2022 -- S 2193 | |
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LC004101 | |
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STATE OF RHODE ISLAND | |
IN GENERAL ASSEMBLY | |
JANUARY SESSION, A.D. 2022 | |
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A N A C T | |
RELATING TO HEALTH AND SAFETY – RIGHTS OF NURSING HOME PATIENTS | |
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Introduced By: Senators de la Cruz, Rogers, E Morgan, F Lombardi, Felag, and Raptakis | |
Date Introduced: February 08, 2022 | |
Referred To: Senate Health & Human Services | |
It is enacted by the General Assembly as follows: | |
1 | SECTION 1. Sections 23-17.5-32 and 23-17.5-33 of the General Laws in Chapter 23-17.5 |
2 | entitled "Rights of Nursing Home Patients" are hereby amended to read as follows: |
3 | 23-17.5-32. Minimum staffing levels. |
4 | (a)(1) Each facility shall have the necessary nursing service personnel (licensed and non- |
5 | licensed) in sufficient numbers on a twenty-four (24) hour basis, to assess the needs of residents, |
6 | to develop and implement resident care plans, to provide direct resident care services, and to |
7 | perform other related activities to maintain the health, safety, and welfare of residents. The facility |
8 | shall have a registered nurse on the premises twenty-four (24) hours a day. |
9 | (2) A facility may be granted relief from subsection (a)(1) of this section, provided that the |
10 | facility provides written request for relief to the department of health in accordance with the rules |
11 | and regulations promulgated by the department of health pursuant to subsection (g) of this section. |
12 | (b) For purposes of this section, the following definitions shall apply: |
13 | (1) "Direct caregiver" means a person who receives monetary compensation as an |
14 | employee of the nursing facility or a subcontractor as a registered nurse, a licensed practical nurse, |
15 | a medication technician, a certified nurse assistant, a licensed physical therapist, a licensed |
16 | occupational therapist, a licensed speech-language pathologist, a mental health worker who is also |
17 | a certified nurse assistant, or a physical therapist assistant. |
18 | (2) "Hours of direct nursing care" means the actual hours of work performed per patient |
19 | day by a direct caregiver. |
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1 | (c)(i) Commencing on January 1, 2022, nursing facilities shall provide a quarterly |
2 | minimum average of three and fifty-eight hundredths (3.58) hours of direct nursing care per |
3 | resident, per day, of which at least two and forty-four hundredths (2.44) hours shall be provided by |
4 | certified nurse assistants. |
5 | (ii) Commencing on January 1, 2023, nursing facilities shall provide a quarterly minimum |
6 | of three and eighty-one hundredths (3.81) hours of direct nursing care per resident, per day, of |
7 | which at least two and six-tenths (2.6) hours shall be provided by certified nurse assistants. |
8 | (d) Director of nursing hours and nursing staff hours spent on administrative duties or non- |
9 | direct caregiving tasks are excluded and may not be counted toward compliance with the minimum |
10 | staffing hours requirement in this section. |
11 | (e) The minimum hours of direct nursing care requirements shall be minimum standards |
12 | only. Nursing facilities shall employ and schedule additional staff as needed to ensure quality |
13 | resident care based on the needs of individual residents and to ensure compliance with all relevant |
14 | state and federal staffing requirements. |
15 | (f) The department shall promulgate rules and regulations to amend the Rhode Island code |
16 | of regulations in consultation with stakeholders to implement these minimum staffing requirements |
17 | on or before October 15, 2021. |
18 | (g) On or before October 15, 2022, the department of health shall promulgate rules and |
19 | regulations establishing a system for determining whether a facility shall be granted an exception |
20 | to the minimum staffing requirements of this section. |
21 | (g)(h) On or before January 1, 2024, and every five (5) years thereafter, the department |
22 | shall consult with consumers, consumer advocates, recognized collective bargaining agents, and |
23 | providers to determine the sufficiency of the staffing standards provided in this section and may |
24 | promulgate rules and regulations to increase the minimum staffing ratios to adequate levels. |
25 | 23-17.5-33. Minimum staffing level compliance and enforcement program. |
26 | (a) Compliance determination. |
27 | (1) The department shall submit proposed rules and regulations for adoption by October |
28 | 15, 2021, establishing a system for determining compliance with minimum staffing requirements |
29 | set forth in § 23-17.5-32. |
30 | (2) Compliance shall be determined quarterly by comparing the number of hours provided |
31 | per resident, per day using the Centers for Medicare and Medicaid Services' payroll-based journal |
32 | and the facility's daily census, as self- reported by the facility to the department on a quarterly basis. |
33 | (3) The department shall use the quarterly payroll-based journal and the self- reported |
34 | census to calculate the number of hours provided per resident, per day and compare this ratio to the |
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1 | minimum staffing standards required under § 23-17.5-32. Discrepancies between job titles |
2 | contained in § 23-17.5-32 and the payroll-based journal shall be addressed by rules and regulations. |
3 | (b) Monetary penalties. |
4 | (1) The department shall submit proposed rules and regulations for adoption on or before |
5 | October 15, 2021, implementing monetary penalty provisions for facilities not in compliance with |
6 | minimum staffing requirements set forth in § 23-17.5-32. |
7 | (2) Monetary penalties shall be imposed quarterly and shall be based on the latest quarter |
8 | for which the department has data. |
9 | (3) No monetary penalty may be issued for noncompliance with the increase in the standard |
10 | set forth in § 23-17.5-32(c)(ii) from January 1, 2023, to March 31, 2023. If a facility is found to be |
11 | noncompliant with the increase in the standard during the period that extends from January 1, 2023, |
12 | to March 31, 2023, the department shall provide a written notice identifying the staffing |
13 | deficiencies and require the facility to provide a sufficiently detailed correction plan to meet the |
14 | statutory minimum staffing levels. |
15 | (4) No monetary penalty shall be assessed to any facility that is granted an exception by |
16 | the department of health to the minimum staffing requirements pursuant to § 23-17.5-32. |
17 | (4)(5) Monetary penalties shall be established based on a formula that calculates on a daily |
18 | basis the cost of wages and benefits for the missing staffing hours. |
19 | (5)(6) All notices of noncompliance shall include the computations used to determine |
20 | noncompliance and establishing the variance between minimum staffing ratios and the department's |
21 | computations. |
22 | (6)(7) The penalty for the first offense shall be two hundred percent (200%) of the cost of |
23 | wages and benefits for the missing staffing hours. The penalty shall increase to two hundred fifty |
24 | percent (250%) of the cost of wages and benefits for the missing staffing hours for the second |
25 | offense and three hundred percent (300%) of the cost of wages and benefits for the missing staffing |
26 | hours for the third and all subsequent offenses. |
27 | (7)(8) For facilities that have an offense in three (3) consecutive quarters, EOHHS shall |
28 | deny any further Medicaid Assistance payments with respect to all individuals entitled to benefits |
29 | who are admitted to the facility on or after January 1, 2022, or shall freeze admissions of new |
30 | residents. |
31 | (c)(1) The penalty shall be imposed regardless of whether the facility has committed other |
32 | violations of this chapter during the same period that the staffing offense occurred. |
33 | (2) The penalty may not be waived except as provided in subsection (c)(3) of this section, |
34 | but the department shall have the discretion to determine the gravity of the violation in situations |
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1 | where there is no more than a ten percent (10%) deviation from the staffing requirements and make |
2 | appropriate adjustments to the penalty. |
3 | (3) The department is granted discretion to waive the penalty when unforeseen |
4 | circumstances have occurred that resulted in call-offs of scheduled staff. This provision shall be |
5 | applied no more than two (2) times per calendar year. |
6 | (4) Nothing in this section diminishes a facility's right to appeal pursuant to the provisions |
7 | of chapter 35 of title 42 ("administrative procedures"). |
8 | (d)(1) Pursuant to rules and regulations established by the department, funds that are |
9 | received from financial penalties shall be used for technical assistance or specialized direct care |
10 | staff training. |
11 | (2) The assessment of a penalty does not supplant the state's investigation process or |
12 | issuance of deficiencies or citations under this title. |
13 | (3) A notice of noncompliance, whether or not the penalty is waived, and the penalty |
14 | assessment shall be prominently posted in the nursing facility and included on the department's |
15 | website. |
16 | SECTION 2. This act shall take effect upon passage. |
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EXPLANATION | |
BY THE LEGISLATIVE COUNCIL | |
OF | |
A N A C T | |
RELATING TO HEALTH AND SAFETY – RIGHTS OF NURSING HOME PATIENTS | |
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1 | This act would require the department of health to promulgate rules and regulations to |
2 | determine whether a nursing home facility shall be granted an exception from the minimum staffing |
3 | level requirements. |
4 | This act would take effect upon passage. |
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