Bill Summary – FastDemocracy

HOUSE AMENDED
     PRIOR PRINTER'S NOS. 695, 1180, 1460               PRINTER'S NO.   1928
                     THE GENERAL ASSEMBLY OF PENNSYLVANIA
                        SENATE BILL
                        No. 668
                                                 Session of
                                                   2023
     INTRODUCED BY J. WARD, COLLETT, SCHWANK, BOSCOLA, COMITTA,
        HAYWOOD, BREWSTER, CAPPELLETTI, BAKER, ROBINSON AND STREET,
        MAY 2, 2023
     AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
        OCTOBER 2, 2024
                                      AN ACT
 Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
    act relating to health care; prescribing the powers and
    duties of the Department of Health; establishing and
    providing the powers and duties of the State Health
    Coordinating Council, health systems agencies and Health Care
    Policy Board in the Department of Health, and State Health
    Facility Hearing Board in the Department of Justice;
    providing for certification of need of health care providers
    and prescribing penalties," providing for certified
    medication aides; and imposing duties on the Department of
    Education HEALTH.                                             <--
    The General Assembly of the Commonwealth of Pennsylvania
 hereby enacts as follows:
    Section 1.    The act of July 19, 1979 (P.L.130, No.48), known
 as the Health Care Facilities Act, is amended by adding a
 chapter to read:
                              CHAPTER 8-C
                      CERTIFIED MEDICATION AIDES
 Section 801-C.    Definitions.
    The following words and phrases when used in this chapter
 shall have the meanings given to them in this section unless the
 context clearly indicates otherwise:
    "Certified medication aide."        An individual certified under
 section 804-C.
    "Department."     The Department of Education HEALTH of the          <--
 Commonwealth.
    "Instructor."     An individual trained to A REGISTERED NURSE        <--
 APPROVED BY THE DEPARTMENT TO TRAIN AND certify medication aides
 under section 804-C.
    "Long-term care nursing facility."       As defined in section
 802.1.
    "Medication aide training program."       The program developed by
 the department under section 804-C(a) for certification as a
 medication aide.
    "NURSE AIDE."     AS DEFINED IN 42 CFR 483.5 (RELATING TO            <--
 DEFINITIONS).
    "PRO RE NATA MEDICATION."       THE PRESCRIPTION OF MEDICATIONS
 WHOSE ADMINISTRATION SHOULD BE BASED ON PATIENTS' IMMEDIATE
 NEEDS RATHER THAN AT PREDETERMINED ADMINISTRATION TIMES.
 Section 802-C.     Requirements.
    (a)   Qualifications.--To be a certified medication aide, an
 individual must:
          (1)   Be a nurse aide with a valid listing on the              <--
    Pennsylvania Nurse Aide Registry.
          (2)   Have at least one year of consecutive experience
    working as a nurse aide in a single long-term care nursing
    facility.
          (1)   BE A NURSE AIDE CURRENTLY LISTED ON THE PENNSYLVANIA <--
    NURSE AIDE REGISTRY, BE ELIGIBLE FOR HIRING AS A NURSE AIDE
    UNDER 42 CFR 483.12(A)(3)(II) (RELATING TO FREEDOM FROM
    ABUSE, NEGLECT AND EXPLOITATION) AND NOT HAVE HAD A
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    CERTIFICATION UNDER THIS CHAPTER REVOKED. A NURSE AIDE WHO
    HAS SUCCESSFULLY HAD A NEGLECT ANNOTATION REMOVED FROM THE
    NURSE AIDE'S LISTING ON THE PENNSYLVANIA NURSE AIDE REGISTRY
    UNDER 42 U.S.C. § 1396R(G)(1)(D) (RELATING TO REQUIREMENTS
    FOR NURSING FACILITIES) SHALL NOT BE PROHIBITED FROM BEING
    ELIGIBLE FOR CERTIFICATION.
          (2)   DURING THE PREVIOUS TWO YEARS, HAVE AT LEAST 1,000
    HOURS OF EXPERIENCE WORKING AS A NURSE AIDE IN A SINGLE LONG-
    TERM CARE NURSING FACILITY.
          (3)   RECEIVE A FORMAL WRITTEN RECOMMENDATION FOR
    CERTIFIED MEDICATION AIDE TRAINING BY THE DIRECTOR OF NURSING
    OF THE LONG-TERM CARE FACILITY IDENTIFIED IN PARAGRAPH (2),
    AND SUBMIT THE RECOMMENDATION TO THE DEPARTMENT. THE
    RECOMMENDATION MUST INCLUDE A STATEMENT CERTIFYING THAT THE
    INDIVIDUAL HAS SATISFIED THE EXPERIENCE REQUIREMENT UNDER
    PARAGRAPH (2).
          (3) (4)   Have successfully completed the medication aide   <--
    training program and met the requisite training and
    competency evaluation requirements.
    (b)   Certification by instructor.--To practice as a certified
 medication aide, an individual must meet the qualifications
 under subsection (a) and be certified by an instructor as
 provided under section 804-C.
 Section 803-C.     Administration of medication.
    (a)   Permissible medication delivery.--A certified medication <--
 aide may administer oral, transdermal, opthalmic, otic, rectal,
 vaginal, inhaled, enteral or topical medication to a resident of
 a long-term care nursing facility.
    (A)   PERMISSIBLE MEDICATION DELIVERY.--A CERTIFIED MEDICATION <--
 AIDE MAY ADMINISTER, UNDER THE SUPERVISION OF A PHYSICALLY ON-
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 SITE REGISTERED NURSE OR LICENSED PRACTICAL NURSE AUTHORIZED BY
 A REGISTERED NURSE, ORAL, TRANSDERMAL, OPHTHALMIC, OTIC, INHALED
 OR TOPICAL MEDICATION TO A RESIDENT OF A LONG-TERM CARE NURSING
 FACILITY. THE FOLLOWING APPLY:
          (1)   THE SUPERVISING REGISTERED NURSE OR LICENSED
    PRACTICAL NURSE AUTHORIZED BY A REGISTERED NURSE SHALL BE
    PHYSICALLY ON-SITE AND AVAILABLE TO THE CERTIFIED MEDICATION
    AIDE.
          (2)   THE CERTIFIED MEDICATION AIDE MAY ONLY ADMINISTER
    MEDICATIONS TO A RESIDENT OF A LONG-TERM CARE NURSING
    FACILITY WHOSE CLINICAL STATUS IS CONSIDERED STABLE.
          (3)   NO MORE THAN TWO CERTIFIED MEDICATION AIDES MAY BE
    SUPERVISED BY A REGISTERED NURSE OR LICENSED PRACTICAL NURSE
    AUTHORIZED BY A REGISTERED NURSE.
          (4)   A CERTIFIED MEDICATION AIDE MAY ADMINISTER A PRO RE
    NATA MEDICATION ACCORDING TO A PHYSICIAN'S, NURSE
    PRACTITIONER'S OR PHYSICIAN ASSISTANT'S ORDERS WITH A
    REGISTERED NURSE ON-SITE. CERTIFIED MEDICATION AIDES SHALL
    DOCUMENT EVERY ADMINISTRATION OF A PRO RE NATA MEDICATION AND
    SYMPTOMS PRECIPITATING ADMINISTRATION.
    (b)   Impermissible medication delivery.--A certified
 medication aide may not:
          (1)   Administer a controlled substance under section 4 of
    the act of April 14, 1972 (P.L.233, No.64), known as The
    Controlled Substance, Drug, Device and Cosmetic Act.
          (2)   Administer medications by gastronomy GASTROSTOMY or <--
    jejunostomy tubes.
          (3)   Add fluid to established gastronomy GASTROSTOMY or     <--
    jejunostomy tube feedings or change established tube feeding
    bags.
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      (4)    Accept verbal or telephone orders for medication
  from a licensed health care professional who is authorized to
  independently diagnose and treat.
      (5)    Administer medication by the following routes:
             (i)    Central lines.
             (ii)    Colostomy.
             (iii)    Intramuscular.
             (iv)    Intrathecal.
             (v)    Intravenous.
             (vi)    Nasogastric.
             (vii)    Nonmetered inhaler.
             (viii)    Subcutaneous injection.
             (ix)    Intradermal.
             (x)    Urethral.
             (xi)    Epidural.
             (xii)    Endotracheal.
             (XIII)    RECTAL.                                      <--
             (XIV)    VAGINAL.
             (XV)    ENTERAL.
      (6)    Administer the following kinds of medications:
             (i)    Barium and other diagnostic contrast media.
             (ii)    Chemotherapeutic agents, except oral
      maintenance chemotherapy.
      (7)    Administer medication by, nor assume responsibility
  for, medication pumps, including client-controlled analgesia.
      (8)    Act as a clinical teaching associate to a student in
  a medication aide training program.
      (9)    ADMINISTER THE FIRST DOSE OF ANY NEW MEDICATION TO A <--
  RESIDENT OF A LONG-TERM CARE NURSING FACILITY.
      (10)    CALCULATE OR ADJUST A MEDICATION DOSE PRESCRIBED BY
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    A PHYSICIAN, NURSE PRACTITIONER OR PHYSICIAN ASSISTANT.
          (11)    DELEGATE THE ADMINISTRATION OF MEDICATION.
          (12)    ADMINISTER MEDICATION WITHOUT THE SUPERVISION OF A
    REGISTERED NURSE OR A LICENSED PRACTICAL NURSE AUTHORIZED BY
    A REGISTERED NURSE WHO IS PHYSICALLY ON-SITE AND AVAILABLE TO
    THE CERTIFIED MEDICATION AIDE.
 Section 804-C.        Medication aide training program and
                 certification.
    (a)   Development.--The department shall develop a medication
 aide training program for an individual to become a certified
 medication aide, which may be offered by a long-term care
 nursing facility. PRIOR TO OPERATING A TRAINING PROGRAM               <--
 AUTHORIZED UNDER THIS SECTION, A LONG-TERM CARE NURSING FACILITY
 SHALL CONTRACT WITH AN INSTRUCTOR APPROVED BY THE DEPARTMENT.
 The department shall include input from industry stakeholders on
 the development and implementation of the program. THE                <--
 DEPARTMENT SHALL CONSULT WITH THE STATE BOARD OF NURSING TO
 DETERMINE IF A NUMBER OF HOURS COMPLETED IN THE MEDICATION AIDE
 TRAINING PROGRAM MAY BE CREDITED TO A STUDENT IN A PRACTICAL
 NURSE EDUCATION PROGRAM UNDER THE ACT OF MARCH 2, 1956 (1955
 P.L.1211, NO.376), KNOWN AS THE PRACTICAL NURSE LAW. The program
 under this section must:
          (1)    Include a minimum of 40 80 hours of classroom and     <--
    clinical INSTRUCTION AND training, exclusive of testing or         <--
    instructor evaluation of whether the individual is competent.
          (2)    INCLUDE A MINIMUM OF 20 HOURS OF SKILLS AND           <--
    DEMONSTRATION, WHICH SHALL INCLUDE:
                 (I)   TEN HOURS OF CLINICAL OBSERVATION AND SKILLS
          DEMONSTRATION UNDER THE DIRECT SUPERVISION OF A
          SUPERVISING REGISTERED NURSE OR LICENSED PRACTICAL NURSE
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      AUTHORIZED BY A REGISTERED NURSE IN A LONG-TERM CARE
      NURSING FACILITY; AND
           (II)    TEN HOURS IN A SKILLS DEMONSTRATION LABORATORY.
      (2) (3)     Be conducted by an approved instructor and         <--
  utilize the State-approved written curriculum and test.
      (3) (4)     Cover the following topics:                        <--
           (i)    The role, responsibilities and performance of
      the prescribing provider in the medication administration
      process.
           (ii)    The rights of the individual regarding
      accepting or refusing medications.
           (iii)    Principles of infection control as they relate
      to medication administration.
           (iv)    Categories of medications and their effects.
           (v)    Effective management of poisoning or medication
      overdose.
           (vi)    Storage and disposal of medications.
           (vii)    Communications with individuals or guardians,
      if applicable, about the individual's medications.
           (viii)       The six principles of medication
      administration, including:
                  (A)    The correct medication.
                  (B)    The correct dosage of the medication.
                  (C)    The medication to the correct individual.
                  (D)    The medication at the correct time.
                  (E)    The medication to the individual by the
           correct method.
                  (F)    The accurate documentation.
      (4) (5)     Include a medication aide training examination     <--
  that requires the demonstration of the requisite knowledge
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    and skills to serve as a certified medication aide.
    (b)   Certification.--An instructor THE DEPARTMENT OF HEALTH          <--
 DEPARTMENT shall issue certification to an individual to                 <--
 practice as a certified medication aide if the individual:
          (1)   Successfully completes the medication aide training
    program.
          (2)   Scores 80% or higher on the examination under
    subsection (a)(4) (A)(5).                                             <--
          (3)   Demonstrates knowledge of the following pertaining
    to administering medications:
                (i)    The name of the medication.
                (ii)    The reason for the medication's use.
                (iii)    Any side effects or adverse reactions.
                (iv)    Any special instructions such as giving certain
          fluids, checking pulse rate or monitoring blood levels.
          (4)   Following direct observation by an instructor, has
    been found competent to be authorized to administer
    medications.
    (c)   Reauthorization.--A certified medication aide shall be          <--
 reauthorized to administer medications at least every two years
 or by the last day of the 24th month from the date of the prior
 authorization. Reauthorization of a certified medication aide
 shall include:
          (1)   Annual completion of 12 hours of continuing
    education, clinical competency demonstration and a medication
    errors prevention course, which shall be developed by the
    department.
          (2)   A written reauthorization by an instructor.
    (C)   RENEWAL OF CERTIFICATION.--A CERTIFIED MEDICATION AIDE          <--
 SHALL BE REQUIRED TO RENEW A CERTIFICATION NO LESS THAN EVERY
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 TWO YEARS OR BY THE LAST DAY OF THE 24TH MONTH FROM THE DATE OF
 THE PRIOR CERTIFICATION. THE FOLLOWING SHALL APPLY:
          (1)   RENEWAL SHALL INCLUDE:
                (I)    PROOF OF COMPLETION OF 12 HOURS OF CONTINUING
          EDUCATION PER YEAR, CLINICAL COMPETENCY DEMONSTRATION AND
          A MEDICATION ERRORS PREVENTION COURSE WHICH SHALL BE
          DEVELOPED BY THE DEPARTMENT.
                (II)    A RECERTIFICATION LETTER WRITTEN BY AN
          INSTRUCTOR RECOMMENDING THE CERTIFIED MEDICATION AIDE FOR
          RENEWAL.
          (2)   A CERTIFIED MEDICATION AIDE SHALL SUBMIT AN ONLINE
    COMPLETED RECERTIFICATION APPLICATION TO THE DEPARTMENT OF         <--
    HEALTH DEPARTMENT.                                                 <--
    (d)   Authorization.--Authorization to practice as a certified
 medication aide shall be valid in any long-term care nursing
 facility.
    (e)   Suspension of medication aide training program.--            <--
          (1)   A long-term care nursing facility's medication aide
    training program may be suspended for cause based on the
    adequacy and effectiveness of the medication aide training
    program.
          (2)   A long-term care nursing facility's medication aide
    training program may not be suspended based on surveys or
    operations of the long-term care nursing facility.
    (E)   CERTIFICATION SANCTION AUTHORIZATION.--THE DEPARTMENT OF <--
 HEALTH DEPARTMENT MAY REVOKE OR SUSPEND A CERTIFIED MEDICATION        <--
 AIDE'S CERTIFICATION, OR OTHERWISE SANCTION A CERTIFIED
 MEDICATION AIDE FOR ANY OF THE FOLLOWING REASONS:
          (1)   FAILURE TO COMPLETE A TIMELY RENEWAL.
          (2)   RECEIVING AN ANNOTATION ON THE NURSE AIDE'S LISTING
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  ON THE PENNSYLVANIA NURSE AIDE REGISTRY UNDER 42 U.S.C. §
  1396R(G)(1)(C) (RELATING TO REQUIREMENTS FOR NURSING
  FACILITIES) FOR ABUSE, NEGLECT OR MISAPPROPRIATION.
        (3)   FAILURE TO PROPERLY ADMINISTER MEDICATION.
        (4)   LACK OF PHYSICAL OR MENTAL ABILITY TO PROVIDE
  ADEQUATE SERVICES.
        (5)   DECEPTIVE OR FRAUDULENT PROCUREMENT OR
  REPRESENTATION OF CERTIFICATION OR FOR MAKING MISLEADING,
  DECEPTIVE OR UNTRUE REPRESENTATIONS TO SECURE OR AID OR ABET
  ANOTHER INDIVIDUAL TO SECURE A CERTIFICATION.
        (6)   WILLFUL OR NEGLIGENT MISCONDUCT IN PROVIDING CARE OR
  PRACTICING BEYOND CERTIFICATION AUTHORIZATION.
        (7)   PRACTICING WITHOUT A CURRENT CERTIFICATION.
        (8)   CONVICTION OF ANY OFFENSE LISTED IN 22 PA. CODE §
  701.13 (RELATING TO NONACCEPTANCE OF CERTAIN APPLICANTS).
        (9)   HAVING A CERTIFICATION OR OTHER AUTHORIZATION TO
  PRACTICE A PROFESSION OR OCCUPATION REVOKED, SUSPENDED OR
  SUBJECTED TO OTHER DISCIPLINARY SANCTION.
  (F)   SANCTIONS.--
        (1)   THE DEPARTMENT OF HEALTH DEPARTMENT MAY ORDER ONE OR <--
  MORE OF THE FOLLOWING AGAINST A CERTIFIED MEDICATION AIDE FOR
  A REASON LISTED UNDER SUBSECTION (E):
              (I)    REVOKE A CERTIFICATION.
              (II)    REQUIRE A CERTIFIED MEDICATION AIDE TO TAKE
        EDUCATIONAL COURSES.
              (III)    IMPOSE A CIVIL PENALTY NOT EXCEEDING $500 ON   <--
        (2)   THE DEPARTMENT MAY IMPOSE A CIVIL PENALTY NOT           <--
  EXCEEDING $500 ON THE FACILITY FOR EACH INCIDENT IN WHICH THE