Bill S5048-2011

Permits certain nurses and patients to exercise the authority under the existing nurse practice act for the provision of care at home

Permits certain nurses and patients to exercise the authority under the existing nurse practice act for the provision of care at home.






VOTE: COMMITTEE VOTE: - Higher Education - May 8, 2012
Ayes (13): LaValle, Alesi, Flanagan, Griffo, Grisanti, Ritchie, Robach, Seward, Zeldin, Stavisky, Parker, Rivera, Serrano
Ayes W/R (5): Maziarz, Kennedy, Krueger, Oppenheimer, Carlucci



TITLE OF BILL: An act to amend the education law, in relation to the provision of nursing level care under a registered nurse's supervision

PURPOSE OR GENERAL IDEA OF BILL: To permit nurses and patients in state-regulated (Public health law article 36) home care agencies to be able to exercise the authority under the existing nurse practice act for the provision of care at home.

SUMMARY OF PROVISIONS: Amends clause (iii) of paragraph a of subdivision 1 of section 6908 of the education law, which is the current nurse practice act exemption that permits nurses and patients/family members to instruct home care aides in certain programs to provide care that would otherwise be permissible for family members under the scope of nursing. The proposed amendment would allow the exemption to apply to nurses/patients in Article 36 home care agencies as well.

JUSTIFICATION: This current exemption in the nurse practice act originates from a 1992 chapter of law (chapter 795). Prior to that chapter, for a patient receiving home care, only a nurse or a family member (acting under an existing exemption to the nurse practice act) could provide care to the patient that would involve tasks that crossover into "the practice of nursing" (e.g., suctioning, medication administration). Patients without family members thus faced sole reliance on nurses providing such care in the home (i.e., including reliance on nurses for care which could be provided by family) and, in the absence of nurses (or family), faced institutionalization or other extreme limitations. With the severe and growing shortage of nurses, patients faced growing access problems as well as limitations in community living that could be addressed with the proper ability to instruct aides to provide services under nurse/patient instruction in the absence of family. Patients urged the Legislature to provide a solution.

Recognizing the issues with regard to patient access, need for efficient use of nursing resources and exorbitant cost, and with the direct involvement of consumers and representatives of the State Nurses Association, the statute was amended to provide for the current exemption. While the legislative proposal sought to address all home care settings, in its final version, the exemption was set forth on an initial conservative basis (with services reimbursable through the Consumer Directed program), which is its form in the present law.

The flexibility that would be accorded nurses and patients under this bill is of core importance to the patients, the nurses, the system and the added efficiency of the Medicaid Program. It is a practical reform with innumerable benefits.

This proposal provides for a long-needed, major improvement in service access, flexibility and efficiency. It's benefits include:

* Enhanced access to and flexibility of care for consumers.

* Enhanced care planning and arrangement flexibility by nurses.

* Opportunity for more efficient deployment of nursing and other agency resources.

* Cost savings to the Medicaid program.

PRIOR LEGISLATIVE HISTORY: New standalone bill. The bill is an amendment to chapter 795 of 1992. This amendment was recently also introduced as part of the comprehensive legislation known as the "Home Care Accessibility and Efficiency Improvement Act, S.5179 of 2009-10, portions of which were enacted as part of the State Deficit Reduction Act of 2009 and the State Health/Medicaid Budget of 2010-11.

FISCAL IMPLICATIONS: It is projected that this legislation would result in over $20 Million in anticipated state-share Medicaid savings through the increased capability of nurses and patients to more efficiently deploy both aide and nursing services in the absence of family members.

EFFECTIVE DATE: This act takes effect immediately.


STATE OF NEW YORK ________________________________________________________________________ 5048 2011-2012 Regular Sessions IN SENATE May 3, 2011 ___________
Introduced by Sen. HANNON -- read twice and ordered printed, and when printed to be committed to the Committee on Higher Education AN ACT to amend the education law, in relation to the provision of nurs- ing level care under a registered nurse's supervision THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Clause (iii) of paragraph a of subdivision 1 of section 6908 of the education law, as amended by chapter 160 of the laws of 2003, is amended to read as follows: (iii) the providing of care by a person acting in the place of a person exempt under clause (i) of this paragraph, but who does hold himself or herself out as one who accepts employment for performing such care, where nursing services are under the instruction of a licensed REGISTERED PROFESSIONAL nurse, or under the instruction of a patient or family or household member determined by a registered professional nurse to be self-directing and capable of providing such instruction, and any remuneration is provided under section three hundred sixty-five-f of the social services law OR FOR SERVICES UNDER AN ENTITY CERTIFIED, APPROVED OR LICENSED UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW; or S 2. This act shall take effect immediately.


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