NY State Senate Bill 2021-S1168A

Archive: Last Bill Status Via A108 - Signed by Governor

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Jun 18, 2021	signed chap.155
Jun 07, 2021	delivered to governor
May 04, 2021	returned to assembly passed senate 3rd reading cal.729 substituted for s1168a
May 04, 2021	substituted by a108b
Apr 28, 2021	advanced to third reading
Apr 27, 2021	2nd report cal.
Apr 26, 2021	1st report cal.729
Apr 22, 2021	print number 1168a
Apr 22, 2021	amend (t) and recommit to health
Jan 07, 2021	referred to health

Votes

- May 4, 2021 - Floor Vote
  A108
  
  63
  
  Aye
  
  0
  
  Nay
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Floor Vote: May 4, 2021
      
      aye (63)
      
      Addabbo Jr.
      
      Akshar
      
      Bailey
      
      Benjamin
      
      Biaggi
      
      Borrello
      
      Boyle
      
      Breslin
      
      Brisport
      
      Brooks
      
      Brouk
      
      Comrie
      
      Cooney
      
      Felder
      
      Gallivan
      
      Gaughran
      
      Gianaris
      
      Gounardes
      
      Griffo
      
      Harckham
      
      Helming
      
      Hinchey
      
      Hoylman-Sigal
      
      Jackson
      
      Jordan
      
      Kaminsky
      
      Kaplan
      
      Kavanagh
      
      Kennedy
      
      Krueger
      
      Lanza
      
      Liu
      
      Mannion
      
      Martucci
      
      Mattera
      
      May
      
      Mayer
      
      Myrie
      
      O'Mara
      
      Oberacker
      
      Ortt
      
      Palumbo
      
      Parker
      
      Persaud
      
      Ramos
      
      Rath III
      
      Reichlin-Melnick
      
      Ritchie
      
      Rivera
      
      Ryan
      
      Salazar
      
      Sanders Jr.
      
      Savino
      
      Sepúlveda
      
      Serino
      
      Serrano
      
      Skoufis
      
      Stavisky
      
      Stec
      
      Stewart-Cousins
      
      Tedisco
      
      Thomas
      
      Weik
  Apr 26, 2021 - Health Committee Vote
  S1168A
  
  14
  
  Aye
  
  0
  
  Nay
  
  1
  
  Aye with Reservations
  
  0
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  - - Health Committee Vote: Apr 26, 2021
      
      aye (14)
      
      Benjamin
      
      Biaggi
      
      Boyle
      
      Brouk
      
      Gallivan
      
      Hoylman-Sigal
      
      Kaminsky
      
      May
      
      Oberacker
      
      Rath III
      
      Rivera
      
      Ryan
      
      Salazar
      
      Thomas
      
      aye wr (1)
      
      Stec

Bill Amendments

Original

A (Active)

co-Sponsors

View additional co-sponsors

2021-S1168 - Details

See Assembly Version of this Bill:: A108
Law Section:: Public Health Law
Laws Affected:: Amd §2805-t, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S7974
2011-2012: S4553
2013-2014: S3691
2015-2016: S782, A8580
2017-2018: S3330, A1532
2019-2020: S1032, A2954

2021-S1168 - Summary

Requires certain facilities establish clinical staffing committees.

2021-S1168 - Sponsor Memo

                                
 
BILL NUMBER: S1168

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law, in relation to enacting the "safe
staffing for quality care act"

 
PURPOSE:

To require all acute care facilities and nursing homes to meet standards
for appropriate staffing ratios of nursing and unlicensed direct care
staff.

 
SUMMARY OF PROVISIONS:

Section 1 is the short title.

Section 2 amends Public Health Law § 2805 to require that application
for operating certificates for a hospital include a direct care staffing
plan.

Section 3 adds nine new sections, 2827 through 2535, which require
hospitals to maintain and comply with a staffing plan; establish the
Acute Care Facility Council to be appointed by the Commissioner of
Health, enumerate the elements of a satisfactory staffing, plan; set
forth minimum nurse to patient ratios; require clinical competency:
provide for emergency situations; require public disclosure of facility
staffing requirements: and allows for private right of action by employ-
ees.

Section 4 amends § 2801-a directing the Public Health and Health Plan-
ning Council to consider staffing violations when reviewing "character,
competence and standing in the community" for applications and renewals
of certificates of incorporation or establishment of a hospital.

Section 5 amends § 2805 requiring the Commissioner to consider staffing
violations when reviewing applications and renewals operating certif-
icates for acute care facilities.

Section 6 amends S 2895-b to establish a Residential Health Care Facili-
ty Council to be appointed by the Commissioner; requires minimum staff
hours of care per resident per day; allows for private right of action
by employees: and requires public disclosure of information about direct
care staffing.

 
JUSTIFICATION:

The hospital nurse-to-patient ratio specified in this bill is based on
peer-reviewed academic research and evidence-based recommendations.  The
minimum care hours specified for residential health care facilities are
also based on research evidence and on the recommendations of the Insti-
tute of Medicine's report, "Keeping Patients Safe: Transforming the Work
Environment of Nurses" (2004).  The number of patients assigned to a
nurse has a direct impact on the quality of care a nurse can provide.
Research publisher in the Journal of the American Medical Association,
estimates five additional deaths per 1,000 patients in hospitals which
routinely staff with only 1:8 nurse to patient ratios compared to those
staffing with 1:4 nurse to-patient ratios. This same study determined
the odds of patient death increased by 71 for each additional patient
the nurse must care for at one time.

Safe nurse staffing also reduces avoidable, adverse patient outcomes.
Research funded by the federal Agency for Healthcare Research and Quali-
ty (AHRQ) has demonstrated that hospitals with lower nurse staffing
levels have higher rates of pneumonia, shock, cardiac arrest, urinary
tract infections and upper gastrointestinal bleeds; all leading to high-
er costs and mortality from hospital-acquired complications.  In nursing
homes, research has demonstrated that safe nurse staffing levels have a
positive impact on facility processes and on resident outcomes. Research
has demonstrated that as nurse turnover increases in nursing homes, the
quality of resident care declines, resulting in more frequent use of
restraints, urinary catheterization, and psychoactive drugs; increased
risk of contractures, pressure ulcers and more survey deficiencies.

A broad range of research demonstrates that increased staffing levels do
not diminish the profitability of facilities. Nursing workforce costs
may rise, but that increase is mitigated by overall savings from
improved patient outcomes and avoided adverse events. The improved
outcomes reduce medical malpractice and other penalties resulting from
avoidable occurrences and poor patient satisfaction.

In 2004, California became the first state to mandate nurse staffing
ratios in hospitals. New statistical analysis reveals that the Califor-
nia mandates are significantly associated with fewer negative outcomes
for patients and staff. The study, published in Health Services Research
and conducted by the Center for Health Outcomes and Policy Research,
University of Pennsylvania, concluded that "improved nurse staffing,
however it is achieved, is associated with better outcomes for nurses
and patients."

Establishing staffing standards for nursing and unlicensed direct care
staff in acute care facilities and residential health care facilities
will help ensure that these facilities operate in a manner that guaran-
tees the public safety and the delivery of quality health care services.
This legislation provides an opportunity to discuss making changes in
New York.

 
LEGISLATIVE HISTORY:

2013-2014: S3691A Hannon/A6571 Gottfried 2015-2016: S782 Hannon/A8580A
Gunther 2017-2018: S3330 Hannon/A1532 Gunther 2019-2020: S1032
Rivera/A2954 Gunther

 
FISCAL IMPLICATIONS:

Some staff time in the Department of Health; possible increased Medicaid
spending to cover the cost of increases, staffing balanced by reduced
Medicaid spending as reduced bad outcomes and reduced staff turnover
reduce health care costs.

 
EFFECTIVE DATE:
Takes effect 180 days after it becomes law.

2021-S1168 - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1168
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              January 7, 2021
                                ___________
 
 Introduced  by  Sen.  RIVERA -- read twice and ordered printed, and when
   printed to be committed 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-
 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:
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD02466-01-1

 S. 1168                             2
 
   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
 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.

 S. 1168                             3
 
   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
 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

 S. 1168                             4
 
 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:
   (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;

 S. 1168                             5
 
   (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
 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,

 S. 1168                             6
 
 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
 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.

 S. 1168                             7
 
   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.
   §  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

 S. 1168                             8
 
 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
 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-

 S. 1168                             9
 
 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
 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.

 S. 1168                            10
 
   (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.

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2021-S1168A (ACTIVE) - Details

See Assembly Version of this Bill:: A108
Law Section:: Public Health Law
Laws Affected:: Amd §2805-t, Pub Health L
Versions Introduced in Other Legislative Sessions:: 2009-2010: S7974
2011-2012: S4553
2013-2014: S3691
2015-2016: S782, A8580
2017-2018: S3330, A1532
2019-2020: S1032, A2954

2021-S1168A (ACTIVE) - Summary

Requires certain facilities establish clinical staffing committees.

2021-S1168A (ACTIVE) - Sponsor Memo

                                
 
BILL NUMBER: S1168A

SPONSOR: RIVERA
 
TITLE OF BILL:

An act to amend the public health law, in relation to establishing clin-
ical staffing committees

 
PURPOSE:

To establish clinical staffing committees in each general hospital to
develop and oversee a clinical staffing plan.

 
SUMMARY OF PROVISIONS:

Section one of the bill requires every general hospital to create a
clinical staffing committee made up of registered nurses, licensed prac-
tical nurses, ancillary staff members providing direct patient care, and
hospital administrators by January 1, 2022. The committee will be
responsible for developing and overseeing the implementation of a clin-
ical staffing plan that will include specific guidelines or ratios,

matrices, or grids indicating how many patients are assigned to each
nurse and the number of ancillary staff in each unit. The Committees
must take into account several factors when developing the plans, which
are required to be completed and submitted to DOH by July 1 each year.
The Committees will also be responsible for reviewing the staffing
plans, making adjustments to the plans, and responding to complaints for
variations from the plans.

The staffing plans must be posted in a publicly conspicuous area and
posted on the DOH hospital profile website. DOH is tasked with investi-
gating potential violations of the staffing plan requirements or any
unresolved complaints that were submitted to a hospital's clinical
staffing committee and the hospital will be subject to civil penalties
for failing to remedy the violation. However, DOH shall take into
account unforeseeable emergency circumstances when determining whether a
hospital is in violation. DOH must also submit an annual report to the
Legislature and Governor by December 31 of each year regarding the
complaints received by DOH and how they were handled.

An advisory commission will be created consisting of 9 members repres-
enting experts in staffing standards and quality of patient care, labor
organizations representing nurses, and hospital representatives. The
Governor, Assembly Speaker, and Temporary President of the Senate will
appoint one member for each of the three categories. The Advisory
Commission will evaluate the staffing levels and other quality metrics
related to nurse staffing in hospitals. The Advisory Commission will
send a report to the Legislature and make a report available to the
public on any further legislative action to improve working conditions
and quality of care in hospitals by October 31, 2024 and every three
years thereafter.

 
JUSTIFICATION:

Having safe and appropriate levels of nurse an ancillary member staffing
has been shown to reduce avoidable and adverse patient outcomes.
Research has demonstrated that hospitals with lower nurse staffing
levels have higher rates of pneumonia, shock, cardiac arrest, urinary
tract infections and upper gastrointestinal bleeds; all leading to high-
er costs and mortality from hospital-acquired complications. The
improved outcomes reduce medical malpractice and other penalties result-
ing from avoidable occurrences and poor patient satisfaction. In addi-
tion, assuring sufficient staffing of hospital personnel protects
patients and supports greater retention of nurses and promotes safer
working conditions.

Allowing each hospital to collaboratively develop these clinical staff-
ing plans with the nurses and other staff will allow for the best staff-
ing outcomes at these hospitals. This hospital-by-hospital approach they
will be able to balance what is best for the patient and workforce while
taking into account the varying needs of each individual hospital.

Establishing these clinical staffing committees and staffing plans for
nursing and unlicensed direct care staff in hospitals will help ensure
that these facilities operate in a manner that guarantees the public
safety and the delivery of quality health care services.

 
LEGISLATIVE HISTORY:

New bill

 
FISCAL IMPLICATIONS:

To be determined.

 
EFFECTIVE DATE:
Immediately

2021-S1168A (ACTIVE) - Bill Text download pdf

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  1168--A
 
                        2021-2022 Regular Sessions
 
                             I N  S E N A T E
 
                              January 7, 2021
                                ___________
 
 Introduced  by  Sens.  RIVERA, ADDABBO, BAILEY, BENJAMIN, BIAGGI, BOYLE,
   BRESLIN, BRISPORT, BROOKS, BROUK, COMRIE, GAUGHRAN, GOUNARDES,  HARCK-
   HAM,  HINCHEY,  HOYLMAN, JACKSON, KAMINSKY, KAPLAN, KAVANAGH, KENNEDY,
   KRUEGER, LIU, MANNION, MATTERA,  MAY,  MAYER,  MYRIE,  PARKER,  RAMOS,
   REICHLIN-MELNICK,  RYAN, SALAZAR, SANDERS, SEPULVEDA, SERINO, SERRANO,
   SKOUFIS, STAVISKY, THOMAS -- read twice and ordered printed, and  when
   printed  to  be  committed  to  the  Committee  on Health -- 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:
   (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
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.

                                                            LBD02466-13-1

 S. 1168--A                          2
 
   (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)  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;

 S. 1168--A                          3
 
   (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.
   (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

 S. 1168--A                          4
 
 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
 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-

 S. 1168--A                          5
 
 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
 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;

 S. 1168--A                          6
 
   (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.
   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,

 S. 1168--A                          7
 
 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
 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

 S. 1168--A                          8
 
 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),
 (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

 S. 1168--A                          9
 
 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.
   (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.

 S. 1168--A                         10
 
   § 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.

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Senate Bill S1168A

Sponsored By

Archive: Last Bill Status Via A108 - Signed by Governor

May 4, 2021 - Floor Vote

Floor Vote: May 4, 2021

Apr 26, 2021 - Health Committee Vote

Health Committee Vote: Apr 26, 2021

Bill Amendments

co-Sponsors

2021-S1168 - Details

2021-S1168 - Summary

2021-S1168 - Sponsor Memo

2021-S1168 - Bill Text download pdf

co-Sponsors

2021-S1168A (ACTIVE) - Details

2021-S1168A (ACTIVE) - Summary

2021-S1168A (ACTIVE) - Sponsor Memo

2021-S1168A (ACTIVE) - Bill Text download pdf

Comments

Senate Bill S1168A

Share this bill

Sponsored By

Archive: Last Bill Status Via A108 - Signed by Governor

Bill Amendments

co-Sponsors

2021-S1168 - Details

2021-S1168 - Summary

2021-S1168 - Sponsor Memo

2021-S1168 - Bill Text download pdf

co-Sponsors

2021-S1168A (ACTIVE) - Details

2021-S1168A (ACTIVE) - Summary

2021-S1168A (ACTIVE) - Sponsor Memo

2021-S1168A (ACTIVE) - Bill Text download pdf

Comments