- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
| Assembly Actions - Lowercase Senate Actions - UPPERCASE | |
|---|---|
| Jun 18, 2021 | signed chap.155 |
| Jun 07, 2021 | delivered to governor |
| May 04, 2021 | returned to assembly passed senate 3rd reading cal.729 substituted for s1168a referred to health delivered to senate passed assembly |
| Apr 29, 2021 | advanced to third reading cal.232 |
| Apr 28, 2021 | reported |
| Apr 22, 2021 | print number 108b |
| Apr 22, 2021 | amend (t) and recommit to ways and means |
| Mar 01, 2021 | reported referred to ways and means |
| Feb 17, 2021 | print number 108a |
| Feb 17, 2021 | amend and recommit to codes |
| Feb 02, 2021 | reported referred to codes |
| Jan 06, 2021 | referred to health |
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View Votes
May 4, 2021 - Floor Vote
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View Floor vote details
Floor Vote: May 4, 2021
Bill Amendments
Original A B (Active)co-Sponsors
Richard Gottfried
Crystal Peoples-Stokes
Didi Barrett
Linda Rosenthal
View additional co-sponsorsHarry B. Bronson
William Colton
Michael Benedetto
Catalina Cruz
William Magnarelli
David Weprin
Jose Rivera
Charles Fall
Jeffrion Aubry
Steven Otis
Phil Steck
Angelo Santabarbara
Kenneth Zebrowski
Thomas Abinanti
Charles Barron
Rebecca Seawright
Latrice Walker
Rodneyse Bichotte Hermelyn
Diana Richardson
Alicia Hyndman
Victor M. Pichardo
Latoya Joyner
Kimberly Jean-Pierre
Nily Rozic
Ron Kim
Andrew Hevesi
Daniel O'Donnell
Erik Dilan
Maritza Davila
Pamela J. Hunter
Jaime R. Williams
Robert C. Carroll
Carrie Woerner
Stacey Pheffer Amato
Billy Jones
Clyde Vanel
Yuh-Line Niou
Al Taylor
Jeffrey Dinowitz
Inez E. Dickens
Monica P. Wallace
Karines Reyes
Steve Stern
Nader sayegh
Jonathan Jacobson
Karen McMahon
Peter Abbate
Kevin Cahill
Nathalia Fernandez
Mathylde Frontus
Harvey Epstein
Marianne Buttenschon
Philip Ramos
Taylor Darling
Edward Braunstein
Carmen De La Rosa
Judy Griffin
Dan Quart
John T. McDonald III
Steven Englebright
Emily Gallagher
Patrick Burke
Anna Kelles
Steven Cymbrowitz
Sarah Clark
Demond Meeks
Karl Brabenec
Doug Smith
Michael Montesano
John Salka
Colin Schmitt
Angelo J. Morinello
Brian D. Miller
Jake Ashby
Melissa Miller
Joe DeStefano
Phara Souffrant Forrest
Jessica Gonzalez-Rojas
Chris Burdick
multi-Sponsors
Brian Barnwell
Vivian Cook
Michael Cusick
Patricia Fahy
View additional multi-sponsorsSandy Galef
Deborah Glick
Donna Lupardo
David McDonough
John K. Mikulin
Amy Paulin
N. Nick Perry
J. Gary Pretlow
Edward Ra
Daniel Rosenthal
Jo Anne Simon
Michaelle C. Solages
Fred Thiele
2021-A108 - Details
See Senate Version of this Bill: S1168 Law Section: Public Health Law Laws Affected: Amd §2805-t, Pub Health L Versions Introduced in Other Legislative Sessions: 2009-2010: S7974
2011-2012: S4553
2013-2014: S3691
2015-2016: A8580, S782
2017-2018: A1532, S3330
2019-2020: A2954, S1032
2021-A108 - Summary
Requires certain facilities establish clinical staffing committees.
2021-A108 - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 108 2021-2022 Regular Sessions I N A S S E M B L Y (PREFILED) January 6, 2021 ___________ Introduced by M. of A. GUNTHER, CRUZ, GOTTFRIED, BARRETT, L. ROSENTHAL, SMITH, BRONSON, COLTON, MONTESANO, BRABENEC, BENEDETTO, MAGNARELLI, SALKA, DeSTEFANO, WEPRIN, SCHMITT, J. RIVERA, FALL, AUBRY, MORINELLO, OTIS, STECK, B. MILLER, ASHBY, SANTABARBARA, ZEBROWSKI, ABINANTI, BARRON, SEAWRIGHT, WALKER, BICHOTTE, RICHARDSON, HYNDMAN, PEOPLES-STOKES, PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI, O'DONNELL, DILAN, DAVILA, HUNTER, WILLIAMS, CARROLL, WOERNER, PHEFFER AMATO, JONES, VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH, JACOBSON, McMAHON, ABBATE, CAHILL, FERNANDEZ, FRONTUS, EPSTEIN, BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART -- Multi-Sponsored by -- M. of A. BARNWELL, COOK, CUSICK, CYMBROWITZ, ENGLEBRIGHT, FAHY, GALEF, GLICK, LUPARDO, McDO- NOUGH, MIKULIN, PAULIN, PERRY, PRETLOW -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to enacting the "safe staffing for quality care act" THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "safe staffing for quality care act". § 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the public health law, paragraph (a) as amended by chapter 923 of the laws of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965, are amended to read as follows: (a) Application for an operating certificate for a hospital shall be made upon forms prescribed by the department. The application shall [contain] INCLUDE the name of the hospital, the kind or kinds of hospi- tal service to be provided, the location and physical description of the institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN SECTION TWENTY- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
LBD02466-01-1 A. 108 2 EIGHT HUNDRED TWENTY-NINE OF THIS ARTICLE, and such other information as the department may require. (b) An operating certificate shall not be issued by the department unless it finds that the premises, equipment, personnel, DOCUMENTED STAFFING PLAN, rules and by-laws, standards of medical care, and hospi- tal service are fit and adequate and that the hospital will be operated in the manner required by this article and rules and regulations there- under. § 3. The public health law is amended by adding nine new sections 2828, 2829, 2830, 2831, 2832, 2833, 2834, 2835 and 2836 to read as follows: § 2828. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF THE FOLLOWING: 1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES; 2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFF- ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES; 3. TO ENSURE THE ADEQUATE PROTECTION OF PATIENTS IN HEALTH CARE SETTINGS, IT IS ESSENTIAL THAT QUALIFIED REGISTERED NURSES AND OTHER LICENSED NURSES BE ACCESSIBLE AND AVAILABLE TO MEET THE NEEDS OF PATIENTS; AND 4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD BE BASED ON THE PATIENT'S CARE NEEDS, THE SEVERITY OF CONDITION, SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES. § 2829. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES, AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE CONTEXT OTHERWISE PLAINLY REQUIRES: 1. "ACUTE CARE FACILITY" SHALL MEAN A HOSPITAL OTHER THAN A RESIDEN- TIAL HEALTH CARE FACILITY AND SHALL ALSO INCLUDE ANY FACILITY THAT PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTI- CLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACIL- ITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR A PUBLIC AUTHORITY OR PUBLIC BENEFIT CORPORATION. 2. "ACUITY SYSTEM" SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT WHICH (A) PREDICTS NURSING CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY, INTENSITY OF NURSING INTERVENTIONS REQUIRED, AND THE COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT'S NURSING CARE PLAN; (B) DETAILS THE AMOUNT OF NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN TERMS THAT READILY CAN BE USED AND UNDERSTOOD BY DIRECT-CARE NURSES. THE ACUITY SYSTEM SHALL TAKE INTO CONSIDERATION THE PATIENT CARE SERVICES PROVIDED NOT ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL. 3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY SYSTEM. 4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS. 5. "DOCUMENTED STAFFING PLAN" SHALL MEAN A DETAILED WRITTEN PLAN SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS- ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN AN ACUTE CARE FACILITY A. 108 3 FOR A GIVEN YEAR, BASED ON REASONABLE PROJECTIONS DERIVED FROM THE PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR UNIT SIZE OR FUNCTION DURING THE CURRENT YEAR. 6. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE OR LICENSED PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW. 7. "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE RECOGNIZED STAND- ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN- NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY. 8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF THIS SECTION AND SECTIONS TWENTY-EIGHT HUNDRED TWENTY-NINE, TWENTY-EIGHT HUNDRED THIRTY, TWENTY-EIGHT HUNDRED THIRTY-ONE, TWENTY-EIGHT HUNDRED THIRTY-TWO, TWENTY-EIGHT HUNDRED THIRTY-THREE, TWENTY-EIGHT HUNDRED THIRTY-FOUR, TWENTY-EIGHT HUNDRED THIRTY-FIVE AND TWENTY-EIGHT HUNDRED THIRTY-SIX OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU- ANT THERETO. 9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND EXPERIENCE AMONG DIRECT-CARE NURSES. 10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT RATIO WITHIN A NURSING DEPARTMENT OR UNIT. 11. "UNIT" SHALL MEAN A PATIENT CARE COMPONENT, AS DEFINED BY THE DEPARTMENT, WITHIN AN ACUTE CARE FACILITY. 12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE IN THE DELIVERY OF PATIENT CARE. § 2830. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER SHALL: 1. APPOINT AN ACUTE CARE FACILITY COUNCIL CONSISTING OF THIRTEEN MEMBERS. NO LESS THAN SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES, THREE OF WHOM SHALL BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINIS- TRATOR. NO LESS THAN TWO MEMBERS OF THE ACUTE CARE FACILITY COUNCIL SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAIN- ING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO REPRESENTATIVES OF ACUTE CARE FACILITIES, ONE REPRESENTATIVE OF A NURS- ING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR CERTIFIED BARGAINING AGENT OF NURSES. THE ACUTE CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUD- ING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE NOT SPECIFIED IN THIS ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVAL- UATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING OF AN OPERATING CERTIFICATE BY THE DEPARTMENT. 2. PROMULGATE, AFTER CONSULTATION WITH THE ACUTE CARE FACILITY COUN- CIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND PROVISIONS OF THE SAFE STAFFING REQUIREMENTS, INCLUDING REGULATIONS DEFINING TERMS, SETTING FORTH DIRECT-CARE NURSE TO PATIENT RATIOS, SETTING FORTH NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS AND A. 108 4 PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS; AND 3. ASSURE THAT THE PROVISIONS OF SAFE STAFFING REQUIREMENTS ARE ENFORCED, INCLUDING THE ISSUANCE OF REGULATIONS WHICH AT A MINIMUM PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE TO COMPLY WITH SUCH REQUIREMENTS AND PUBLIC ACCESS TO INFORMATION REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS PURSUANT TO SUCH REQUIREMENTS. § 2831. STAFFING REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH ACUTE CARE FACILITY SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN EACH DEPART- MENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED CARE NEEDS OF THE PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY SHALL MEET THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS SECTION. 2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF- ICATE TO ANY ACUTE CARE FACILITY UNLESS SUCH FACILITY ANNUALLY SUBMITS TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND APPROPRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING YEAR. THE DOCUMENTED STAFFING PLAN SHALL: (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF THIS SECTION; (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER LAWS, RULES OR REGULATIONS; (C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN; (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES, TRANSFERS AND ADMISSIONS, STAFF BREAKS, MEALS, ROUTINE AND EXPECTED ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING CARE; (E) INCLUDE A PLAN TO MEET NECESSARY STAFFING LEVELS AND SERVICES PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC- TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY OTHER PERSONNEL; (F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT; (G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS; (H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH SUCH CLASSIFICATION; AND (I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES- ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER SUPPORTIVE AND ASSISTIVE STAFF. 3. MINIMUM STAFFING REQUIREMENTS. (A) THE DOCUMENTED STAFFING PLAN SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA- TIENT RATIOS: A. 108 5 (I) ONE NURSE TO ONE PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND OR THIRD STAGE OF LABOR; (II) ONE NURSE TO TWO PATIENTS: MATERNAL/CHILD CARE UNITS FOR THE FIRST STAGE OF LABOR, AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS; (III) ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA- TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME- DIATE CARE NURSERY UNITS; (IV) ONE NURSE TO THREE PATIENTS: POSTPARTUM MOTHER/BABY COUPLETS (MAXIMUM SIX PATIENTS PER NURSE); (V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS, POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI- ATRIC UNITS; (VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS AND SUBACUTE PATIENTS; AND (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS. FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO, PSYCHIATRIC UNITS, AND ACUTE CARE FACILITIES OPERATED PURSUANT TO THE MENTAL HYGIENE LAW OR THE CORRECTION LAW, THE DEPARTMENT SHALL ESTABLISH BY REGULATION THE APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT RATIO. (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF PATIENTS THAT MAY BE ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME. (C) THERE SHALL BE NO AVERAGING OF THE NUMBER OF PATIENTS AND THE TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY PERIOD OF TIME. (D) THE COMMISSIONER, IN CONSULTATION WITH THE ACUTE CARE FACILITY COUNCIL, SHALL ESTABLISH REGULATIONS PROVIDING FOR THE MAINTENANCE OF MINIMUM NURSE-TO-PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING DURING ROUTINE OR EXPECTED ABSENCES FROM THE UNIT, SUCH AS MEALS OR BREAKS. 4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC- TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS ASSIGNED TO THE LICENSED PRACTICAL NURSE SHALL ALSO BE INCLUDED IN CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES- SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC- TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE LICENSED PRACTICAL NURSE. 5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS- ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI- CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC- TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL. 6. ADJUSTMENTS BY FACILITY. THE MINIMUM STAFFING REQUIREMENT AND NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL BE ADJUSTED BY THE ACUTE CARE FACILITY AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE NURSES. ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMIN- ING NURSING CARE REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS, THE NEED FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY, THE COMPLEXITY OF CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT A. 108 6 CARE PLAN AND THE ABILITY FOR SELF-CARE, AND THE LICENSURE OF THE PERSONNEL REQUIRED FOR CARE. 7. COMMISSIONER REGULATIONS. THE COMMISSIONER MAY BY REGULATION REQUIRE A DOCUMENTED STAFFING PLAN TO HAVE HIGHER NURSE-TO-PATIENT RATIOS THAN THOSE SET FORTH IN THIS SECTION. 8. NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT PROVIDES FOR STAFFING RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION. § 2832. COMPLIANCE WITH STAFFING PLAN AND RECORDKEEPING. 1. EACH ACUTE CARE FACILITY SHALL AT ALL TIMES STAFF IN ACCORDANCE WITH ITS DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE; PROVIDED, HOWEVER, THAT NOTHING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS, NOR SHALL THE REQUIREMENTS SET FORTH IN SUCH SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT. 2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN AN ACUTE CARE FACILITY UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTI- CLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR ORIENTATION IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURS- ING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMON- STRATED CURRENT COMPETENCE IN PROVIDING CARE IN THAT UNIT OR CLINICAL AREA. ACUTE CARE FACILITIES THAT UTILIZE TEMPORARY NURSING AGENCIES SHALL HAVE AND ADHERE TO A WRITTEN PROCEDURE TO ORIENT AND EVALUATE PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETEN- CY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO. IN THE EVENT OF AN EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD TO UNSAFE PATIENT CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT UNIT OR CLINICAL AREA, PROVIDED THAT SUCH NURSES SHALL BE ASSIGNED PATIENTS APPROPRIATE TO THEIR SKILL AND COMPETENCY LEVEL. THE FACILITY SHALL ESTABLISH A CONSISTENT PLAN FOR ADDRESSING EMERGENCY STAFFING SITUATIONS AND MONITOR OUTCOMES. EMERGENCIES ARE DEFINED AS NATURAL DISASTERS, DECLARED EMERGENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS NOT REASONABLY ANTICIPATED AND PLANNED FOR AND NOT REGULARLY OCCURRING WITHIN THE FACILITY. 3. EACH ACUTE CARE FACILITY SHALL MAINTAIN ACCURATE DAILY RECORDS SHOWING: (A) THE NUMBER OF PATIENTS ADMITTED, RELEASED AND PRESENT IN EACH NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; (B) THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS- ING DEPARTMENT OR UNIT WITHIN SUCH FACILITY; AND (C) THE IDENTITY AND DUTY HOURS OF EACH DIRECT-CARE NURSE IN EACH NURSING DEPARTMENT OR UNIT WITHIN SUCH FACILITY. 4. EACH ACUTE CARE FACILITY SHALL MAINTAIN DAILY STATISTICS, BY NURS- ING DEPARTMENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJURY AND MEDICAL ERRORS. 5. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE MAINTAINED FOR A PERIOD OF SEVEN YEARS. 6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE MADE AVAILABLE UPON REQUEST TO THE DEPARTMENT AND TO THE PUBLIC; PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL COMPLY WITH THE APPLICABLE PATIENT PRIVACY LAWS, RULES AND REGULATIONS, AND A. 108 7 THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE IDENTITY AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC. § 2833. WORK ASSIGNMENT POLICY. 1. GENERAL. EACH ACUTE CARE FACILITY SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN WORK ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT. 2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT: (A) FOR WHICH THE NURSE IS NOT PREPARED BY EDUCATION, TRAINING OR EXPERIENCE TO SAFELY FULFILL THE ASSIGNMENT WITHOUT COMPROMISING OR JEOPARDIZING PATIENT SAFETY, THE NURSE'S ABILITY TO MEET FORESEEABLE PATIENT NEEDS OR THE NURSE'S LICENSE; OR (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS. 3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL CONTAIN PROCEDURES FOR THE FOLLOWING: (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED OF AN ASSIGNMENT OR CONTINUED DUTY; (B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH- ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN- UED DUTY; (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES THE REQUEST TO BE RELIEVED IF: (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY, (II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS CONDITIONS JUSTIFYING REFUSAL; AND (D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED, BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION, PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO NURSING. § 2834. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY ACUTE CARE FACILITY SHALL: 1. POST IN A CONSPICUOUS PLACE READILY ACCESSIBLE TO THE GENERAL PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT FACILITY TOGETHER WITH INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE FACILITY'S STAFF- ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED; 2. UPON REQUEST, MAKE COPIES OF THE DOCUMENTED STAFFING PLAN FILED WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND 3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION: (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT, (B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM, AND (C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT DURING THE SHIFT. A. 108 8 § 2835. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE- GATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS PROMULGATED PURSUANT TO THIS ARTICLE. § 2836. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT HUNDRED THIRTY-THREE OF THIS ARTICLE. ANY ACUTE CARE FACILITY THAT VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGN- MENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-THREE OF THIS ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS. § 4. Section 2801-a of the public health law is amended by adding a new subdivision 3-b to read as follows: 3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI- TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC- TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS. § 5. Section 2805 of the public health law is amended by adding a new subdivision 3 to read as follows: 3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD- ANCE WITH THIS ARTICLE, THE COMMISSIONER SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS. § 6. The public health law is amended by adding a new section 2895-b to read as follows: § 2895-B. RESIDENTIAL HEALTH CARE FACILITY STAFFING LEVELS. 1. DEFI- NITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: (A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE RESIDEN- TIAL HEALTH CARE FACILITY NURSE AIDE REGISTRY PURSUANT TO SECTION TWEN- TY-EIGHT HUNDRED THREE-J OF THIS CHAPTER. (B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT THAT TIME. 2. COMMISSIONER AND RESIDENTIAL HEALTH CARE FACILITY COUNCIL; POWERS AND DUTIES. THE COMMISSIONER SHALL: APPOINT A RESIDENTIAL HEALTH CARE FACILITY COUNCIL CONSISTING OF THIRTEEN MEMBERS. NO LESS THAN TWO MEMBERS SHALL BE DIRECT CARE LICENSED PRACTICAL NURSES, NO LESS THAN TWO MEMBERS SHALL BE DIRECT CARE CERTIFIED NURSE ASSISTANTS AND NO LESS A. 108 9 THAN ONE MEMBER SHALL BE A DIRECT CARE REGISTERED PROFESSIONAL NURSE. THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURS- ES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND A REPRESENTATIVE OF NURSING PROFESSIONAL ASSOCIATIONS. THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY OPERA- TORS, TWO REPRESENTATIVES OF RESIDENTIAL HEALTH CARE FACILITY NURSE ADMINISTRATORS AND ONE REPRESENTATIVE OF CONSUMERS. THE RESIDENTIAL HEALTH CARE FACILITY COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVEL- OPMENT OF REGULATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLA- TURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARDING STAFFING LEVELS IN RESIDENTIAL HEALTH CARE FACILITIES. 3. STAFFING STANDARDS. (A) THE COMMISSIONER, IN CONSULTATION WITH THE COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR RESIDEN- TIAL HEALTH CARE FACILITY MINIMUM STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAIN- TAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BE- ING OF EACH RESIDENT OF THE FACILITY. THE COMMISSIONER SHALL ALSO REQUIRE BY REGULATION THAT EVERY RESIDENTIAL HEALTH CARE FACILITY MAIN- TAIN RECORDS ON ITS STAFFING LEVELS, REPORT ON SUCH RECORDS TO THE DEPARTMENT, AND MAKE SUCH RECORDS AVAILABLE FOR INSPECTION BY THE DEPARTMENT. (B) EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL: (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY. (C) SUBJECT TO SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS UNDER SUBDIVISION FOUR OF THIS SECTION. (D) IN DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED WHILE PERFORMING SERVICES THAT ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD PREPARATION, HOUSEKEEPING, LAUNDRY, MAINTENANCE SERVICES, OR OTHER ACTIVITIES THAT ARE NOT DIRECT NURSING CARE. 4. STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE OF THIS SECTION, EVERY RESIDENTIAL HEALTH CARE FACILITY SHALL MAINTAIN A STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING: (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE; (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A LICENSED PRACTICAL NURSE OR A REGISTERED NURSE; (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE MINIMUM OF 0.75 HOURS OF CARE PER RESIDENT PROVIDED BY A REGISTERED NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN APPROPRIATE LEVEL OF REGISTERED NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK, TO MEET RESIDENT NEEDS; AND (D) RESIDENTIAL HEALTH CARE FACILITIES THAT CARE FOR SUBACUTE PATIENTS SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PATIENT RATIO: ONE NURSE TO FIVE PATIENTS. 5. ANY RESIDENTIAL HEALTH CARE FACILITY THAT VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGNMENT POLICY UNDER THIS SECTION MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING A. 108 10 REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A PREVAILING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS. 6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACIL- ITY IS REQUIRED TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY- EIGHT HUNDRED FIVE-T OF THIS CHAPTER. INFORMATION UNDER THIS PARAGRAPH SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES AND THE STAFF, AS REQUIRED BY THE COMMISSIONER. (B) A RESIDENTIAL HEALTH CARE FACILITY SHALL POST A SUMMARY OF THIS SECTION, PROVIDED BY THE DEPARTMENT, IN PROXIMITY TO EACH POSTING REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION. § 7. If any provision of this act, or any application of any provision of this act, is held to be invalid, or ruled by any federal agency to violate or be inconsistent with any applicable federal law or regu- lation, that shall not affect the validity or effectiveness of any other provision of this act, or of any other application of any provision of this act. § 8. This act shall take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the addition, amend- ment and/or repeal of any rule or regulation necessary for the implemen- tation of this act on its effective date are authorized to be made and completed on or before such effective date.
co-Sponsors
Richard Gottfried
Crystal Peoples-Stokes
Didi Barrett
Linda Rosenthal
View additional co-sponsorsHarry B. Bronson
William Colton
Michael Benedetto
Catalina Cruz
William Magnarelli
David Weprin
Jose Rivera
Charles Fall
Jeffrion Aubry
Steven Otis
Phil Steck
Angelo Santabarbara
Kenneth Zebrowski
Thomas Abinanti
Charles Barron
Rebecca Seawright
Latrice Walker
Rodneyse Bichotte Hermelyn
Diana Richardson
Alicia Hyndman
Victor M. Pichardo
Latoya Joyner
Kimberly Jean-Pierre
Nily Rozic
Ron Kim
Andrew Hevesi
Daniel O'Donnell
Erik Dilan
Maritza Davila
Pamela J. Hunter
Jaime R. Williams
Robert C. Carroll
Carrie Woerner
Stacey Pheffer Amato
Billy Jones
Clyde Vanel
Yuh-Line Niou
Al Taylor
Jeffrey Dinowitz
Inez E. Dickens
Monica P. Wallace
Karines Reyes
Steve Stern
Nader sayegh
Jonathan Jacobson
Karen McMahon
Peter Abbate
Kevin Cahill
Nathalia Fernandez
Mathylde Frontus
Harvey Epstein
Marianne Buttenschon
Philip Ramos
Taylor Darling
Edward Braunstein
Carmen De La Rosa
Judy Griffin
Dan Quart
John T. McDonald III
Steven Englebright
Emily Gallagher
Patrick Burke
Anna Kelles
Steven Cymbrowitz
Sarah Clark
Demond Meeks
Karl Brabenec
Doug Smith
Michael Montesano
John Salka
Colin Schmitt
Angelo J. Morinello
Brian D. Miller
Jake Ashby
Melissa Miller
Joe DeStefano
Phara Souffrant Forrest
Jessica Gonzalez-Rojas
Chris Burdick
Zohran Mamdani
Marcela Mitaynes
William Conrad
Michael Cusick
Khaleel Anderson
Stefani Zinerman
Michael Lawler
multi-Sponsors
Brian Barnwell
Vivian Cook
Patricia Fahy
Sandy Galef
View additional multi-sponsorsDeborah Glick
Donna Lupardo
David McDonough
John K. Mikulin
Amy Paulin
N. Nick Perry
J. Gary Pretlow
Edward Ra
Daniel Rosenthal
Jo Anne Simon
Michaelle C. Solages
Fred Thiele
2021-A108A - Details
See Senate Version of this Bill: S1168 Law Section: Public Health Law Laws Affected: Amd §2805-t, Pub Health L Versions Introduced in Other Legislative Sessions: 2009-2010: S7974
2011-2012: S4553
2013-2014: S3691
2015-2016: A8580, S782
2017-2018: A1532, S3330
2019-2020: A2954, S1032
2021-A108A - Summary
Requires certain facilities establish clinical staffing committees.
2021-A108A - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 108--A 2021-2022 Regular Sessions I N A S S E M B L Y (PREFILED) January 6, 2021 ___________ Introduced by M. of A. GUNTHER, GOTTFRIED, PEOPLES-STOKES, BARRETT, L. ROSENTHAL, BRONSON, COLTON, BENEDETTO, CRUZ, MAGNARELLI, WEPRIN, J. RIVERA, FALL, AUBRY, OTIS, STECK, SANTABARBARA, ZEBROWSKI, ABINAN- TI, BARRON, SEAWRIGHT, WALKER, BICHOTTE HERMELYN, RICHARDSON, HYNDMAN, PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI, O'DONNELL, DILAN, DAVILA, HUNTER, WILLIAMS, CARROLL, WOERNER, PHEFFER AMATO, JONES, VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH, JACOBSON, McMAHON, ABBATE, CAHILL, FERNANDEZ, FRONTUS, EPSTEIN, BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART, McDONALD, ENGLEBRIGHT, GALLAGHER, BURKE, KELLES, CYMBROWITZ, CLARK, MEEKS, BRABENEC, SMITH, MONTESANO, SALKA, SCHMITT, MORINELLO, B. MILL- ER, ASHBY, M. MILLER, DeSTEFANO, FORREST, GONZALEZ-ROJAS, BURDICK -- Multi-Sponsored by -- M. of A. BARNWELL, COOK, CUSICK, FAHY, GALEF, GLICK, LUPARDO, McDONOUGH, MIKULIN, PAULIN, PERRY, PRETLOW, RA, D. ROSENTHAL, SIMON, SOLAGES, THIELE -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to enacting the "safe staffing for quality care act" THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Short title. This act shall be known and may be cited as the "safe staffing for quality care act". § 2. Paragraphs (a) and (b) of subdivision 2 of section 2805 of the public health law, paragraph (a) as amended by chapter 923 of the laws of 1973 and paragraph (b) as added by chapter 795 of the laws of 1965, are amended to read as follows: (a) Application for an operating certificate for a hospital shall be made upon forms prescribed by the department. The application shall [contain] INCLUDE the name of the hospital, the kind or kinds of hospi- EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted. LBD02466-07-1 A. 108--A 2 tal service to be provided, the location and physical description of the institution, A DOCUMENTED STAFFING PLAN, AS DEFINED IN SECTION TWENTY- EIGHT HUNDRED TWENTY-NINE OF THIS ARTICLE, and such other information as the department may require. (b) An operating certificate shall not be issued by the department unless it finds that the premises, equipment, personnel, DOCUMENTED STAFFING PLAN, rules and by-laws, standards of medical care, and hospi- tal service are fit and adequate and that the hospital will be operated in the manner required by this article and rules and regulations there- under. § 3. The public health law is amended by adding nine new sections 2828, 2829, 2830, 2831, 2832, 2833, 2834, 2835 and 2836 to read as follows: § 2828. POLICY AND PURPOSE. THE LEGISLATURE FINDS AND DECLARES ALL OF THE FOLLOWING: 1. HEALTH CARE SERVICES ARE BECOMING COMPLEX AND IT IS INCREASINGLY DIFFICULT FOR PATIENTS TO ACCESS INTEGRATED SERVICES; 2. THE QUALITY OF PATIENT CARE IS JEOPARDIZED BECAUSE OF NURSE STAFF- ING SHORTAGES AND IMPROPER UTILIZATION OF NURSING SERVICES; 3. TO ENSURE THE ADEQUATE PROTECTION OF PATIENTS IN HEALTH CARE SETTINGS, IT IS ESSENTIAL THAT QUALIFIED REGISTERED NURSES AND OTHER LICENSED NURSES BE ACCESSIBLE AND AVAILABLE TO MEET THE NEEDS OF PATIENTS; AND 4. THE BASIC PRINCIPLES OF STAFFING IN THE HEALTH CARE SETTING SHOULD BE BASED ON THE PATIENT'S CARE NEEDS, THE SEVERITY OF CONDITION, SERVICES NEEDED AND THE COMPLEXITY SURROUNDING THOSE SERVICES. § 2829. SAFE STAFFING; DEFINITIONS. THE FOLLOWING WORDS AND PHRASES, AS USED IN THIS ARTICLE, SHALL HAVE THE FOLLOWING MEANINGS UNLESS THE CONTEXT OTHERWISE PLAINLY REQUIRES: 1. "HOSPITAL" SHALL MEAN A GENERAL HOSPITAL UNDER THIS ARTICLE AND SHALL ALSO INCLUDE ANY FACILITY THAT PROVIDES HEALTH CARE SERVICES PURSUANT TO THE MENTAL HYGIENE LAW, ARTICLE NINETEEN-G OF THE EXECUTIVE LAW OR THE CORRECTION LAW IF SUCH FACILITY IS OPERATED BY THE STATE OR A POLITICAL SUBDIVISION OF THE STATE OR A PUBLIC AUTHORITY OR PUBLIC BENE- FIT CORPORATION. 2. "ACUITY SYSTEM" SHALL MEAN AN ESTABLISHED MEASUREMENT INSTRUMENT WHICH (A) PREDICTS NURSING CARE REQUIREMENTS FOR INDIVIDUAL PATIENTS BASED ON SEVERITY OF PATIENT ILLNESS, NEED FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY, INTENSITY OF NURSING INTERVENTIONS REQUIRED, AND THE COMPLEXITY OF CLINICAL NURSING JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT'S NURSING CARE PLAN; (B) DETAILS THE AMOUNT OF NURSING CARE NEEDED, BOTH IN NUMBER OF DIRECT-CARE NURSES AND IN SKILL MIX OF NURSING PERSONNEL REQUIRED, ON A DAILY BASIS, FOR EACH PATIENT IN A NURSING DEPARTMENT OR UNIT; AND (C) IS STATED IN TERMS THAT READILY CAN BE USED AND UNDERSTOOD BY DIRECT-CARE NURSES. THE ACUITY SYSTEM SHALL TAKE INTO CONSIDERATION THE PATIENT CARE SERVICES PROVIDED NOT ONLY BY REGISTERED PROFESSIONAL NURSES BUT ALSO BY LICENSED PRACTICAL NURSES, SOCIAL WORKERS AND OTHER HEALTH CARE PERSONNEL. 3. "ASSESSMENT TOOL" SHALL MEAN A MEASUREMENT SYSTEM THAT COMPARES THE STAFFING LEVEL IN EACH NURSING DEPARTMENT OR UNIT AGAINST ACTUAL PATIENT NURSING CARE REQUIREMENTS IN ORDER TO REVIEW THE ACCURACY OF AN ACUITY SYSTEM. 4. "DIRECT-CARE NURSE" AND "DIRECT-CARE NURSING STAFF" SHALL MEAN ANY NURSE WHO HAS PRINCIPAL RESPONSIBILITY TO OVERSEE OR CARRY OUT MEDICAL REGIMENS, NURSING OR OTHER BEDSIDE CARE FOR ONE OR MORE PATIENTS. A. 108--A 3 5. "DOCUMENTED STAFFING PLAN" SHALL MEAN A DETAILED WRITTEN PLAN SETTING FORTH THE MINIMUM NUMBER AND CLASSIFICATION OF DIRECT-CARE NURS- ES REQUIRED IN EACH NURSING DEPARTMENT OR UNIT IN A HOSPITAL FOR A GIVEN YEAR, BASED ON REASONABLE PROJECTIONS DERIVED FROM THE PATIENT CENSUS AND AVERAGE ACUITY LEVEL WITHIN EACH DEPARTMENT OR UNIT DURING THE PRIOR YEAR, THE DEPARTMENT OR UNIT SIZE AND GEOGRAPHY, THE NATURE OF SERVICES PROVIDED AND ANY FORESEEABLE CHANGES IN DEPARTMENT OR UNIT SIZE OR FUNC- TION DURING THE CURRENT YEAR. 6. "NURSE" SHALL MEAN A REGISTERED PROFESSIONAL NURSE OR LICENSED PRACTICAL NURSE LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW. 7. "NURSING CARE" SHALL MEAN THAT CARE WHICH IS WITHIN THE DEFINITION OF THE PRACTICE OF NURSING PURSUANT TO SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW, OR OTHERWISE ENCOMPASSED WITH THE RECOGNIZED STAND- ARDS OF NURSING PRACTICE, INCLUDING ASSESSMENT, NURSING DIAGNOSIS, PLAN- NING, INTERVENTION, EVALUATION AND PATIENT ADVOCACY. 8. "SAFE STAFFING REQUIREMENTS" SHALL MEAN THE PROVISIONS OF THIS SECTION AND SECTIONS TWENTY-EIGHT HUNDRED TWENTY-NINE, TWENTY-EIGHT HUNDRED THIRTY, TWENTY-EIGHT HUNDRED THIRTY-ONE, TWENTY-EIGHT HUNDRED THIRTY-TWO, TWENTY-EIGHT HUNDRED THIRTY-THREE, TWENTY-EIGHT HUNDRED THIRTY-FOUR, TWENTY-EIGHT HUNDRED THIRTY-FIVE AND TWENTY-EIGHT HUNDRED THIRTY-SIX OF THIS ARTICLE AND ALL RULES AND REGULATIONS ADOPTED PURSU- ANT THERETO. 9. "SKILL MIX" SHALL MEAN THE DIFFERENCES IN LICENSING, SPECIALTY AND EXPERIENCE AMONG DIRECT-CARE NURSES. 10. "STAFFING LEVEL" SHALL MEAN THE ACTUAL NUMERICAL NURSE TO PATIENT RATIO WITHIN A NURSING DEPARTMENT OR UNIT. 11. "UNIT" SHALL MEAN A PATIENT CARE COMPONENT, AS DEFINED BY THE DEPARTMENT, WITHIN A HOSPITAL. 12. "NON-NURSING DIRECT-CARE STAFF" SHALL MEAN ANY EMPLOYEE WHO IS NOT A NURSE OR OTHER PERSON LICENSED, CERTIFIED OR REGISTERED UNDER TITLE EIGHT OF THE EDUCATION LAW WHOSE PRINCIPAL RESPONSIBILITY IS TO CARRY OUT PATIENT CARE FOR ONE OR MORE PATIENTS OR PROVIDES DIRECT ASSISTANCE IN THE DELIVERY OF PATIENT CARE. § 2830. COMMISSIONER AND COUNCIL; POWERS AND DUTIES. THE COMMISSIONER SHALL: 1. APPOINT A HOSPITAL COUNCIL CONSISTING OF THIRTEEN MEMBERS. NO LESS THAN SEVEN MEMBERS SHALL BE REGISTERED PROFESSIONAL NURSES, THREE OF WHOM SHALL BE DIRECT CARE REGISTERED NURSES, THREE OF WHOM SHALL BE NURSE MANAGERS AND ONE OF WHOM SHALL BE A NURSE ADMINISTRATOR. NO LESS THAN TWO MEMBERS OF THE HOSPITAL COUNCIL SHALL BE REPRESENTATIVES OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF NON-NURSING DIRECT CARE STAFF. THERE SHALL BE AT LEAST TWO REPRESENTATIVES OF HOSPI- TALS, ONE REPRESENTATIVE OF A NURSING PROFESSIONAL ASSOCIATION, AND ONE REPRESENTATIVE OF A RECOGNIZED OR CERTIFIED BARGAINING AGENT OF NURSES. THE HOSPITAL COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS, INCLUDING REGISTERED PROFESSIONAL NURSE TO PATIENT STAFFING REQUIREMENTS AND NON-NURSING DIRECT-CARE STAFF TO PATIENT RATIOS THAT ARE NOT SPECIFIED IN THIS ARTICLE; THE EFFICACY OF ACUITY SYSTEMS SUBMITTED FOR APPROVAL BY THE COMMISSIONER; THE DEVELOPMENT OF AN ASSESSMENT TOOL USED TO EVALUATE THE EFFICACY OF ACUITY SYSTEMS; AND REVIEW AND MAKE RECOMMENDATIONS ON APPROVAL OF STAFFING PLANS PRIOR TO THE GRANTING OF AN OPERATING CERTIFICATE BY THE DEPARTMENT. 2. PROMULGATE, AFTER CONSULTATION WITH THE HOSPITAL COUNCIL, THE RULES AND REGULATIONS NECESSARY TO CARRY OUT THE PURPOSES AND PROVISIONS OF THE SAFE STAFFING REQUIREMENTS, INCLUDING REGULATIONS DEFINING TERMS, A. 108--A 4 SETTING FORTH DIRECT-CARE NURSE TO PATIENT RATIOS, SETTING FORTH NON- NURSING DIRECT-CARE STAFF TO PATIENT RATIOS AND PRESCRIBING THE PROCESS FOR APPROVING FACILITY SPECIFIC ACUITY SYSTEMS; AND 3. ASSURE THAT THE PROVISIONS OF SAFE STAFFING REQUIREMENTS ARE ENFORCED, INCLUDING THE ISSUANCE OF REGULATIONS WHICH AT A MINIMUM PROVIDE FOR AN ACCESSIBLE AND CONFIDENTIAL SYSTEM TO REPORT THE FAILURE TO COMPLY WITH SUCH REQUIREMENTS AND PUBLIC ACCESS TO INFORMATION REGARDING REPORTS OF INSPECTIONS, RESULTS, DEFICIENCIES AND CORRECTIONS PURSUANT TO SUCH REQUIREMENTS. § 2831. STAFFING REQUIREMENTS. 1. STAFFING REQUIREMENTS. EACH HOSPITAL SHALL ENSURE THAT IT IS STAFFED IN A MANNER THAT PROVIDES SUFFICIENT, APPROPRIATELY QUALIFIED DIRECT-CARE NURSES IN EACH DEPARTMENT OR UNIT WITHIN SUCH FACILITY IN ORDER TO MEET THE INDIVIDUALIZED CARE NEEDS OF THE PATIENTS THEREIN. AT A MINIMUM, EACH SUCH FACILITY SHALL MEET THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS SECTION. 2. STAFFING PLAN. THE DEPARTMENT SHALL NOT ISSUE AN OPERATING CERTIF- ICATE TO ANY HOSPITAL UNLESS SUCH FACILITY ANNUALLY SUBMITS TO THE DEPARTMENT A DOCUMENTED STAFFING PLAN AND A WRITTEN CERTIFICATION THAT THE SUBMITTED STAFFING PLAN IS SUFFICIENT TO PROVIDE ADEQUATE AND APPRO- PRIATE DELIVERY OF HEALTH CARE SERVICES TO PATIENTS FOR THE ENSUING YEAR. THE DOCUMENTED STAFFING PLAN SHALL: (A) MEET THE MINIMUM REQUIREMENTS SET FORTH IN SUBDIVISION THREE OF THIS SECTION; (B) BE ADEQUATE TO MEET ANY ADDITIONAL REQUIREMENTS PROVIDED BY OTHER LAWS, RULES OR REGULATIONS; (C) EMPLOY AND IDENTIFY AN ACUITY SYSTEM FOR ADDRESSING FLUCTUATIONS IN ACTUAL PATIENT ACUITY LEVELS AND NURSING CARE REQUIREMENTS REQUIRING INCREASED STAFFING LEVELS ABOVE THE MINIMUMS SET FORTH IN THE PLAN; (D) FACTOR IN OTHER UNIT OR DEPARTMENT ACTIVITY SUCH AS DISCHARGES, TRANSFERS AND ADMISSIONS, STAFF BREAKS, MEALS, ROUTINE AND EXPECTED ABSENCES FROM THE UNIT AND ADMINISTRATIVE AND SUPPORT TASKS THAT ARE EXPECTED TO BE DONE BY DIRECT-CARE NURSES IN ADDITION TO DIRECT NURSING CARE; (E) INCLUDE A PLAN TO MEET NECESSARY STAFFING LEVELS AND SERVICES PROVIDED BY NON-NURSING DIRECT-CARE STAFF IN MEETING PATIENT CARE NEEDS PURSUANT TO SUBDIVISION ONE OF THIS SECTION; PROVIDED, HOWEVER, THAT THE STAFFING PLAN SHALL NOT INCORPORATE OR ASSUME THAT NURSING CARE FUNC- TIONS REQUIRED BY LAWS, RULES OR REGULATIONS, OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY OTHER PERSONNEL; (F) IDENTIFY THE SYSTEM THAT WILL BE USED TO DOCUMENT ACTUAL STAFFING ON A DAILY BASIS WITHIN EACH DEPARTMENT OR UNIT; (G) INCLUDE A WRITTEN ASSESSMENT OF THE ACCURACY OF THE PRIOR YEAR'S STAFFING PLAN IN LIGHT OF ACTUAL STAFFING NEEDS; (H) IDENTIFY EACH NURSE STAFF CLASSIFICATION REFERENCED IN SUCH PLAN TOGETHER WITH A STATEMENT SETTING FORTH MINIMUM QUALIFICATIONS FOR EACH SUCH CLASSIFICATION; AND (I) BE DEVELOPED IN CONSULTATION WITH A MAJORITY OF THE DIRECT-CARE NURSES WITHIN EACH DEPARTMENT OR UNIT OR, WHERE SUCH NURSES ARE REPRES- ENTED, WITH THE APPLICABLE RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING REPRESENTATIVE OR REPRESENTATIVES OF THE DIRECT-CARE NURSES AND OF OTHER SUPPORTIVE AND ASSISTIVE STAFF. 3. MINIMUM STAFFING REQUIREMENTS. (A) THE DOCUMENTED STAFFING PLAN SHALL INCORPORATE, AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PA- TIENT RATIOS: A. 108--A 5 (I) ONE NURSE TO ONE PATIENT: OPERATING ROOM AND TRAUMA EMERGENCY UNITS AND MATERNAL/CHILD CARE UNITS FOR THE SECOND OR THIRD STAGE OF LABOR; (II) ONE NURSE TO TWO PATIENTS: MATERNAL/CHILD CARE UNITS FOR THE FIRST STAGE OF LABOR, AND ALL CRITICAL CARE AREAS INCLUDING EMERGENCY CRITICAL CARE AND ALL INTENSIVE CARE UNITS AND POSTANESTHESIA UNITS; (III) ONE NURSE TO THREE PATIENTS: ANTEPARTUM, EMERGENCY ROOM, PEDIA- TRICS, STEP-DOWN AND TELEMETRY UNITS AND UNITS FOR NEWBORNS AND INTERME- DIATE CARE NURSERY UNITS; (IV) ONE NURSE TO THREE PATIENTS: POSTPARTUM MOTHER/BABY COUPLETS (MAXIMUM SIX PATIENTS PER NURSE); (V) ONE NURSE TO FOUR PATIENTS: NON-CRITICAL ANTEPARTUM PATIENTS, POSTPARTUM MOTHER ONLY UNITS AND MEDICAL/SURGICAL AND ACUTE CARE PSYCHI- ATRIC UNITS; (VI) ONE NURSE TO FIVE PATIENTS: REHABILITATION UNITS AND SUBACUTE PATIENTS; AND (VII) ONE NURSE TO SIX PATIENTS: WELL-BABY NURSERY UNITS. FOR ANY UNITS NOT LISTED IN THIS PARAGRAPH, INCLUDING, BUT NOT LIMITED TO, PSYCHIATRIC UNITS, AND HOSPITALS OPERATED PURSUANT TO THE MENTAL HYGIENE LAW OR THE CORRECTION LAW, THE DEPARTMENT SHALL ESTABLISH BY REGULATION THE APPROPRIATE DIRECT-CARE NURSE-TO-PATIENT RATIO. (B) THE NURSE-TO-PATIENT RATIOS SET FORTH IN PARAGRAPH (A) OF THIS SUBDIVISION SHALL REFLECT THE MAXIMUM NUMBER OF PATIENTS THAT MAY BE ASSIGNED TO EACH DIRECT-CARE NURSE IN A UNIT AT ANY ONE TIME. (C) THERE SHALL BE NO AVERAGING OF THE NUMBER OF PATIENTS AND THE TOTAL NUMBER OF NURSES ON THE UNIT DURING ANY ONE SHIFT NOR OVER ANY PERIOD OF TIME. (D) THE COMMISSIONER, IN CONSULTATION WITH THE HOSPITAL COUNCIL, SHALL ESTABLISH REGULATIONS PROVIDING FOR THE MAINTENANCE OF MINIMUM NURSE-TO- PATIENT RATIOS, AS SET FORTH IN THIS SECTION, INCLUDING DURING ROUTINE OR EXPECTED ABSENCES FROM THE UNIT, SUCH AS MEALS OR BREAKS. 4. LICENSED PRACTICAL NURSES. IN ANY SITUATION IN WHICH LICENSED PRAC- TICAL NURSES ARE INCLUDED IN THE DOCUMENTED STAFFING PLAN, ANY PATIENTS ASSIGNED TO THE LICENSED PRACTICAL NURSE SHALL ALSO BE INCLUDED IN CALCULATING THE NUMBER OF PATIENTS ASSIGNED TO ANY REGISTERED PROFES- SIONAL NURSE WHO IS REQUIRED BY LAW, RULE, REGULATION, CONTRACT OR PRAC- TICE TO SUPERVISE OR OVERSEE THE DIRECT-NURSING CARE PROVIDED BY THE LICENSED PRACTICAL NURSE. 5. SKILL MIX. THE SKILL MIX SHALL NOT INCORPORATE OR ASSUME THAT NURS- ING CARE FUNCTIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A REGISTERED PROFESSIONAL NURSE ARE TO BE PERFORMED BY A LICENSED PRACTI- CAL NURSE OR UNLICENSED ASSISTIVE PERSONNEL, OR THAT NURSING CARE FUNC- TIONS REQUIRED BY SECTION SIXTY-NINE HUNDRED TWO OF THE EDUCATION LAW OR ACCEPTED STANDARDS OF PRACTICE TO BE PERFORMED BY A LICENSED PRACTICAL NURSE ARE TO BE PERFORMED BY UNLICENSED ASSISTIVE PERSONNEL. 6. ADJUSTMENTS BY FACILITY. THE MINIMUM STAFFING REQUIREMENT AND NURSE-TO-PATIENT RATIO SET FORTH IN THIS SECTION SHALL BE ADJUSTED BY THE HOSPITAL AS NECESSARY TO REFLECT THE NEED FOR ADDITIONAL DIRECT-CARE NURSES. ADDITIONAL STAFF SHALL BE ASSIGNED IN ACCORDANCE WITH THE APPROVED, FACILITY-SPECIFIC PATIENT ACUITY SYSTEM FOR DETERMINING NURS- ING CARE REQUIREMENTS, INCLUDING THE SEVERITY OF THE ILLNESS, THE NEED FOR SPECIALIZED EQUIPMENT AND TECHNOLOGY, THE COMPLEXITY OF CLINICAL JUDGMENT NEEDED TO DESIGN, IMPLEMENT AND EVALUATE THE PATIENT CARE PLAN AND THE ABILITY FOR SELF-CARE, AND THE LICENSURE OF THE PERSONNEL REQUIRED FOR CARE. A. 108--A 6 7. COMMISSIONER REGULATIONS. THE COMMISSIONER MAY BY REGULATION REQUIRE A DOCUMENTED STAFFING PLAN TO HAVE HIGHER NURSE-TO-PATIENT RATIOS THAN THOSE SET FORTH IN THIS SECTION. 8. NOTHING CONTAINED IN THIS SECTION SHALL SUPERSEDE OR DIMINISH THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT THAT PROVIDES FOR STAFFING RATIOS THAT EXCEED THE RATIOS ESTABLISHED UNDER THIS SECTION. § 2832. COMPLIANCE WITH STAFFING PLAN AND RECORDKEEPING. 1. EACH HOSPITAL SHALL AT ALL TIMES STAFF IN ACCORDANCE WITH ITS DOCUMENTED STAFFING PLAN AND THE STAFFING STANDARDS SET FORTH IN SECTION TWENTY- EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE; PROVIDED, HOWEVER, THAT NOTH- ING IN THIS SECTION SHALL BE DEEMED TO PRECLUDE ANY SUCH FACILITY FROM IMPLEMENTING HIGHER DIRECT-CARE NURSE-TO-PATIENT STAFFING LEVELS, NOR SHALL THE REQUIREMENTS SET FORTH IN SUCH SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE BE DEEMED TO SUPERSEDE OR REPLACE ANY HIGHER REQUIREMENTS OTHERWISE MANDATED BY LAW, REGULATION OR CONTRACT. 2. FOR PURPOSES OF COMPLIANCE WITH THE MINIMUM STAFFING REQUIREMENTS STANDARDS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED THIRTY-ONE OF THIS ARTICLE, NO NURSE SHALL BE ASSIGNED, OR INCLUDED IN THE NURSE-TO-PATIENT RATIO COUNT IN A NURSING UNIT OR A CLINICAL AREA WITHIN A HOSPITAL UNLESS THAT NURSE HAS AN APPROPRIATE LICENSE PURSUANT TO ARTICLE ONE HUNDRED THIRTY-NINE OF THE EDUCATION LAW, HAS RECEIVED PRIOR ORIENTATION IN THAT CLINICAL AREA SUFFICIENT TO PROVIDE COMPETENT NURSING CARE TO THE PATIENTS IN THAT UNIT OR CLINICAL AREA, AND HAS DEMONSTRATED CURRENT COMPETENCE IN PROVIDING CARE IN THAT UNIT OR CLINICAL AREA. HOSPITALS THAT UTILIZE TEMPORARY NURSING AGENCIES SHALL HAVE AND ADHERE TO A WRIT- TEN PROCEDURE TO ORIENT AND EVALUATE PERSONNEL FROM SUCH SOURCES TO ENSURE ADEQUATE ORIENTATION AND COMPETENCY PRIOR TO INCLUSION IN THE NURSE-TO-PATIENT RATIO. IN THE EVENT OF AN EMERGENCY STAFFING SITUATION IN WHICH INSUFFICIENT STAFFING MAY LEAD TO UNSAFE PATIENT CARE, NURSES MAY BE TEMPORARILY ASSIGNED TO A DIFFERENT UNIT OR CLINICAL AREA, PROVIDED THAT SUCH NURSES SHALL BE ASSIGNED PATIENTS APPROPRIATE TO THEIR SKILL AND COMPETENCY LEVEL. THE HOSPITAL SHALL ESTABLISH A CONSISTENT PLAN FOR ADDRESSING EMERGENCY STAFFING SITUATIONS AND MONITOR OUTCOMES. EMERGENCIES ARE DEFINED AS NATURAL DISASTERS, DECLARED EMER- GENCIES, MASS CASUALTY INCIDENTS OR OTHER EVENTS NOT REASONABLY ANTIC- IPATED AND PLANNED FOR AND NOT REGULARLY OCCURRING WITHIN THE HOSPITAL. 3. EACH HOSPITAL SHALL MAINTAIN ACCURATE DAILY RECORDS SHOWING: (A) THE NUMBER OF PATIENTS ADMITTED, RELEASED AND PRESENT IN EACH NURSING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL; (B) THE INDIVIDUAL ACUITY LEVEL OF EACH PATIENT PRESENT IN EACH NURS- ING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL; AND (C) THE IDENTITY AND DUTY HOURS OF EACH DIRECT-CARE NURSE IN EACH NURSING DEPARTMENT OR UNIT WITHIN SUCH HOSPITAL. 4. EACH HOSPITAL SHALL MAINTAIN DAILY STATISTICS, BY NURSING DEPART- MENT AND UNIT, OF MORTALITY, MORBIDITY, INFECTION, ACCIDENT, INJURY AND MEDICAL ERRORS. 5. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE MAINTAINED FOR A PERIOD OF SEVEN YEARS. 6. ALL RECORDS REQUIRED TO BE KEPT PURSUANT TO THIS SECTION SHALL BE MADE AVAILABLE UPON REQUEST TO THE DEPARTMENT AND TO THE PUBLIC; PROVIDED, HOWEVER, THAT INFORMATION RELEASED TO THE PUBLIC SHALL COMPLY WITH THE APPLICABLE PATIENT PRIVACY LAWS, RULES AND REGULATIONS, AND THAT IN FACILITIES OPERATED PURSUANT TO THE CORRECTION LAW THE IDENTITY AND HOURS OF STAFF SHALL NOT BE RELEASED TO THE PUBLIC. § 2833. WORK ASSIGNMENT POLICY. 1. GENERAL. EACH HOSPITAL SHALL ADOPT, DISSEMINATE TO DIRECT-CARE NURSES AND COMPLY WITH A WRITTEN WORK A. 108--A 7 ASSIGNMENT POLICY, THAT MEETS THE REQUIREMENTS OF SUBDIVISIONS TWO AND THREE OF THIS SECTION, DETAILING THE CIRCUMSTANCES UNDER WHICH A DIRECT-CARE NURSE MAY REFUSE A WORK ASSIGNMENT. 2. MINIMUM CONDITIONS. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL PERMIT A DIRECT-CARE NURSE TO REFUSE AN ASSIGNMENT: (A) FOR WHICH THE NURSE IS NOT PREPARED BY EDUCATION, TRAINING OR EXPERIENCE TO SAFELY FULFILL THE ASSIGNMENT WITHOUT COMPROMISING OR JEOPARDIZING PATIENT SAFETY, THE NURSE'S ABILITY TO MEET FORESEEABLE PATIENT NEEDS OR THE NURSE'S LICENSE; OR (B) WOULD OTHERWISE VIOLATE THE SAFE STAFFING REQUIREMENTS. 3. MINIMUM PROCEDURES. AT A MINIMUM, THE WORK ASSIGNMENT POLICY SHALL CONTAIN PROCEDURES FOR THE FOLLOWING: (A) REASONABLE REQUIREMENTS FOR PRIOR NOTICE TO THE NURSE'S SUPERVISOR REGARDING THE NURSE'S REQUEST AND SUPPORTING REASONS FOR BEING RELIEVED OF AN ASSIGNMENT OR CONTINUED DUTY; (B) WHERE FEASIBLE, AN OPPORTUNITY FOR THE SUPERVISOR TO REVIEW THE SPECIFIC CONDITIONS SUPPORTING THE NURSE'S REQUEST, AND TO DECIDE WHETH- ER TO REMEDY THE CONDITIONS, TO RELIEVE THE NURSE OF THE ASSIGNMENT, OR TO DENY THE NURSE'S REQUEST TO BE RELIEVED OF THE ASSIGNMENT OR CONTIN- UED DUTY; (C) A PROCESS THAT PERMITS THE NURSE TO EXERCISE THE RIGHT TO REFUSE THE ASSIGNMENT OR CONTINUED ON-DUTY STATUS WHEN THE SUPERVISOR DENIES THE REQUEST TO BE RELIEVED IF: (I) THE SUPERVISOR REJECTS THE REQUEST WITHOUT PROPOSING A REMEDY OR THE PROPOSED REMEDY WOULD BE INADEQUATE OR UNTIMELY, (II) THE COMPLAINT AND INVESTIGATION PROCESS WITH A REGULATORY AGENCY WOULD BE UNTIMELY TO ADDRESS THE CONCERN, AND (III) THE EMPLOYEE IN GOOD FAITH BELIEVES THAT THE ASSIGNMENT MEETS CONDITIONS JUSTIFYING REFUSAL; AND (D) RECOGNITION THAT A NURSE WHO REFUSES AN ASSIGNMENT PURSUANT TO A WORK ASSIGNMENT POLICY AS SET FORTH IN THIS SECTION SHALL NOT BE DEEMED, BY REASON THEREOF, TO HAVE ENGAGED IN NEGLIGENT OR INCOMPETENT ACTION, PATIENT ABANDONMENT, OR OTHERWISE TO HAVE VIOLATED ANY LAW RELATING TO NURSING. § 2834. PUBLIC DISCLOSURE OF STAFFING REQUIREMENTS. EVERY HOSPITAL SHALL: 1. POST IN A CONSPICUOUS PLACE READILY ACCESSIBLE TO THE GENERAL PUBLIC A NOTICE PREPARED BY THE DEPARTMENT SETTING FORTH A SUMMARY OF THE SAFE STAFFING REQUIREMENTS APPLICABLE TO THAT HOSPITAL TOGETHER WITH INFORMATION ABOUT WHERE DETAILED INFORMATION ABOUT THE HOSPITAL'S STAFF- ING PLAN AND ACTUAL STAFFING MAY BE OBTAINED; 2. UPON REQUEST, MAKE COPIES OF THE DOCUMENTED STAFFING PLAN FILED WITH THE DEPARTMENT AVAILABLE TO THE PUBLIC; AND 3. UPON REQUEST MAKE READILY AVAILABLE TO THE NURSING STAFF WITHIN A DEPARTMENT OR UNIT, DURING EACH WORK SHIFT, THE FOLLOWING INFORMATION: (A) A COPY OF THE CURRENT STAFFING PLAN FOR THAT DEPARTMENT OR UNIT, (B) DOCUMENTATION OF THE NUMBER OF DIRECT-CARE NURSES REQUIRED TO BE PRESENT DURING THE SHIFT, BASED ON THE APPROVED ADOPTED ACUITY SYSTEM, AND (C) DOCUMENTATION OF THE ACTUAL NUMBER OF DIRECT-CARE NURSES PRESENT DURING THE SHIFT. § 2835. ENFORCEMENT RESPONSIBILITIES. THE DEPARTMENT SHALL NOT DELE- GATE ITS RESPONSIBILITIES TO ENFORCE THE SAFE STAFFING REQUIREMENTS PROMULGATED PURSUANT TO THIS ARTICLE. § 2836. PRIVATE RIGHT OF ACTION FOR VIOLATIONS OF SECTION TWENTY-EIGHT HUNDRED THIRTY-THREE OF THIS ARTICLE. ANY HOSPITAL THAT VIOLATES THE A. 108--A 8 RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGNMENT POLICY UNDER SECTION TWENTY-EIGHT HUNDRED THIRTY-THREE OF THIS ARTICLE MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT OF COMPE- TENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRI- ATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A PREVAIL- ING PLAINTIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A PRIVATE ACTION PURSUANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS. § 4. Section 2801-a of the public health law is amended by adding a new subdivision 3-b to read as follows: 3-B. IN CONSIDERING CHARACTER, COMPETENCE AND STANDING IN THE COMMUNI- TY UNDER SUBDIVISION THREE OF THIS SECTION, THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRAC- TICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS. § 5. Section 2805 of the public health law is amended by adding a new subdivision 3 to read as follows: 3. IN DETERMINING WHETHER TO ISSUE OR RENEW AN OPERATING CERTIFICATE TO AN APPLICANT SEEKING TO OPERATE, OR OPERATING, A HOSPITAL IN ACCORD- ANCE WITH THIS ARTICLE, THE COMMISSIONER SHALL CONSIDER ANY PAST VIOLATIONS OF STATE OR FEDERAL RULES, REGULATIONS OR STATUTES RELATING TO EMPLOYER-EMPLOYEE RELATIONS, WORKPLACE SAFETY, COLLECTIVE BARGAINING OR ANY OTHER LABOR RELATED PRACTICES, OBLIGATIONS OR IMPERATIVES. THE PUBLIC HEALTH AND HEALTH PLANNING COUNCIL SHALL GIVE SUBSTANTIAL WEIGHT TO VIOLATIONS OF THE PROVISIONS OF THIS CHAPTER CONCERNING NURSE STAFF AND SUPPORTIVE STAFF RATIOS. § 6. The public health law is amended by adding a new section 2895-b to read as follows: § 2895-B. NURSING HOME STAFFING LEVELS. 1. DEFINITIONS. AS USED IN THIS SECTION, THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING MEANINGS: (A) "CERTIFIED NURSE AIDE" MEANS ANY PERSON INCLUDED IN THE NURSING HOME NURSE AIDE REGISTRY PURSUANT TO SECTION TWENTY-EIGHT HUNDRED THREE-J OF THIS CHAPTER. (B) "STAFFING RATIO" MEANS THE QUOTIENT OF THE NUMBER OF PERSONNEL IN A PARTICULAR CATEGORY REGULARLY ON DUTY FOR A PARTICULAR TIME PERIOD IN A NURSING HOME DIVIDED BY THE NUMBER OF RESIDENTS OF THE NURSING HOME AT THAT TIME. 2. COMMISSIONER AND NURSING HOME COUNCIL; POWERS AND DUTIES. THE COMMISSIONER SHALL: APPOINT A NURSING HOME COUNCIL CONSISTING OF THIR- TEEN MEMBERS. NO LESS THAN TWO MEMBERS SHALL BE DIRECT CARE LICENSED PRACTICAL NURSES, NO LESS THAN TWO MEMBERS SHALL BE DIRECT CARE CERTI- FIED NURSE ASSISTANTS AND NO LESS THAN ONE MEMBER SHALL BE A DIRECT CARE REGISTERED PROFESSIONAL NURSE. THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN ONE REPRESENTATIVE EACH OF RECOGNIZED OR CERTIFIED COLLECTIVE BARGAINING AGENTS OF REGISTERED NURSES, OF NON-REGISTERED NURSE DIRECT CARE STAFF AND A REPRESENTATIVE OF NURSING PROFESSIONAL ASSOCIATIONS. THE COUNCIL SHALL ALSO INCLUDE NO LESS THAN TWO REPRESENTATIVES OF NURS- ING HOME OPERATORS, TWO REPRESENTATIVES OF NURSING HOME NURSE ADMINIS- A. 108--A 9 TRATORS AND ONE REPRESENTATIVE OF CONSUMERS. THE NURSING HOME COUNCIL SHALL ADVISE THE COMMISSIONER IN THE DEVELOPMENT OF REGULATIONS RELATING TO THE STAFFING STANDARDS UNDER THIS SECTION; AND MAY FROM TIME TO TIME, REPORT TO THE GOVERNOR, THE LEGISLATURE, THE PUBLIC AND THE COMMISSIONER ANY RECOMMENDATIONS REGARDING STAFFING LEVELS IN NURSING HOMES. 3. STAFFING STANDARDS. (A) THE COMMISSIONER, IN CONSULTATION WITH THE COUNCIL, SHALL, BY REGULATION, ESTABLISH STAFFING STANDARDS FOR NURSING HOME MINIMUM STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICA- BLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY. THE COMMISSIONER SHALL ALSO REQUIRE BY REGULATION THAT EVERY NURSING HOME MAINTAIN RECORDS ON ITS STAFFING LEVELS, REPORT ON SUCH RECORDS TO THE DEPARTMENT, AND MAKE SUCH RECORDS AVAILABLE FOR INSPECTION BY THE DEPARTMENT. (B) EVERY NURSING HOME SHALL: (I) COMPLY WITH THE STAFFING STANDARDS UNDER THIS SECTION; AND (II) EMPLOY SUFFICIENT STAFFING LEVELS TO MEET APPLICABLE STANDARDS OF SERVICE AND CARE AND TO PROVIDE SERVICE AND CARE AND TO PROVIDE SERVICES TO ATTAIN OR MAINTAIN THE HIGHEST PRACTICABLE PHYSICAL, MENTAL, AND PSYCHOSOCIAL WELL-BEING OF EACH RESIDENT OF THE FACILITY. (C) SUBJECT TO SUBDIVISION FIVE OF THIS SECTION, STAFFING STANDARDS UNDER THIS SECTION SHALL, AT A MINIMUM, BE THE STAFFING STANDARDS UNDER SUBDIVISION FOUR OF THIS SECTION. (D) IN DETERMINING COMPLIANCE WITH THE STAFFING STANDARDS UNDER THIS SECTION, AN INDIVIDUAL SHALL NOT BE COUNTED WHILE PERFORMING SERVICES THAT ARE NOT DIRECT NURSING CARE, SUCH AS ADMINISTRATIVE SERVICES, FOOD PREPARATION, HOUSEKEEPING, LAUNDRY, MAINTENANCE SERVICES, OR OTHER ACTIVITIES THAT ARE NOT DIRECT NURSING CARE. 4. STATUTORY STANDARD. BEGINNING TWO YEARS AFTER THE EFFECTIVE DATE OF THIS SECTION, EVERY NURSING HOME SHALL MAINTAIN A STAFFING RATIO EQUAL TO AT LEAST THE FOLLOWING: (A) 2.8 HOURS OF CARE PER RESIDENT PER DAY BY A CERTIFIED NURSE AIDE; (B) 1.3 HOURS OF CARE PER RESIDENT PER DAY BY A LICENSED PRACTICAL NURSE OR A REGISTERED NURSE; (C) 0.75 HOURS OF CARE PER RESIDENT PER DAY BY A REGISTERED NURSE; THE MINIMUM OF 0.75 HOURS OF CARE PER RESIDENT PROVIDED BY A REGISTERED NURSE SHALL BE DIVIDED AMONG ALL SHIFTS TO ENSURE AN APPROPRIATE LEVEL OF REGISTERED NURSE CARE TWENTY-FOUR HOURS PER DAY, SEVEN DAYS A WEEK, TO MEET RESIDENT NEEDS; AND (D) NURSING HOMES THAT CARE FOR SUBACUTE PATIENTS SHALL MAINTAIN AT A MINIMUM, THE FOLLOWING DIRECT-CARE NURSE-TO-PATIENT RATIO: ONE NURSE TO FIVE PATIENTS. 5. ANY NURSING HOME THAT VIOLATES THE RIGHTS OF AN EMPLOYEE PURSUANT TO AN ADOPTED WORK ASSIGNMENT POLICY UNDER THIS SECTION MAY BE HELD LIABLE TO SUCH EMPLOYEE IN AN ACTION BROUGHT IN A COURT OF COMPETENT JURISDICTION FOR SUCH LEGAL OR EQUITABLE RELIEF AS MAY BE APPROPRIATE TO EFFECTUATE THE PURPOSES OF THE SAFE STAFFING REQUIREMENTS, INCLUDING BUT NOT LIMITED TO REINSTATEMENT, PROMOTION, LOST WAGES AND BENEFITS, AND COMPENSATORY AND CONSEQUENTIAL DAMAGES RESULTING FROM THE VIOLATION TOGETHER WITH AN EQUAL AMOUNT IN LIQUIDATED DAMAGES. THE COURT IN SUCH ACTION SHALL, IN ADDITION TO ANY JUDGMENT AWARDED TO A PREVAILING PLAIN- TIFF, AWARD REASONABLE ATTORNEYS' FEES AND COSTS OF ACTION TO BE PAID BY THE DEFENDANT. AN EMPLOYEE'S RIGHT TO INSTITUTE A PRIVATE ACTION PURSU- ANT TO THIS SUBDIVISION SHALL NOT BE LIMITED BY ANY OTHER RIGHT GRANTED BY THE SAFE STAFFING REQUIREMENTS. A. 108--A 10 6. PUBLIC DISCLOSURE OF STAFFING LEVELS. (A) A NURSING HOME SHALL POST INFORMATION REGARDING NURSE STAFFING THAT THE FACILITY IS REQUIRED TO MAKE AVAILABLE TO THE PUBLIC UNDER SECTION TWENTY-EIGHT HUNDRED FIVE-T OF THIS CHAPTER. INFORMATION UNDER THIS PARAGRAPH SHALL BE DISPLAYED IN A FORM APPROVED BY THE DEPARTMENT AND BE POSTED IN A MANNER WHICH IS VISIBLE AND ACCESSIBLE TO RESIDENTS, THEIR FAMILIES AND THE STAFF, AS REQUIRED BY THE COMMISSIONER. (B) A NURSING HOME SHALL POST A SUMMARY OF THIS SECTION, PROVIDED BY THE DEPARTMENT, IN PROXIMITY TO EACH POSTING REQUIRED BY PARAGRAPH (A) OF THIS SUBDIVISION. § 7. If any provision of this act, or any application of any provision of this act, is held to be invalid, or ruled by any federal agency to violate or be inconsistent with any applicable federal law or regu- lation, that shall not affect the validity or effectiveness of any other provision of this act, or of any other application of any provision of this act. § 8. This act shall take effect on the one hundred eightieth day after it shall have become a law. Effective immediately, the addition, amend- ment and/or repeal of any rule or regulation necessary for the implemen- tation of this act on its effective date are authorized to be made and completed on or before such effective date.
co-Sponsors
Richard Gottfried
Crystal Peoples-Stokes
Didi Barrett
Linda Rosenthal
View additional co-sponsorsHarry B. Bronson
William Colton
Michael Benedetto
Catalina Cruz
William Magnarelli
David Weprin
Jose Rivera
Charles Fall
Jeffrion Aubry
Steven Otis
Phil Steck
Angelo Santabarbara
Kenneth Zebrowski
Thomas Abinanti
Charles Barron
Rebecca Seawright
Latrice Walker
Rodneyse Bichotte Hermelyn
Diana Richardson
Alicia Hyndman
Victor M. Pichardo
Latoya Joyner
Kimberly Jean-Pierre
Nily Rozic
Ron Kim
Andrew Hevesi
Daniel O'Donnell
Erik Dilan
Maritza Davila
Pamela J. Hunter
Jaime R. Williams
Robert C. Carroll
Carrie Woerner
Stacey Pheffer Amato
Billy Jones
Clyde Vanel
Yuh-Line Niou
Al Taylor
Jeffrey Dinowitz
Inez E. Dickens
Monica P. Wallace
Karines Reyes
Steve Stern
Nader sayegh
Jonathan Jacobson
Karen McMahon
Peter Abbate
Kevin Cahill
Nathalia Fernandez
Mathylde Frontus
Harvey Epstein
Marianne Buttenschon
Philip Ramos
Taylor Darling
Edward Braunstein
Carmen De La Rosa
Judy Griffin
Dan Quart
John T. McDonald III
Steven Englebright
Emily Gallagher
Patrick Burke
Anna Kelles
Steven Cymbrowitz
Sarah Clark
Demond Meeks
Karl Brabenec
Doug Smith
Michael Montesano
John Salka
Colin Schmitt
Angelo J. Morinello
Brian D. Miller
Jake Ashby
Melissa Miller
Joe DeStefano
Phara Souffrant Forrest
Jessica Gonzalez-Rojas
Chris Burdick
Zohran Mamdani
Marcela Mitaynes
William Conrad
Michael Cusick
Khaleel Anderson
Stefani Zinerman
Michael Lawler
Jen Lunsford
N. Nick Perry
Albert A. Stirpe
Helene Weinstein
Charles Lavine
Brian Barnwell
multi-Sponsors
Vivian Cook
Patricia Fahy
Sandy Galef
Deborah Glick
View additional multi-sponsorsDonna Lupardo
David McDonough
John K. Mikulin
Amy Paulin
J. Gary Pretlow
Edward Ra
Daniel Rosenthal
Jo Anne Simon
Michaelle C. Solages
Fred Thiele
2021-A108B (ACTIVE) - Details
See Senate Version of this Bill: S1168 Law Section: Public Health Law Laws Affected: Amd §2805-t, Pub Health L Versions Introduced in Other Legislative Sessions: 2009-2010: S7974
2011-2012: S4553
2013-2014: S3691
2015-2016: A8580, S782
2017-2018: A1532, S3330
2019-2020: A2954, S1032
2021-A108B (ACTIVE) - Summary
Requires certain facilities establish clinical staffing committees.
2021-A108B (ACTIVE) - Bill Text download pdf
S T A T E O F N E W Y O R K ________________________________________________________________________ 108--B 2021-2022 Regular Sessions I N A S S E M B L Y (PREFILED) January 6, 2021 ___________ Introduced by M. of A. GUNTHER, GOTTFRIED, PEOPLES-STOKES, BARRETT, L. ROSENTHAL, BRONSON, COLTON, BENEDETTO, CRUZ, MAGNARELLI, WEPRIN, J. RIVERA, FALL, AUBRY, OTIS, STECK, SANTABARBARA, ZEBROWSKI, ABINAN- TI, BARRON, SEAWRIGHT, WALKER, BICHOTTE HERMELYN, RICHARDSON, HYNDMAN, PICHARDO, JOYNER, JEAN-PIERRE, ROZIC, KIM, HEVESI, O'DONNELL, DILAN, DAVILA, HUNTER, WILLIAMS, CARROLL, WOERNER, PHEFFER AMATO, JONES, VANEL, NIOU, TAYLOR, DINOWITZ, DICKENS, WALLACE, REYES, STERN, SAYEGH, JACOBSON, McMAHON, ABBATE, CAHILL, FERNANDEZ, FRONTUS, EPSTEIN, BUTTENSCHON, RAMOS, DARLING, BRAUNSTEIN, DE LA ROSA, GRIFFIN, QUART, McDONALD, ENGLEBRIGHT, GALLAGHER, BURKE, KELLES, CYMBROWITZ, CLARK, MEEKS, BRABENEC, SMITH, MONTESANO, SALKA, SCHMITT, MORINELLO, B. MILL- ER, ASHBY, M. MILLER, DeSTEFANO, FORREST, GONZALEZ-ROJAS, BURDICK, MAMDANI, MITAYNES, CONRAD, CUSICK, ANDERSON, ZINERMAN, LAWLER -- Multi-Sponsored by -- M. of A. BARNWELL, COOK, FAHY, GALEF, GLICK, LUPARDO, McDONOUGH, MIKULIN, PAULIN, PERRY, PRETLOW, RA, D. ROSENTHAL, SIMON, SOLAGES, THIELE -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee -- reported and referred to the Committee on Ways and Means -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to establishing clin- ical staffing committees THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Section 2805-t of the public health law, as added by chap- ter 422 of the laws of 2009, is amended to read as follows: § 2805-t. [Disclosure] CLINICAL STAFFING COMMITTEES AND DISCLOSURE of nursing quality indicators. 1. LEGISLATIVE INTENT. THE LEGISLATURE HEREBY FINDS AND DECLARES: EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted.
LBD02466-12-1 A. 108--B 2 (A) RESEARCH DEMONSTRATES THAT NURSES PLAY A CRITICAL ROLE IN IMPROV- ING PATIENT SAFETY AND QUALITY OF CARE; (B) APPROPRIATE STAFFING OF GENERAL HOSPITAL PERSONNEL, INCLUDING REGISTERED NURSES AVAILABLE FOR PATIENT CARE, ASSISTS IN REDUCING ERRORS, COMPLICATIONS AND ADVERSE PATIENT CARE EVENTS, IMPROVES STAFF SAFETY AND SATISFACTION, AND REDUCES INCIDENCES OF WORKPLACE INJURIES; (C) HEALTH CARE PROFESSIONAL, TECHNICAL, AND SUPPORT STAFF COMPRISE VITAL COMPONENTS OF THE PATIENT CARE TEAM, BRINGING THEIR PARTICULAR SKILLS AND SERVICES TO ENSURING QUALITY PATIENT CARE; (D) ENSURING SUFFICIENT STAFFING OF GENERAL HOSPITAL PERSONNEL, INCLUDING REGISTERED NURSES, IS AN URGENT PUBLIC POLICY PRIORITY IN ORDER TO PROTECT PATIENTS AND SUPPORT GREATER RETENTION OF REGISTERED NURSES AND SAFER WORKING CONDITIONS; AND (E) IT IS THE PUBLIC POLICY OF THE STATE TO PROMOTE EVIDENCE-BASED NURSE STAFFING STANDARDS AND INCREASE TRANSPARENCY OF HEALTH CARE DATA AND DECISION MAKING BASED ON THE DATA. 2. CLINICAL STAFFING COMMITTEE. (A) EACH GENERAL HOSPITAL LICENSED PURSUANT TO THIS ARTICLE SHALL ESTABLISH AND MAINTAIN A CLINICAL STAFF- ING COMMITTEE, EITHER BY CREATING A NEW COMMITTEE OR ASSIGNING THE FUNC- TIONS OF THE CLINICAL STAFFING COMMITTEE TO AN EXISTING COMMITTEE, NO LATER THAN JANUARY FIRST, TWO THOUSAND TWENTY-TWO. (B) WHERE A COLLECTIVE BARGAINING AGREEMENT PROVIDES FOR A STAFFING COMMITTEE, THE REQUIRED FUNCTIONS OF THE CLINICAL STAFFING COMMITTEE ESTABLISHED PURSUANT TO THIS SECTION SHALL BE INCORPORATED INTO THAT COMMITTEE. ANY STAFFING OR NON-STAFFING COMMITTEES ESTABLISHED BY A COLLECTIVE BARGAINING AGREEMENT, SHALL CONTINUE TO FUNCTION IN ACCORD- ANCE WITH THE TERMS OF THE AGREEMENT, AND THE CLINICAL STAFFING COMMIT- TEE ESTABLISHED BY THIS SECTION SHALL NOT LIMIT OR OTHERWISE SUPPLANT THE COLLECTIVE BARGAINING AGREEMENT. (C) AT LEAST ONE-HALF OF THE MEMBERS OF THE CLINICAL STAFFING COMMIT- TEE SHALL BE REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY MEMBERS OF THE FRONTLINE TEAM CURRENTLY PROVIDING OR SUPPORTING DIRECT PATIENT CARE AND UP TO ONE-HALF OF THE MEMBERS SHALL BE SELECTED BY THE GENERAL HOSPITAL ADMINISTRATION AND SHALL INCLUDE BUT NOT BE LIMITED TO THE CHIEF FINANCIAL OFFICER, THE CHIEF NURSING OFFICER, AND PATIENT CARE UNIT DIRECTORS OR MANAGERS OR THEIR DESIGNEES. THE SELECTION OF THE REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY FRONTLINE TEAM MEMBERS OF THE COMMITTEE SHALL BE ACCORDING TO THEIR RESPECTIVE COLLECTIVE BARGAINING AGREEMENTS IF THERE IS ONE IN EFFECT AT THE GENER- AL HOSPITAL FOR THEIR BARGAINING UNIT. IF THERE IS NO APPLICABLE COLLEC- TIVE BARGAINING AGREEMENT, THE MEMBERS OF THE CLINICAL STAFFING COMMIT- TEE WHO ARE REGISTERED NURSES, LICENSED PRACTICAL NURSES, AND ANCILLARY MEMBERS PROVIDING DIRECT PATIENT CARE SHALL BE SELECTED BY THEIR PEERS. ANCILLARY MEMBERS OF THE FRONTLINE TEAM ON THE COMMITTEE SHALL INCLUDE BUT ARE NOT LIMITED TO PATIENT CARE TECHNICIANS, CERTIFIED NURSING ASSISTANTS, OTHER NON-LICENSED STAFF ASSISTING WITH NURSING OR CLERICAL TASKS, AND UNIT CLERKS. 3. EMPLOYEE PARTICIPATION. PARTICIPATION IN THE CLINICAL STAFFING COMMITTEE BY A GENERAL HOSPITAL EMPLOYEE SHALL BE ON SCHEDULED WORK TIME AND COMPENSATED AT THE APPROPRIATE RATE OF PAY. CLINICAL STAFFING COMMITTEE MEMBERS SHALL BE FULLY RELIEVED OF ALL OTHER WORK DUTIES DURING MEETINGS OF THE COMMITTEE AND SHALL NOT HAVE WORK DUTIES ADDED OR DISPLACED TO OTHER TIMES AS A RESULT OF THEIR COMMITTEE RESPONSIBIL- ITIES. 4. PRIMARY RESPONSIBILITIES. PRIMARY RESPONSIBILITIES OF THE CLINICAL STAFFING COMMITTEE SHALL INCLUDE THE FOLLOWING FUNCTIONS: A. 108--B 3 (A) DEVELOPMENT AND OVERSIGHT OF IMPLEMENTATION OF AN ANNUAL CLINICAL STAFFING PLAN. THE CLINICAL STAFFING PLAN SHALL INCLUDE SPECIFIC STAFF- ING FOR EACH PATIENT CARE UNIT AND WORK SHIFT AND SHALL BE BASED ON THE NEEDS OF PATIENTS. STAFFING PLANS SHALL INCLUDE SPECIFIC GUIDELINES OR RATIOS, MATRICES, OR GRIDS INDICATING HOW MANY PATIENTS ARE ASSIGNED TO EACH REGISTERED NURSE AND THE NUMBER OF NURSES AND ANCILLARY STAFF TO BE PRESENT ON EACH UNIT AND SHIFT AND SHALL BE USED AS THE PRIMARY COMPO- NENT OF THE GENERAL HOSPITAL STAFFING BUDGET. (B) FACTORS TO BE CONSIDERED AND INCORPORATED IN THE DEVELOPMENT OF THE PLAN SHALL INCLUDE, BUT ARE NOT LIMITED TO: (I) CENSUS, INCLUDING TOTAL NUMBERS OF PATIENTS ON THE UNIT ON EACH SHIFT AND ACTIVITY SUCH AS PATIENT DISCHARGES, ADMISSIONS, AND TRANS- FERS; (II) MEASURES OF ACUITY AND INTENSITY OF ALL PATIENTS AND NATURE OF THE CARE TO BE DELIVERED ON EACH UNIT AND SHIFT; (III) SKILL MIX; (IV) THE AVAILABILITY, LEVEL OF EXPERIENCE, AND SPECIALTY CERTIF- ICATION OR TRAINING OF NURSING PERSONNEL PROVIDING PATIENT CARE, INCLUD- ING CHARGE NURSES, ON EACH UNIT AND SHIFT; (V) THE NEED FOR SPECIALIZED OR INTENSIVE EQUIPMENT; (VI) THE ARCHITECTURE AND GEOGRAPHY OF THE PATIENT CARE UNIT, INCLUD- ING BUT NOT LIMITED TO PLACEMENT OF PATIENT ROOMS, TREATMENT AREAS, NURSING STATIONS, MEDICATION PREPARATION AREAS, AND EQUIPMENT; (VII) MECHANISMS AND PROCEDURES TO PROVIDE FOR ONE-TO-ONE PATIENT OBSERVATION, WHEN NEEDED, FOR PATIENTS ON PSYCHIATRIC OR OTHER UNITS AS APPROPRIATE; (VIII) OTHER SPECIAL CHARACTERISTICS OF THE UNIT OR COMMUNITY PATIENT POPULATION, INCLUDING AGE, CULTURAL AND LINGUISTIC DIVERSITY AND NEEDS, FUNCTIONAL ABILITY, COMMUNICATION SKILLS, AND OTHER RELEVANT SOCIAL OR SOCIO-ECONOMIC FACTORS; (IX) MEASURES TO INCREASE WORKER AND PATIENT SAFETY, WHICH COULD INCLUDE MEASURES TO IMPROVE PATIENT THROUGHPUT; (X) STAFFING GUIDELINES ADOPTED OR PUBLISHED BY OTHER STATES OR LOCAL JURISDICTIONS, NATIONAL NURSING PROFESSIONAL ASSOCIATIONS, SPECIALTY NURSING ORGANIZATIONS, AND OTHER HEALTH PROFESSIONAL ORGANIZATIONS; (XI) AVAILABILITY OF OTHER PERSONNEL SUPPORTING NURSING SERVICES ON THE UNIT; (XII) WAIVER OF PLAN REQUIREMENTS IN THE CASE OF UNFORESEEABLE EMER- GENCY CIRCUMSTANCES AS DEFINED IN SUBDIVISION FOURTEEN OF THIS SECTION; (XIII) COVERAGE TO ENABLE REGISTERED NURSES, LICENSED PRACTICAL NURS- ES, AND ANCILLARY STAFF TO TAKE MEAL AND REST BREAKS, PLANNED TIME OFF, AND UNPLANNED ABSENCES THAT ARE REASONABLY FORESEEABLE AS REQUIRED BY LAW OR THE TERMS OF AN APPLICABLE COLLECTIVE BARGAINING AGREEMENT, IF ANY, BETWEEN THE GENERAL HOSPITAL AND A REPRESENTATIVE OF THE NURSING OR ANCILLARY STAFF; (XIV) THE NURSING QUALITY INDICATORS REQUIRED UNDER SUBDIVISION SEVEN- TEEN OF THIS SECTION; (XV) GENERAL HOSPITAL FINANCES AND RESOURCES; AND (XVI) PROVISIONS FOR LIMITED SHORT-TERM ADJUSTMENTS MADE BY APPROPRI- ATE GENERAL HOSPITAL PERSONNEL OVERSEEING PATIENT CARE OPERATIONS TO THE STAFFING LEVELS REQUIRED BY THE PLAN, NECESSARY TO ACCOUNT FOR UNEX- PECTED CHANGES IN CIRCUMSTANCES THAT ARE TO BE OF LIMITED DURATION. (C) SEMIANNUAL REVIEW OF THE STAFFING PLAN AGAINST PATIENT NEEDS AND KNOWN EVIDENCE-BASED STAFFING INFORMATION, INCLUDING THE NURSING SENSI- TIVE QUALITY INDICATORS COLLECTED BY THE GENERAL HOSPITAL. A. 108--B 4 (D) REVIEW, ASSESSMENT, AND RESPONSE TO COMPLAINTS REGARDING POTENTIAL VIOLATIONS OF THE ADOPTED STAFFING PLAN, STAFFING VARIATIONS, OR OTHER CONCERNS REGARDING THE IMPLEMENTATION OF THE STAFFING PLAN AND WITHIN THE PURVIEW OF THE COMMITTEE. 5. COMPLIANCE PROVISIONS. (A) THE CLINICAL STAFFING PLAN SHALL COMPLY WITH ALL FEDERAL AND STATE LAWS AND REGULATIONS AND SHALL NOT DIMINISH OTHER STANDARDS CONTAINED IN STATE OR FEDERAL LAW AND REGULATIONS, OR THE TERMS OF AN APPLICABLE COLLECTIVE BARGAINING AGREEMENT, IF ANY. (B) THE CLINICAL STAFFING PLAN SHALL COMPLY WITH APPLICABLE LAWS AND REGULATIONS, INCLUDING, BUT NOT LIMITED TO: (I) REGULATIONS MADE BY THE DEPARTMENT ON BURN UNIT STAFFING, LIVER TRANSPLANT STAFFING, AND OPERATING ROOM CIRCULATING NURSE STAFFING; (II) STAFFING REGULATIONS TO BE PROMULGATED BY THE COMMISSIONER RELAT- ING TO STAFFING IN INTENSIVE CARE AND CRITICAL CARE UNITS NO LATER THAN JANUARY FIRST, TWO THOUSAND TWENTY-TWO. SUCH REGULATIONS SHALL CONSIDER THE FACTORS SET FORTH IN PARAGRAPH (B) OF SUBDIVISION FOUR OF THIS SECTION, STANDARDS IN PLACE IN NEIGHBORING STATES, AND A MINIMUM STAND- ARD OF TWELVE HOURS OF REGISTERED NURSE CARE PER PATIENT PER DAY; (III) SUCH OTHER STAFFING STANDARDS OR REGULATIONS AS ARE CURRENTLY IN EFFECT OR MAY HEREAFTER BE ESTABLISHED BY THE DEPARTMENT OR ENACTED BY THE LEGISLATURE; AND (IV) THE PROVISIONS OF SECTION ONE HUNDRED SIXTY-SEVEN OF THE LABOR LAW AND ANY RELATED REGULATIONS. (C) THE CLINICAL STAFFING PLAN SHALL COMPLY WITH AND INCORPORATE ANY MINIMUM STAFFING LEVELS PROVIDED FOR IN ANY APPLICABLE COLLECTIVE BARGAINING AGREEMENT, INCLUDING BUT NOT LIMITED TO NURSE-TO-PATIENT RATIOS, CAREGIVER-TO-PATIENT RATIOS, STAFFING GRIDS, STAFFING MATRICES, OR OTHER STAFFING PROVISIONS. 6. PROCESS FOR ADOPTION OF CLINICAL STAFFING PLANS. (A) THE CLINICAL STAFFING COMMITTEE SHALL PRODUCE THE GENERAL HOSPITAL'S ANNUAL CLINICAL STAFFING PLAN BY JULY FIRST OF EACH YEAR. (B) CLINICAL STAFFING PLANS SHALL BE DEVELOPED AND ADOPTED BY CONSEN- SUS OF THE CLINICAL STAFFING COMMITTEE. FOR THE PURPOSES OF DETERMINING WHETHER THERE IS A CONSENSUS, THE MANAGEMENT MEMBERS OF THE COMMITTEE SHALL HAVE ONE VOTE AND THE EMPLOYEE MEMBERS OF THE COMMITTEE SHALL HAVE ONE VOTE, REGARDLESS OF THE ACTUAL NUMBER OF MEMBERS OF THE COMMITTEE. EACH SIDE MAY DETERMINE ITS OWN METHOD OF CASTING ITS VOTE TO ADOPT ALL OR PART OF THE CLINICAL STAFFING PLAN. (C) THE GENERAL HOSPITAL SHALL ADOPT ANY CLINICAL STAFFING PLAN THAT IS WHOLLY OR PARTIALLY RECOMMENDED BY A CONSENSUS OF THE CLINICAL STAFF- ING COMMITTEE. IF THERE IS NO CONSENSUS ON THE RECOMMENDED STAFFING PLAN OR ANY OF ITS PARTS, THE CHIEF EXECUTIVE OFFICER OF THE GENERAL HOSPITAL SHALL USE THE OFFICER'S DISCRETION TO ADOPT A PLAN OR PARTIAL PLAN FOR WHICH THERE IS NO CONSENSUS. IN THIS CASE, THE CHIEF EXECUTIVE OFFICER SHALL PROVIDE A WRITTEN EXPLANATION OF THE ELEMENTS OF THE CLINICAL STAFFING PLAN THAT THE COMMITTEE WAS UNABLE TO AGREE ON, INCLUDING THE FINAL WRITTEN PROPOSALS FROM THE TWO PARTIES AND THEIR RATIONALES. IN NO EVENT MAY A CHIEF EXECUTIVE OFFICER FAIL TO INCLUDE IN THE ADOPTED PLAN ANY STAFFING RELATED TERMS AND CONDITIONS OF THE PLAN THAT HAS PREVIOUS- LY BEEN ADOPTED THROUGH ANY APPLICABLE COLLECTIVE BARGAINING AGREEMENT. (D) EACH GENERAL HOSPITAL SHALL ADOPT AND SUBMIT ITS FIRST HOSPITAL CLINICAL STAFFING PLAN UNDER THIS SECTION TO THE DEPARTMENT NO LATER THAN JULY FIRST, TWO THOUSAND TWENTY-TWO AND ANNUALLY THEREAFTER. THE PLAN SUBMITTED TO THE DEPARTMENT SHALL, WHERE APPLICABLE, INCLUDE THE WRITTEN EXPLANATION FROM THE CHIEF EXECUTIVE OFFICER AND WRITTEN PROPOSALS FROM THE TWO PARTIES REGARDING ELEMENTS THAT THE COMMITTEE DID A. 108--B 5 NOT AGREE ON AS REQUIRED IN PARAGRAPH (C) OF THIS SUBDIVISION. THE SUBMITTED CLINICAL STAFFING PLAN SHALL INCLUDE DATA, FROM AT LEAST THE PREVIOUS YEAR, ON THE FREQUENCY AND DURATION OF VARIATIONS FROM THE ADOPTED CLINICAL STAFFING PLAN, THE NUMBER OF COMPLAINTS RELATING TO THE CLINICAL STAFFING PLAN AND THEIR DISPOSITION, AS WELL AS DESCRIPTIONS OF UNRESOLVED COMPLAINTS SUBMITTED PURSUANT TO PARAGRAPH (B) OF SUBDIVISION SEVEN OF THIS SECTION. THE DEPARTMENT SHALL POST THE PLAN AS PART OF EACH INDIVIDUAL GENERAL HOSPITAL'S HEALTH PROFILE ON THE WEBSITE OF THE DEPARTMENT NO LATER THAN JULY THIRTY-FIRST OF EACH YEAR. IF THE ADOPTED CLINICAL STAFFING PLAN IS SUBSEQUENTLY AMENDED, THE AMENDED PLAN SHALL BE SUBMITTED TO THE DEPARTMENT WITHIN THIRTY DAYS OF ADOPTION. ADOPTED STAFFING PLANS SHALL BE AMENDED TO INCLUDE NEWLY CREATED UNITS AND EXISTING UNITS THAT UNDERGO CLINICAL OR PROGRAMMATIC CHANGES THAT FUNDA- MENTALLY ALTER THEIR CHARACTER OR NATURE. THE DEPARTMENT SHALL POST AMENDED STAFFING PLANS UPON RECEIPT. 7. IMPLEMENTATION OF CLINICAL STAFFING PLANS. (A) BEGINNING JANUARY FIRST, TWO THOUSAND TWENTY-THREE, AND ANNUALLY THEREAFTER, EACH GENERAL HOSPITAL SHALL IMPLEMENT THE CLINICAL STAFFING PLAN ADOPTED BY JULY FIRST OF THE PRIOR CALENDAR YEAR, AND ANY SUBSEQUENT AMENDMENTS, AND ASSIGN PERSONNEL TO EACH PATIENT CARE UNIT IN ACCORDANCE WITH THE PLAN. (B) A REGISTERED NURSE, LICENSED PRACTICAL NURSE, ANCILLARY MEMBER OF THE FRONTLINE TEAM, OR COLLECTIVE BARGAINING REPRESENTATIVE MAY REPORT TO THE CLINICAL STAFFING COMMITTEE ANY VARIATIONS WHERE THE PERSONNEL ASSIGNMENT IN A PATIENT CARE UNIT IS NOT IN ACCORDANCE WITH THE ADOPTED STAFFING PLAN AND MAY MAKE A COMPLAINT TO THE COMMITTEE BASED ON THE VARIATIONS. (C) THE CLINICAL STAFFING COMMITTEE SHALL DEVELOP A PROCESS TO EXAM- INE, RESPOND TO, AND TRACK DATA SUBMITTED UNDER PARAGRAPH (B) OF THIS SUBDIVISION. THE CLINICAL STAFFING COMMITTEE MAY BY CONSENSUS, AS DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION, DETERMINE A COMPLAINT RESOLVED OR DISMISSED. THE CLINICAL STAFFING COMMITTEE SHALL ALSO ESTABLISH AGREED UPON RULES AND CRITERIA TO PROVIDE FOR CONFIDEN- TIALITY OF COMPLAINTS THAT ARE IN THE PROCESS OF BEING EXAMINED OR ARE FOUND TO BE UNSUBSTANTIATED. THIS SUBDIVISION DOES NOT INFRINGE UPON OR LIMIT THE RIGHTS OF ANY COLLECTIVE BARGAINING REPRESENTATIVE OF EMPLOY- EES, OR OF ANY EMPLOYEE OR GROUP OF EMPLOYEES PURSUANT TO APPLICABLE LAW, INCLUDING WITHOUT LIMITATION ANY APPLICABLE STATE OR FEDERAL LABOR LAWS. 8. POSTING OF STAFFING INFORMATION. EACH GENERAL HOSPITAL SHALL POST, IN A PUBLICLY CONSPICUOUS AREA ON EACH PATIENT CARE UNIT, THE CLINICAL STAFFING PLAN FOR THAT UNIT AND THE ACTUAL DAILY STAFFING FOR THAT SHIFT ON THAT UNIT AS WELL AS THE RELEVANT CLINICAL STAFFING. 9. RETALIATION AND INTIMIDATION PROHIBITED. A GENERAL HOSPITAL SHALL NOT RETALIATE AGAINST OR ENGAGE IN ANY FORM OF INTIMIDATION OF: (A) AN EMPLOYEE FOR PERFORMING ANY DUTIES OR RESPONSIBILITIES IN CONNECTION WITH THE CLINICAL STAFFING COMMITTEE; OR (B) AN EMPLOYEE, PATIENT, OR OTHER INDIVIDUAL WHO NOTIFIES THE CLIN- ICAL STAFFING COMMITTEE OR THE HOSPITAL ADMINISTRATION OF THE INDIVID- UAL'S STAFFING CONCERNS. 10. SPECIAL CONSIDERATIONS. NOTHING IN THIS SECTION IS INTENDED TO CREATE UNREASONABLE BURDENS ON CRITICAL ACCESS HOSPITALS UNDER 42 U.S.C. SEC. 1395I-4 AND SOLE COMMUNITY HOSPITALS UNDER 42 U.S.C. SEC. 1395WW(D)(5) RELATED TO THE OPERATION OF THEIR CLINICAL STAFFING COMMIT- TEES. CRITICAL ACCESS AND SOLE COMMUNITY HOSPITALS MAY DEVELOP FLEXIBLE APPROACHES TO ACCOMPLISH THE REQUIREMENTS OF THIS SECTION. CLINICAL STAFFING PLANS FROM SUCH ENTITIES SUBMITTED TO THE DEPARTMENT SHALL A. 108--B 6 CONTAIN A DESCRIPTION OF ANY WAYS IN WHICH THE GENERAL HOSPITAL'S APPROACH TO CREATING THE PLAN DIFFERED FROM THE PROCESS OUTLINED IN THIS SECTION. THIS SUBDIVISION DOES NOT RELIEVE SUCH ENTITIES FROM COMPLI- ANCE WITH OTHER PROVISIONS OF THIS SECTION RELATED TO THE ADOPTION, IMPLEMENTATION AND ADHERENCE TO AN ADOPTED CLINICAL STAFFING PLAN, REPORTING AND DISCLOSURE, OR OTHER REQUIREMENTS OF THIS SECTION. 11. INVESTIGATIONS. (A) THE DEPARTMENT SHALL INVESTIGATE POTENTIAL VIOLATIONS OF THIS SECTION FOLLOWING RECEIPT OF A COMPLAINT WITH SUPPORTING EVIDENCE, OF FAILURE TO: (I) FORM OR ESTABLISH A CLINICAL STAFFING COMMITTEE; (II) COMPLY WITH THE REQUIREMENTS OF THIS SECTION IN CREATING A CLIN- ICAL STAFFING PLAN; (III) ADOPT ALL OR PART OF A CLINICAL STAFFING PLAN THAT IS APPROVED BY CONSENSUS OF THE CLINICAL STAFFING COMMITTEE AND SUBMITTED TO THE DEPARTMENT; (IV) CONDUCT A SEMIANNUAL REVIEW OF A CLINICAL STAFFING PLAN; OR (V) SUBMIT TO THE DEPARTMENT A CLINICAL STAFFING PLAN ON AN ANNUAL BASIS AND ANY UPDATES. (B) THE DEPARTMENT SHALL INITIATE AN INVESTIGATION OF UNRESOLVED COMPLAINTS, THAT HAVE FIRST BEEN SUBMITTED TO THE CLINICAL STAFFING COMMITTEE, REGARDING COMPLIANCE WITH THE CLINICAL STAFFING PLAN, PERSON- NEL ASSIGNMENTS IN A PATIENT CARE UNIT OR STAFFING LEVELS, OR ANY OTHER REQUIREMENT OF THE ADOPTED CLINICAL STAFFING PLAN, EXCLUDING COMPLAINTS DETERMINED BY THE CLINICAL STAFFING COMMITTEE TO BE RESOLVED OR DISMISSED AS DETERMINED BY CONSENSUS OF THE CLINICAL STAFFING COMMITTEE AS DESCRIBED IN PARAGRAPH (B) OF SUBDIVISION SIX OF THIS SECTION. (C) THE DEPARTMENT SHALL INITIATE AN INVESTIGATION AFTER MAKING AN ASSESSMENT THAT THERE IS A PATTERN OF FAILURE TO RESOLVE COMPLAINTS SUBMITTED TO THE CLINICAL STAFFING COMMITTEE OR A PATTERN OF FAILURE TO REACH CONSENSUS ON THE ADOPTION OF ALL OR PART OF A CLINICAL STAFFING PLAN. IN THE CASE OF A PATTERN OF FAILURE TO RESOLVE COMPLAINTS OR TO REACH CONSENSUS ON THE ADOPTION OF ALL OR PART OF A CLINICAL STAFFING PLAN, THE DEPARTMENT SHALL DETERMINE IF THE PATTERN WAS DUE TO ONE OF THE PARTIES ROUTINELY REFUSING TO RESOLVE COMPLAINTS OR REACH CONSENSUS. (D) ANY DEPARTMENT INVESTIGATION OF A COMPLAINT UNDER THIS SUBDIVISION SHALL CONSIDER WHETHER UNFORESEEABLE EMERGENCY CIRCUMSTANCES AS DEFINED IN SUBDIVISION FOURTEEN OF THIS SECTION CONTRIBUTED TO THE FAILURE OF THE GENERAL HOSPITAL TO COMPLY WITH THIS SECTION. (E) AFTER AN INVESTIGATION CONDUCTED UNDER PARAGRAPH (A) OR (B) OF THIS SUBDIVISION, IF THE DEPARTMENT DETERMINES THAT THERE HAS BEEN A VIOLATION, THE DEPARTMENT SHALL REQUIRE THE GENERAL HOSPITAL TO SUBMIT A CORRECTIVE PLAN OF ACTION WITHIN FORTY-FIVE DAYS OF THE PRESENTATION OF FINDINGS FROM THE DEPARTMENT TO THE HOSPITAL. IF THE DEPARTMENT DETER- MINES AFTER INVESTIGATION UNDER PARAGRAPH (C) OF THIS SUBDIVISION THAT THE GENERAL HOSPITAL REPRESENTATIVES ON THE CLINICAL STAFFING COMMITTEE WERE RESPONSIBLE FOR A PATTERN OF NOT RESOLVING COMPLAINTS OR FOR A PATTERN OF NOT REACHING CONSENSUS, THE DEPARTMENT SHALL REQUIRE THE GENERAL HOSPITAL TO SUBMIT A CORRECTIVE ACTION PLAN WITHIN FORTY-FIVE DAYS OF THE PRESENTATION OF FINDINGS TO THE GENERAL HOSPITAL. IF THE DEPARTMENT FINDS THAT THE FRONTLINE STAFF REPRESENTATIVES ON THE CLIN- ICAL STAFFING COMMITTEE WERE RESPONSIBLE FOR A PATTERN OF NOT RESOLVING COMPLAINTS OR FOR A PATTERN OF NOT REACHING CONSENSUS, THE DEPARTMENT SHALL NOT REQUIRE THE GENERAL HOSPITAL TO SUBMIT A CORRECTIVE ACTION PLAN OR IMPOSE A CIVIL PENALTY ON THE GENERAL HOSPITAL PURSUANT TO SUBDIVISION TWELVE OF THIS SECTION. A. 108--B 7 12. CIVIL PENALTIES. IN THE EVENT THAT A GENERAL HOSPITAL FAILS TO SUBMIT OR SUBMITS BUT FAILS TO IMPLEMENT A CORRECTIVE ACTION PLAN IN RESPONSE TO A VIOLATION OR VIOLATIONS FOUND BY THE DEPARTMENT BASED ON A COMPLAINT FILED PURSUANT TO PARAGRAPH (A), (B) OR (C) OF SUBDIVISION ELEVEN OF THIS SECTION, THE DEPARTMENT MAY IMPOSE A CIVIL PENALTY AS AUTHORIZED BY SECTION TWELVE OF THIS CHAPTER FOR ALL VIOLATIONS ASSERTED AGAINST THE GENERAL HOSPITAL, UNTIL THE GENERAL HOSPITAL SUBMITS OR IMPLEMENTS A CORRECTIVE ACTION PLAN OR TAKES OTHER ACTION DIRECTED BY THE DEPARTMENT. 13. POSTING OF PENALTIES AND RELATED INFORMATION. THE DEPARTMENT SHALL MAINTAIN FOR PUBLIC INSPECTION, INCLUDING POSTING ON THE GENERAL HOSPI- TAL PROFILE ON THE DEPARTMENT WEBSITE, RECORDS OF ANY CIVIL PENALTIES, ADMINISTRATIVE ACTIONS, OR LICENSE SUSPENSIONS OR REVOCATIONS IMPOSED ON GENERAL HOSPITALS UNDER THIS SECTION. 14. UNFORESEEABLE EMERGENCY CIRCUMSTANCES. (A) FOR PURPOSES OF THIS SECTION, "UNFORESEEABLE EMERGENCY CIRCUMSTANCE" MEANS: (I) ANY OFFICIALLY DECLARED NATIONAL, STATE, OR MUNICIPAL EMERGENCY; (II) WHEN A GENERAL HOSPITAL DISASTER PLAN IS ACTIVATED; OR (III) ANY UNFORESEEN DISASTER OR OTHER CATASTROPHIC EVENT THAT IMME- DIATELY AFFECTS OR INCREASES THE NEED FOR HEALTH CARE SERVICES. (B) IN DETERMINING WHETHER A GENERAL HOSPITAL HAS VIOLATED ITS OBLI- GATIONS UNDER THIS SECTION TO COMPLY WITH THE GENERAL HOSPITAL'S CLIN- ICAL STAFFING PLAN, IT SHALL NOT BE A DEFENSE THAT IT WAS UNABLE TO SECURE SUFFICIENT STAFF IF THE LACK OF STAFFING WAS FORESEEABLE AND COULD BE PRUDENTLY PLANNED FOR OR INVOLVED ROUTINE NURSE STAFFING NEEDS THAT AROSE DUE TO TYPICAL STAFFING PATTERNS, TYPICAL LEVELS OF ABSENTEE- ISM, AND TIME OFF TYPICALLY APPROVED BY THE EMPLOYER FOR VACATION, HOLI- DAYS, SICK LEAVE, AND PERSONAL LEAVE. 15. COMPLAINTS. NOTHING IN THIS SECTION SHALL BE CONSTRUED TO PRECLUDE THE ABILITY TO SUBMIT A COMPLAINT TO THE DEPARTMENT AS PROVIDED FOR UNDER THIS CHAPTER. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS SUPPLANTING OTHER COMPLAINT MECHANISMS ESTABLISHED BY A GENERAL HOSPI- TAL, INCLUDING MECHANISMS DESIGNED TO AID IN COMPLIANCE WITH OTHER FEDERAL, STATE OR LOCAL LAWS. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS LIMITING OR SUPPLANTING THE RIGHTS OF EMPLOYEES AND THEIR COLLECTIVE BARGAINING REPRESENTATIVES TO FULLY ENFORCE ANY AND ALL RIGHTS UNDER THE TERMS OF A COLLECTIVE BARGAINING AGREEMENT. AN EMPLOY- ER SHALL NOT ASSERT OR ATTEMPT TO ASSERT A CLAIM THAT ENFORCEMENT OF THE COLLECTIVE BARGAINING AGREEMENT IS BARRED OR LIMITED BY ANY PROVISIONS OF THIS SECTION. 16. ANNUAL REPORT. (A) THE DEPARTMENT SHALL SUBMIT AN ANNUAL REPORT TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE AND THE GOVERNOR ON OR BEFORE DECEMBER THIRTY-FIRST OF EACH YEAR. THIS REPORT SHALL INCLUDE THE NUMBER OF COMPLAINTS SUBMITTED TO THE DEPARTMENT, THE DISPOSITION OF THESE COMPLAINTS, THE NUMBER OF INVESTIGATIONS CONDUCTED, AND THE ASSOCIATED COSTS FOR COMPLAINT INVESTIGATIONS, IF ANY. (B) PRIOR TO THE SUBMISSION OF THE REPORT, THE COMMISSIONER SHALL CONVENE A STAKEHOLDER WORKGROUP CONSISTING OF HOSPITAL ASSOCIATIONS AND UNIONS REPRESENTING NURSES AND OTHER ANCILLARY MEMBERS OF THE FRONTLINE TEAM. THE STAKEHOLDER WORKGROUP SHALL REVIEW THE REPORT PRIOR TO ITS SUBMISSION TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE. 17. DISCLOSURE OF NURSING QUALITY INDICATORS. (A) Every facility with an operating certificate pursuant to the requirements of this article A. 108--B 8 shall make available to the public information regarding nurse staffing and patient outcomes as specified by the commissioner by rule and regu- lation. The commissioner shall promulgate rules and regulations on the disclosure of nursing quality indicators providing for the disclosure of information including at least the following, as appropriate to the reporting facility: [(a)] (I) The number of registered nurses providing direct care and the ratio of patients per registered nurse, full-time equivalent, providing direct care. This information shall be expressed in actual numbers, in terms of total hours of nursing care per patient, including adjustment for case mix and acuity, and as a percentage of patient care staff, and shall be broken down in terms of the total patient care staff, each unit, and each shift. [(b)] (II) The number of licensed practical nurses providing direct care. This information shall be expressed in actual numbers, in terms of total hours of nursing care per patient including adjustment for case mix and acuity, and as a percentage of patient care staff, and shall be broken down in terms of the total patient care staff, each unit, and each shift. [(c)] (III) The number of unlicensed personnel utilized to provide direct patient care, including adjustment for case mix and acuity. This information shall be expressed both in actual numbers and as a percent- age of patient care staff and shall be broken down in terms of the total patient care staff, each unit, and each shift. [(d)] (IV) Incidence of adverse patient care, including incidents such as medication errors, patient injury, decubitus ulcers, nosocomial infections, and nosocomial urinary tract infections. [(e)] (V) Methods used for determining and adjusting staffing levels and patient care needs and the facility's compliance with these methods. [(f)] (VI) Data regarding complaints filed with any state or federal regulatory agency, or an accrediting agency, and data regarding investi- gations and findings as a result of those complaints, degree of compli- ance with acceptable standards, and the findings of scheduled inspection visits. [2.] (B) Such information shall be provided to the commissioner of any state agency responsible for licensing or accrediting the facility, or responsible for overseeing the delivery of services either directly or indirectly, TO ANY EMPLOYEE OF A GENERAL HOSPITAL OR THE EMPLOYEE'S COLLECTIVE BARGAINING AGENT, IF ANY, and to any member of the public who requests such information directly from the facility. Written statements containing such information shall state the source and date thereof. (C) THE COMMISSIONER SHALL MAKE REGULATIONS TO PROVIDE A UNIFORM FORMAT OR FORM FOR COMPLYING WITH THE REPORTING REQUIREMENTS OF SUBPARA- GRAPHS (I), (II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION, ALLOW- ING PATIENTS AND THE PUBLIC TO CLEARLY UNDERSTAND AND COMPARE STAFFING PATTERNS AND ACTUAL LEVELS OF STAFFING ACROSS FACILITIES. SUCH UNIFORM FORMAT OR FORM SHALL ALLOW FACILITIES TO INCLUDE A DESCRIPTION OF ADDI- TIONAL RESOURCES AVAILABLE TO SUPPORT UNIT LEVEL PATIENT CARE AND A DESCRIPTION OF THE GENERAL HOSPITAL. THE INFORMATION REQUIRED BY SUBPAR- AGRAPHS (I), (II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION, REPORTED IN A MANNER DETERMINED BY THE COMMISSIONER, SHALL BE FILED WITH THE DEPARTMENT ELECTRONICALLY ON A QUARTERLY BASIS AND SHALL BE AVAIL- ABLE TO THE PUBLIC ON THE DEPARTMENT'S WEBSITE. THE REGULATIONS SHALL TAKE EFFECT NO LATER THAN DECEMBER THIRTY-FIRST, TWO THOUSAND TWENTY- TWO. INFORMATION REQUIRED TO BE PROVIDED PURSUANT TO SUBPARAGRAPHS (I), A. 108--B 9 (II) AND (III) OF PARAGRAPH (A) OF THIS SUBDIVISION SHALL BE MADE AVAIL- ABLE TO THE PUBLIC NO LATER THAN JULY FIRST, TWO THOUSAND TWENTY-THREE. 18. ADVISORY COMMISSION. (A) THERE IS HEREBY ESTABLISHED AN INDEPEND- ENT ADVISORY COMMISSION, COMPOSED OF NINE EXPERTS IN STAFFING STANDARDS AND QUALITY OF PATIENT CARE, INCLUDING: THREE EXPERTS IN NURSING PRAC- TICE, QUALITY OF NURSING CARE OR PATIENT CARE STANDARDS, ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE OF WHOM SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE; THREE REPRESENTATIVES OF UNIONS REPRESENTING NURSES, ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE OF WHOM SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE; AND THREE MEMBERS REPRESENTING GENERAL HOSPITALS, ONE OF WHOM SHALL BE APPOINTED BY THE GOVERNOR, ONE OF WHOM SHALL BE APPOINTED BY THE SPEAKER OF THE ASSEMBLY AND ONE OF WHOM SHALL BE APPOINTED BY THE TEMPORARY PRESIDENT OF THE SENATE. THE MEMBERS OF THE COMMISSION SHALL SERVE AT THE PLEASURE OF THE APPOINTING OFFICIAL. MEMBERS OF THE COMMISSION SHALL KEEP CONFIDENTIAL ANY INFORMATION RECEIVED IN THE COURSE OF THEIR DUTIES AND MAY ONLY USE SUCH INFORMATION IN THE COURSE OF CARRYING OUT THEIR DUTIES ON THE COMMISSION, EXCEPT THOSE REPORTS REQUIRED TO BE ISSUED BY THE COMMISSION UNDER THIS SECTION, WHICH MAY ONLY INCLUDE DE-IDENTIFIED INFORMATION. (B) THE ADVISORY COMMISSION SHALL CONVENE FROM TIME TO TIME IN ORDER TO EVALUATE THE EFFECTIVENESS OF THE CLINICAL STAFFING COMMITTEES REQUIRED BY THIS SECTION. SUCH REVIEW SHALL EVALUATE THE FOLLOWING METRICS, INCLUDING BUT NOT LIMITED TO QUANTITATIVE AND QUALITATIVE DATA ON WHETHER STAFFING LEVELS WERE IMPROVED AND MAINTAINED, PATIENT SATIS- FACTION, EMPLOYEE SATISFACTION, PATIENT QUALITY OF CARE METRICS, WORK- PLACE SAFETY, AND ANY OTHER METRICS THE COMMISSION DEEMS RELEVANT. THE COMMISSION SHALL ALSO REVIEW THE ANNUAL REPORT SUBMITTED BY THE DEPART- MENT AND MAKE RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPO- RARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE AS SET FORTH IN PARAGRAPH (D) OF THIS SUBDIVI- SION. (C) THE ADVISORY COMMISSION MAY COLLECT AND SHALL BE PROVIDED ALL RELEVANT INFORMATION, NECESSARY TO CARRY OUT ITS FUNCTIONS, FROM THE DEPARTMENT AND OTHER STATE AGENCIES. THE COMMISSION MAY ALSO INVITE TESTIMONY BY EXPERTS IN THE FIELD AND FROM THE PUBLIC. IN MAKING ITS RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE, THE COMMISSION SHALL ANALYZE RELEVANT DATA, INCLUDING DATA AND FACTORS SET FORTH IN PARAGRAPH (B) OF SUBDIVISION FOUR OF THIS SECTION RELATED TO CLINICAL STAFFING PLANS. THE COMMISSION MAY ALSO MAKE RECOMMENDATIONS FOR ADDITIONAL OR ENHANCED ENFORCEMENT MECHANISMS OR POWERS TO ADDRESS GENERAL HOSPITAL FAILURE TO COMPLY WITH THIS SECTION AND RECOMMEND THE APPROPRIATION OF FUNDING FOR THE DEPARTMENT TO ENFORCE THIS SECTION OR TO ASSIST GENERAL HOSPITALS IN HIRING ADDITIONAL STAFF TO COMPLY WITH THIS SECTION. (D) THE ADVISORY COMMISSION SHALL SUBMIT TO THE SPEAKER OF THE ASSEM- BLY, THE TEMPORARY PRESIDENT OF THE SENATE AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE, AND MAKE AVAILABLE TO THE PUBLIC A REPORT THAT MAKES RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMIT- TEES OF THE ASSEMBLY AND SENATE FOR FURTHER LEGISLATIVE ACTION, IF ANY, IN ORDER TO IMPROVE WORKING CONDITIONS AND QUALITY OF CARE IN GENERAL HOSPITALS PURSUANT TO THIS SECTION AND ITS INTENT. A. 108--B 10 (E) THE COMMISSION SHALL SUBMIT ITS REPORT AND RECOMMENDATIONS TO THE SPEAKER OF THE ASSEMBLY, THE TEMPORARY PRESIDENT OF THE SENATE, AND THE CHAIRS OF THE HEALTH COMMITTEES OF THE ASSEMBLY AND SENATE NO LATER THAN OCTOBER THIRTY-FIRST, TWO THOUSAND TWENTY-FOUR, ONCE THREE YEARS OF STAFFING PLANS HAVE BEEN SUBMITTED TO THE DEPARTMENT PURSUANT TO THIS SECTION. (F) MEMBERS OF THE COMMISSION SHALL RECEIVE NO COMPENSATION FOR THEIR SERVICES, BUT SHALL BE ALLOWED THEIR ACTUAL AND NECESSARY EXPENSES INCURRED IN THE PERFORMANCE OF THEIR DUTIES HEREUNDER. (G) THE LEGISLATURE MAY APPROPRIATE FUNDING FOR THE COMMISSION TO HIRE STAFF OR CONSULTANTS AND PROVIDE FOR THE OPERATION OF THE COMMISSION AS REASONABLY NECESSARY TO FULFILL ITS FUNCTIONS. § 2. If any provision of this act, or any application of any provision of this act, is held to be invalid, or to violate or be inconsistent with any federal law or regulation, that shall not affect the validity or effectiveness of any other provision of this act, or of any other application of any provision of this act, which can be given effect without that provision or application; and to that end, the provisions and applications of this act are severable. § 3. This act shall take effect immediately.
