S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                    108
 
                        2021-2022 Regular Sessions
 
                           I N  A S S E M B L Y
 
                                (PREFILED)
 
                              January 6, 2021
                                ___________
 
 Introduced  by M. of A. GUNTHER, CRUZ, GOTTFRIED, BARRETT, L. ROSENTHAL,
   SMITH, BRONSON, COLTON, MONTESANO,  BRABENEC,  BENEDETTO,  MAGNARELLI,
   SALKA,  DeSTEFANO, WEPRIN, SCHMITT, J. RIVERA, FALL, AUBRY, MORINELLO,
   OTIS, STECK,  B. MILLER,  ASHBY,  SANTABARBARA,  ZEBROWSKI,  ABINANTI,
   BARRON,    SEAWRIGHT,    WALKER,    BICHOTTE,   RICHARDSON,   HYNDMAN,
   PEOPLES-STOKES, 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  --  Multi-Sponsored  by  --  M. of A. BARNWELL, COOK,
   CUSICK, CYMBROWITZ, ENGLEBRIGHT, FAHY, GALEF,  GLICK,  LUPARDO,  McDO-
   NOUGH,  MIKULIN,  PAULIN,  PERRY, PRETLOW -- read once and referred to
   the Committee on Health
 
 AN ACT to amend the public health law, in relation to enacting the "safe
   staffing for quality care act"
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "safe staffing for quality care act".
   § 2. Paragraphs (a) and (b) of subdivision 2 of section  2805  of  the
 public  health  law, paragraph (a) as amended by chapter 923 of the laws
 of 1973 and paragraph (b) as added by chapter 795 of the laws  of  1965,
 are amended to read as follows:
   (a)  Application  for an operating certificate for a hospital shall be
 made upon forms prescribed by  the  department.  The  application  shall
 [contain]  INCLUDE the name of the hospital, the kind or kinds of hospi-
 tal service to be provided, the location and physical description of the
 institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN  SECTION  TWENTY-

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

                                                            LBD02466-01-1

 A. 108                              2
 
 EIGHT HUNDRED TWENTY-NINE OF THIS ARTICLE, and such other information as
 the department may require.
   (b)  An  operating  certificate  shall not be issued by the department
 unless it finds that  the  premises,  equipment,  personnel,  DOCUMENTED
 STAFFING  PLAN, rules and by-laws, standards of medical care, and hospi-
 tal service are fit and adequate and that the hospital will be  operated
 in  the manner required by this article and rules and regulations there-
 under.
   § 3. The public health law is amended  by  adding  nine  new  sections
 2828,  2829,  2830,  2831,  2832,  2833,  2834, 2835 and 2836 to read as
 follows:
   § 2828. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL  OF
 THE FOLLOWING:
   1.  HEALTH  CARE  SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY
 DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES;
   2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE  STAFF-
 ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES;
   3.  TO  ENSURE  THE  ADEQUATE  PROTECTION  OF  PATIENTS IN HEALTH CARE
 SETTINGS, IT IS ESSENTIAL THAT QUALIFIED  REGISTERED  NURSES  AND  OTHER
 LICENSED  NURSES  BE  ACCESSIBLE  AND  AVAILABLE  TO  MEET  THE NEEDS OF
 PATIENTS; AND
   4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING  SHOULD
 BE  BASED  ON  THE  PATIENT'S  CARE  NEEDS,  THE  SEVERITY OF CONDITION,
 SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES.
   § 2829. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS  AND  PHRASES,
 AS  USED  IN  THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE
 CONTEXT OTHERWISE PLAINLY REQUIRES:
   1. "ACUTE CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN  A  RESIDEN-
 TIAL  HEALTH  CARE  FACILITY  AND  SHALL  ALSO INCLUDE ANY FACILITY THAT
 PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW,  ARTI-
 CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL-
 ITY  IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR
 A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION.
   2. "ACUITY SYSTEM" SHALL MEAN AN  ESTABLISHED  MEASUREMENT  INSTRUMENT
 WHICH  (A)  PREDICTS  NURSING  CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS
 BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND
 TECHNOLOGY,  INTENSITY  OF  NURSING  INTERVENTIONS  REQUIRED,  AND   THE
 COMPLEXITY  OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND
 EVALUATE THE PATIENT'S NURSING CARE PLAN;  (B)  DETAILS  THE  AMOUNT  OF
 NURSING  CARE  NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL
 MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN
 A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN  TERMS  THAT  READILY
 CAN  BE  USED  AND  UNDERSTOOD  BY DIRECT-CARE NURSES. THE ACUITY SYSTEM
 SHALL TAKE INTO CONSIDERATION THE PATIENT  CARE  SERVICES  PROVIDED  NOT
 ONLY  BY  REGISTERED  PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL
 NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL.
   3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE
 STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT
 NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF  AN  ACUITY
 SYSTEM.
   4.  "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY
 NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY  OUT  MEDICAL
 REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS.
   5.  "DOCUMENTED  STAFFING  PLAN"  SHALL  MEAN  A DETAILED WRITTEN PLAN
 SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS-
 ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY

 A. 108                              3
 
 FOR A GIVEN YEAR, BASED  ON  REASONABLE  PROJECTIONS  DERIVED  FROM  THE
 PATIENT  CENSUS  AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT
 DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE  AND  GEOGRAPHY,  THE
 NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR
 UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR.
   6.  "NURSE"  SHALL  MEAN  A  REGISTERED PROFESSIONAL NURSE OR LICENSED
 PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE  OF
 THE EDUCATION LAW.
   7.  "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION
 OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF
 THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE  RECOGNIZED  STAND-
 ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN-
 NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY.
   8.  "SAFE  STAFFING  REQUIREMENTS"  SHALL  MEAN THE PROVISIONS OF THIS
 SECTION AND  SECTIONS  TWENTY-EIGHT  HUNDRED  TWENTY-NINE,  TWENTY-EIGHT
 HUNDRED  THIRTY,  TWENTY-EIGHT  HUNDRED THIRTY-ONE, TWENTY-EIGHT HUNDRED
 THIRTY-TWO,  TWENTY-EIGHT  HUNDRED  THIRTY-THREE,  TWENTY-EIGHT  HUNDRED
 THIRTY-FOUR,  TWENTY-EIGHT  HUNDRED THIRTY-FIVE AND TWENTY-EIGHT HUNDRED
 THIRTY-SIX OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED  PURSU-
 ANT THERETO.
   9.  "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND
 EXPERIENCE AMONG DIRECT-CARE NURSES.
   10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO  PATIENT
 RATIO WITHIN A NURSING DEPARTMENT OR UNIT.
   11.  "UNIT"  SHALL  MEAN  A  PATIENT CARE COMPONENT, AS DEFINED BY THE
 DEPARTMENT, WITHIN AN ACUTE CARE FACILITY.
   12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT
 A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR  REGISTERED  UNDER  TITLE
 EIGHT  OF  THE  EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY
 OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT  ASSISTANCE
 IN THE DELIVERY OF PATIENT CARE.
   §  2830. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER
 SHALL:
   1. APPOINT AN ACUTE  CARE  FACILITY  COUNCIL  CONSISTING  OF  THIRTEEN
 MEMBERS.  NO  LESS  THAN  SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL
 NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES,  THREE  OF
 WHOM  SHALL  BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINIS-
 TRATOR. NO LESS THAN TWO MEMBERS OF  THE  ACUTE  CARE  FACILITY  COUNCIL
 SHALL  BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAIN-
 ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO
 REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A  NURS-
 ING  PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR
 CERTIFIED BARGAINING AGENT OF NURSES. THE ACUTE  CARE  FACILITY  COUNCIL
 SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD-
 ING  REGISTERED  PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND
 NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE  NOT  SPECIFIED
 IN  THIS  ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL
 BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL-
 UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS
 ON APPROVAL OF STAFFING PLANS PRIOR TO  THE  GRANTING  OF  AN  OPERATING
 CERTIFICATE BY THE DEPARTMENT.
   2.  PROMULGATE,  AFTER CONSULTATION WITH THE ACUTE CARE FACILITY COUN-
 CIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE  PURPOSES  AND
 PROVISIONS  OF  THE  SAFE  STAFFING  REQUIREMENTS, INCLUDING REGULATIONS
 DEFINING TERMS, SETTING  FORTH  DIRECT-CARE  NURSE  TO  PATIENT  RATIOS,
 SETTING  FORTH  NON-NURSING  DIRECT-CARE  STAFF  TO  PATIENT  RATIOS AND

 A. 108                              4
 
 PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY  SYSTEMS;
 AND
   3.  ASSURE  THAT  THE  PROVISIONS  OF  SAFE  STAFFING REQUIREMENTS ARE
 ENFORCED, INCLUDING THE ISSUANCE  OF  REGULATIONS  WHICH  AT  A  MINIMUM
 PROVIDE  FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE
 TO COMPLY WITH  SUCH  REQUIREMENTS  AND  PUBLIC  ACCESS  TO  INFORMATION
 REGARDING  REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS
 PURSUANT TO SUCH REQUIREMENTS.
   § 2831. STAFFING REQUIREMENTS. 1. STAFFING  REQUIREMENTS.  EACH  ACUTE
 CARE  FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES
 SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN  EACH  DEPART-
 MENT  OR  UNIT  WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED
 CARE NEEDS OF THE PATIENTS THEREIN. AT A  MINIMUM,  EACH  SUCH  FACILITY
 SHALL  MEET  THE  REQUIREMENTS  OF  SUBDIVISIONS  TWO  AND THREE OF THIS
 SECTION.
   2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING  CERTIF-
 ICATE  TO  ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS
 TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION
 THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE  ADEQUATE  AND
 APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING
 YEAR. THE DOCUMENTED STAFFING PLAN SHALL:
   (A)  MEET  THE  MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF
 THIS SECTION;
   (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY  OTHER
 LAWS, RULES OR REGULATIONS;
   (C)  EMPLOY  AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS
 IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS  REQUIRING
 INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN;
   (D)  FACTOR  IN  OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES,
 TRANSFERS AND ADMISSIONS, STAFF  BREAKS,  MEALS,  ROUTINE  AND  EXPECTED
 ABSENCES  FROM  THE  UNIT  AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE
 EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT  NURSING
 CARE;
   (E)  INCLUDE  A  PLAN  TO  MEET NECESSARY STAFFING LEVELS AND SERVICES
 PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE  NEEDS
 PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE
 STAFFING  PLAN  SHALL  NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC-
 TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED  STANDARDS  OF
 PRACTICE  TO  BE  PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE
 PERFORMED BY OTHER PERSONNEL;
   (F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL  STAFFING
 ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT;
   (G)  INCLUDE  A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S
 STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS;
   (H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN  SUCH  PLAN
 TOGETHER  WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH
 SUCH CLASSIFICATION; AND
   (I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY  OF  THE  DIRECT-CARE
 NURSES  WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES-
 ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING
 REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER
 SUPPORTIVE AND ASSISTIVE STAFF.
   3. MINIMUM STAFFING REQUIREMENTS. (A)  THE  DOCUMENTED  STAFFING  PLAN
 SHALL  INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA-
 TIENT RATIOS:

 A. 108                              5
 
   (I) ONE NURSE TO ONE PATIENT:  OPERATING  ROOM  AND  TRAUMA  EMERGENCY
 UNITS  AND  MATERNAL/CHILD  CARE  UNITS FOR THE SECOND OR THIRD STAGE OF
 LABOR;
   (II)  ONE  NURSE  TO TWO PATIENTS:   MATERNAL/CHILD CARE UNITS FOR THE
 FIRST STAGE OF LABOR, AND ALL CRITICAL CARE  AREAS  INCLUDING  EMERGENCY
 CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS;
   (III)  ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA-
 TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME-
 DIATE CARE NURSERY UNITS;
   (IV) ONE NURSE TO THREE PATIENTS:    POSTPARTUM  MOTHER/BABY  COUPLETS
 (MAXIMUM SIX PATIENTS PER NURSE);
   (V)  ONE  NURSE  TO  FOUR  PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS,
 POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI-
 ATRIC UNITS;
   (VI) ONE NURSE TO FIVE PATIENTS:  REHABILITATION  UNITS  AND  SUBACUTE
 PATIENTS; AND
   (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS.
   FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED
 TO,  PSYCHIATRIC  UNITS,  AND ACUTE CARE FACILITIES OPERATED PURSUANT TO
 THE MENTAL HYGIENE LAW OR  THE  CORRECTION  LAW,  THE  DEPARTMENT  SHALL
 ESTABLISH  BY  REGULATION  THE  APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT
 RATIO.
   (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN  PARAGRAPH  (A)  OF  THIS
 SUBDIVISION  SHALL  REFLECT  THE  MAXIMUM NUMBER OF PATIENTS THAT MAY BE
 ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME.
   (C) THERE SHALL BE NO AVERAGING OF THE  NUMBER  OF  PATIENTS  AND  THE
 TOTAL  NUMBER  OF  NURSES  ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY
 PERIOD OF TIME.
   (D) THE COMMISSIONER, IN CONSULTATION WITH  THE  ACUTE  CARE  FACILITY
 COUNCIL,  SHALL  ESTABLISH  REGULATIONS PROVIDING FOR THE MAINTENANCE OF
 MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING
 DURING ROUTINE OR EXPECTED ABSENCES FROM THE  UNIT,  SUCH  AS  MEALS  OR
 BREAKS.
   4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC-
 TICAL  NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS
 ASSIGNED TO THE LICENSED PRACTICAL  NURSE  SHALL  ALSO  BE  INCLUDED  IN
 CALCULATING  THE  NUMBER  OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES-
 SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC-
 TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING  CARE  PROVIDED  BY  THE
 LICENSED PRACTICAL NURSE.
   5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS-
 ING  CARE  FUNCTIONS  REQUIRED  BY SECTION SIXTY-NINE HUNDRED TWO OF THE
 EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO  BE  PERFORMED  BY  A
 REGISTERED  PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI-
 CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE  FUNC-
 TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR
 ACCEPTED  STANDARDS  OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL
 NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL.
   6. ADJUSTMENTS BY FACILITY.   THE  MINIMUM  STAFFING  REQUIREMENT  AND
 NURSE-TO-PATIENT  RATIO  SET  FORTH IN THIS SECTION SHALL BE ADJUSTED BY
 THE ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR  ADDITIONAL
 DIRECT-CARE  NURSES.    ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE
 WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN-
 ING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY  OF  THE  ILLNESS,
 THE  NEED  FOR  SPECIALIZED  EQUIPMENT AND TECHNOLOGY, THE COMPLEXITY OF
 CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE  THE  PATIENT

 A. 108                              6
 
 CARE  PLAN  AND  THE  ABILITY  FOR  SELF-CARE,  AND THE LICENSURE OF THE
 PERSONNEL REQUIRED FOR CARE.
   7.  COMMISSIONER  REGULATIONS.    THE  COMMISSIONER  MAY BY REGULATION
 REQUIRE A DOCUMENTED  STAFFING  PLAN  TO  HAVE  HIGHER  NURSE-TO-PATIENT
 RATIOS THAN THOSE SET FORTH IN THIS SECTION.
   8.   NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE
 TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT  PROVIDES  FOR  STAFFING
 RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION.
   §  2832.  COMPLIANCE  WITH  STAFFING PLAN AND RECORDKEEPING. 1.   EACH
 ACUTE CARE FACILITY SHALL AT ALL TIMES  STAFF  IN  ACCORDANCE  WITH  ITS
 DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION
 TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE; PROVIDED, HOWEVER, THAT
 NOTHING  IN  THIS  SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY
 FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT  STAFFING  LEVELS,
 NOR  SHALL  THE  REQUIREMENTS  SET  FORTH  IN  SUCH SECTION TWENTY-EIGHT
 HUNDRED THIRTY-ONE OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY
 HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT.
   2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM  STAFFING  REQUIREMENTS
 STANDARDS  SET  FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS
 ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT
 RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN  AN  ACUTE  CARE
 FACILITY  UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI-
 CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION  LAW,  HAS  RECEIVED  PRIOR
 ORIENTATION  IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS-
 ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND  HAS  DEMON-
 STRATED  CURRENT  COMPETENCE  IN PROVIDING CARE IN THAT UNIT OR CLINICAL
 AREA. ACUTE CARE FACILITIES  THAT  UTILIZE  TEMPORARY  NURSING  AGENCIES
 SHALL  HAVE  AND  ADHERE  TO  A WRITTEN PROCEDURE TO ORIENT AND EVALUATE
 PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN-
 CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO.  IN THE EVENT OF AN
 EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD  TO
 UNSAFE  PATIENT  CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT
 UNIT OR CLINICAL AREA, PROVIDED  THAT  SUCH  NURSES  SHALL  BE  ASSIGNED
 PATIENTS  APPROPRIATE  TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY
 SHALL ESTABLISH A CONSISTENT  PLAN  FOR  ADDRESSING  EMERGENCY  STAFFING
 SITUATIONS  AND  MONITOR  OUTCOMES.   EMERGENCIES ARE DEFINED AS NATURAL
 DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS
 NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT  REGULARLY  OCCURRING
 WITHIN THE FACILITY.
   3.  EACH  ACUTE  CARE  FACILITY  SHALL MAINTAIN ACCURATE DAILY RECORDS
 SHOWING:
   (A) THE NUMBER OF PATIENTS ADMITTED,  RELEASED  AND  PRESENT  IN  EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY;
   (B)  THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS-
 ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND
   (C) THE IDENTITY AND DUTY HOURS OF  EACH  DIRECT-CARE  NURSE  IN  EACH
 NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY.
   4.  EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS-
 ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY,  INFECTION,  ACCIDENT,
 INJURY AND MEDICAL ERRORS.
   5.  ALL  RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE
 MAINTAINED FOR A PERIOD OF SEVEN YEARS.
   6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION  SHALL  BE
 MADE  AVAILABLE  UPON  REQUEST  TO  THE  DEPARTMENT  AND  TO THE PUBLIC;
 PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL  COMPLY
 WITH  THE  APPLICABLE  PATIENT  PRIVACY LAWS, RULES AND REGULATIONS, AND

 A. 108                              7

 THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE  IDENTITY
 AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC.
   §  2833. WORK ASSIGNMENT POLICY. 1. GENERAL.  EACH ACUTE CARE FACILITY
 SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN
 WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS  TWO
 AND  THREE  OF  THIS  SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A
 DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT.
   2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY  SHALL
 PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT:
   (A)  FOR  WHICH  THE  NURSE  IS NOT PREPARED BY EDUCATION, TRAINING OR
 EXPERIENCE TO SAFELY FULFILL  THE  ASSIGNMENT  WITHOUT  COMPROMISING  OR
 JEOPARDIZING  PATIENT  SAFETY,  THE  NURSE'S ABILITY TO MEET FORESEEABLE
 PATIENT NEEDS OR THE NURSE'S LICENSE; OR
   (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS.
   3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY  SHALL
 CONTAIN PROCEDURES FOR THE FOLLOWING:
   (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR
 REGARDING  THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED
 OF AN ASSIGNMENT OR CONTINUED DUTY;
   (B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR  TO  REVIEW  THE
 SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH-
 ER  TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR
 TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR  CONTIN-
 UED DUTY;
   (C)  A  PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE
 THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN  THE  SUPERVISOR  DENIES
 THE REQUEST TO BE RELIEVED IF:
   (I)  THE  SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR
 THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY,
   (II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY  AGENCY
 WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND
   (III)  THE  EMPLOYEE  IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS
 CONDITIONS JUSTIFYING REFUSAL; AND
   (D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT  TO  A
 WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED,
 BY  REASON  THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION,
 PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW  RELATING  TO
 NURSING.
   §  2834.  PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY ACUTE CARE
 FACILITY SHALL:
   1. POST IN A CONSPICUOUS  PLACE  READILY  ACCESSIBLE  TO  THE  GENERAL
 PUBLIC  A  NOTICE  PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF
 THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH
 INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF-
 ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED;
   2. UPON REQUEST, MAKE COPIES OF THE  DOCUMENTED  STAFFING  PLAN  FILED
 WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND
   3.  UPON  REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A
 DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION:
   (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT,
   (B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED  TO  BE
 PRESENT  DURING  THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM,
 AND
   (C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE  NURSES  PRESENT
 DURING THE SHIFT.

 A. 108                              8
 
   §  2835.  ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE-
 GATE ITS RESPONSIBILITIES TO  ENFORCE  THE  SAFE  STAFFING  REQUIREMENTS
 PROMULGATED PURSUANT TO THIS ARTICLE.
   § 2836. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT
 HUNDRED  THIRTY-THREE  OF  THIS  ARTICLE.   ANY ACUTE CARE FACILITY THAT
 VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED  WORK  ASSIGN-
 MENT  POLICY  UNDER  SECTION  TWENTY-EIGHT  HUNDRED THIRTY-THREE OF THIS
 ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION  BROUGHT  IN  A
 COURT  OF  COMPETENT  JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS
 MAY BE APPROPRIATE TO EFFECTUATE  THE  PURPOSES  OF  THE  SAFE  STAFFING
 REQUIREMENTS,  INCLUDING  BUT  NOT  LIMITED TO REINSTATEMENT, PROMOTION,
 LOST WAGES AND BENEFITS,  AND  COMPENSATORY  AND  CONSEQUENTIAL  DAMAGES
 RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
 DAMAGES.  THE  COURT  IN  SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT
 AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES  AND
 COSTS  OF  ACTION  TO  BE  PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO
 INSTITUTE A PRIVATE ACTION PURSUANT TO THIS  SUBDIVISION  SHALL  NOT  BE
 LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   §  4.  Section  2801-a of the public health law is amended by adding a
 new subdivision 3-b to read as follows:
   3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI-
 TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH
 PLANNING COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR  FEDERAL
 RULES,  REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS,
 WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC-
 TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING
 COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF
 THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS.
   § 5. Section 2805 of the public health law is amended by adding a  new
 subdivision 3 to read as follows:
   3.  IN  DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE
 TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN  ACCORD-
 ANCE  WITH  THIS  ARTICLE,  THE  COMMISSIONER  SHALL  CONSIDER  ANY PAST
 VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR  STATUTES  RELATING
 TO  EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING
 OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS  OR  IMPERATIVES.  THE
 PUBLIC  HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT
 TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING  NURSE  STAFF
 AND SUPPORTIVE STAFF RATIOS.
   §  6.  The public health law is amended by adding a new section 2895-b
 to read as follows:
   § 2895-B. RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS.  1.  DEFI-
 NITIONS.  AS  USED  IN  THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE
 FOLLOWING MEANINGS:
   (A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN  THE  RESIDEN-
 TIAL  HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION TWEN-
 TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER.
   (B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL  IN
 A  PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN
 A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT
 THAT TIME.
   2. COMMISSIONER AND RESIDENTIAL HEALTH CARE FACILITY  COUNCIL;  POWERS
 AND  DUTIES.  THE  COMMISSIONER SHALL: APPOINT A RESIDENTIAL HEALTH CARE
 FACILITY COUNCIL CONSISTING  OF  THIRTEEN  MEMBERS.  NO  LESS  THAN  TWO
 MEMBERS  SHALL  BE DIRECT   CARE LICENSED PRACTICAL NURSES, NO LESS THAN
 TWO MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO  LESS

 A. 108                              9

 THAN    ONE MEMBER SHALL BE A DIRECT CARE REGISTERED PROFESSIONAL NURSE.
 THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE  EACH  OF
 RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS-
 ES,  OF  NON-REGISTERED  NURSE DIRECT CARE STAFF AND A REPRESENTATIVE OF
 NURSING PROFESSIONAL ASSOCIATIONS. THE COUNCIL  SHALL  ALSO  INCLUDE  NO
 LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA-
 TORS,  TWO  REPRESENTATIVES  OF  RESIDENTIAL  HEALTH CARE FACILITY NURSE
 ADMINISTRATORS AND ONE  REPRESENTATIVE  OF  CONSUMERS.  THE  RESIDENTIAL
 HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL-
 OPMENT  OF  REGULATIONS  RELATING  TO  THE STAFFING STANDARDS UNDER THIS
 SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA-
 TURE, THE PUBLIC AND  THE  COMMISSIONER  ANY  RECOMMENDATIONS  REGARDING
 STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES.
   3. STAFFING STANDARDS.  (A) THE COMMISSIONER, IN CONSULTATION WITH THE
 COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN-
 TIAL  HEALTH  CARE  FACILITY  MINIMUM STAFFING LEVELS TO MEET APPLICABLE
 STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN-
 TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE-
 ING OF EACH RESIDENT  OF  THE  FACILITY.  THE  COMMISSIONER  SHALL  ALSO
 REQUIRE  BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN-
 TAIN RECORDS ON ITS STAFFING LEVELS,  REPORT  ON  SUCH  RECORDS  TO  THE
 DEPARTMENT,  AND  MAKE  SUCH  RECORDS  AVAILABLE  FOR  INSPECTION BY THE
 DEPARTMENT.
   (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL:
   (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND
   (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF
 SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES
 TO ATTAIN OR MAINTAIN THE  HIGHEST  PRACTICABLE  PHYSICAL,  MENTAL,  AND
 PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY.
   (C)  SUBJECT  TO  SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS
 UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS  UNDER
 SUBDIVISION FOUR OF THIS SECTION.
   (D)  IN  DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS
 SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED  WHILE  PERFORMING  SERVICES
 THAT  ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD
 PREPARATION,  HOUSEKEEPING,  LAUNDRY,  MAINTENANCE  SERVICES,  OR  OTHER
 ACTIVITIES THAT ARE NOT DIRECT NURSING CARE.
   4.    STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE
 OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A
 STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING:
   (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE;
   (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY  BY  A  LICENSED  PRACTICAL
 NURSE OR A REGISTERED NURSE;
   (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE
 MINIMUM  OF  0.75  HOURS  OF  CARE PER RESIDENT PROVIDED BY A REGISTERED
 NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN  APPROPRIATE  LEVEL
 OF  REGISTERED  NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK,
 TO MEET RESIDENT NEEDS; AND
   (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS
 SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE  NURSE-TO-PATIENT
 RATIO: ONE NURSE TO FIVE PATIENTS.
   5.    ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF
 AN EMPLOYEE PURSUANT TO AN ADOPTED WORK  ASSIGNMENT  POLICY  UNDER  THIS
 SECTION  MAY  BE  HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A
 COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR  EQUITABLE  RELIEF  AS
 MAY  BE  APPROPRIATE  TO  EFFECTUATE  THE  PURPOSES OF THE SAFE STAFFING

 A. 108                             10
 
 REQUIREMENTS, INCLUDING BUT NOT  LIMITED  TO  REINSTATEMENT,  PROMOTION,
 LOST  WAGES  AND  BENEFITS,  AND  COMPENSATORY AND CONSEQUENTIAL DAMAGES
 RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED
 DAMAGES.  THE  COURT  IN  SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT
 AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES  AND
 COSTS  OF  ACTION  TO  BE  PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO
 INSTITUTE A PRIVATE ACTION PURSUANT TO THIS  SUBDIVISION  SHALL  NOT  BE
 LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS.
   6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE
 FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL-
 ITY  IS  REQUIRED  TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY-
 EIGHT HUNDRED FIVE-T OF THIS CHAPTER.  INFORMATION UNDER THIS  PARAGRAPH
 SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN
 A  MANNER  WHICH  IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES
 AND THE STAFF, AS REQUIRED BY THE COMMISSIONER.
   (B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A  SUMMARY  OF  THIS
 SECTION,  PROVIDED  BY  THE  DEPARTMENT,  IN  PROXIMITY  TO EACH POSTING
 REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION.
   § 7. If any provision of this act, or any application of any provision
 of this act, is held to be invalid, or ruled by any  federal  agency  to
 violate  or  be  inconsistent  with  any applicable federal law or regu-
 lation, 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.
   § 8. This act shall take effect on the one hundred eightieth day after
 it  shall have become a law. Effective immediately, the addition, amend-
 ment and/or repeal of any rule or regulation necessary for the implemen-
 tation of this act on its effective date are authorized to be  made  and
 completed on or before such effective date.

                            
 
                     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.