S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   7187
 
                        2023-2024 Regular Sessions
 
                           I N  A S S E M B L Y
 
                               May 12, 2023
                                ___________
 
 Introduced  by M. of A. EPSTEIN -- read once and referred to the Commit-
   tee on Higher Education
 
 AN ACT to amend the public health law and the social  services  law,  in
   relation to the authority of nurse practitioners and physician assist-
   ants to prescribe certain services

   THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section 1. Subdivisions 4, 5 and 14 of  section  3602  of  the  public
 health  law,  subdivisions 4 and 5 as amended by chapter 376 of the laws
 of 2015, subdivision 14 as added by chapter 622 of the laws of 1988, are
 amended to read as follows:
   4. "Home  health  aide  services"  means  simple  health  care  tasks,
 personal hygiene services, housekeeping tasks essential to the patient's
 health  and  other  related  supportive services. Such services shall be
 prescribed by a physician, NURSE PRACTITIONER, OR  PHYSICIAN  ASSISTANT,
 ACTING  WITHIN  THE  PROFESSIONAL'S LAWFUL SCOPE OF PRACTICE UNDER TITLE
 EIGHT OF THE EDUCATION LAW, in accordance with a plan of  treatment  for
 the  patient  and shall be under the supervision of a registered profes-
 sional nurse from a certified home health agency or,  when  appropriate,
 from  a  provider  of  a  long  term home health care program and of the
 appropriate professional therapist from such agency or provider when the
 aide carries out simple procedures as an extension of  physical,  speech
 or  occupational  therapy.  [Such  services  may  also  be prescribed or
 ordered by a nurse practitioner to the  extent  authorized  by  law  and
 consistent  with  subdivision three of section six thousand nine hundred
 two of the education law and not prohibited  by  federal  law  or  regu-
 lation.]
   5.  "Personal  care  services"  means services to assist with personal
 hygiene,  dressing,  feeding  and  household  tasks  essential  to   the
 patient's  health.  Such  services  shall  be prescribed by a physician,
 NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, ACTING  WITHIN  THE  PROFES-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD11270-01-3
              

 A. 7187                             2
 
 SIONAL'S  LAWFUL  SCOPE  OF  PRACTICE UNDER TITLE EIGHT OF THE EDUCATION
 LAW, in accordance with a plan of home care supervised by  a  registered
 professional  nurse. [Such services may also be prescribed or ordered by
 a nurse practitioner to the extent authorized by law and consistent with
 subdivision three of section six thousand nine hundred two of the educa-
 tion law and not prohibited by federal law or regulations.]
   14.  "AIDS  home  care  program"  means a coordinated plan of care and
 services provided at home to persons  who  are  medically  eligible  for
 placement  in a hospital or residential health care facility and who (a)
 are diagnosed [by a physician]  as  having  acquired  immune  deficiency
 syndrome  (AIDS),  or  (b)  are deemed by a physician, [within his judg-
 ment,] NURSE PRACTITIONER, OR PHYSICIAN  ASSISTANT,  ACTING  WITHIN  THE
 PROFESSIONAL'S  LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE EDUCA-
 TION LAW, to be infected with the etiologic  agent  of  acquired  immune
 deficiency  syndrome,  and  who  has an illness, infirmity or disability
 which  can  be  reasonably  ascertained  to  be  associated  with   such
 infection.  Such  program shall be provided only by a provider of a long
 term home health care program specifically authorized pursuant  to  this
 article  to  provide  an AIDS home care program or by an AIDS center, as
 defined in regulations promulgated  by  the  commissioner,  specifically
 authorized  pursuant  to  this  article  to  provide  an  AIDS home care
 program. Such program shall be provided in the person's home or  in  the
 home  of  a  responsible  relative,  other responsible adult, adult care
 facilities specifically approved to admit or retain residents  for  such
 program, or in other residential settings as approved by the commission-
 er in conjunction with the commissioner of social services. Such program
 shall  provide  services  including,  but  not  be  limited to, the full
 complement of health, social and environmental services provided by long
 term home health care programs in accordance with regulations promulgat-
 ed by the commissioner. Such programs  shall  also  provide  such  other
 services  as  required by the commissioner to assure appropriate care at
 home for persons eligible under this section.
   § 2. Paragraph (d) and subparagraph (i) of paragraph (e)  of  subdivi-
 sion  2  of  section  365-a of the social services law, paragraph (d) as
 amended by chapter 59 of the laws of 1993, subparagraph (i) of paragraph
 (e) as amended by section 2 of part MM of chapter  56  of  the  laws  of
 2020, are amended to read as follows:
   (d) home health services provided in a recipient's home and prescribed
 by a physician, NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, ACTING WITH-
 IN  THE PROFESSIONAL'S LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE
 EDUCATION LAW, including services of a nurse provided on a part-time  or
 intermittent  basis  rendered by an approved home health agency or if no
 such agency is available, by a registered nurse, licensed to practice in
 this state, acting under the written orders of a physician, NURSE  PRAC-
 TITIONER,  OR  PHYSICIAN  ASSISTANT,  ACTING  WITHIN  THE PROFESSIONAL'S
 LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF  THE  EDUCATION  LAW,  and
 home  health aide service by an individual or shared aide provided by an
 approved home health agency when such services are determined to be cost
 effective and appropriate to meet the recipient's needs  for  assistance
 subject  to  the provisions of [section three hundred sixty-seven-j and]
 section three hundred sixty-seven-o of this title;
   (i) personal care  services,  including  personal  emergency  response
 services,  shared aide and an individual aide, subject to the provisions
 of subparagraphs (ii), (iii), (iv), (v)  and  (vi)  of  this  paragraph,
 furnished  to  an  individual  who  is not an inpatient or resident of a
 hospital, nursing facility, intermediate care facility  for  individuals
 A. 7187                             3
 
 with  intellectual  disabilities,  or institution for mental disease, as
 determined to meet the recipient's needs for assistance when cost effec-
 tive and appropriate, and when prescribed  by  a  qualified  independent
 physician, NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, ACTING WITHIN THE
 PROFESSIONAL'S  LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE EDUCA-
 TION LAW, selected or approved by the department of health,  in  accord-
 ance  with the recipient's plan of treatment and provided by individuals
 who are qualified to provide such services,  who  are  supervised  by  a
 registered  nurse and who are not members of the recipient's family, and
 furnished in the recipient's home or other location;
   § 3. Paragraph (b) of subdivision 1 of section  364-i  of  the  social
 services  law, as amended by chapter 693 of the laws of 1996, is amended
 to read as follows:
   (b) a physician, NURSE PRACTITIONER, OR  PHYSICIAN  ASSISTANT,  ACTING
 WITHIN  THE PROFESSIONAL'S LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF
 THE EDUCATION LAW, certifies that  such  applicant  no  longer  requires
 acute  hospital  care,  but  still  requires  medical  care which can be
 provided by a certified home health agency, long term home  health  care
 program, hospice or residential health care facility;
   §  4.  Subdivisions 2, 3 and 5 of section 367-c of the social services
 law, subdivisions 2 and 3 as amended by chapter 636 of the laws of 1980,
 subdivision 5 as amended by chapter 165 of the laws of 1991, are amended
 to read as follows:
   2. If a person eligible to receive services under  the  provisions  of
 this  title  who requires care, treatment, maintenance, nursing or other
 services in a nursing home desires to remain and is deemed by [his]  THE
 PERSON'S  physician,  NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, ACTING
 WITHIN THE PROFESSIONAL'S LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT  OF
 THE  EDUCATION LAW, able to remain in [his] THE PERSON'S own home or the
 home of a responsible relative or other responsible adult if the  neces-
 sary  services are provided, such person or [his] THE PERSON'S represen-
 tative shall so inform the local social services  official.  If  a  long
 term home health care program as defined under article thirty-six of the
 public  health law is provided in the social services district for which
 [he] THE OFFICIAL  has  authority,  such  official  shall  authorize  an
 assessment under the provisions of section thirty-six hundred sixteen of
 the  public  health  law. If the results of the assessment indicate that
 the person can receive the appropriate level of care at home, the  offi-
 cial  shall prepare for that person a plan for the provision of services
 comparable to those that would be rendered in a nursing home. In  devel-
 oping  such plan, the official shall consult with those persons perform-
 ing the assessment. The services shall be provided by a  certified  home
 health  agency, hospital, or residential health care facility authorized
 by the commissioner of health under article  thirty-six  of  the  public
 health  law to provide a long term home health care program. At the time
 of the initial assessment, and at the time of each subsequent assessment
 performed under the provisions of section thirty-six hundred sixteen  of
 the  public health law, or more often if the person's needs require, the
 official shall establish a monthly budget in accordance with which  [he]
 THE  OFFICIAL  shall  authorize  payment for the services provided under
 such plan. Total monthly expenditures made under  this  title  for  such
 person  shall  not  exceed  a  maximum of seventy-five per cent, or such
 lesser percentage as may be determined by the commissioner, of the aver-
 age of the monthly rates payable  under  this  title  for  nursing  home
 services  within the social services district for which the official has
 authority. However, if a continuing assessment  of  the  person's  needs
 A. 7187                             4
 
 demonstrates  that  [he]  THE  PERSON  requires  increased services, the
 social services official may authorize the  expenditure  of  any  amount
 accrued  under this section during the past twelve months as a result of
 the  expenditures  for  that  person  not  exceeding such maximum. If an
 assessment of the person's  needs  demonstrates  that  [he]  THE  PERSON
 requires  services the payment for which would exceed such monthly maxi-
 mum, but it can be reasonably anticipated that  total  expenditures  for
 required  services  for  such person will not exceed such maximum calcu-
 lated over a one year period, the social services official may authorize
 payment for such services.
   3. If a person eligible to receive services under  the  provisions  of
 this  title who requires health related care and services in an interme-
 diate care facility desires  to  remain  and  is  deemed  by  [his]  THE
 PERSON'S  physician,  NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT, ACTING
 WITHIN THE PROFESSIONAL'S LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT  OF
 THE  EDUCATION LAW, able to remain in [his] THE PERSON'S own home or the
 home of a responsible relative or other responsible adult if the  neces-
 sary  services are provided, such person or [his] THE PERSON'S represen-
 tative shall so inform the local social services official.   If  a  long
 term home health care program as defined under article thirty-six of the
 public  health law is provided in the social services district for which
 [he] THE OFFICIAL  has  authority,  such  official  shall  authorize  an
 assessment under the provisions of section thirty-six hundred sixteen of
 the  public  health  law. If the results of the assessment indicate that
 the person can receive the appropriate level of care at home, the  offi-
 cial  shall prepare for that person a plan for the provision of services
 comparable to those that would  be  rendered  in  an  intermediate  care
 facility. In developing such plan, the official shall consult with those
 persons  performing  the assessment. The services shall be provided by a
 certified home health  agency,  hospital,  or  residential  health  care
 facility  authorized by the commissioner of health under article thirty-
 six of the public health law to provide a long  term  home  health  care
 program.  At  the time of the initial assessment and at the time of each
 subsequent assessment performed under the provisions of section  thirty-
 six  hundred  sixteen  of  the  public  health law, or more often if the
 person's needs require, the official shall establish a monthly budget in
 accordance with which [he] THE OFFICIAL shall authorize payment for  the
 services provided under that plan. Total monthly expenditures made under
 this  title  for  such person shall not exceed a maximum of seventy-five
 per cent, or such lesser percentage as may be determined by the  commis-
 sioner,  of  the  average of the monthly rates paid under this title for
 the provision of health related care and services in  intermediate  care
 facilities  within  the  social services district for which the official
 has authority. However, if a continuing assessment of the person's needs
 demonstrates that [he]  THE  PERSON  requires  increased  services,  the
 social  services  official  may  authorize the expenditure of any amount
 accrued under this section during the past twelve months as a result  of
 the  expenditures  for  that  person  not  exceeding such maximum. If an
 assessment of the person's  needs  demonstrates  that  [he]  THE  PERSON
 requires  services the payment for which would exceed such monthly maxi-
 mum, but it can be reasonably anticipated that  total  expenditures  for
 required  services  for  such person will not exceed such maximum calcu-
 lated over a one year period, the social services official may authorize
 payment for such services.
   5. If a person eligible to receive services under  the  provisions  of
 this  title  who is medically eligible for care, treatment, maintenance,
 A. 7187                             5
 
 nursing or other services in a nursing home or is medically eligible for
 health related care  and  services  in  an  intermediate  care  facility
 desires  to  and is deemed by [his or her] THE PERSON'S physician, NURSE
 PRACTITIONER,  OR  PHYSICIAN ASSISTANT, ACTING WITHIN THE PROFESSIONAL'S
 LAWFUL SCOPE OF PRACTICE UNDER TITLE EIGHT OF THE EDUCATION LAW, able to
 remain in an adult care facility, other than a shelter for adults, which
 is able and willing to retain such person if the necessary services  are
 provided, such person or [his or her] THE PERSON'S representatives shall
 so inform the local social services official. If a long term home health
 care  program  is provided in a social services district, an official of
 such district shall authorize an  assessment  under  the  provisions  of
 section  three thousand six hundred sixteen of the public health law. If
 the results of the assessment indicate that the person can  receive  the
 appropriate  level  of  care at such location, and meets the appropriate
 standards for continued stay for such facility as are established by law
 and regulation, such official shall prepare for that person a  plan  for
 the  provision  of services. In developing such plan, the official shall
 consult with those persons performing the assessment and with the opera-
 tor of the adult care facility. The services shall be provided by a long
 term home health care program authorized pursuant to article  thirty-six
 of  the  public  health  law, provided, however that notwithstanding the
 provisions of section three thousand six hundred sixteen  of  such  law,
 services  shall  not  be provided prior to the completion of the assess-
 ment. At the time of the initial assessment and  at  the  time  of  each
 subsequent  assessment  performed  under the provisions of section three
 thousand six hundred sixteen of the public health law, or more often  if
 the person's needs require, the official shall establish a monthly budg-
 et  in  accordance  with which [he] THE OFFICIAL shall authorize payment
 for the services provided under that plan,  provided,  however  that  no
 services  shall  be  authorized  in  the  plan which the operator of the
 facility is required by law and regulation to  provide.  The  long  term
 home  health  care  program  providing  services authorized in such plan
 shall be solely responsible for managing and providing or arranging  for
 such  authorized services. The operator of the adult care facility shall
 be solely responsible for managing and providing  those  services  which
 the  facility  is required by law or regulation to provide. However, the
 two entities shall collaborate to  assure  coordination.  Total  monthly
 expenditures  made  under  this title for such person shall not exceed a
 maximum of fifty percent, or such lesser percentage as may be determined
 by the commissioner, of the average of the monthly rates paid under this
 title for the provision of nursing home services or health related  care
 and  services in intermediate care facilities, whichever is appropriate,
 within the social services district for which the official has  authori-
 ty.  However,  if  a  continuing assessment of the person's needs demon-
 strates that he or she requires increased services, the social  services
 official  may authorize the expenditure of any amount accrued under this
 section during the past twelve months as a result  of  the  expenditures
 for  that  person  not  exceeding  such maximum. If an assessment of the
 person's needs  demonstrates  that  [he  or  she]  THE  PERSON  requires
 services the payment for which would exceed such monthly maximum, but it
 can  be  reasonably  anticipated  that  total  expenditures for required
 services for such person will not exceed such maximum calculated over  a
 one  year period, the social services official may authorize payment for
 such services. The provisions of this subdivision shall not be deemed to
 alter standards for admission to an adult care facility  nor  shall  the
 A. 7187                             6
 
 admission  of a person into such facility be contingent on such person's
 enrollment in a long term home health care program.
   §  5.  This  act  shall take effect on the sixtieth day after it shall
 have become a law. Effective immediately, the addition, amendment and/or
 repeal of any rule or regulation necessary  for  the  implementation  of
 this  act  on its effective date are authorized to be made and completed
 on or before such effective date.