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PAG LIN
1 1 Section 1. NEW SECTION. 135M.1 TITLE.
1 2 This chapter shall be known and may be cited as the "Safe
1 3 Staffing for Quality Care Act".
1 4 Sec. 2. NEW SECTION. 135M.2 FINDINGS.
1 5 The general assembly finds that:
1 6 1. The state has a substantial interest in assuring that
1 7 delivery of health care services to patients in health
1 8 facilities is adequate and safe and that health facilities
1 9 retain sufficient nursing staff in order to promote optimal
1 10 health care outcomes.
1 11 2. Inadequate and poorly monitored nurse staffing
1 12 practices jeopardize delivery of quality health care services
1 13 and adversely impact the health of patients who use health
1 14 facilities.
1 15 3. Research indicates that health facility nurses work
1 16 substantial overtime hours and that nurses working twelve-hour
1 17 shifts work the most overtime hours per week.
1 18 4. Mandatory overtime and lengthy work hours for direct-
1 19 care nurses constitute a threat to the health and safety of
1 20 patients, adversely impact the general well-being of nurses
1 21 and their families, and result in greater turnover, which
1 22 increases long-term shortages of nursing personnel.
1 23 5. Inadequate health facility staffing results in
1 24 dangerous medical errors and patient infections.
1 25 6. Recent changes in the health care delivery system are
1 26 resulting in a higher acuity level among patients in health
1 27 facilities.
1 28 7. The basic principles of staffing in health facilities
1 29 should focus on patient health care needs and be based on
1 30 consideration of patient acuity levels and the services
1 31 necessary to ensure optimal health care outcomes.
1 32 8. A substantial number of nurses indicate that patient
1 33 acuity measurements are inadequate and that many health
1 34 facilities rarely, if ever, staff according to an acuity
1 35 measurement tool.
2 1 9. To ensure adequate protection and care for patients in
2 2 health facilities, it is essential that qualified licensed
2 3 nurses be accessible and available to meet the nursing needs
2 4 of patients.
2 5 10. Establishing staffing standards will ensure that
2 6 health facilities throughout the state operate in a manner
2 7 that guarantees the public safety and the delivery of quality
2 8 health care services.
2 9 Sec. 3. NEW SECTION. 135M.3 DEFINITIONS.
2 10 As used in this chapter, unless the context otherwise
2 11 requires:
2 12 1. "Acuity system" means an established measurement
2 13 instrument that does all of the following:
2 14 a. Predicts nursing care requirements for individual
2 15 patients based on severity of patient illness, need for
2 16 specialized equipment and technology, intensity of nursing
2 17 interventions required, and the complexity of clinical nursing
2 18 judgment needed to design, implement, and evaluate the
2 19 patient's nursing care plan.
2 20 b. Specifies the amount of nursing care needed, both in
2 21 number of nurses and in skill mix of nursing personnel
2 22 required, on a daily basis, for each patient in a nursing
2 23 department or unit.
2 24 c. Is stated in terms that readily can be used and
2 25 understood by direct-care nursing staff.
2 26 2. "Assessment tool" means a measurement system that
2 27 compares the staffing level in each nursing department or unit
2 28 against actual patient nursing care requirements in order to
2 29 review the accuracy of an acuity system.
2 30 3. "Critical care unit" means a unit of a hospital that is
2 31 established to safeguard and protect patients whose severity
2 32 of medical conditions requires continuous monitoring and
2 33 complex nursing intervention.
2 34 4. "Declared state of emergency" means an officially
2 35 designated state of emergency that has been declared by a
3 1 federal, state, or local government official having authority
3 2 to declare that the state, county, municipality, or locality
3 3 is in a state of emergency, but does not include a state of
3 4 emergency which results from a labor dispute in the health
3 5 care industry.
3 6 5. "Direct-care nurse" and "direct-care nursing staff"
3 7 include any nurse who has direct responsibility to oversee or
3 8 carry out medical regimens or nursing care for one or more
3 9 patients.
3 10 6. "Documented staffing plan" means a detailed, written
3 11 plan that specifies the minimum number, skill mix, and
3 12 classification of licensed nurses required in each nursing
3 13 department or unit in the health facility for a given year,
3 14 based on reasonable projections derived from the patient
3 15 census and average acuity level within each department or unit
3 16 during the prior year, the department or unit size and
3 17 geography, the nature of services provided, and any
3 18 foreseeable changes in department or unit size or function
3 19 during the year.
3 20 7. "Health facility" means an acute care hospital, an
3 21 outpatient surgical facility, or an institution operating as a
3 22 psychiatric hospital or operating a designated psychiatric
3 23 unit, regulated by the department of inspections and appeals.
3 24 8. "Nurse" means either a registered nurse or a licensed
3 25 practical nurse.
3 26 9. "Nursing care" means care which falls within the scope
3 27 of practice set forth in chapter 152 or is otherwise
3 28 encompassed within recognized professional standards of
3 29 nursing practice, including assessment, nursing diagnosis,
3 30 planning, intervention, evaluation, and patient advocacy.
3 31 10. "Off-duty" means, with reference to a health facility
3 32 employee, that the individual has no restrictions placed on
3 33 the individual and is free of all duty on behalf of the health
3 34 facility.
3 35 11. "On-duty" means, with reference to a health facility
4 1 employee, that the individual is required to be available and
4 2 ready to perform services on request within or on behalf of
4 3 the health facility and includes any rest periods or breaks
4 4 during which the individual's ability to leave the health
4 5 facility is restricted either expressly or by work-related
4 6 circumstances beyond the individual's control.
4 7 12. "Outpatient surgical facility" means the same as
4 8 defined in section 135.61.
4 9 13. "Skill mix" means the combination of licensing,
4 10 specialty, and experience levels among direct-care nurses.
4 11 14. "Staffing level" means the actual numerical nurse-to-
4 12 patient ratio by nurse classification within a nursing
4 13 department or unit.
4 14 Sec. 4. NEW SECTION. 135M.4 HEALTH FACILITY STAFFING
4 15 STANDARDS.
4 16 1. a. Each health facility shall ensure that the facility
4 17 is staffed in a manner that provides sufficient, appropriately
4 18 qualified nursing staff of each classification in each
4 19 department or unit within the facility, to meet the
4 20 individualized care needs of the patients in the facility and
4 21 to meet the requirements of this section.
4 22 b. As a condition of licensure, each health facility
4 23 shall, annually, submit to the department of inspections and
4 24 appeals a documented staffing plan accompanied by written
4 25 certification that the staffing plan is sufficient to provide
4 26 adequate and appropriate delivery of health care services to
4 27 patients for the subsequent year. The staffing plan shall:
4 28 (1) Meet the minimum requirements pursuant to subsection
4 29 2.
4 30 (2) Comply with all additional requirements established by
4 31 state or federal law or regulation.
4 32 (3) Identify and utilize an approved acuity system to
4 33 address fluctuations in actual patient acuity levels and
4 34 nursing care requirements that necessitate increased staffing
4 35 levels above the minimums specified in the plan.
5 1 (4) Factor in other unit or department activities such as
5 2 discharges, transfers and admissions, and administrative and
5 3 support tasks that are expected to be performed by direct-care
5 4 nurses, in addition to direct-care nursing staff activities.
5 5 (5) Identify the assessment tool used to validate the
5 6 acuity system on which the plan is based.
5 7 (6) Identify the system which will be used to document
5 8 actual staffing on a daily basis within each department or
5 9 unit.
5 10 (7) Include a written assessment of the accuracy of the
5 11 prior year's staffing plan compared with the prior year's
5 12 actual staffing needs.
5 13 (8) Identify each nursing staff classification referenced
5 14 in the plan accompanied by a statement specifying minimum
5 15 qualifications for each referenced classification.
5 16 (9) Be developed in consultation with the direct-care
5 17 nursing staff within each department or unit or, if the staff
5 18 is represented, with the applicable recognized or certified
5 19 collective bargaining representative of the direct-care
5 20 nursing staff.
5 21 2. a. The staffing plan shall allocate a sufficient
5 22 number of direct-care nurses to provide for a ratio of one
5 23 direct-care nurse to one patient in a pediatric recovery room,
5 24 in an operating room, and for special procedures; and a ratio
5 25 of one direct-care nurse to two patients in a burn unit and an
5 26 adult recovery room. The health facility, in consultation
5 27 with the direct-care nursing staff within each nursing
5 28 department or unit or, if staff is represented, with the
5 29 recognized or certified collective bargaining representative
5 30 of the direct-care nursing staff, shall establish minimum,
5 31 specific, numerical direct-care nurse-to-patient ratios for
5 32 other health facility nursing departments and units and shall
5 33 incorporate the ratios in the staffing plan.
5 34 b. The minimum number of direct-care nurse-to-patient
5 35 staff established in paragraph "a" shall constitute the
6 1 minimum number of direct-care nursing staff that shall be
6 2 assigned to and present within a nursing department or unit.
6 3 If the approved acuity system adopted by the facility
6 4 indicates that additional staff is required, the health
6 5 facility shall staff at the higher staffing level.
6 6 c. The department of inspections and appeals shall adopt
6 7 rules prescribing the method by which the department shall
6 8 approve a health facility's acuity system. The rules may
6 9 include a method for categorical approval of acuity systems.
6 10 d. (1) The skill mix reflected in a staffing plan shall
6 11 assure that all of the following elements of the nursing
6 12 process are performed in the planning and delivery of care for
6 13 each patient: assessment, nursing diagnosis, planning,
6 14 intervention, evaluation, and patient advocacy.
6 15 (2) Registered nurses shall constitute at least fifty
6 16 percent of the direct-care nurses included in the staffing
6 17 plan.
6 18 (3) The skill mix shall not incorporate or assume that
6 19 nursing care functions required by state or federal law or
6 20 regulation, or accepted standards of practice that are
6 21 required to be performed by a licensed nurse, may be performed
6 22 by unlicensed assistive personnel.
6 23 3. a. As a condition of licensure, a health facility
6 24 shall at all times staff in accordance with its staffing plan
6 25 and the staffing standards specified in the plan, provided,
6 26 however, that nothing in this chapter shall be deemed to
6 27 preclude a health facility from implementing higher direct-
6 28 care nurse-to-patient staffing levels.
6 29 b. A nurse shall not be assigned or included in the count
6 30 of assigned nursing staff for purposes of compliance with
6 31 minimum staffing requirements in a nursing department or unit
6 32 or a clinical area within the health facility, without
6 33 appropriate licensing, prior orientation, and verification
6 34 that the nurse is capable of providing competent nursing care
6 35 to patients.
7 1 4. a. As a condition of licensure, each health facility
7 2 shall maintain accurate daily records showing all of the
7 3 following:
7 4 (1) The number of patients admitted, released, and present
7 5 in each nursing department or unit within the facility.
7 6 (2) The individual acuity level of each patient present in
7 7 each nursing department or unit within the facility.
7 8 (3) The identity and duty hours of each direct-care nurse
7 9 in each nursing department or unit within the facility.
7 10 b. As a condition of licensure, each health facility shall
7 11 maintain daily statistics, by nursing department and unit, of
7 12 mortality, morbidity, infection, accident, injury, and medical
7 13 errors.
7 14 c. All records required under this subsection shall be
7 15 maintained for a period of seven years.
7 16 d. All records required under this subsection shall be
7 17 made available upon request to the department of inspections
7 18 and appeals and to the public, provided, however, that
7 19 information released to the public shall not contain the name
7 20 or other personal identifying information, apart from acuity
7 21 level, for any individual patient.
7 22 Sec. 5. NEW SECTION. 135M.5 MANDATORY OVERTIME AND
7 23 EXCESSIVE DUTY HOURS.
7 24 1. a. Notwithstanding any other provision of law to the
7 25 contrary and subject only to the exceptions in this section, a
7 26 health facility shall not directly or indirectly mandate or
7 27 otherwise require a health facility employee to work or be in
7 28 on-duty status, in excess of any of the following:
7 29 (1) The scheduled work shift or duty period.
7 30 (2) Twelve hours in a twenty-four-hour period.
7 31 (3) Eighty hours in a fourteen-consecutive-day period.
7 32 b. As used in this section, "mandatory" or "mandate" means
7 33 any request which, if refused or declined by the health
7 34 facility employee, may result in discharge, discipline, loss
7 35 of promotion, or other adverse employment consequence.
8 1 c. Nothing in this subsection is intended to prohibit a
8 2 health facility employee from voluntarily working overtime.
8 3 2. a. A health facility employee shall not work or be in
8 4 on-duty status in excess of sixteen hours in any twenty-four-
8 5 hour period.
8 6 b. A health facility employee working sixteen hours in any
8 7 twenty-four-hour period shall be given at least eight
8 8 consecutive hours off duty before being required to return to
8 9 duty.
8 10 c. A health facility employee shall not be required to
8 11 work or be on duty more than seven consecutive days without at
8 12 least one consecutive twenty-four-hour period off duty within
8 13 that time.
8 14 3. a. During a declared state of emergency in which a
8 15 health facility is requested or otherwise reasonably may be
8 16 expected to provide an exceptional level of emergency or other
8 17 medical services to the community, the mandatory overtime
8 18 prohibition specified in subsection 1, paragraph "a", shall
8 19 not apply to the following extent:
8 20 (1) Health facility employees may be required to work or
8 21 be on duty up to the maximum hours limitation specified in
8 22 subsection 2, paragraph "a", provided the health facility has
8 23 taken the steps specified in paragraph "b" of this subsection.
8 24 (2) Prior to requiring any health facility employee to
8 25 work mandatory overtime, the health facility shall make
8 26 reasonable efforts to fill the health facility's immediate
8 27 staffing needs through alternative efforts, including
8 28 requesting off-duty staff to voluntarily report to work,
8 29 requesting on-duty staff to volunteer for overtime hours, and
8 30 recruiting per diem and registry staff to report to work.
8 31 (3) The exemption under this paragraph "a" shall not
8 32 exceed the duration of the declared state of emergency or the
8 33 health facility's direct role in responding to medical needs
8 34 resulting from the declared state of emergency, whichever is
8 35 less.
9 1 b. During a declared state of emergency for which a health
9 2 facility is requested or otherwise reasonably may be expected
9 3 to provide an exceptional level of emergency or other medical
9 4 services to the community, the maximum hours limitation in
9 5 subsection 2, paragraph "a", shall be lifted to the following
9 6 extent:
9 7 (1) Health facility employees may work or remain on duty
9 8 for more than the maximum hour limitations set forth in
9 9 subsection 2, paragraph "a", provided that all of the
9 10 following conditions are met:
9 11 (a) The decision to work the additional time is
9 12 voluntarily made by the individual health facility employee
9 13 affected.
9 14 (b) The health facility employee is given at least one
9 15 uninterrupted four-hour rest period before commencing the
9 16 first sixteen hours of duty and an uninterrupted eight-hour
9 17 rest period at the completion of twenty-four hours of duty.
9 18 (c) A health facility employee shall not work or remain on
9 19 duty for more than twenty-eight consecutive hours in a
9 20 seventy-two-hour period.
9 21 (d) A health facility employee who has been on duty for
9 22 more than sixteen hours in a twenty-four-hour period who
9 23 informs the health facility that the employee requires
9 24 immediate rest must be relieved from duty as soon as possible,
9 25 consistent with patient safety needs, and given at least eight
9 26 uninterrupted hours off duty before being required to return
9 27 for duty.
9 28 (2) As used in this paragraph "b", "rest period" means a
9 29 period in which an individual may be required to remain on the
9 30 premises of the health facility, but is not subject to
9 31 restraint or duty or responsibility for work or duty should
9 32 the occasion arise.
9 33 (3) The exemption in this paragraph "b" shall not exceed
9 34 the duration of the declared state of emergency or the health
9 35 facility's direct role in responding to medical needs
10 1 resulting from the declared state of emergency, whichever is
10 2 less.
10 3 4. A work shift schedule or overtime program established
10 4 pursuant to a collective bargaining agreement negotiated on
10 5 behalf of the health facility employees by a bona fide labor
10 6 organization may provide for mandatory on-duty hours in excess
10 7 of those permitted under this section, provided adequate
10 8 measures are included in the agreement to ensure against
10 9 excessive fatigue on the part of the affected employees.
10 10 Sec. 6. NEW SECTION. 135M.6 EMPLOYEE RIGHTS.
10 11 1. As a condition of licensure, each health facility shall
10 12 adopt and disseminate to direct-care nursing staff a written
10 13 policy that complies with the requirements set forth in this
10 14 section detailing the circumstances under which a direct-care
10 15 nurse may refuse a work assignment. At a minimum, the work
10 16 assignment policy shall permit a direct-care nurse to refuse
10 17 an assignment for which:
10 18 a. The nurse is not prepared by education, training, or
10 19 experience to safely fulfill the assignment without
10 20 compromising or jeopardizing patient safety, the nurse's
10 21 ability to meet foreseeable patient needs, or the nurse's
10 22 license.
10 23 b. The nurse has volunteered to work overtime but
10 24 determines that the nurse's level of fatigue or decreased
10 25 alertness would compromise or jeopardize patient safety, the
10 26 nurse's ability to meet foreseeable patient needs, or the
10 27 nurse's license.
10 28 c. The assignment otherwise would violate requirements
10 29 specified in this chapter.
10 30 2. At a minimum, the work assignment policy shall contain
10 31 procedures for all of the following:
10 32 a. Reasonable requirements for prior notice to the nurse's
10 33 supervisor regarding the nurse's request and supporting
10 34 reasons for being relieved of the assignment or continued
10 35 duty.
11 1 b. If feasible, an opportunity for the supervisor to
11 2 review the specific conditions supporting the nurse's request
11 3 to be relieved of the assignment or continued duty, and to
11 4 decide whether to remedy the conditions, to relieve the nurse
11 5 of the assignment, or to deny the nurse's request.
11 6 c. A process which permits the nurse to exercise the right
11 7 to refuse the assignment or continued on-duty status when the
11 8 supervisor denies the request to be relieved if all of the
11 9 following apply:
11 10 (1) The supervisor rejects the request without proposing a
11 11 remedy or the proposed remedy would be inadequate or untimely.
11 12 (2) The complaint and investigation process provided
11 13 through the department of inspections and appeals would be
11 14 untimely to address the concern.
11 15 (3) The employee in good faith believes that the
11 16 assignment meets the conditions justifying refusal.
11 17 3. A health facility shall not penalize or discriminate or
11 18 retaliate in any manner against a health facility employee
11 19 with respect to compensation, terms, conditions, or privileges
11 20 of employment, who in good faith, individually, or in
11 21 conjunction with another person or persons does any of the
11 22 following:
11 23 a. Reports a violation or suspected violation of this
11 24 chapter to a public regulatory agency, a private accreditation
11 25 body, or management personnel of the health facility.
11 26 b. Initiates, cooperates with, or otherwise participates
11 27 in an investigation or proceeding brought by a regulatory
11 28 agency or private accreditation body concerning matters
11 29 covered by this chapter.
11 30 c. Informs or discusses with other employees, with a
11 31 representative of the employees, with patients or a patient
11 32 representative, or with the public, violations or suspected
11 33 violations of this chapter.
11 34 d. Otherwise avails the employee of the rights established
11 35 in this chapter.
12 1 4. For the purposes of this section, a health facility
12 2 employee is deemed to act in good faith if the employee
12 3 reasonably believes all of the following:
12 4 a. That the information reported or disclosed is true.
12 5 b. That a violation has occurred or may occur.
12 6 5. a. Any health facility that violates section 135M.5 or
12 7 this section may be held liable to any employee affected in an
12 8 action brought in a court of competent jurisdiction for such
12 9 legal or equitable relief as may be appropriate to effectuate
12 10 the purposes of this chapter, including but not limited to
12 11 reinstatement, promotion, payment of lost wages and benefits,
12 12 and payment of compensatory and consequential damages
12 13 resulting from the violation together with an equal amount in
12 14 liquidated damages. The court in such action shall, in
12 15 addition to any judgment awarded to the plaintiff, award
12 16 reasonable attorney fees and costs of action to be paid by the
12 17 defendant.
12 18 b. The employee's right to institute a private action
12 19 under this subsection is not limited by any other rights
12 20 granted under this chapter.
12 21 Sec. 7. NEW SECTION. 135M.7 ENFORCEMENT – PENALTIES.
12 22 1. A health facility shall post in a conspicuous place
12 23 readily accessible to the general public, a notice prepared by
12 24 the department of inspections and appeals specifying in
12 25 summary form the mandatory provisions of this chapter.
12 26 2. Mandatory and actual nurse staffing levels in each
12 27 nursing department or unit shall be posted daily in a
12 28 conspicuous place readily accessible to the general public.
12 29 3. a. Upon request, the health facility shall make copies
12 30 of the staffing plan, filed with the department of inspections
12 31 and appeals, available to the general public.
12 32 b. Each nursing department or unit within a health
12 33 facility shall post or otherwise make readily available to the
12 34 nursing staff, during each work shift, all of the following:
12 35 (1) A copy of the current staffing plan for that
13 1 department or unit.
13 2 (2) Documentation of the number of direct-care nursing
13 3 staff required to be present during the shift, based on the
13 4 approved adopted acuity system.
13 5 (3) Documentation of the actual number of direct-care
13 6 nursing staff present during the shift.
13 7 4. The department of inspections and appeals shall enforce
13 8 this chapter and shall adopt rules necessary for enforcement.
13 9 At a minimum, the rules shall provide for:
13 10 a. Unannounced, random compliance site visits to health
13 11 facilities.
13 12 b. An accessible and confidential system for the public
13 13 and nursing staff to report a health facility's failure to
13 14 comply with this chapter.
13 15 c. A systematic means for investigating and correcting
13 16 violations of this chapter.
13 17 d. Public access to information regarding reports of
13 18 inspections, results, deficiencies, and corrections.
13 19 e. A process for imposing penalties for violations of the
13 20 staffing requirements of this chapter.
13 21 5. The department of inspections and appeals and the
13 22 department of workforce development shall have concurrent
13 23 jurisdiction to ensure compliance with this chapter and to
13 24 implement rules and regulations as necessary or appropriate to
13 25 carry out this function.
13 26 6. a. A determination that a health facility has violated
13 27 this chapter may result in revocation of the health facility's
13 28 licensure.
13 29 b. (1) A health facility that violates any staffing
13 30 requirements specified in section 135M.4 is subject to a fine
13 31 of not less than fifteen thousand dollars per day, per
13 32 violation, for each day that the violation occurs or
13 33 continues.
13 34 (2) A health facility that fails to post a notice required
13 35 under this chapter is subject to a fine of one thousand
14 1 dollars per day for each day that the required notice is not
14 2 posted.
14 3 (3) A health facility that violates section 135M.5 or
14 4 135M.6 is subject to a fine of fifteen thousand dollars per
14 5 violation.
14 6 (4) A person or health facility that fails to report or
14 7 falsifies information, or coerces, threatens, intimidates, or
14 8 otherwise influences another person to fail to report or to
14 9 falsify information required to be reported under this
14 10 chapter, is subject to a fine of up to fifteen thousand
14 11 dollars for each such incident.
14 12 c. Upon investigation, the department of inspections and
14 13 appeals shall notify the health facility of all deficiencies
14 14 in the facility's compliance with this chapter and the rules
14 15 adopted under this chapter. The notice may include an order
14 16 to take corrective action within a specified time period,
14 17 including but not limited to any of the following:
14 18 (1) Revising the facility staffing plan.
14 19 (2) Reducing the number of patients within a nursing
14 20 department or unit.
14 21 (3) Temporarily closing a nursing department or unit to
14 22 any further patient admissions until corrections are made.
14 23 (4) Temporarily transferring patients to another nursing
14 24 department or unit within the facility until corrections are
14 25 made.
14 26 d. (1) The department of inspections and appeals may
14 27 issue an order of correction as follows:
14 28 (a) On an emergency basis, without prior notice or
14 29 opportunity for a hearing, if an investigation determines that
14 30 patient care is being compromised in a manner that poses an
14 31 immediate jeopardy to the health or safety of patients.
14 32 (b) In accordance with the provisions for suspension of
14 33 licensure of a health facility in chapter 135B.
14 34 (2) The order of correction shall be in writing and shall
14 35 contain a statement of the reasons for the order.
15 1 (3) Upon the failure of a health facility to comply with
15 2 an order of correction in a timely manner, the department of
15 3 inspections and appeals may take such action the department
15 4 deems appropriate, including but not limited to:
15 5 (a) Appointing an administrative overseer for the
15 6 facility.
15 7 (b) Closing the facility or unit to patient admissions.
15 8 (c) Placing the health facility's emergency room on bypass
15 9 status.
15 10 (d) Revoking the health facility's license.
15 11 e. Any person who willfully violates this chapter in a
15 12 manner that evidences a pattern or practice of violations
15 13 which is likely to have a serious and adverse impact on
15 14 patient care or the potential for serious injury or death for
15 15 patients or employees is guilty of an aggravated misdemeanor.
15 16 f. (1) A determination that a health facility has
15 17 violated the provisions of this chapter shall result in an
15 18 order of reimbursement to the medical assistance program or in
15 19 termination from participation in the medical assistance
15 20 program for a period of time to be determined by the
15 21 department of inspections and appeals in consultation with the
15 22 department of human services.
15 23 (2) A health facility that falsifies or causes to be
15 24 falsified documentation required by this chapter shall be
15 25 prohibited from receiving any medical assistance reimbursement
15 26 for a period of six months.
15 27 EXPLANATION
15 28 This bill relates to staffing requirements for health
15 29 facilities. For the purposes of the bill, "health facility"
15 30 means an acute care hospital, an outpatient surgical facility,
15 31 or an institution operating as a psychiatric hospital or
15 32 operating a designated psychiatric unit, regulated by the
15 33 department of inspections and appeals.
15 34 The bill specifies facility staffing standards, prohibits
15 35 mandatory overtime, specifies maximum hours that a health
16 1 facility employee may work or be on duty, provides for
16 2 exceptions under a state of emergency, establishes rights for
16 3 nursing staff of a health facility, and protects health
16 4 facility employees from retaliation for reporting or otherwise
16 5 publicizing violations or suspected violations.
16 6 The bill provides for a private right of action for a nurse
16 7 if a health facility violates the provisions of the bill,
16 8 provides for public disclosure of violations of the bill,
16 9 provides for regulatory oversight by the department of
16 10 inspections and appeals, provides civil penalties, and
16 11 provides a criminal penalty of an aggravated misdemeanor which
16 12 carries with it a maximum penalty not to exceed two years and
16 13 a fine of at least $500 but not to exceed $5,000 for a willful
16 14 violation of the Code chapter that evidences a pattern or
16 15 practice of violation and is likely to have serious and
16 16 adverse impact on patient care or the potential for serious
16 17 injury or death for patients or employees. The bill also
16 18 provides for the loss of reimbursement for a health facility
16 19 under the medical assistance program for violation of the
16 20 chapter.
16 21 LSB 5842XS 79
16 22 pf/cf/24.1
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