S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   4177
 
                        2023-2024 Regular Sessions
 
                             I N  S E N A T E
 
                             February 6, 2023
                                ___________
 
 Introduced  by  Sen. WALCZYK -- read twice and ordered printed, and when
   printed to be committed to the Committee on Higher Education
 
 AN ACT to amend the education law and the public health law, in relation
   to authorizing  certain  nursing  home  medication  aides  to  perform
   certain   advanced  tasks;  and  providing  for  the  repeal  of  such
   provisions upon expiration thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Section  6908 of the education law is amended by adding a
 new subdivision 3 to read as follows:
   3. THIS ARTICLE SHALL NOT BE CONSTRUED  AS  PROHIBITING  THE  ADMINIS-
 TRATION OF MEDICATION BY A NURSING HOME MEDICATION AIDE CERTIFIED PURSU-
 ANT  TO SECTION TWENTY-EIGHT HUNDRED THREE-J OF THE PUBLIC HEALTH LAW AS
 ADDED BY CHAPTER SEVEN HUNDRED SEVENTEEN OF THE LAWS OF NINETEEN HUNDRED
 EIGHTY-NINE IN RESIDENTIAL HEALTH CARE FACILITIES, AS DEFINED IN ARTICLE
 TWENTY-EIGHT OF THE PUBLIC HEALTH LAW, IN THE COUNTY OF ST. LAWRENCE, IN
 ACCORDANCE WITH REGULATIONS DEVELOPED BY THE COMMISSIONER, IN  CONSULTA-
 TION  WITH  THE  COMMISSIONER OF HEALTH.  AT A MINIMUM, SUCH REGULATIONS
 SHALL:
   A. AUTHORIZE THE ADMINISTRATION OF MEDICATIONS WHICH ARE  ROUTINE  AND
 PREFILLED  OR OTHERWISE PACKAGED IN A MANNER THAT PROMOTES RELATIVE EASE
 OF  ADMINISTRATION,  PROVIDED  THAT  ADMINISTRATION  OF  MEDICATIONS  BY
 INJECTION SHALL BE PROHIBITED. PROVIDED, HOWEVER, SUCH PROHIBITION SHALL
 NOT  APPLY  TO  INJECTIONS  OF  INSULIN OR OTHER INJECTIONS FOR DIABETES
 CARE, TO INJECTIONS OF LOW MOLECULAR WEIGHT HEPARIN, AND  TO  PRE-FILLED
 AUTO-INJECTIONS  OF  EPINEPHRINE  FOR  EMERGENCY PURPOSES, AND PROVIDED,
 FURTHER, THAT ENTITIES EMPLOYING NURSING HOME MEDICATION AIDES  PURSUANT
 TO  THIS  SUBDIVISION  SHALL  ESTABLISH A SYSTEMATIC APPROACH TO ADDRESS
 DRUG DIVERSION;
   B. PROVIDE THAT MEDICATION ADMINISTRATION BY NURSING  HOME  MEDICATION
 AIDES MAY BE PERFORMED ONLY UNDER THE DIRECT SUPERVISION OF A REGISTERED
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06862-01-3
              

 S. 4177                             2
 
 PROFESSIONAL  NURSE  LICENSED  IN  NEW  YORK STATE, AS SET FORTH IN THIS
 SUBDIVISION AND SUBDIVISION EIGHT OF SECTION SIXTY-NINE HUNDRED NINE  OF
 THIS  ARTICLE, WHERE SUCH NURSE IS EMPLOYED BY A RESIDENTIAL HEALTH CARE
 FACILITY  LICENSED  OR CERTIFIED PURSUANT TO THE PUBLIC HEALTH LAW. SUCH
 NURSING SUPERVISION SHALL:
   (I) INCLUDE TRAINING AND PERIODIC ASSESSMENT  OF  THE  PERFORMANCE  OF
 MEDICATION ADMINISTRATION;
   (II)  BE  DETERMINED  BY THE REGISTERED PROFESSIONAL NURSE RESPONSIBLE
 FOR SUPERVISING SUCH MEDICATION ADMINISTRATION BASED UPON THE COMPLEXITY
 OF SUCH MEDICATION ADMINISTRATION, THE SKILL AND EXPERIENCE OF THE NURS-
 ING HOME MEDICATION AIDE, AND THE HEALTH STATUS OF  THE  INDIVIDUAL  FOR
 WHOM SUCH MEDICATION ADMINISTRATION IS BEING PERFORMED;
   (III) INCLUDE A COMPREHENSIVE INITIAL AND THEREAFTER REGULAR AND ONGO-
 ING ASSESSMENT OF THE INDIVIDUAL'S NEEDS;
   (IV)  INCLUDE AS A REQUIREMENT THAT THE SUPERVISING REGISTERED PROFES-
 SIONAL NURSE  SHALL  VISIT  INDIVIDUALS  RECEIVING  MEDICATION  FOR  THE
 PURPOSE OF SUPERVISING THE MEDICATION ADMINISTRATION PROVIDED BY NURSING
 HOME  MEDICATION  AIDES  AND  INCLUDE AS A REQUIREMENT THAT A REGISTERED
 PROFESSIONAL NURSE SHALL BE AVAILABLE TO  THE  NURSING  HOME  MEDICATION
 AIDE  TWENTY-FOUR HOURS A DAY, SEVEN DAYS A WEEK, PROVIDED THAT A REGIS-
 TERED PROFESSIONAL NURSE SHALL  BE  AVAILABLE  TO  VISIT  AN  INDIVIDUAL
 RECEIVING  MEDICATION  AS  NECESSARY TO PROTECT THE HEALTH AND SAFETY OF
 SUCH INDIVIDUAL; AND
   (V) AS SHALL BE SPECIFIED BY THE COMMISSIONER, BE PROVIDED IN A MANNER
 THAT TAKES INTO ACCOUNT INDIVIDUAL CARE NEEDS AND  CASE  MIX  COMPLEXITY
 AND  PROVIDE  THAT  THE  NUMBER  OF  INDIVIDUALS SERVED BY A SUPERVISING
 REGISTERED PROFESSIONAL NURSE IS REASONABLE AND PRUDENT;
   C. ESTABLISH A PROCESS BY WHICH A REGISTERED  PROFESSIONAL  NURSE  MAY
 ASSIGN MEDICATION ADMINISTRATION TO A NURSING HOME MEDICATION AIDE. SUCH
 PROCESS SHALL INCLUDE, BUT NOT BE LIMITED TO:
   (I) ALLOWING ASSIGNMENT OF MEDICATION ADMINISTRATION TO A NURSING HOME
 MEDICATION  AIDE ONLY WHERE SUCH NURSING HOME MEDICATION AIDE HAS DEMON-
 STRATED TO THE SATISFACTION OF THE SUPERVISING  REGISTERED  PROFESSIONAL
 NURSE  COMPETENCY  IN  MEDICATION  ADMINISTRATION THAT SUCH NURSING HOME
 MEDICATION AIDE IS AUTHORIZED TO PERFORM, A WILLINGNESS TO PERFORM  SUCH
 MEDICATION ADMINISTRATION, AND THE ABILITY TO EFFECTIVELY AND EFFICIENT-
 LY  COMMUNICATE  WITH THE INDIVIDUAL RECEIVING MEDICATION AND UNDERSTAND
 SUCH INDIVIDUAL'S NEEDS;
   (II) PROHIBITING ASSIGNMENT OF MEDICATION ADMINISTRATION TO A  NURSING
 HOME MEDICATION AIDE IF THE INDIVIDUAL RECEIVING SERVICES DECLINES TO BE
 SERVED BY A NURSING HOME MEDICATION AIDE;
   (III)  AUTHORIZING  THE  SUPERVISING  REGISTERED PROFESSIONAL NURSE TO
 REVOKE ANY ASSIGNED MEDICATION ADMINISTRATION FROM A NURSING HOME  MEDI-
 CATION AIDE FOR ANY REASON; AND
   (IV)  AUTHORIZING  MULTIPLE  REGISTERED PROFESSIONAL NURSES TO JOINTLY
 AGREE TO ASSIGN MEDICATION ADMINISTRATION TO A NURSING  HOME  MEDICATION
 AIDE, PROVIDED FURTHER THAT ONLY ONE REGISTERED PROFESSIONAL NURSE SHALL
 BE  REQUIRED TO DETERMINE IF THE NURSING HOME MEDICATION AIDE HAS DEMON-
 STRATED COMPETENCY IN THE MEDICATION ADMINISTRATION TO BE PERFORMED;
   D. PROVIDE THAT MEDICATION ADMINISTRATION MAY  BE  PERFORMED  ONLY  IN
 ACCORDANCE  WITH  AND  PURSUANT  TO  AN AUTHORIZED HEALTH PRACTITIONER'S
 ORDERED CARE;
   E. PROVIDE THAT ONLY A CERTIFIED  NURSING  HOME  MEDICATION  AIDE  MAY
 PERFORM MEDICATION ADMINISTRATION AS A NURSING HOME MEDICATION AIDE WHEN
 SUCH AIDE HAS:
 S. 4177                             3
 
   (I)  AT LEAST ONE YEAR OF EXPERIENCE PROVIDING RESIDENTIAL HEALTH CARE
 SERVICES;
   (II) COMPLETED THE REQUISITE TRAINING AND DEMONSTRATED COMPETENCIES OF
 A  NURSING  HOME  MEDICATION  AIDE  AS DETERMINED BY THE COMMISSIONER IN
 CONSULTATION WITH THE COMMISSIONER OF HEALTH;
   (III) SUCCESSFULLY COMPLETED COMPETENCY EXAMINATIONS  SATISFACTORY  TO
 THE COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER OF HEALTH; AND
   (IV)  MEETS  OTHER  APPROPRIATE  QUALIFICATIONS  AS  DETERMINED BY THE
 COMMISSIONER IN CONSULTATION WITH THE COMMISSIONER OF HEALTH;
   F. PROVIDE THAT ONLY AN INDIVIDUAL WHO HAS  SATISFIED  ALL  APPLICABLE
 TRAINING  REQUIREMENTS AND HAVING PASSED THE APPLICABLE COMPETENCY EXAM-
 INATIONS AND WHO MEETS OTHER REQUIREMENTS AS SET  FORTH  IN  REGULATIONS
 ISSUED  BY  THE COMMISSIONER OF HEALTH PURSUANT TO THE PUBLIC HEALTH LAW
 MAY PERFORM MEDICATION ADMINISTRATION PURSUANT TO THIS  SUBDIVISION  AND
 MAY HOLD HIMSELF OR HERSELF OUT AS A NURSING HOME MEDICATION AIDE;
   G.  ESTABLISH  MINIMUM  STANDARDS  OF  TRAINING FOR THE PERFORMANCE OF
 MEDICATION ADMINISTRATION BY NURSING HOME  MEDICATION  AIDES,  INCLUDING
 DIDACTIC  TRAINING, CLINICAL TRAINING, AND A SUPERVISED CLINICAL PRACTI-
 CUM WITH STANDARDS SET FORTH BY THE COMMISSIONER OF HEALTH;
   H. PROVIDE THAT NURSING HOME MEDICATION AIDES SHALL RECEIVE  CASE-SPE-
 CIFIC  TRAINING  ON  THE MEDICATION ADMINISTRATION TO BE ASSIGNED BY THE
 SUPERVISING NURSE, PROVIDED THAT ADDITIONAL TRAINING  SHALL  TAKE  PLACE
 WHENEVER ADDITIONAL MEDICATION ADMINISTRATION IS ASSIGNED;
   I.  PROHIBIT  A  NURSING  HOME MEDICATION AIDE FROM HOLDING HIMSELF OR
 HERSELF OUT, OR ACCEPTING EMPLOYMENT AS, A PERSON LICENSED  TO  PRACTICE
 NURSING UNDER THE PROVISIONS OF THIS ARTICLE;
   J.  PROVIDE  THAT  A  NURSING HOME MEDICATION AIDE IS NOT REQUIRED NOR
 PERMITTED TO ASSESS THE MEDICATION OR MEDICAL NEEDS OF AN INDIVIDUAL;
   K. PROVIDE THAT A NURSING HOME MEDICATION AIDE SHALL NOT BE AUTHORIZED
 TO PERFORM ANY ACTIVITIES PURSUANT TO THIS SUBDIVISION THAT ARE  OUTSIDE
 THE  SCOPE  OF  PRACTICE  OF A LICENSED PRACTICAL NURSE OR THAT HAVE NOT
 BEEN APPROPRIATELY ASSIGNED BY THE SUPERVISING  REGISTERED  PROFESSIONAL
 NURSE;
   L.  PROVIDE  THAT  A  NURSING  HOME MEDICATION AIDE SHALL DOCUMENT ALL
 MEDICATION ADMINISTRATION TO EACH INDIVIDUAL THROUGH THE USE OF A  MEDI-
 CATION ADMINISTRATION RECORD; AND
   M.  PROVIDE  THAT  THE SUPERVISING REGISTERED PROFESSIONAL NURSE SHALL
 RETAIN THE DISCRETION TO DECIDE WHETHER TO  ASSIGN  MEDICATION  ADMINIS-
 TRATION  TO  NURSING  HOME MEDICATION AIDES UNDER THIS PROGRAM AND SHALL
 NOT BE SUBJECT TO COERCION, RETALIATION, OR THE THREAT OF RETALIATION.
   § 2. Section 6909 of the education law is  amended  by  adding  a  new
 subdivision 11 to read as follows:
   11.  A  REGISTERED PROFESSIONAL NURSE, WHILE WORKING FOR A RESIDENTIAL
 HEALTH CARE FACILITY LICENSED OR CERTIFIED PURSUANT TO THE PUBLIC HEALTH
 LAW, MAY, IN ACCORDANCE WITH THIS SUBDIVISION, ASSIGN NURSING HOME MEDI-
 CATION AIDES TO PERFORM MEDICATION ADMINISTRATION FOR INDIVIDUALS PURSU-
 ANT TO THE PROVISIONS OF SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED
 EIGHT OF THIS ARTICLE AND SUPERVISE NURSING HOME  MEDICATION  AIDES  WHO
 PERFORM ASSIGNED MEDICATION ADMINISTRATION.
   (A)  PRIOR  TO ASSIGNING OR MODIFYING AN ASSIGNMENT TO PERFORM MEDICA-
 TION ADMINISTRATION, THE REGISTERED PROFESSIONAL NURSE SHALL:
   (I) COMPLETE A NURSING ASSESSMENT TO ASCERTAIN  THE  CLIENT'S  CURRENT
 HEALTH STATUS AND CARE NEEDS; AND
   (II)  PROVIDE TO THE NURSING HOME MEDICATION AIDE WRITTEN, INDIVIDUAL-
 SPECIFIC INSTRUCTIONS FOR PERFORMING THE MEDICATION  ADMINISTRATION  AND
 S. 4177                             4
 
 CRITERIA  FOR  IDENTIFYING,  REPORTING  AND  RESPONDING  TO  PROBLEMS OR
 COMPLICATIONS.
   (B)  THE  REGISTERED  PROFESSIONAL  NURSE  SHALL NOT ASSIGN MEDICATION
 ADMINISTRATION UNLESS:
   (I) THE MEDICATION ADMINISTRATION TO BE ASSIGNED IS CONSISTENT WITH AN
 AUTHORIZED HEALTH PRACTITIONER'S ORDERED CARE;
   (II) THE REGISTERED PROFESSIONAL NURSE PROVIDES CASE SPECIFIC TRAINING
 TO THE NURSING HOME MEDICATION AIDE AND  PERSONALLY  VERIFIES  THAT  THE
 NURSING  HOME  MEDICATION  AIDE  CAN  SAFELY AND COMPETENTLY PERFORM THE
 MEDICATION ADMINISTRATION;
   (III) THE REGISTERED PROFESSIONAL NURSE DETERMINES  THAT  THE  NURSING
 HOME  MEDICATION  AIDE  IS  WILLING  TO PERFORM SUCH MEDICATION ADMINIS-
 TRATION; AND
   (IV) THE REGISTERED PROFESSIONAL NURSE  DETERMINES  THAT  THE  NURSING
 HOME  MEDICATION AIDE IS ABLE TO EFFECTIVELY AND EFFICIENTLY COMMUNICATE
 WITH THE INDIVIDUAL RECEIVING SERVICES AND UNDERSTAND SUCH  INDIVIDUAL'S
 NEEDS.
   (C) THE SUPERVISING REGISTERED PROFESSIONAL NURSE SHALL:
   (I)  VISIT  INDIVIDUALS RECEIVING MEDICATION FOR THE PURPOSE OF SUPER-
 VISING THE MEDICATION ADMINISTRATION PROVIDED BY NURSING HOME MEDICATION
 AIDES; AND
   (II) CONDUCT REGULAR AND ONGOING ASSESSMENT OF THE INDIVIDUAL'S NEEDS.
   § 3. Section 6906 of the education law is  amended  by  adding  a  new
 subdivision 10 to read as follows:
   (10)  IN  CONJUNCTION WITH AND AS A CONDITION OF EACH TRIENNIAL REGIS-
 TRATION, THE DEPARTMENT SHALL ASK AND A LICENSED PRACTICAL  NURSE  SHALL
 INDICATE  WHETHER THE LICENSED PRACTICAL NURSE IS OR HAS PREVIOUSLY BEEN
 AUTHORIZED AS A NURSING HOME MEDICATION  AIDE  PURSUANT  TO  SUBDIVISION
 THREE  OF  SECTION SIXTY-NINE HUNDRED EIGHT OF THIS ARTICLE. THE DEPART-
 MENT SHALL PROVIDE RESPONSES TO THE DEPARTMENT OF HEALTH AND THE DEPART-
 MENT OF HEALTH SHALL INCLUDE SUCH  INFORMATION  IN  REPORTS  RELATED  TO
 NURSING HOME MEDICATION AIDES.
   §  4.  Section 206 of the public health law is amended by adding a new
 subdivision 32 to read as follows:
   32. THE COMMISSIONER SHALL NOTIFY THE COMMISSIONER OF EDUCATION IN ANY
 INSTANCE IN WHICH A REGISTERED PROFESSIONAL NURSE  ENGAGES  IN  IMPROPER
 BEHAVIOR  WHILE  SUPERVISING  A NURSING HOME MEDICATION AIDE PURSUANT TO
 SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF  THE  EDUCATION
 LAW.
   §  5. Section 2801 of the public health law is amended by adding a new
 subdivision 15 to read as follows:
   15. "NURSING HOME MEDICATION AIDES" MEANS NURSING HOME AIDES  WHO  ARE
 AUTHORIZED  TO PERFORM MEDICATION ADMINISTRATION AS DELINEATED IN SUBDI-
 VISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF  THE  EDUCATION  LAW
 AND  REGULATIONS ISSUED BY THE COMMISSIONER OF EDUCATION RELATING THERE-
 TO. THE COMMISSIONER SHALL PROMULGATE REGULATIONS REGARDING SUCH  AIDES,
 WHICH  SHALL  INCLUDE  A PROCESS FOR THE LIMITATION OR REVOCATION OF THE
 NURSING HOME  MEDICATION  AIDE'S  AUTHORIZATION  TO  PERFORM  MEDICATION
 ADMINISTRATION IN APPROPRIATE CASES.
   §  6. Section 2803-j of the public health law, as added by chapter 717
 of the laws of 1989, is amended by adding a new subdivision 5 to read as
 follows:
   5. THE DEPARTMENT SHALL INDICATE WITHIN THE NURSING  HOME  NURSE  AIDE
 REGISTRY  WHEN  A  NURSING  HOME NURSE AIDE HAS SATISFIED ALL APPLICABLE
 TRAINING AND RECERTIFICATION REQUIREMENTS AND HAS PASSED THE  APPLICABLE
 COMPETENCY  EXAMINATIONS  NECESSARY TO PERFORM MEDICATION ADMINISTRATION
 S. 4177                             5
 
 PURSUANT TO SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED EIGHT OF THE
 EDUCATION LAW AND REGULATIONS ISSUED THERETO. ANY LIMITATION OR  REVOCA-
 TION  OF  THE NURSING HOME MEDICATION AIDE'S AUTHORIZATION ALSO SHALL BE
 INDICATED ON THE REGISTRY.
   §  7.  On or before October 1, 2029, the commissioner of health shall,
 in consultation with the commissioner of education, issue  a  report  on
 the  implementation  of nursing home medication aides in the state. Such
 report shall include the number of nursing home medication aides author-
 ized pursuant to this act; the number of nursing home nurse  aides  that
 became  authorized  to  perform medication administration; the number of
 nursing home medication aides that became registered as licensed practi-
 cal nurses; the types of medication that nursing home  medication  aides
 are  administering;  the  number of complaints pertaining to  medication
 administration provided by  nursing  home  medication  aides  that  were
 reported  to  the  department  of health; and the number of nursing home
 medication aides who had their authorization limited  or  revoked.  Such
 report  shall  provide recommendations to the governor and the chairs of
 the senate and assembly health and higher education committees regarding
 the implementation of nursing home medication  aides  pursuant  to  this
 act, and any recommendations related thereto.
   § 8. This act shall take effect immediately; provided that:
   a.  sections  one  and  three  of this act shall take effect two years
 after this act shall have  become  a  law.  Effective  immediately,  the
 commissioner  of  education  is authorized to adopt or amend regulations
 and take such other actions as are necessary to implement the provisions
 of sections one and two of this act on or before  such  effective  date;
 provided,  further, that no medication administration shall be performed
 pursuant to the provisions of subdivision three of section 6908  of  the
 education  law,  as  added by section one of this act, on or before such
 effective date; provided further, that  no    medication  administration
 shall  be  performed  pursuant to such provisions until such regulations
 are adopted and except in conformance with such regulations including in
 conformance with the provisions  of  such  regulations  related  to  the
 completion of nursing home medication aide training and the satisfaction
 of competency examination requirements.
   b. this act shall expire and be deemed repealed March 31, 2030.