S T A T E   O F   N E W   Y O R K
       ________________________________________________________________________
                                         2141
                              2015-2016 Regular Sessions
                                 I N  A S S E M B L Y
                                   January 15, 2015
                                      ___________
       Introduced  by M. of A. GOTTFRIED, GUNTHER, JAFFEE, LIFTON, ENGLEBRIGHT,
         ROBINSON, ROSENTHAL, ORTIZ, HOOPER -- Multi-Sponsored by -- M.  of  A.
         ARROYO,  BRENNAN,  BROOK-KRASNY,  CLARK,  COLTON,  DINOWITZ,  HEASTIE,
         MARKEY, McDONOUGH, MONTESANO, PAULIN, PERRY, TITONE -- read  once  and
         referred to the Committee on Health
       AN ACT to amend the public health law, in relation to requiring a regis-
         tered  nurse  on  staff  at facilities certified for enhanced assisted
         living or special needs assisted living
         THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
       BLY, DO ENACT AS FOLLOWS:
    1    Section  1. Section 4655 of the public health law, as added by chapter
    2  2 of the laws of 2004, is amended to read as follows:
    3    S 4655. Certification procedures and requirements. 1.  Notwithstanding
    4  any other provision of law, an assisted living operator may apply to the
    5  department to obtain an enhanced assisted living certificate pursuant to
    6  this section.
    7    (a) Such application shall be on a form approved by the department.
    8    (b)  An  assisted living operator may apply for such a certificate for
    9  the entire facility or any number of beds at the facility.
   10    (c) To obtain an enhanced assisted living certificate,  the  applicant
   11  must  submit  a  plan to the department setting forth how the additional
   12  needs of residents will be safely and appropriately met  at  such  resi-
   13  dence.  Such  plan  shall include, but need not be limited to, a written
   14  description of services, staffing levels, staff education and  training,
   15  work experience, and any environmental modifications that have been made
   16  or  will  be  made  to  protect  the  health, safety and welfare of such
   17  persons in the residence. THE PLAN SHALL DESCRIBE HOW THE FACILITY  WILL
   18  MEET THE REGISTERED NURSE STAFFING REQUIREMENT.
   19    (d) In addition to any other requirements of assisted living, an oper-
   20  ator  of  enhanced assisted living may hire care staff directly pursuant
   21  to standards developed by the department or contract with  a  home  care
        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD02691-01-5
       A. 2141                             2
    1  services  agency  which has been approved to operate pursuant to article
    2  thirty-six of this chapter.
    3    (e)  No  assisted  living  residence  shall  be  certified as enhanced
    4  assisted living unless and  until  the  applicant  obtains  the  written
    5  approval of the department.
    6    (F)  (I)  TO  OBTAIN OR RENEW AN ENHANCED ASSISTED LIVING CERTIFICATE,
    7  THE APPLICANT SHALL BE REQUIRED TO HAVE A  REGISTERED  NURSE  ONSITE  TO
    8  ASSESS AND MONITOR THE CONDITION OF RESIDENTS.
    9    (II)  THE  REGISTERED  NURSE SHALL BE AT THE FACILITY A MINIMUM OF ONE
   10  SHIFT PER DAY, FIVE DAYS PER WEEK. THE PRINCIPAL DUTIES  OF  THE  REGIS-
   11  TERED NURSE SHALL BE COORDINATING RESIDENT CARE, PROVIDING ONGOING RESI-
   12  DENT  ASSESSMENT  AND  MONITORING,  AND  ENSURING THAT ALL RESIDENTS ARE
   13  RECEIVING APPROPRIATE CARE.
   14    (III) FACILITIES WITH RESIDENT POPULATIONS THAT DO NOT NECESSITATE THE
   15  MONITORING OR OVERSIGHT SERVICES OF A REGISTERED NURSE ON  A  FULL  TIME
   16  BASIS MAY ALSO EMPLOY THE REGISTERED NURSE IN AN ADMINISTRATIVE OR OTHER
   17  CAPACITY,  AS  APPROPRIATE  FOR  THE  FACILITY. FACILITIES CHOOSING THIS
   18  OPTION MUST DEMONSTRATE THAT RESIDENTS ARE RECEIVING ADEQUATE ASSESSMENT
   19  AND MONITORING.
   20    (IV) EXISTING ENHANCED ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO
   21  FURNISH PROOF OF COMPLIANCE WITH THIS PARAGRAPH NO LATER  THAN  EIGHTEEN
   22  MONTHS AFTER THIS PARAGRAPH SHALL HAVE BECOME A LAW.
   23    2.  No  resident  shall be permitted to continue to age in place under
   24  the terms of an enhanced assisted living certificate unless  the  opera-
   25  tor,  the  resident's  physician, THE FACILITY'S STAFF REGISTERED NURSE,
   26  and, if applicable, the resident's licensed or certified home care agen-
   27  cy, agree that the additional needs of the resident can  be  safely  and
   28  appropriately  met  at  the  residence. A resident eligible for enhanced
   29  assisted living or his or her representative shall submit to  the  resi-
   30  dence a written report from a physician, which report shall state that:
   31    (a) the physician has physically examined the resident within the last
   32  month; and
   33    (b)  the  resident  is not in need of twenty-four hour skilled nursing
   34  care or medical care which would require  placement  in  a  hospital  or
   35  residential health care facility.
   36    3. The residence must notify a resident that, while the residence will
   37  make  reasonable  efforts to facilitate the resident's ability to age in
   38  place pursuant to an individualized service plan, there may be  a  point
   39  reached where the needs of the resident cannot be safely or appropriate-
   40  ly  met  at  the  residence, requiring the transfer of the resident to a
   41  more appropriate facility in accordance  with  the  provisions  of  this
   42  article.
   43    4. If a resident reaches the point where he or she is in need of twen-
   44  ty-four  hour  skilled  nursing  care  or  medical  care  required to be
   45  provided by facilities licensed pursuant to article twenty-eight of this
   46  chapter or article nineteen, thirty-one  or  thirty-two  of  the  mental
   47  hygiene  law, AS DETERMINED BY THE PATIENT'S PHYSICIAN OR THE FACILITY'S
   48  STAFF RESIDENT NURSE, then the resident  must  be  discharged  from  the
   49  residence  and  the  operator  shall initiate proceedings for the termi-
   50  nation of the residency agreement of such resident  in  accordance  with
   51  the  provisions  of  section  four  hundred  sixty-one-h  of  the social
   52  services law.  Provided, however, a resident may remain at the residence
   53  if each of the following conditions are met:
   54    (a) a resident in need of twenty-four hour  skilled  nursing  care  or
   55  medical care hires appropriate nursing, medical or hospice staff to care
   56  for his or her increased needs;
       A. 2141                             3
    1    (b)  the  resident's physician [and], home care services agency [both]
    2  AND THE FACILITY'S STAFF REGISTERED NURSE  ALL  determine  and  document
    3  that,  with the provision of such additional nursing, medical or hospice
    4  care, the resident can be safely cared for in the residence,  and  would
    5  not  require  placement  in  a  hospital, nursing home or other facility
    6  licensed under article twenty-eight of this chapter or article nineteen,
    7  thirty-one or thirty-two of the mental hygiene law;
    8    (c) the operator agrees to retain the resident and to  coordinate  the
    9  care  provided  by  the  operator and the additional nursing, medical or
   10  hospice staff; and
   11    (d) the resident is otherwise eligible to reside at the residence.
   12    5. In addition to the requirements otherwise required for licensure as
   13  assisted living, any residence that  advertises  or  markets  itself  as
   14  serving  individuals  with special needs, including, but not limited to,
   15  individuals with  dementia  or  cognitive  impairments,  must  submit  a
   16  special needs plan to the department setting forth how the special needs
   17  of  such  residents  will  be safely and appropriately met at such resi-
   18  dence. Such plan shall include, but need not be limited  to,  a  written
   19  description  of  specialized  services, staffing levels, staff education
   20  and training, work  experience,  professional  affiliations  or  special
   21  characteristics  relevant to serving persons with special needs, and any
   22  environmental modifications that have been  made  or  will  be  made  to
   23  protect the health, safety and welfare of such persons in the residence.
   24  In approving an application for special needs certification, the depart-
   25  ment shall develop standards to ensure adequate staffing and training in
   26  order  to  safely meet the needs of the resident. The standards shall be
   27  based upon recommendations of the task force established by section five
   28  of [the] chapter TWO of the laws of two thousand four [which added  this
   29  section].  IN  ADDITION  TO ANY OTHER STANDARDS WHICH THE DEPARTMENT MAY
   30  DEVELOP, APPLICANTS FOR SPECIAL NEEDS ASSISTED LIVING CERTIFICATES SHALL
   31  BE SUBJECT TO THE SAME REGISTERED NURSE STAFFING  REQUIREMENTS  DETAILED
   32  IN  PARAGRAPHS  (C) AND (F) OF SUBDIVISION ONE OF THIS SECTION. No resi-
   33  dence shall market [themselves] ITSELF as providing specialized services
   34  unless and until the  department  has  approved  such  applicant  for  a
   35  special  needs  assisted  living  certificate.  EXISTING  SPECIAL  NEEDS
   36  ASSISTED LIVING RESIDENCES SHALL BE REQUIRED TO FURNISH PROOF OF COMPLI-
   37  ANCE WITH THE NEW STAFFING REQUIREMENTS NO LATER  THAN  EIGHTEEN  MONTHS
   38  AFTER THIS SENTENCE SHALL HAVE BECOME A LAW.
   39    6. An enhanced assisted living certificate shall not be required of an
   40  adult care facility, or part thereof, which has obtained approval by the
   41  department  to  operate  an  assisted living program pursuant to section
   42  four hundred sixty-one-l of the social services law. Provided,  however,
   43  such  exemption shall only apply to those beds at the facility which are
   44  subject to the assisted living program.
   45    S 2. This act shall take effect on the ninetieth day  after  it  shall
   46  have  become  a  law;  provided  that any rules and regulations, and any
   47  other actions necessary to implement the provisions of this act  on  its
   48  effective  date are authorized and directed to be completed on or before
   49  such date.