PATIENT CARE UNIT, INCLUD-
ING BUT NOT LIMITED TO PLACEMENT OF PATIENT ROOMS, TREATMENT AREAS,
NURSING STATIONS, MEDICATION PREPARATION AREAS, AND EQUIPMENT;
(VII) MECHANISMS AND PROCEDURES TO PROVIDE FOR ONE-TO-ONE PATIENT
OBSERVATION, WHEN NEEDED, FOR PATIENTS ON PSYCHIATRIC OR OTHER UNITS AS
APPROPRIATE;
(VIII) OTHER SPECIAL CHARACTERISTICS OF THE UNIT OR COMMUNITY PATIENT
POPULATION, INCLUDING AGE, CULTURAL AND LINGUISTIC DIVERSITY AND NEEDS,
FUNCTIONAL ABILITY, COMMUNICATION SKILLS, AND OTHER RELEVANT SOCIAL OR
SOCIO-ECONOMIC FACTORS;
(IX) MEASURES TO INCREASE WORKER AND PATIENT SAFETY, WHICH COULD
INCLUDE MEASURES TO IMPROVE PATIENT THROUGHPUT;
(X) STAFFING GUIDELINES ADOPTED OR PUBLISHED BY OTHER STATES OR LOCAL
JURISDICTIONS, NATIONAL NURSING PROFESSIONAL ASSOCIATIONS, SPECIALTY
NURSING ORGANIZATIONS, AND OTHER HEALTH PROFESSIONAL ORGANIZATIONS;
(XI) AVAILABILITY OF OTHER PERSONNEL SUPPORTING NURSING SERVICES ON
THE UNIT;
(XII) WAIVER OF PLAN REQUIREMENTS IN THE CASE OF UNFORESEEABLE EMER-
GENCY CIRCUMSTANCES AS DEFINED IN SUBDIVISION FOURTEEN OF THIS SECTION;
(XIII) COVERAGE TO ENABLE REGISTERED NURSES, LICENSED PRACTICAL NURS-
ES, AND ANCILLARY STAFF TO TAKE MEAL AND REST BREAKS, PLANNED TIME OFF,
AND UNPLANNED ABSENCES THAT ARE REASONABLY FORESEEABLE AS REQUIRED BY
LAW OR THE TERMS OF AN APPLICABLE COLLECTIVE BARGAINING AGREEMENT, IF
ANY, BETWEEN THE GENERAL HOSPITAL AND A REPRESENTATIVE OF THE NURSING OR
ANCILLARY STAFF;
(XIV) THE NURSING QUALITY INDICATORS REQUIRED UNDER SUBDIVISION SEVEN-
TEEN OF THIS SECTION;
(XV) GENERAL HOSPITAL FINANCES AND RESOURCES; AND
(XVI) PROVISIONS FOR LIMITED SHORT-TERM ADJUSTMENTS MADE BY APPROPRI-
ATE GENERAL HOSPITAL PERSONNEL OVERSEEING PATIENT CARE OPERATIONS TO THE
STAFFING LEVELS REQUIRED BY THE PLAN, NECESSARY TO ACCOUNT FOR UNEX-
PECTED CHANGES IN CIRCUMSTANCES THAT ARE TO BE OF LIMITED DURATION.
(C) SEMIANNUAL REVIEW OF THE STAFFING PLAN AGAINST PATIENT NEEDS AND
KNOWN EVIDENCE-BASED STAFFING INFORMATION, INCLUDING THE NURSING SENSI-
TIVE QUALITY INDICATORS COLLECTED BY THE GENERAL HOSPITAL.
A. 108--B 4
(D) REVIEW, ASSESSMENT, AND RESPONSE TO COMPLAINTS REGARDING POTENTIAL
VIOLATIONS OF THE ADOPTED STAFFING PLAN, STAFFING VARIATIONS, OR OTHER
CONCERNS REGARDING THE IMPLEMENTATION OF THE STAFFING PLAN AND WITHIN
THE PURVIEW OF THE COMMITTEE.
5. COMPLIANCE PROVISIONS. (A) THE CLINICAL STAFFING PLAN SHALL COMPLY
WITH ALL FEDERAL AND STATE LAWS AND REGULATIONS AND SHALL NOT DIMINISH
OTHER STANDARDS CONTAINED IN STATE OR FEDERAL LAW AND REGULATIONS, OR
THE TERMS OF AN APPLICABLE COLLECTIVE BARGAINING AGREEMENT, IF ANY.
(B) THE CLINICAL STAFFING PLAN SHALL COMPLY WITH APPLICABLE LAWS AND
REGULATIONS, INCLUDING, BUT NOT LIMITED TO:
(I) REGULATIONS MADE BY THE DEPARTMENT ON BURN UNIT STAFFING, LIVER
TRANSPLANT STAFFING, AND OPERATING ROOM CIRCULATING NURSE STAFFING;
(II) STAFFING REGULATIONS TO BE PROMULGATED BY THE COMMISSIONER RELAT-
ING TO STAFFING IN INTENSIVE CARE AND CRITICAL CARE UNITS NO LATER THAN
JANUARY FIRST, TWO THOUSAND TWENTY-TWO. SUCH REGULATIONS SHALL CONSIDER
THE FACTORS SET FORTH IN PARAGRAPH (B) OF SUBDIVISION FOUR OF THIS
SECTION, STANDARDS IN PLACE IN NEIGHBORING STATES, AND A MINIMUM STAND-
ARD OF TWELVE HOURS OF REGISTERED NURSE CARE PER PATIENT PER DAY;
(III) SUCH OTHER STAFFING STANDARDS OR REGULATIONS AS ARE CURRENTLY IN
EFFECT OR MAY HEREAFTER BE ESTABLISHED BY THE DEPARTMENT OR ENACTED BY
THE LEGISLATURE; AND
(IV) THE PROVISIONS OF SECTION ONE HUNDRED SIXTY-SEVEN OF THE LABOR
LAW AND ANY RELATED REGULATIONS.
(C) THE CLINICAL STAFFING PLAN SHALL COMPLY WITH AND INCORPORATE ANY
MINIMUM STAFFING LEVELS PROVIDED FOR IN ANY APPLICABLE COLLECTIVE
BARGAINING AGREEMENT, INCLUDING BUT NOT LIMITED TO NURSE-TO-PATIENT
RATIOS, CAREGIVER-TO-PATIENT RATIOS, STAFFING GRIDS, STAFFING MATRICES,
OR OTHER STAFFING PROVISIONS.
6. PROCESS FOR ADOPTION OF CLINICAL STAFFING PLANS. (A) THE CLINICAL
STAFFING COMMITTEE SHALL PRODUCE THE GENERAL HOSPITAL'S ANNUAL CLINICAL
STAFFING PLAN BY JULY FIRST OF EACH YEAR.
(B) CLINICAL STAFFING PLANS SHALL BE DEVELOPED AND ADOPTED BY CONSEN-
SUS OF THE CLINICAL STAFFING COMMITTEE. FOR THE PURPOSES OF DETERMINING
WHETHER THERE IS A CONSENSUS, THE MANAGEMENT MEMBERS OF THE COMMITTEE
SHALL HAVE ONE VOTE AND THE EMPLOYEE MEMBERS OF THE COMMITTEE SHALL HAVE
ONE VOTE, REGARDLESS OF THE ACTUAL NUMBER OF MEMBERS OF THE COMMITTEE.
EACH SIDE MAY DETERMINE ITS OWN METHOD OF CASTING ITS VOTE TO ADOPT ALL
OR PART OF THE CLINICAL STAFFING PLAN.
(C) THE GENERAL HOSPITAL SHALL ADOPT ANY CLINICAL STAFFING PLAN THAT
IS WHOLLY OR PARTIALLY RECOMMENDED BY A CONSENSUS OF THE CLINICAL STAFF-
ING COMMITTEE. IF THERE IS NO CONSENSUS ON THE RECOMMENDED STAFFING PLAN
OR ANY OF ITS PARTS, THE CHIEF EXECUTIVE OFFICER OF THE GENERAL HOSPITAL
SHALL USE THE OFFICER'S DISCRETION TO ADOPT A PLAN OR PARTIAL PLAN FOR
WHICH THERE IS NO CONSENSUS. IN THIS CASE, THE CHIEF EXECUTIVE OFFICER
SHALL PROVIDE A WRITTEN EXPLANATION OF THE ELEMENTS OF THE CLINICAL
STAFFING PLAN THAT THE COMMITTEE WAS UNABLE TO AGREE ON, INCLUDING THE
FINAL WRITTEN PROPOSALS FROM THE TWO PARTIES AND THEIR RATIONALES. IN NO
EVENT MAY A CHIEF EXECUTIVE OFFICER FAIL TO INCLUDE IN THE ADOPTED PLAN
ANY STAFFING RELATED TERMS AND CONDITIONS OF THE PLAN THAT HAS PREVIOUS-
LY BEEN ADOPTED THROUGH ANY APPLICABLE COLLECTIVE BARGAINING AGREEMENT.
(D) EACH GENERAL HOSPITAL SHALL ADOPT AND SUBMIT ITS FIRST HOSPITAL
CLINICAL STAFFING PLAN UNDER THIS SECTION TO THE DEPARTMENT NO LATER
THAN JULY FIRST, TWO THOUSAND TWENTY-TWO AND ANNUALLY THEREAFTER. THE
PLAN SUBMITTED TO THE DEPARTMENT SHALL, WHERE APPLICABLE, INCLUDE THE
WRITTEN EXPLANATION FROM THE CHIEF EXECUTIVE OFFICER AND WRITTEN
PROPOSALS FROM THE TWO PARTIES REGARDING ELEMENTS THAT THE COMMITTEE DID
A. 108--B 5
NOT AGREE ON AS REQUIRED IN PARAGRAPH (C) OF THIS SUBDIVISION. THE
SUBMITTED CLINICAL STAFFING PLAN SHALL INCLUDE DATA, FROM AT LEAST THE
PREVIOUS YEAR, ON THE FREQUENCY AND DURATION OF VARIATIONS FROM THE
ADOPTED CLINICAL STAFFING PLAN, THE NUMBER OF COMPLAINTS RELATING TO THE
CLINICAL STAFFING PLAN AND THEIR DISPOSITION, AS WELL AS DESCRIPTIONS OF
UNRESOLVED COMPLAINTS SUBMITTED PURSUANT TO PARAGRAPH (B) OF SUBDIVISION
SEVEN OF THIS SECTION. THE DEPARTMENT SHALL POST THE PLAN AS PART OF
EACH INDIVIDUAL GENERAL HOSPITAL'S HEALTH PROFILE ON THE WEBSITE OF THE
DEPARTMENT NO LATER THAN JULY THIRTY-FIRST OF EACH YEAR. IF THE ADOPTED
CLINICAL STAFFING PLAN IS SUBSEQUENTLY AMENDED, THE AMENDED PLAN SHALL
BE SUBMITTED TO THE DEPARTMENT WITHIN THIRTY DAYS OF ADOPTION. ADOPTED
STAFFING PLANS SHALL BE AMENDED TO INCLUDE NEWLY CREATED UNITS AND
EXISTING UNITS THAT UNDERGO CLINICAL OR PROGRAMMATIC CHANGES THAT FUNDA-
MENTALLY ALTER THEIR CHARACTER OR NATURE. THE DEPARTMENT SHALL POST
AMENDED STAFFING PLANS UPON RECEIPT.
7. IMPLEMENTATION OF CLINICAL STAFFING PLANS. (A) BEGINNING JANUARY
FIRST, TWO THOUSAND TWENTY-THREE, AND ANNUALLY THEREAFTER, EACH GENERAL
HOSPITAL SHALL IMPLEMENT THE CLINICAL STAFFING PLAN ADOPTED BY JULY
FIRST OF THE PRIOR CALENDAR YEAR, AND ANY SUBSEQUENT AMENDMENTS, AND
ASSIGN PERSONNEL TO EACH PATIENT CARE UNIT IN ACCORDANCE WITH THE PLAN.
(B) A REGISTERED NURSE, LICENSED PRACTICAL NURSE, ANCILLARY MEMBER OF
THE FRONTLINE TEAM, OR COLLECTIVE BARGAINING REPRESENTATIVE MAY REPORT
TO THE CLINICAL STAFFING COMMITTEE ANY VARIATIONS WHERE THE PERSONNEL
ASSIGNMENT IN A PATIENT CARE UNIT IS NOT IN ACCORDANCE WITH THE ADOPTED
STAFFING PLAN AND MAY MAKE A COMPLAINT TO THE COMMITTEE BASED ON THE
VARIATIONS.
(C) THE CLINICAL STAFFING COMMITTEE SHALL DEVELOP A PROCESS TO EXAM-
INE, RESPOND TO, AND TRACK DATA SUBMITTED UNDER PARAGRAPH (B) OF THIS
SUBDIVISION. THE CLINICAL STAFFING COMMITTEE MAY BY CONSENSUS, AS
DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION, DETERMINE
A COMPLAINT RESOLVED OR DISMISSED. THE CLINICAL STAFFING COMMITTEE SHALL
ALSO ESTABLISH AGREED UPON RULES AND CRITERIA TO PROVIDE FOR CONFIDEN-
TIALITY OF COMPLAINTS THAT ARE IN THE PROCESS OF BEING EXAMINED OR ARE
FOUND TO BE UNSUBSTANTIATED. THIS SUBDIVISION DOES NOT INFRINGE UPON OR
LIMIT THE RIGHTS OF ANY COLLECTIVE BARGAINING REPRESENTATIVE OF EMPLOY-
EES, OR OF ANY EMPLOYEE OR GROUP OF EMPLOYEES PURSUANT TO APPLICABLE
LAW, INCLUDING WITHOUT LIMITATION ANY APPLICABLE STATE OR FEDERAL LABOR
LAWS.
8. POSTING OF STAFFING INFORMATION. EACH GENERAL HOSPITAL SHALL POST,
IN A PUBLICLY CONSPICUOUS AREA ON EACH PATIENT CARE UNIT, THE CLINICAL
STAFFING PLAN FOR THAT UNIT AND THE ACTUAL DAILY STAFFING FOR THAT SHIFT
ON THAT UNIT AS WELL AS THE RELEVANT CLINICAL STAFFING.
9. RETALIATION AND INTIMIDATION PROHIBITED. A GENERAL HOSPITAL SHALL
NOT RETALIATE AGAINST OR ENGAGE IN ANY FORM OF INTIMIDATION OF:
(A) AN EMPLOYEE FOR PERFORMING ANY DUTIES OR RESPONSIBILITIES IN
CONNECTION WITH THE CLINICAL STAFFING COMMITTEE; OR
(B) AN EMPLOYEE, PATIENT, OR OTHER INDIVIDUAL WHO NOTIFIES THE CLIN-
ICAL STAFFING COMMITTEE OR THE HOSPITAL ADMINISTRATION OF THE INDIVID-
UAL'S STAFFING CONCERNS.
10. SPECIAL CONSIDERATIONS. NOTHING IN THIS SECTION IS INTENDED TO
CREATE UNREASONABLE BURDENS ON CRITICAL ACCESS HOSPITALS UNDER 42 U.S.C.
SEC. 1395I-4 AND SOLE COMMUNITY HOSPITALS UNDER 42 U.S.C. SEC.
1395WW(D)(5) RELATED TO THE OPERATION OF THEIR CLINICAL STAFFING COMMIT-
TEES. CRITICAL ACCESS AND SOLE COMMUNITY HOSPITALS MAY DEVELOP FLEXIBLE
APPROACHES TO ACCOMPLISH THE REQUIREMENTS OF THIS SECTION. CLINICAL
STAFFING PLANS FROM SUCH ENTITIES SUBMITTED TO THE DEPARTMENT SHALL
A. 108--B 6
CONTAIN A DESCRIPTION OF ANY WAYS IN WHICH THE GENERAL HOSPITAL'S
APPROACH TO CREATING THE PLAN DIFFERED FROM THE PROCESS OUTLINED IN THIS
SECTION. THIS SUBDIVISION DOES NOT RELIEVE SUCH ENTITIES FROM COMPLI-
ANCE WITH OTHER PROVISIONS OF THIS SECTION RELATED TO THE ADOPTION,
IMPLEMENTATION AND ADHERENCE TO AN ADOPTED CLINICAL STAFFING PLAN,
REPORTING AND DISCLOSURE, OR OTHER REQUIREMENTS OF THIS SECTION.
11. INVESTIGATIONS. (A) THE DEPARTMENT SHALL INVESTIGATE POTENTIAL
VIOLATIONS OF THIS SECTION FOLLOWING RECEIPT OF A COMPLAINT WITH
SUPPORTING EVIDENCE, OF FAILURE TO:
(I) FORM OR ESTABLISH A CLINICAL STAFFING COMMITTEE;
(II) COMPLY WITH THE REQUIREMENTS OF THIS SECTION IN CREATING A CLIN-
ICAL STAFFING PLAN;
(III) ADOPT ALL OR PART OF A CLINICAL STAFFING PLAN THAT IS APPROVED
BY CONSENSUS OF THE CLINICAL STAFFING COMMITTEE AND SUBMITTED TO THE
DEPARTMENT;
(IV) CONDUCT A SEMIANNUAL REVIEW OF A CLINICAL STAFFING PLAN; OR
(V) SUBMIT TO THE DEPARTMENT A CLINICAL STAFFING PLAN ON AN ANNUAL
BASIS AND ANY UPDATES.
(B) THE DEPARTMENT SHALL INITIATE AN INVESTIGATION OF UNRESOLVED
COMPLAINTS, THAT HAVE FIRST BEEN SUBMITTED TO THE CLINICAL STAFFING
COMMITTEE, REGARDING COMPLIANCE WITH THE CLINICAL STAFFING PLAN, PERSON-
NEL ASSIGNMENTS IN A PATIENT CARE UNIT OR STAFFING LEVELS, OR ANY OTHER
REQUIREMENT OF THE ADOPTED CLINICAL STAFFING PLAN, EXCLUDING COMPLAINTS
DETERMINED BY THE CLINICAL STAFFING COMMITTEE TO BE RESOLVED OR
DISMISSED AS DETERMINED BY CONSENSUS OF THE CLINICAL STAFFING COMMITTEE
AS DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION.
(C) THE DEPARTMENT SHALL INITIATE AN INVESTIGATION AFTER MAKING AN
ASSESSMENT THAT THERE IS A PATTERN OF FAILURE TO RESOLVE COMPLAINTS
SUBMITTED TO THE CLINICAL STAFFING COMMITTEE OR A PATTERN OF FAILURE TO
REACH CONSENSUS ON THE ADOPTION OF ALL OR PART OF A CLINICAL STAFFING
PLAN. IN THE CASE OF A PATTERN OF FAILURE TO RESOLVE COMPLAINTS OR TO
REACH CONSENSUS ON THE ADOPTION OF ALL OR PART OF A CLINICAL STAFFING
PLAN, THE DEPARTMENT SHALL DETERMINE IF THE PATTERN WAS DUE TO ONE OF
THE PARTIES ROUTINELY REFUSING TO RESOLVE COMPLAINTS OR REACH CONSENSUS.
(D) ANY DEPARTMENT INVESTIGATION OF A COMPLAINT UNDER THIS SUBDIVISION
SHALL CONSIDER WHETHER UNFORESEEABLE EMERGENCY CIRCUMSTANCES AS DEFINED
IN SUBDIVISION FOURTEEN OF THIS SECTION CONTRIBUTED TO THE FAILURE OF
THE GENERAL HOSPITAL TO COMPLY WITH THIS SECTION.
(E) AFTER AN INVESTIGATION CONDUCTED UNDER PARAGRAPH (A) OR (B) OF
THIS SUBDIVISION, IF THE DEPARTMENT DETERMINES THAT THERE HAS BEEN A
VIOLATION, THE DEPARTMENT SHALL REQUIRE THE GENERAL HOSPITAL TO SUBMIT A
CORRECTIVE PLAN OF ACTION WITHIN FORTY-FIVE DAYS OF THE PRESENTATION OF
FINDINGS FROM THE DEPARTMENT TO THE HOSPITAL. IF THE DEPARTMENT DETER-
MINES AFTER INVESTIGATION UNDER PARAGRAPH (C) OF THIS SUBDIVISION THAT
THE GENERAL HOSPITAL REPRESENTATIVES ON THE CLINICAL STAFFING COMMITTEE
WERE RESPONSIBLE FOR A PATTERN OF NOT RESOLVING COMPLAINTS OR FOR A
PATTERN OF NOT REACHING CONSENSUS, THE DEPARTMENT SHALL REQUIRE THE
GENERAL HOSPITAL TO SUBMIT A CORRECTIVE ACTION PLAN WITHIN FORTY-FIVE
DAYS OF THE PRESENTATION OF FINDINGS TO THE GENERAL HOSPITAL. IF THE
DEPARTMENT FINDS THAT THE FRONTLINE STAFF REPRESENTATIVES ON THE CLIN-
ICAL STAFFING COMMITTEE WERE RESPONSIBLE FOR A PATTERN OF NOT RESOLVING
COMPLAINTS OR FOR A PATTERN OF NOT REACHING CONSENSUS, THE DEPARTMENT
SHALL NOT REQUIRE THE GENERAL HOSPITAL TO SUBMIT A CORRECTIVE ACTION
PLAN OR IMPOSE A CIVIL PENALTY ON THE GENERAL HOSPITAL PURSUANT TO
SUBDIVISION TWELVE OF THIS SECTION.
A. 108--B 7
12. CIVIL PENALTIES. IN THE EVENT THAT A GENERAL HOSPITAL FAILS TO
SUBMIT OR SUBMITS BUT FAILS TO IMPLEMENT A CORRECTIVE ACTION PLAN IN
RESPONSE TO A VIOLATION OR VIOLATIONS FOUND BY THE DEPARTMENT BASED ON A
COMPLAINT FILED PURSUANT TO PARAGRAPH (A), (B) OR (C) OF SUBDIVISION
ELEVEN OF THIS SECTION, THE DEPARTMENT MAY IMPOSE A CIVIL PENALTY AS
AUTHORIZED BY SECTION TWELVE OF THIS CHAPTER FOR ALL VIOLATIONS ASSERTED
AGAINST THE GENERAL HOSPITAL, UNTIL THE GENERAL HOSPITAL SUBMITS OR
IMPLEMENTS A CORRECTIVE ACTION PLAN OR TAKES OTHER ACTION DIRECTED BY
THE DEPARTMENT.
13. POSTING OF PENALTIES AND RELATED INFORMATION. THE DEPARTMENT SHALL
MAINTAIN FOR PUBLIC INSPECTION, INCLUDING POSTING ON THE GENERAL HOSPI-
TAL PROFILE ON THE DEPARTMENT WEBSITE, RECORDS OF ANY CIVIL PENALTIES,
ADMINISTRATIVE ACTIONS, OR LICENSE SUSPENSIONS OR REVOCATIONS IMPOSED ON
GENERAL HOSPITALS UNDER THIS SECTION.
14. UNFORESEEABLE EMERGENCY CIRCUMSTANCES. (A) FOR PURPOSES OF THIS
SECTION, "UNFORESEEABLE EMERGENCY CIRCUMSTANCE" MEANS:
(I) ANY OFFICIALLY DECLARED NATIONAL, STATE, OR MUNICIPAL EMERGENCY;
(II) WHEN A GENERAL HOSPITAL DISASTER PLAN IS ACTIVATED; OR
(III) ANY UNFORESEEN DISASTER OR OTHER CATASTROPHIC EVENT THAT IMME-
DIATELY AFFECTS OR INCREASES THE NEED FOR HEALTH CARE SERVICES.
(B) IN DETERMINING WHETHER A GENERAL HOSPITAL HAS VIOLATED ITS OBLI-
GATIONS UNDER THIS SECTION TO COMPLY WITH THE GENERAL HOSPITAL'S CLIN-
ICAL STAFFING PLAN, IT SHALL NOT BE A DEFENSE THAT IT WAS UNABLE TO
SECURE SUFFICIENT STAFF IF THE LACK OF STAFFING WAS FORESEEABLE AND
COULD BE PRUDENTLY PLANNED FOR OR INVOLVED ROUTINE NURSE STAFFING NEEDS
THAT AROSE DUE TO TYPICAL STAFFING PATTERNS, TYPICAL LEVELS OF ABSENTEE-
ISM, AND TIME OFF TYPICALLY APPROVED BY THE EMPLOYER FOR VACATION, HOLI-
DAYS, SICK LEAVE, AND PERSONAL LEAVE.
15. COMPLAINTS. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PRECLUDE
THE ABILITY TO SUBMIT A COMPLAINT TO THE DEPARTMENT AS PROVIDED FOR
UNDER THIS CHAPTER. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS
SUPPLANTING OTHER COMPLAINT MECHANISMS ESTABLISHED BY A GENERAL HOSPI-
TAL, INCLUDING MECHANISMS DESIGNED TO AID IN COMPLIANCE WITH OTHER
FEDERAL, STATE OR LOCAL LAWS. NOTHING IN THIS SECTION SHALL BE
CONSTRUED AS LIMITING OR SUPPLANTING THE RIGHTS OF EMPLOYEES AND THEIR
COLLECTIVE BARGAINING REPRESENTATIVES TO FULLY ENFORCE ANY AND ALL
RIGHTS UNDER THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT. AN EMPLOY-
ER SHALL NOT ASSERT OR ATTEMPT TO ASSERT A CLAIM THAT ENFORCEMENT OF THE
COLLECTIVE BARGAINING AGREEMENT IS BARRED OR LIMITED BY ANY PROVISIONS
OF THIS SECTION.
16. ANNUAL REPORT. (A) THE DEPARTMENT SHALL SUBMIT AN ANNUAL REPORT TO
THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND
THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE AND THE
GOVERNOR ON OR BEFORE DECEMBER THIRTY-FIRST OF EACH YEAR. THIS REPORT
SHALL INCLUDE THE NUMBER OF COMPLAINTS SUBMITTED TO THE DEPARTMENT, THE
DISPOSITION OF THESE COMPLAINTS, THE NUMBER OF INVESTIGATIONS CONDUCTED,
AND THE ASSOCIATED COSTS FOR COMPLAINT INVESTIGATIONS, IF ANY.
(B) PRIOR TO THE SUBMISSION OF THE REPORT, THE COMMISSIONER SHALL
CONVENE A STAKEHOLDER WORKGROUP CONSISTING OF HOSPITAL ASSOCIATIONS AND
UNIONS REPRESENTING NURSES AND OTHER ANCILLARY MEMBERS OF THE FRONTLINE
TEAM. THE STAKEHOLDER WORKGROUP SHALL REVIEW THE REPORT PRIOR TO ITS
SUBMISSION TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF
THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND
SENATE.
17. DISCLOSURE OF NURSING QUALITY INDICATORS. (A) Every facility with
an operating certificate pursuant to the requirements of this article
A. 108--B 8
shall make available to the public information regarding nurse staffing
and patient outcomes as specified by the commissioner by rule and regu-
lation. The commissioner shall promulgate rules and regulations on the
disclosure of nursing quality indicators providing for the disclosure of
information including at least the following, as appropriate to the
reporting facility:
[(a)] (I) The number of registered nurses providing direct care and
the ratio of patients per registered nurse, full-time equivalent,
providing direct care. This information shall be expressed in actual
numbers, in terms of total hours of nursing care per patient, including
adjustment for case mix and acuity, and as a percentage of patient care
staff, and shall be broken down in terms of the total patient care
staff, each unit, and each shift.
[(b)] (II) The number of licensed practical nurses providing direct
care. This information shall be expressed in actual numbers, in terms of
total hours of nursing care per patient including adjustment for case
mix and acuity, and as a percentage of patient care staff, and shall be
broken down in terms of the total patient care staff, each unit, and
each shift.
[(c)] (III) The number of unlicensed personnel utilized to provide
direct patient care, including adjustment for case mix and acuity. This
information shall be expressed both in actual numbers and as a percent-
age of patient care staff and shall be broken down in terms of the total
patient care staff, each unit, and each shift.
[(d)] (IV) Incidence of adverse patient care, including incidents such
as medication errors, patient injury, decubitus ulcers, nosocomial
infections, and nosocomial urinary tract infections.
[(e)] (V) Methods used for determining and adjusting staffing levels
and patient care needs and the facility's compliance with these methods.
[(f)] (VI) Data regarding complaints filed with any state or federal
regulatory agency, or an accrediting agency, and data regarding investi-
gations and findings as a result of those complaints, degree of compli-
ance with acceptable standards, and the findings of scheduled inspection
visits.
[2.] (B) Such information shall be provided to the commissioner of any
state agency responsible for licensing or accrediting the facility, or
responsible for overseeing the delivery of services either directly or
indirectly, TO ANY EMPLOYEE OF A GENERAL HOSPITAL OR THE EMPLOYEE'S
COLLECTIVE BARGAINING AGENT, IF ANY, and to any member of the public who
requests such information directly from the facility. Written statements
containing such information shall state the source and date thereof.
(C) THE COMMISSIONER SHALL MAKE REGULATIONS TO PROVIDE A UNIFORM
FORMAT OR FORM FOR COMPLYING WITH THE REPORTING REQUIREMENTS OF SUBPARA-
GRAPHS (I), (II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION, ALLOW-
ING PATIENTS AND THE PUBLIC TO CLEARLY UNDERSTAND AND COMPARE STAFFING
PATTERNS AND ACTUAL LEVELS OF STAFFING ACROSS FACILITIES. SUCH UNIFORM
FORMAT OR FORM SHALL ALLOW FACILITIES TO INCLUDE A DESCRIPTION OF ADDI-
TIONAL RESOURCES AVAILABLE TO SUPPORT UNIT LEVEL PATIENT CARE AND A
DESCRIPTION OF THE GENERAL HOSPITAL. THE INFORMATION REQUIRED BY SUBPAR-
AGRAPHS (I), (II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION,
REPORTED IN A MANNER DETERMINED BY THE COMMISSIONER, SHALL BE FILED WITH
THE DEPARTMENT ELECTRONICALLY ON A QUARTERLY BASIS AND SHALL BE AVAIL-
ABLE TO THE PUBLIC ON THE DEPARTMENT'S WEBSITE. THE REGULATIONS SHALL
TAKE EFFECT NO LATER THAN DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY-
TWO. INFORMATION REQUIRED TO BE PROVIDED PURSUANT TO SUBPARAGRAPHS (I),
A. 108--B 9
(II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION SHALL BE MADE AVAIL-
ABLE TO THE PUBLIC NO LATER THAN JULY FIRST, TWO THOUSAND TWENTY-THREE.
18. ADVISORY COMMISSION. (A) THERE IS HEREBY ESTABLISHED AN INDEPEND-
ENT ADVISORY COMMISSION, COMPOSED OF NINE EXPERTS IN STAFFING STANDARDS
AND QUALITY OF PATIENT CARE, INCLUDING: THREE EXPERTS IN NURSING PRAC-
TICE, QUALITY OF NURSING CARE OR PATIENT CARE STANDARDS, ONE OF WHOM
SHALL BE APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED BY
THE SPEAKER OF THE ASSEMBLY AND ONE OF WHOM SHALL BE APPOINTED BY THE
TEMPORARY PRESIDENT OF THE SENATE; THREE REPRESENTATIVES OF UNIONS
REPRESENTING NURSES, ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR, ONE
OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE OF
WHOM SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE; AND
THREE MEMBERS REPRESENTING GENERAL HOSPITALS, ONE OF WHOM SHALL BE
APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER
OF THE ASSEMBLY AND ONE OF WHOM SHALL BE APPOINTED BY THE TEMPORARY
PRESIDENT OF THE SENATE. THE MEMBERS OF THE COMMISSION SHALL SERVE AT
THE PLEASURE OF THE APPOINTING OFFICIAL. MEMBERS OF THE COMMISSION
SHALL KEEP CONFIDENTIAL ANY INFORMATION RECEIVED IN THE COURSE OF THEIR
DUTIES AND MAY ONLY USE SUCH INFORMATION IN THE COURSE OF CARRYING OUT
THEIR DUTIES ON THE COMMISSION, EXCEPT THOSE REPORTS REQUIRED TO BE
ISSUED BY THE COMMISSION UNDER THIS SECTION, WHICH MAY ONLY INCLUDE
DE-IDENTIFIED INFORMATION.
(B) THE ADVISORY COMMISSION SHALL CONVENE FROM TIME TO TIME IN ORDER
TO EVALUATE THE EFFECTIVENESS OF THE CLINICAL STAFFING COMMITTEES
REQUIRED BY THIS SECTION. SUCH REVIEW SHALL EVALUATE THE FOLLOWING
METRICS, INCLUDING BUT NOT LIMITED TO QUANTITATIVE AND QUALITATIVE DATA
ON WHETHER STAFFING LEVELS WERE IMPROVED AND MAINTAINED, PATIENT SATIS-
FACTION, EMPLOYEE SATISFACTION, PATIENT QUALITY OF CARE METRICS, WORK-
PLACE SAFETY, AND ANY OTHER METRICS THE COMMISSION DEEMS RELEVANT. THE
COMMISSION SHALL ALSO REVIEW THE ANNUAL REPORT SUBMITTED BY THE DEPART-
MENT AND MAKE RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPO-
RARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF
THE ASSEMBLY AND SENATE AS SET FORTH IN PARAGRAPH (D) OF THIS SUBDIVI-
SION.
(C) THE ADVISORY COMMISSION MAY COLLECT AND SHALL BE PROVIDED ALL
RELEVANT INFORMATION, NECESSARY TO CARRY OUT ITS FUNCTIONS, FROM THE
DEPARTMENT AND OTHER STATE AGENCIES. THE COMMISSION MAY ALSO INVITE
TESTIMONY BY EXPERTS IN THE FIELD AND FROM THE PUBLIC. IN MAKING ITS
RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT
OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY
AND SENATE, THE COMMISSION SHALL ANALYZE RELEVANT DATA, INCLUDING DATA
AND FACTORS SET FORTH IN PARAGRAPH (B) OF SUBDIVISION FOUR OF THIS
SECTION RELATED TO CLINICAL STAFFING PLANS. THE COMMISSION MAY ALSO
MAKE RECOMMENDATIONS FOR ADDITIONAL OR ENHANCED ENFORCEMENT MECHANISMS
OR POWERS TO ADDRESS GENERAL HOSPITAL FAILURE TO COMPLY WITH THIS
SECTION AND RECOMMEND THE APPROPRIATION OF FUNDING FOR THE DEPARTMENT TO
ENFORCE THIS SECTION OR TO ASSIST GENERAL HOSPITALS IN HIRING ADDITIONAL
STAFF TO COMPLY WITH THIS SECTION.
(D) THE ADVISORY COMMISSION SHALL SUBMIT TO THE SPEAKER OF THE ASSEM-
BLY, THE TEMPORARY PRESIDENT OF THE SENATE AND THE CHAIRS OF THE HEALTH
COMMITTEES OF THE ASSEMBLY AND SENATE, AND MAKE AVAILABLE TO THE PUBLIC
A REPORT THAT MAKES RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE
TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMIT-
TEES OF THE ASSEMBLY AND SENATE FOR FURTHER LEGISLATIVE ACTION, IF ANY,
IN ORDER TO IMPROVE WORKING CONDITIONS AND QUALITY OF CARE IN GENERAL
HOSPITALS PURSUANT TO THIS SECTION AND ITS INTENT.
A. 108--B 10
(E) THE COMMISSION SHALL SUBMIT ITS REPORT AND RECOMMENDATIONS TO THE
SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE
CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE NO LATER THAN
OCTOBER THIRTY-FIRST, TWO THOUSAND TWENTY-FOUR, ONCE THREE YEARS OF
STAFFING PLANS HAVE BEEN SUBMITTED TO THE DEPARTMENT PURSUANT TO THIS
SECTION.
(F) MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR THEIR
SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES
INCURRED IN THE PERFORMANCE OF THEIR DUTIES HEREUNDER.
(G) THE LEGISLATURE MAY APPROPRIATE FUNDING FOR THE COMMISSION TO HIRE
STAFF OR CONSULTANTS AND PROVIDE FOR THE OPERATION OF THE COMMISSION AS
REASONABLY NECESSARY TO FULFILL ITS FUNCTIONS.
§ 2. If any provision of this act, or any application of any provision
of this act, is held to be invalid, or to violate or be inconsistent
with any federal law or regulation, 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, which can be given effect
without that provision or application; and to that end, the provisions
and applications of this act are severable.
§ 3. This act shall take effect immediately.