Amendment No. 492

Assembly Amendment to Assembly Bill No. 586 (BDR 40-870)

Proposed by: Committee on Health and Human Services

Amendment Box:

Resolves Conflicts with: N/A

Amends: Summary: Title: Preamble: Joint Sponsorship:

ASSEMBLY ACTION Initial and Date | SENATE ACTION Initial and Date

Adopted Lost | Adopted Lost

Concurred In Not | Concurred In Not

Receded Not | Receded Not

Amend section 1, page 1, line 2, by deleting "13," and inserting "15,".

Amend the bill as a whole by renumbering sections 2 through 8 as sections 3 through 9 and adding a new section designated sec. 2, following section 1, to read as follows:

"Sec. 2. For the purposes of sections 2 to 15, inclusive, of this act, "medical facility" is limited to a:

1. Facility for intermediate care;

2. Facility for skilled nursing;

3. Independent center for emergency medical care; or

4. Hospital.".

Amend sec. 2, page 1, by deleting line 12 and inserting:

"substance that results in harm or injury to the patient;".

Amend sec. 2, page 1, by deleting line 15 and inserting:

"antibiotics,

while the patient was under the direct care of the medical facility.".

Amend sec. 6, page 2, line 35, by deleting:

"2 to 5," and inserting:

"3 to 6,".

Amend sec. 6, page 2, line 36, after "act." by inserting:

"The report must include factors for adjusting risk based upon the population and patients served by the medical facility.".

Amend sec. 7, page 2, line 39, by deleting:

"2 to 5," and inserting:

"3 to 6,".

Amend sec. 8, page 3, by deleting lines 5 through 11 and inserting:

"its patients based on the severity of their conditions that establishes a method of determining required number of employees for each unit of service, patient and shift. The system must include:

(a) A method to determine the requirements for nursing care for a patient.

(b) An established method by which the amount of nursing care needed for each category of patient is validated for each unit of service and each shift.

(c) An established method to discern trends and patterns of delivery of nursing care by each unit of service, shift and level of licensed and nonlicensed employee.

(d) A mechanism by which the accuracy of the method described in paragraph (a) can be tested. The mechanism must address:

(1) The amount of nursing care needed by category of patient and pattern of delivery of care, reviewed on an annual basis or more often if warranted by changes in the number of patients or the severity of their conditions;

(2) The skill of the staff; and

(3) The model for delivery of care to patients.

(e) A method to determine allocation of staff resources based on the requirements for nursing care for each shift and each unit of service.

(f) A method by which the medical facility validates the reliability of the system for classifying patients for each shift and each unit of service.

2. The administrator of nursing services within the medical facility or a designee of the administrator shall develop a written staffing plan based on the need for care of patients determined by the system for classifying patients. The staffing plan must be developed and used for each unit of patient care and must specify the requirements for care of patients and the required level of staffing for licensed and nonlicensed employees. The plan must include:

(a) Requirements for staffing as determined by the system for classifying patients for each unit of service, documented each day and each shift.

(b) The actual staffing provided, documented each day and each shift.

(c) The variance between the required and actual staffing, documented each day and each shift.

The plan must be retained for 7 years.

3. The system for classifying patients must be reviewed at least annually by a committee appointed by the administrator of nursing services to determine whether the system accurately measures needed care for patients. At least one-half of the members of the committee must be registered nurses who provide direct care to patients.

4. If a review pursuant to subsection 3 reveals that adjustments are necessary in the system for classifying patients to ensure accuracy in measuring needed care for patients, the adjustments must be made within 30 days. The medical facility must have a policy and procedure to determine how such adjustments will be made. The policy and procedure must be retained for 7 years.".

Amend the bill as a whole by deleting sec. 9.

Amend sec. 10, page 4, line 8, after "provisions of" by inserting:

"sections 2 to 15, inclusive, of".

Amend sec. 13, page 5, line 13, by deleting "6" and inserting "7".

Amend the bill as a whole by renumbering sec. 14 as sec. 16 and adding new sections designated sections 14 and 15, following sec. 13, to read as follows:

"Sec. 14. 1. A person who fails to report or falsifies information, or coerces, threatens, intimidates or otherwise influences another person to fail to report or falsify information required to be reported pursuant to sections 3 to 6, inclusive, of this act, is subject to a civil penalty of not more than $10,000 for each violation.

2. A person who willfully and repeatedly violates subsection 1, if the violation is related to:

(a) A pattern or practice of such violations; or

(b) The quality of care or services provided by or conditions at a medical facility that would likely lead to serious injury or death for patients or employees of the medical facility,

is guilty of a gross misdemeanor, may be barred from accepting payment pursuant to a state-financed health insurance program and may have his license to operate a medical facility suspended or revoked.

Sec. 15. 1. A person in a position of responsibility for staffing in a medical facility who fails to ensure that there is sufficient staff to fulfill the requirements of a staffing plan developed pursuant to section 9 of this act is subject to a civil penalty of not more than $10,000 for each violation.

2. A person who willfully and repeatedly violates subsection 1, or who coerces, threatens, intimidates or otherwise influences another person to fail to fulfill the requirements of a staffing plan developed pursuant to section 9 of this act, if the violation is related to:

(a) A pattern or practice of such violations; or

(b) The quality of care or services provided by or conditions at a medical facility that would likely lead to serious injury or death for patients or employees of the medical facility,

is guilty of a gross misdemeanor, may be barred from accepting payment pursuant to a state-financed health insurance program and may have his license to operate a medical facility suspended or revoked.".

Amend the title of the bill to read as follows:

"AN ACT relating to health care; requiring the establishment of a system for classifying patients and a staffing plan for certain medical facilities; requiring the state board of health to adopt certain regulations; requiring certain medical facilities to report certain information to the board; prohibiting certain acts by employees of certain medical facilities; providing penalties; and providing other matters properly relating thereto.".