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

BILL NUMBER:S2943

Title of bill

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

Purpose

To permit nurses and patients in state-regulated (Public Health Law Article 36) home care agencies to be able to exercise the authority under the existing Nurse Practice Act for the provision of care at home.

Summary of provisions

Amends Education Law § 6908(1)(iii), which is the current Nurse Practice Act exemption that permits nurses and patients/family members to instruct home care aides in certain programs to provide care that would otherwise be permissible for family members under the scope of nursing. The proposed amendment would allow the exemption to apply to nurses/patients in Article 36 home care agencies as well.

Justification

The current exemption in the Nurse Practice Act origi- nates from Chapter 795 of 1992. Prior to that chapter, for a patient receiving home care, only a nurse or a family member (acting under an existing exemption to the Nurse Practice Act) could provide care to the patient that involved tasks crossing into "the practice of nursing" (e.g. suctioning, medication administration). Patients without family members thus faced sole reliance on nurses to provide such care in the home. In the absence of nurses or family to provide this such care, these individuals faced institutionalization or other extreme limita- tions. With the severe and growing shortage of nurses, patients faced growing access problems as well as limitations in community living that could be addressed with the proper ability to instruct aides to provide services under nurse/patient instruction in the absence of family. Patients urged the Legislature to provide a solution.

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

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

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

* Enhanced access to and flexibility of care for consumers.

* Enhanced care planning and arrangement flexibility by nurses.

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

* Cost savings to the Medicaid program.

Legislative history

2012: S.5048 reported to Finance 2011: S.5048 died in Health This amendment was recently also introduced as part of the comprehensive legislation known as the "Home Care Accessibility and Efficiency Improvement Act, S.5179 of 2009-10,portions of which were enacted as part of the State Deficit Reduction Act of 2009 and the State Health/Medicaid Budget of 2010-11.

Fiscal implications

It is projected that this legislation would result in over S20 Million in anticipated state-share Medicaid savings through the increased capability of nurses and patients to more efficiently deploy both aide and nursing services in the absence of family members.

Effective date

This act takes effect immediately.