CS/CS/HB 247

1
A bill to be entitled
2An act relating to nursing facilities; amending s.
3400.141, F.S.; authorizing certain licensed nursing
4facilities to develop a plan to provide certain training
5for nursing assistants; providing for rules relating to
6approval of training programs by the Agency for Health
7Care Administration; amending s. 400.147, F.S.; redefining
8the term "adverse incident"; deleting the requirement that
9a nursing facility notify the agency of an adverse
10incident; deleting notification requirements; requiring
11that a risk manager determine if an incident was an
12adverse incident; providing applicability of federal
13reporting requirements to investigations of adverse
14incidents; amending s. 400.19, F.S.; providing that the
15most recent survey is a licensure survey under certain
16conditions for purposes of future survey scheduling;
17amending s. 400.195, F.S.; conforming a cross-reference;
18amending s. 400.23, F.S.; revising provisions relating to
19a facility's use of licensed nurses to meet certain
20minimum staffing requirements; providing an effective
21date.
22
23Be It Enacted by the Legislature of the State of Florida:
24
25     Section 1.  Section 400.141, Florida Statutes, is amended
26to read:
27     400.141  Administration and management of nursing home
28facilities.--Every licensed facility shall comply with all
29applicable standards and rules of the agency and shall:
30     (1)  Be under the administrative direction and charge of a
31licensed administrator.
32     (2)  Appoint a medical director licensed pursuant to
33chapter 458 or chapter 459. The agency may establish by rule
34more specific criteria for the appointment of a medical
35director.
36     (3)  Have available the regular, consultative, and
37emergency services of physicians licensed by the state.
38     (4)  Provide for resident use of a community pharmacy as
39specified in s. 400.022(1)(q). Any other law to the contrary
40notwithstanding, a registered pharmacist licensed in Florida,
41that is under contract with a facility licensed under this
42chapter or chapter 429, shall repackage a nursing facility
43resident's bulk prescription medication which has been packaged
44by another pharmacist licensed in any state in the United States
45into a unit dose system compatible with the system used by the
46nursing facility, if the pharmacist is requested to offer such
47service. In order to be eligible for the repackaging, a resident
48or the resident's spouse must receive prescription medication
49benefits provided through a former employer as part of his or
50her retirement benefits, a qualified pension plan as specified
51in s. 4972 of the Internal Revenue Code, a federal retirement
52program as specified under 5 C.F.R. s. 831, or a long-term care
53policy as defined in s. 627.9404(1). A pharmacist who correctly
54repackages and relabels the medication and the nursing facility
55which correctly administers such repackaged medication under the
56provisions of this subsection shall not be held liable in any
57civil or administrative action arising from the repackaging. In
58order to be eligible for the repackaging, a nursing facility
59resident for whom the medication is to be repackaged shall sign
60an informed consent form provided by the facility which includes
61an explanation of the repackaging process and which notifies the
62resident of the immunities from liability provided herein. A
63pharmacist who repackages and relabels prescription medications,
64as authorized under this subsection, may charge a reasonable fee
65for costs resulting from the implementation of this provision.
66     (5)  Provide for the access of the facility residents to
67dental and other health-related services, recreational services,
68rehabilitative services, and social work services appropriate to
69their needs and conditions and not directly furnished by the
70licensee. When a geriatric outpatient nurse clinic is conducted
71in accordance with rules adopted by the agency, outpatients
72attending such clinic shall not be counted as part of the
73general resident population of the nursing home facility, nor
74shall the nursing staff of the geriatric outpatient clinic be
75counted as part of the nursing staff of the facility, until the
76outpatient clinic load exceeds 15 a day.
77     (6)  Be allowed and encouraged by the agency to provide
78other needed services under certain conditions. If the facility
79has a standard licensure status, and has had no class I or class
80II deficiencies during the past 2 years or has been awarded a
81Gold Seal under the program established in s. 400.235, it may be
82encouraged by the agency to provide services, including, but not
83limited to, respite and adult day services, which enable
84individuals to move in and out of the facility. A facility is
85not subject to any additional licensure requirements for
86providing these services. Respite care may be offered to persons
87in need of short-term or temporary nursing home services.
88Respite care must be provided in accordance with this part and
89rules adopted by the agency. However, the agency shall, by rule,
90adopt modified requirements for resident assessment, resident
91care plans, resident contracts, physician orders, and other
92provisions, as appropriate, for short-term or temporary nursing
93home services. The agency shall allow for shared programming and
94staff in a facility which meets minimum standards and offers
95services pursuant to this subsection, but, if the facility is
96cited for deficiencies in patient care, may require additional
97staff and programs appropriate to the needs of service
98recipients. A person who receives respite care may not be
99counted as a resident of the facility for purposes of the
100facility's licensed capacity unless that person receives 24-hour
101respite care. A person receiving either respite care for 24
102hours or longer or adult day services must be included when
103calculating minimum staffing for the facility. Any costs and
104revenues generated by a nursing home facility from
105nonresidential programs or services shall be excluded from the
106calculations of Medicaid per diems for nursing home
107institutional care reimbursement.
108     (7)  If the facility has a standard license or is a Gold
109Seal facility, exceeds the minimum required hours of licensed
110nursing and certified nursing assistant direct care per resident
111per day, and is part of a continuing care facility licensed
112under chapter 651 or a retirement community that offers other
113services pursuant to part III of this chapter or part I or part
114III of chapter 429 on a single campus, be allowed to share
115programming and staff. At the time of inspection and in the
116semiannual report required pursuant to subsection (15), a
117continuing care facility or retirement community that uses this
118option must demonstrate through staffing records that minimum
119staffing requirements for the facility were met. Licensed nurses
120and certified nursing assistants who work in the nursing home
121facility may be used to provide services elsewhere on campus if
122the facility exceeds the minimum number of direct care hours
123required per resident per day and the total number of residents
124receiving direct care services from a licensed nurse or a
125certified nursing assistant does not cause the facility to
126violate the staffing ratios required under s. 400.23(3)(a).
127Compliance with the minimum staffing ratios shall be based on
128total number of residents receiving direct care services,
129regardless of where they reside on campus. If the facility
130receives a conditional license, it may not share staff until the
131conditional license status ends. This subsection does not
132restrict the agency's authority under federal or state law to
133require additional staff if a facility is cited for deficiencies
134in care which are caused by an insufficient number of certified
135nursing assistants or licensed nurses. The agency may adopt
136rules for the documentation necessary to determine compliance
137with this provision.
138     (8)  Maintain the facility premises and equipment and
139conduct its operations in a safe and sanitary manner.
140     (9)  If the licensee furnishes food service, provide a
141wholesome and nourishing diet sufficient to meet generally
142accepted standards of proper nutrition for its residents and
143provide such therapeutic diets as may be prescribed by attending
144physicians. In making rules to implement this subsection, the
145agency shall be guided by standards recommended by nationally
146recognized professional groups and associations with knowledge
147of dietetics.
148     (10)  Keep full records of resident admissions and
149discharges; medical and general health status, including medical
150records, personal and social history, and identity and address
151of next of kin or other persons who may have responsibility for
152the affairs of the residents; and individual resident care plans
153including, but not limited to, prescribed services, service
154frequency and duration, and service goals. The records shall be
155open to inspection by the agency.
156     (11)  Keep such fiscal records of its operations and
157conditions as may be necessary to provide information pursuant
158to this part.
159     (12)  Furnish copies of personnel records for employees
160affiliated with such facility, to any other facility licensed by
161this state requesting this information pursuant to this part.
162Such information contained in the records may include, but is
163not limited to, disciplinary matters and any reason for
164termination. Any facility releasing such records pursuant to
165this part shall be considered to be acting in good faith and may
166not be held liable for information contained in such records,
167absent a showing that the facility maliciously falsified such
168records.
169     (13)  Publicly display a poster provided by the agency
170containing the names, addresses, and telephone numbers for the
171state's abuse hotline, the State Long-Term Care Ombudsman, the
172Agency for Health Care Administration consumer hotline, the
173Advocacy Center for Persons with Disabilities, the Florida
174Statewide Advocacy Council, and the Medicaid Fraud Control Unit,
175with a clear description of the assistance to be expected from
176each.
177     (14)  Submit to the agency the information specified in s.
178400.071(1)(b) for a management company within 30 days after the
179effective date of the management agreement.
180     (15)  Submit semiannually to the agency, or more frequently
181if requested by the agency, information regarding facility
182staff-to-resident ratios, staff turnover, and staff stability,
183including information regarding certified nursing assistants,
184licensed nurses, the director of nursing, and the facility
185administrator. For purposes of this reporting:
186     (a)  Staff-to-resident ratios must be reported in the
187categories specified in s. 400.23(3)(a) and applicable rules.
188The ratio must be reported as an average for the most recent
189calendar quarter.
190     (b)  Staff turnover must be reported for the most recent
19112-month period ending on the last workday of the most recent
192calendar quarter prior to the date the information is submitted.
193The turnover rate must be computed quarterly, with the annual
194rate being the cumulative sum of the quarterly rates. The
195turnover rate is the total number of terminations or separations
196experienced during the quarter, excluding any employee
197terminated during a probationary period of 3 months or less,
198divided by the total number of staff employed at the end of the
199period for which the rate is computed, and expressed as a
200percentage.
201     (c)  The formula for determining staff stability is the
202total number of employees that have been employed for more than
20312 months, divided by the total number of employees employed at
204the end of the most recent calendar quarter, and expressed as a
205percentage.
206     (d)  A nursing facility that has failed to comply with
207state minimum-staffing requirements for 2 consecutive days is
208prohibited from accepting new admissions until the facility has
209achieved the minimum-staffing requirements for a period of 6
210consecutive days. For the purposes of this paragraph, any person
211who was a resident of the facility and was absent from the
212facility for the purpose of receiving medical care at a separate
213location or was on a leave of absence is not considered a new
214admission. Failure to impose such an admissions moratorium
215constitutes a class II deficiency.
216     (e)  A nursing facility which does not have a conditional
217license may be cited for failure to comply with the standards in
218s. 400.23(3)(a)1.a. only if it has failed to meet those
219standards on 2 consecutive days or if it has failed to meet at
220least 97 percent of those standards on any one day.
221     (f)  A facility which has a conditional license must be in
222compliance with the standards in s. 400.23(3)(a) at all times.
223
224Nothing in this section shall limit the agency's ability to
225impose a deficiency or take other actions if a facility does not
226have enough staff to meet the residents' needs.
227     (16)  Report monthly the number of vacant beds in the
228facility which are available for resident occupancy on the day
229the information is reported.
230     (17)  Notify a licensed physician when a resident exhibits
231signs of dementia or cognitive impairment or has a change of
232condition in order to rule out the presence of an underlying
233physiological condition that may be contributing to such
234dementia or impairment. The notification must occur within 30
235days after the acknowledgment of such signs by facility staff.
236If an underlying condition is determined to exist, the facility
237shall arrange, with the appropriate health care provider, the
238necessary care and services to treat the condition.
239     (18)  If the facility implements a dining and hospitality
240attendant program, ensure that the program is developed and
241implemented under the supervision of the facility director of
242nursing. A licensed nurse, licensed speech or occupational
243therapist, or a registered dietitian must conduct training of
244dining and hospitality attendants. A person employed by a
245facility as a dining and hospitality attendant must perform
246tasks under the direct supervision of a licensed nurse.
247     (19)  Report to the agency any filing for bankruptcy
248protection by the facility or its parent corporation,
249divestiture or spin-off of its assets, or corporate
250reorganization within 30 days after the completion of such
251activity.
252     (20)  Maintain general and professional liability insurance
253coverage that is in force at all times. In lieu of general and
254professional liability insurance coverage, a state-designated
255teaching nursing home and its affiliated assisted living
256facilities created under s. 430.80 may demonstrate proof of
257financial responsibility as provided in s. 430.80(3)(h).
258     (21)  Maintain in the medical record for each resident a
259daily chart of certified nursing assistant services provided to
260the resident. The certified nursing assistant who is caring for
261the resident must complete this record by the end of his or her
262shift. This record must indicate assistance with activities of
263daily living, assistance with eating, and assistance with
264drinking, and must record each offering of nutrition and
265hydration for those residents whose plan of care or assessment
266indicates a risk for malnutrition or dehydration.
267     (22)  Before November 30 of each year, subject to the
268availability of an adequate supply of the necessary vaccine,
269provide for immunizations against influenza viruses to all its
270consenting residents in accordance with the recommendations of
271the United States Centers for Disease Control and Prevention,
272subject to exemptions for medical contraindications and
273religious or personal beliefs. Subject to these exemptions, any
274consenting person who becomes a resident of the facility after
275November 30 but before March 31 of the following year must be
276immunized within 5 working days after becoming a resident.
277Immunization shall not be provided to any resident who provides
278documentation that he or she has been immunized as required by
279this subsection. This subsection does not prohibit a resident
280from receiving the immunization from his or her personal
281physician if he or she so chooses. A resident who chooses to
282receive the immunization from his or her personal physician
283shall provide proof of immunization to the facility. The agency
284may adopt and enforce any rules necessary to comply with or
285implement this subsection.
286     (23)  Assess all residents for eligibility for pneumococcal
287polysaccharide vaccination (PPV) and vaccinate residents when
288indicated within 60 days after the effective date of this act in
289accordance with the recommendations of the United States Centers
290for Disease Control and Prevention, subject to exemptions for
291medical contraindications and religious or personal beliefs.
292Residents admitted after the effective date of this act shall be
293assessed within 5 working days of admission and, when indicated,
294vaccinated within 60 days in accordance with the recommendations
295of the United States Centers for Disease Control and Prevention,
296subject to exemptions for medical contraindications and
297religious or personal beliefs. Immunization shall not be
298provided to any resident who provides documentation that he or
299she has been immunized as required by this subsection. This
300subsection does not prohibit a resident from receiving the
301immunization from his or her personal physician if he or she so
302chooses. A resident who chooses to receive the immunization from
303his or her personal physician shall provide proof of
304immunization to the facility. The agency may adopt and enforce
305any rules necessary to comply with or implement this subsection.
306     (24)  Annually encourage and promote to its employees the
307benefits associated with immunizations against influenza viruses
308in accordance with the recommendations of the United States
309Centers for Disease Control and Prevention. The agency may adopt
310and enforce any rules necessary to comply with or implement this
311subsection.
312
313Facilities having a standard license that have been awarded a
314Gold Seal under the program established in s. 400.235 may
315develop a plan to provide certified nursing assistant training
316as prescribed by federal regulations and state rules and may
317apply to the agency for approval of their program. The agency
318may adopt rules relating to the approval, suspension, or
319termination of a certified nursing assistant training program.
320     Section 2.  Subsections (5) through (15) of section
321400.147, Florida Statutes, are amended to read:
322     400.147  Internal risk management and quality assurance
323program.--
324     (5)  For purposes of reporting to the agency under this
325section, the term "adverse incident" means:
326     (a)  An event over which facility personnel could exercise
327control and which is associated in whole or in part with the
328facility's intervention, rather than the condition for which
329such intervention occurred, and which results in one of the
330following:
331     1.  Death;
332     2.  Brain or spinal damage;
333     3.  Permanent disfigurement;
334     4.  Fracture or dislocation of bones or joints;
335     5.  A limitation of neurological, physical, or sensory
336function;
337     6.  Any condition that required medical attention to which
338the resident has not given his or her informed consent,
339including failure to honor advanced directives; or
340     7.  Any condition that required the transfer of the
341resident, within or outside the facility, to a unit providing a
342more acute level of care due to the adverse incident, rather
343than the resident's condition prior to the adverse incident;
344     (b)  Abuse, neglect, or exploitation as defined in s.
345415.102;
346     (c)  Abuse, neglect and harm as defined in s. 39.01;
347     (d)  Resident elopement; or
348     (e)  An event that is reported to a law enforcement agency
349regarding a resident, other than for transportation.
350     (6)  The internal risk manager of each licensed facility
351shall:
352     (a)  Investigate every allegation of sexual misconduct
353which is made against a member of the facility's personnel who
354has direct patient contact when the allegation is that the
355sexual misconduct occurred at the facility or at the grounds of
356the facility;
357     (b)  Report every allegation of sexual misconduct to the
358administrator of the licensed facility; and
359     (c)  Notify the resident representative or guardian of the
360victim that an allegation of sexual misconduct has been made and
361that an investigation is being conducted.
362     (7)(a)  The facility shall initiate an investigation and
363shall notify the agency within 1 business day after the risk
364manager or his or her designee has received a report pursuant to
365paragraph (1)(d). The notification must be made in writing and
366be provided electronically, by facsimile device or overnight
367mail delivery. The notification must include information
368regarding the identity of the affected resident, the type of
369adverse incident, the initiation of an investigation by the
370facility, and whether the events causing or resulting in the
371adverse incident represent a potential risk to any other
372resident. The notification is confidential as provided by law
373and is not discoverable or admissible in any civil or
374administrative action, except in disciplinary proceedings by the
375agency or the appropriate regulatory board. The agency may
376investigate, as it deems appropriate, any such incident and
377prescribe measures that must or may be taken in response to the
378incident. The agency shall review each incident and determine
379whether it potentially involved conduct by the health care
380professional who is subject to disciplinary action, in which
381case the provisions of s. 456.073 shall apply.
382     (b)(8)(a)  Each facility shall complete the investigation
383and submit an adverse incident report to the agency for each
384adverse incident within 15 calendar days after its occurrence.
385If, after a complete investigation, the risk manager determines
386that the incident was not an adverse incident as defined in
387subsection (5), the facility shall include this information in
388the report. The agency shall develop a form for reporting this
389information.
390     (c)(b)  The information reported to the agency pursuant to
391paragraph (b) (a) which relates to persons licensed under
392chapter 458, chapter 459, chapter 461, or chapter 466 shall be
393reviewed by the agency. The agency shall determine whether any
394of the incidents potentially involved conduct by a health care
395professional who is subject to disciplinary action, in which
396case the provisions of s. 456.073 shall apply.
397     (d)(c)  The report submitted to the agency must also
398contain the name of the risk manager of the facility.
399     (e)(d)  The adverse incident report is confidential as
400provided by law and is not discoverable or admissible in any
401civil or administrative action, except in disciplinary
402proceedings by the agency or the appropriate regulatory board.
403     (f)  Nothing in this subsection shall affect any federal
404reporting requirements.
405     (8)(9)  By the 10th of each month, each facility subject to
406this section shall report any notice received pursuant to s.
407400.0233(2) and each initial complaint that was filed with the
408clerk of the court and served on the facility during the
409previous month by a resident or a resident's family member,
410guardian, conservator, or personal legal representative. The
411report must include the name of the resident, the resident's
412date of birth and social security number, the Medicaid
413identification number for Medicaid-eligible persons, the date or
414dates of the incident leading to the claim or dates of
415residency, if applicable, and the type of injury or violation of
416rights alleged to have occurred. Each facility shall also submit
417a copy of the notices received pursuant to s. 400.0233(2) and
418complaints filed with the clerk of the court. This report is
419confidential as provided by law and is not discoverable or
420admissible in any civil or administrative action, except in such
421actions brought by the agency to enforce the provisions of this
422part.
423     (9)(10)  The agency shall review, as part of its licensure
424inspection process, the internal risk management and quality
425assurance program at each facility regulated by this section to
426determine whether the program meets standards established in
427statutory laws and rules, is being conducted in a manner
428designed to reduce adverse incidents, and is appropriately
429reporting incidents as required by this section.
430     (10)(11)  There is no monetary liability on the part of,
431and a cause of action for damages may not arise against, any
432risk manager for the implementation and oversight of the
433internal risk management and quality assurance program in a
434facility licensed under this part as required by this section,
435or for any act or proceeding undertaken or performed within the
436scope of the functions of such internal risk management and
437quality assurance program if the risk manager acts without
438intentional fraud.
439     (11)(12)  If the agency, through its receipt of the adverse
440incident reports prescribed in subsection (7), or through any
441investigation, has a reasonable belief that conduct by a staff
442member or employee of a facility is grounds for disciplinary
443action by the appropriate regulatory board, the agency shall
444report this fact to the regulatory board.
445     (12)(13)  The agency may adopt rules to administer this
446section.
447     (13)(14)  The agency shall annually submit to the
448Legislature a report on nursing home adverse incidents. The
449report must include the following information arranged by
450county:
451     (a)  The total number of adverse incidents.
452     (b)  A listing, by category, of the types of adverse
453incidents, the number of incidents occurring within each
454category, and the type of staff involved.
455     (c)  A listing, by category, of the types of injury caused
456and the number of injuries occurring within each category.
457     (d)  Types of liability claims filed based on an adverse
458incident or reportable injury.
459     (e)  Disciplinary action taken against staff, categorized
460by type of staff involved.
461     (14)(15)  Information gathered by a credentialing
462organization under a quality assurance program is not
463discoverable from the credentialing organization. This
464subsection does not limit discovery of, access to, or use of
465facility records, including those records from which the
466credentialing organization gathered its information.
467     Section 3.  Subsection (3) of section 400.19, Florida
468Statutes, is amended to read:
469     400.19  Right of entry and inspection.--
470     (3)  The agency shall every 15 months conduct at least one
471unannounced inspection to determine compliance by the licensee
472with statutes, and with rules adopted promulgated under the
473provisions of those statutes, governing minimum standards of
474construction, quality and adequacy of care, and rights of
475residents. The survey shall be conducted every 6 months for the
476next 2-year period if the facility has been cited for a class I
477deficiency, has been cited for two or more class II deficiencies
478arising from separate surveys or investigations within a 60-day
479period, or has had three or more substantiated complaints within
480a 6-month period, each resulting in at least one class I or
481class II deficiency. In addition to any other fees or fines in
482this part, the agency shall assess a fine for each facility that
483is subject to the 6-month survey cycle. The fine for the 2-year
484period shall be $6,000, one-half to be paid at the completion of
485each survey. The agency may adjust this fine by the change in
486the Consumer Price Index, based on the 12 months immediately
487preceding the increase, to cover the cost of the additional
488surveys. If such deficiencies are overturned as the result of
489administrative action but additional surveys have already been
490conducted pursuant to this section, the most recent survey shall
491be considered a licensure survey for purposes of scheduling
492future surveys. The agency shall verify through subsequent
493inspection that any deficiency identified during inspection is
494corrected. However, the agency may verify the correction of a
495class III or class IV deficiency unrelated to resident rights or
496resident care without reinspecting the facility if adequate
497written documentation has been received from the facility, which
498provides assurance that the deficiency has been corrected. The
499giving or causing to be given of advance notice of such
500unannounced inspections by an employee of the agency to any
501unauthorized person shall constitute cause for suspension of not
502fewer than 5 working days according to the provisions of chapter
503110.
504     Section 4.  Paragraph (d) of subsection (1) of section
505400.195, Florida Statutes, is amended to read:
506     400.195  Agency reporting requirements.--
507     (1)  For the period beginning June 30, 2001, and ending
508June 30, 2005, the Agency for Health Care Administration shall
509provide a report to the Governor, the President of the Senate,
510and the Speaker of the House of Representatives with respect to
511nursing homes. The first report shall be submitted no later than
512December 30, 2002, and subsequent reports shall be submitted
513every 6 months thereafter. The report shall identify facilities
514based on their ownership characteristics, size, business
515structure, for-profit or not-for-profit status, and any other
516characteristics the agency determines useful in analyzing the
517varied segments of the nursing home industry and shall report:
518     (d)  Information regarding deficiencies cited, including
519information used to develop the Nursing Home Guide WATCH LIST
520pursuant to s. 400.191, and applicable rules, a summary of data
521generated on nursing homes by Centers for Medicare and Medicaid
522Services Nursing Home Quality Information Project, and
523information collected pursuant to s. 400.147(8) s. 400.147(9),
524relating to litigation.
525     Section 5.  Paragraph (a) of subsection (3) of section
526400.23, Florida Statutes, is amended to read:
527     400.23  Rules; evaluation and deficiencies; licensure
528status.--
529     (3)(a)1.  The agency shall adopt rules providing minimum
530staffing requirements for nursing homes. These requirements
531shall include, for each nursing home facility:
532     a.  A minimum certified nursing assistant staffing of 2.6
533hours of direct care per resident per day beginning January 1,
5342003, and increasing to 2.7 hours of direct care per resident
535per day beginning January 1, 2007. Beginning January 1, 2002, a
536no facility may not shall staff below one certified nursing
537assistant per 20 residents, and must provide a minimum licensed
538nursing staffing of 1.0 hour of direct care per resident per day
539but never below one licensed nurse per 40 residents.
540     b.  Beginning January 1, 2007, a minimum weekly average
541certified nursing assistant staffing of 2.9 hours of direct care
542per resident per day. For the purpose of this sub-subparagraph,
543a week is defined as Sunday through Saturday.
544     2.  Nursing assistants employed under s. 400.211(2) may be
545included in computing the staffing ratio for certified nursing
546assistants only if their job responsibilities include only
547nursing-assistant-related duties.
548     3.  Each nursing home must document compliance with
549staffing standards as required under this paragraph and post
550daily the names of staff on duty for the benefit of facility
551residents and the public.
552     4.  The agency shall recognize the use of licensed nurses
553for compliance with minimum staffing requirements for certified
554nursing assistants, provided that the facility otherwise meets
555the minimum staffing requirements for licensed nurses and that
556the licensed nurses are performing the duties of a certified
557nursing assistant. Unless otherwise approved by the agency,
558Licensed nurses counted toward the minimum staffing requirements
559for certified nursing assistants must exclusively perform the
560duties of a certified nursing assistant for the entire shift and
561not also be counted toward the minimum staffing requirements for
562licensed nurses. If the agency approved a facility's request to
563use a licensed nurse to perform both licensed nursing and
564certified nursing assistant duties, The facility must allocate
565the amount of staff time specifically spent on certified nursing
566assistant duties for the purpose of documenting compliance with
567minimum staffing requirements for certified and licensed nursing
568staff. In no event may the hours of a licensed nurse with dual
569job responsibilities be counted twice.
570     Section 6.  This act shall take effect July 1, 2008.


CODING: Words stricken are deletions; words underlined are additions.