House File 283 - Introduced
HOUSE FILE
BY MASCHER
Passed House, Date Passed Senate, Date
Vote: Ayes Nays Vote: Ayes Nays
Approved
A BILL FOR
1 An Act relating to health facility staffing standards and
2 providing penalties.
3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
4 TLSB 2290HH 81
5 pf/cf/24
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 located within this state is adequate and safe and
1 9 that health facilities retain sufficient nursing staff in
1 10 order to promote optimal health care outcomes.
1 11 2. Recent changes in health care delivery systems are
1 12 resulting in a higher acuity level among patients in health
1 13 facilities.
1 14 3. Inadequate hospital staffing results in dangerous
1 15 medical errors and patient infections. Registered nurses
1 16 constitute the highest percentage of direct health care staff
1 17 in acute care facilities and have a central role in health
1 18 care delivery.
1 19 4. Mandatory overtime and lengthy work hours for direct=
1 20 care nurses constitute a threat to the health and safety of
1 21 patients, adversely impact the general well=being of nurses
1 22 and their families, and result in greater turnover, which
1 23 increases long=term shortages of nursing personnel.
1 24 5. To ensure the adequate protection of and care for
1 25 patients in health facilities, it is essential that qualified
1 26 registered nurses be accessible and available to meet the
1 27 nursing needs of patients. Inadequate and poorly monitored
1 28 nurse staffing practices, which result in having too few
1 29 registered nurses available to provide care, jeopardize
1 30 delivery of quality health care services and adversely impact
1 31 the health of patients who enter hospitals and outpatient
1 32 emergency and surgical centers.
1 33 6. The basic principles of staffing in health care
1 34 facilities should focus on patient health care needs and be
1 35 based on consideration of patient acuity levels and services
2 1 necessary to ensure optimal outcomes.
2 2 7. While the focus of this chapter is registered nurses
2 3 who are principal caregivers, safe staffing practices
2 4 recognize the importance of all health care workers in
2 5 providing quality patient care. Establishing staffing
2 6 standards for registered nurses shall not be interpreted as
2 7 justifying the understaffing of other critical health care
2 8 workers, including licensed practical nurses and unlicensed
2 9 assistive personnel. Indeed, the availability of these other
2 10 health care workers enables registered nurses to focus on the
2 11 nursing care functions that only registered nurses, by law,
2 12 are permitted to perform, and thereby contributes to the goal
2 13 of attaining adequate staffing levels.
2 14 8. To ensure patient safety, adequate hospital patient
2 15 acuity measurements must be in place and must be followed.
2 16 9. Establishing staffing standards for registered nurses
2 17 in acute care facilities will ensure that health facilities
2 18 throughout the state operate in a manner that guarantees the
2 19 public safety and the delivery of quality health care
2 20 services.
2 21 10. In order to meet the staffing standards established in
2 22 this chapter, the state recognizes the need to create
2 23 incentives to increase the number of registered nurses within
2 24 the state.
2 25 Sec. 3. NEW SECTION. 135M.3 DEFINITIONS.
2 26 As used in this chapter, unless the context otherwise
2 27 requires:
2 28 1. "Acuity system" means an established measurement
2 29 instrument that does all of the following:
2 30 a. Predicts nursing care requirements for individual
2 31 patients based on severity of patient illness, need for
2 32 specialized equipment and technology, intensity of nursing
2 33 interventions required, and the complexity of clinical nursing
2 34 judgment needed to design, implement, and evaluate the
2 35 patient's nursing care plan.
3 1 b. Specifies the amount of nursing care needed, both in
3 2 number of direct=care nurses and in skill mix of nursing
3 3 personnel required, on a daily basis, for each patient in a
3 4 nursing department or unit.
3 5 c. Is stated in terms that readily can be used and
3 6 understood by direct=care nurses.
3 7 d. Takes into consideration the patient care services
3 8 provided not only by registered nurses but also by licensed
3 9 practical nurses and other health care personnel.
3 10 2. "Assessment tool" means a measurement system that
3 11 compares the staffing level in each nursing department or unit
3 12 against actual patient nursing care requirements in order to
3 13 review the accuracy of an acuity system.
3 14 3. "Critical care unit" means a unit of a hospital that is
3 15 established to safeguard and protect patients whose severity
3 16 of medical condition requires continuous monitoring and
3 17 complex nursing intervention.
3 18 4. "Declared state of emergency" means an officially
3 19 designated state of emergency that has been declared by a
3 20 federal, state, or local government official having authority
3 21 to declare that the state, county, municipality, or locality
3 22 is in a state of emergency, but does not include a state of
3 23 emergency which results from a labor dispute in the health
3 24 care industry.
3 25 5. "Department" means the department of inspections and
3 26 appeals.
3 27 6. "Direct=care nurse" and "direct=care nursing staff"
3 28 mean a registered nurse or nurses with direct responsibility
3 29 to oversee or carry out medical regimens, nursing, or other
3 30 bedside care for one or more patients.
3 31 7. "Documented staffing plan" means a detailed, written
3 32 plan that specifies the minimum number and classification of
3 33 direct=care nurses required in each nursing department or unit
3 34 in the health care facility for a given year, based on
3 35 reasonable projections derived from the patient census and
4 1 average acuity level within each department or unit during the
4 2 prior year, the department or unit size and geography, the
4 3 nature of services provided, and any foreseeable changes in
4 4 department or unit size or function during the current year.
4 5 8. "Extended care facility" means a home health care
4 6 agency, a hospice, or a long=term care nursing facility.
4 7 9. "Health facility" means an acute care hospital, an
4 8 outpatient surgical facility, or an institution operating as a
4 9 psychiatric hospital or operating a designated psychiatric
4 10 unit, regulated by the department.
4 11 10. "Nurse" means an individual licensed to practice
4 12 professional nursing.
4 13 11. "Nursing care" means care which falls within the scope
4 14 of practice set forth in chapter 152 or is otherwise
4 15 encompassed within recognized professional standards of
4 16 nursing practice, including assessment, nursing diagnosis,
4 17 planning, intervention, evaluation, and patient advocacy.
4 18 12. "Off=duty" means, with reference to a health facility
4 19 employee, that the individual has no restrictions placed on
4 20 the individual and is free of all duty on behalf of the health
4 21 facility.
4 22 13. "On=duty" means, with reference to a health facility
4 23 employee, that the individual is required to be available and
4 24 ready to perform services on request within or on behalf of
4 25 the health facility and includes any rest periods or breaks
4 26 during which the individual's ability to leave the health
4 27 facility is restricted either expressly or by work=related
4 28 circumstances beyond the individual's control.
4 29 14. "Outpatient surgical facility" means the same as
4 30 defined in section 135.61.
4 31 15. "Skill mix" means the combination of licensing,
4 32 specialty, and experience levels among direct=care nurses.
4 33 16. "Staffing level" means the actual numerical nurse=to=
4 34 patient ratio within a nursing department or unit.
4 35 17. "Unit" means a patient care component within a
5 1 facility as defined by the department.
5 2 Sec. 4. NEW SECTION. 135M.4 HEALTH FACILITY STAFFING
5 3 STANDARDS.
5 4 1. A health facility, other than an extended care
5 5 facility, shall ensure that it is staffed in a manner that
5 6 provides sufficient, appropriately qualified direct=care
5 7 nurses in each department or unit within the facility in order
5 8 to meet the individualized care needs of its patients and to
5 9 meet the requirements specified in this section.
5 10 2. a. As a condition of licensure, each health facility,
5 11 annually, shall submit to the department a documented staffing
5 12 plan accompanied by a written certification that the staffing
5 13 plan is sufficient to provide adequate and appropriate
5 14 delivery of health care services to patients for the
5 15 subsequent year. The staffing plan shall do all of the
5 16 following:
5 17 (1) Meet the minimum requirements pursuant to paragraph
5 18 "b".
5 19 (2) Comply with all additional requirements established by
5 20 state or federal law or regulation.
5 21 (3) Identify and utilize an approved acuity system for
5 22 addressing fluctuations in actual patient acuity levels and
5 23 nursing care requirements that necessitate increased staffing
5 24 levels above the minimums specified in the plan.
5 25 (4) Factor in other unit or department activities such as
5 26 discharges, transfers and admissions, administrative and
5 27 support tasks that are expected to be performed by direct=care
5 28 nurses, in addition to direct nursing care activities.
5 29 (5) Factor in the staffing level of and services provided
5 30 by other health care personnel in meeting patient care needs.
5 31 (6) Identify the assessment tool used to validate the
5 32 acuity system relied on in the plan.
5 33 (7) Identify the system that will be used to document
5 34 actual staffing on a daily basis within each department or
5 35 unit.
6 1 (8) Include a written assessment of the accuracy of the
6 2 prior year's staffing plan compared with actual staffing
6 3 needs.
6 4 (9) Identify each nursing staff classification referenced
6 5 in the plan accompanied by a statement specifying minimum
6 6 qualifications for each referenced classification.
6 7 (10) Be developed in consultation with a majority of the
6 8 direct=care nursing staff within each department or unit or,
6 9 if the nursing staff is represented, with the applicable
6 10 recognized or certified collective bargaining representative
6 11 of the direct=care nursing staff.
6 12 b. The staffing plan shall incorporate, at a minimum, the
6 13 following direct=care nurse=to=patient ratios:
6 14 (1) For operating room and trauma emergency units: One
6 15 nurse to one patient.
6 16 (2) For all critical care areas, including emergency
6 17 critical care and all intensive care units, labor and delivery
6 18 units, and postanesthesia units: One nurse to two patients.
6 19 (3) For antepartum, emergency room, pediatrics, step=down,
6 20 and telemetry units: One nurse to three patients.
6 21 (4) For intermediate care nursery, medical or surgical,
6 22 and acute care psychiatric units: One nurse to four patients.
6 23 (5) For rehabilitation units: One nurse to five patients.
6 24 (6) For postpartum in three couplets and well=baby nursery
6 25 units: One nurse to six patients.
6 26 (7) For any units not listed in this paragraph "b",
6 27 including psychiatric units in facilities other than acute
6 28 care hospitals, such direct=care nurse=to=patient ratio as
6 29 established by the department.
6 30 c. The ratios established in paragraph "b" shall
6 31 constitute the minimum number of direct=care nurses to be
6 32 allocated within a department or unit. Additional direct=care
6 33 nurses shall be added and the ratio adjusted to ensure
6 34 adequate staffing of each nursing department or unit, in
6 35 accordance with an approved acuity system.
7 1 d. This subsection shall not be interpreted to preclude
7 2 the department from establishing and requiring a staffing plan
7 3 that provides for higher nurse=to=patient ratios than those
7 4 specified in paragraph "b".
7 5 e. The staffing plan shall not incorporate or assume that
7 6 nursing care functions required by state or federal law or
7 7 regulation, or accepted standards of practice to be performed
7 8 by a registered nurse, may be performed by other personnel.
7 9 Sec. 5. NEW SECTION. 135M.5 MANDATORY OVERTIME AND
7 10 EXCESSIVE DUTY HOURS.
7 11 1. a. Notwithstanding any other provision of law to the
7 12 contrary and subject only to the exceptions in this section, a
7 13 health facility shall not directly or indirectly mandate or
7 14 otherwise require a nurse to work or be in on=duty status, in
7 15 excess of any of the following:
7 16 (1) The scheduled work shift or duty period.
7 17 (2) Twelve hours in a twenty=four=hour period.
7 18 (3) Eighty hours in a fourteen=consecutive=day period.
7 19 b. As used in this section, "mandatory" or "mandate" means
7 20 any request which, if refused or declined by the health
7 21 facility nurse, may result in discharge, discipline, loss of
7 22 promotion, or other adverse employment consequence.
7 23 c. Nothing in this subsection is intended to prohibit a
7 24 health facility nurse from voluntarily working overtime.
7 25 2. a. A health facility nurse shall not work or be in on=
7 26 duty status in excess of sixteen hours in any twenty=four=hour
7 27 period.
7 28 b. A health facility nurse working sixteen hours in any
7 29 twenty=four=hour period shall be given at least eight
7 30 consecutive hours off duty before being required to return to
7 31 duty.
7 32 c. A health facility nurse shall not be required to work
7 33 or be on duty more than seven consecutive days without at
7 34 least one consecutive twenty=four=hour period off duty within
7 35 that time.
8 1 3. a. During a declared state of emergency in which a
8 2 health facility is requested or otherwise reasonably may be
8 3 expected to provide an exceptional level of emergency or other
8 4 medical services to the community, the mandatory overtime
8 5 prohibition specified in subsection 1, paragraph "a", shall
8 6 not apply to the following extent:
8 7 (1) Health facility nurses may be required to work or be
8 8 on duty up to the maximum hours limitation specified in
8 9 subsection 2, paragraph "a", provided the health facility has
8 10 taken the steps specified in paragraph "b" of this subsection.
8 11 (2) Prior to requiring any health facility nurse to work
8 12 mandatory overtime, the health facility shall make reasonable
8 13 efforts to fill the health facility's immediate staffing needs
8 14 through alternative efforts, including requesting off=duty
8 15 staff to voluntarily report to work, requesting on=duty staff
8 16 to volunteer for overtime hours, and recruiting per diem and
8 17 registry staff to report to work.
8 18 (3) The exemption under this paragraph "a" shall not
8 19 exceed the duration of the declared state of emergency or the
8 20 health facility's direct role in responding to medical needs
8 21 resulting from the declared state of emergency, whichever is
8 22 less.
8 23 b. During a declared state of emergency for which a health
8 24 facility is requested or otherwise reasonably may be expected
8 25 to provide an exceptional level of emergency or other medical
8 26 services to the community, the maximum hours limitation in
8 27 subsection 2, paragraph "a", shall be lifted to the following
8 28 extent:
8 29 (1) A health facility nurse may work or remain on duty for
8 30 more than the maximum hour limitations set forth in subsection
8 31 2, paragraph "a", provided that all of the following
8 32 conditions are met:
8 33 (a) The decision to work the additional time is
8 34 voluntarily made by the individual health facility nurse
8 35 affected.
9 1 (b) The health facility nurse is given at least one
9 2 uninterrupted four=hour rest period before commencing the
9 3 first sixteen hours of duty and an uninterrupted eight=hour
9 4 rest period at the completion of twenty=four hours of duty.
9 5 (c) A health facility nurse shall not work or remain on
9 6 duty for more than twenty=eight consecutive hours in a
9 7 seventy=two=hour period.
9 8 (d) A health facility nurse who has been on duty for more
9 9 than sixteen hours in a twenty=four=hour period who informs
9 10 the health facility that the nurse requires immediate rest
9 11 must be relieved from duty as soon as possible, consistent
9 12 with patient safety needs, and given at least eight
9 13 uninterrupted hours off duty before being required to return
9 14 for duty.
9 15 (2) As used in this paragraph "b", "rest period" means a
9 16 period in which an individual may be required to remain on the
9 17 premises of the health facility, but is not subject to
9 18 restraint or duty or responsibility for work or duty should
9 19 the occasion arise.
9 20 (3) The exemption in this paragraph "b" shall not exceed
9 21 the duration of the declared state of emergency or the health
9 22 facility's direct role in responding to medical needs
9 23 resulting from the declared state of emergency, whichever is
9 24 less.
9 25 4. A work shift schedule or overtime program established
9 26 pursuant to a collective bargaining agreement negotiated on
9 27 behalf of the health facility nurses by a bona fide labor
9 28 organization may provide for mandatory on=duty hours in excess
9 29 of those permitted under this section, provided adequate
9 30 measures are included in the agreement to ensure against
9 31 excessive fatigue on the part of the affected employees.
9 32 Sec. 6. NEW SECTION. 135M.6 DIRECT=CARE NURSE == WORK
9 33 ASSIGNMENT POLICY.
9 34 1. As a condition of licensure, each health facility shall
9 35 adopt and disseminate to direct=care nursing staff a written
10 1 policy that complies with the requirements set forth in this
10 2 section detailing the circumstances under which a direct=care
10 3 nurse may refuse a work assignment. At a minimum, the work
10 4 assignment policy shall permit a direct=care nurse to refuse
10 5 an assignment for which:
10 6 a. The direct=care nurse is not prepared by education,
10 7 training, or experience to safely fulfill the assignment
10 8 without compromising or jeopardizing patient safety, the
10 9 direct=care nurse's ability to meet foreseeable patient needs,
10 10 or the direct=care nurse's license.
10 11 b. The direct=care nurse has volunteered to work overtime
10 12 but determines that the direct=care nurse's level of fatigue
10 13 or decreased alertness would compromise or jeopardize patient
10 14 safety, the direct=care nurse's ability to meet foreseeable
10 15 patient needs, or the direct=care nurse's license.
10 16 c. The assignment otherwise would violate requirements
10 17 specified in this chapter.
10 18 2. At a minimum, the work assignment policy shall contain
10 19 procedures for all of the following:
10 20 a. Reasonable requirements for prior notice to the nurse's
10 21 supervisor regarding the direct=care nurse's request and
10 22 supporting reasons for being relieved of the assignment or
10 23 continued duty.
10 24 b. If feasible, an opportunity for the supervisor to
10 25 review the specific conditions supporting the direct=care
10 26 nurse's request to be relieved of the assignment or continued
10 27 duty, and to decide whether to remedy the conditions, to
10 28 relieve the direct=care nurse of the assignment, or to deny
10 29 the direct=care nurse's request.
10 30 c. A process which permits the direct=care nurse to
10 31 exercise the right to refuse the assignment or continued on=
10 32 duty status when the supervisor denies the request to be
10 33 relieved if all of the following apply:
10 34 (1) The supervisor rejects the request without proposing a
10 35 remedy or the proposed remedy would be inadequate or untimely.
11 1 (2) The complaint and investigation process provided
11 2 through the department of inspections and appeals would be
11 3 untimely to address the concern.
11 4 (3) The direct=care nurse in good faith believes that the
11 5 assignment meets the conditions justifying refusal.
11 6 Sec. 7. NEW SECTION. 135M.7 HEALTH FACILITY NURSES ==
11 7 RIGHTS.
11 8 1. A health facility shall not penalize or discriminate or
11 9 retaliate in any manner against a health facility nurse with
11 10 respect to compensation, terms, conditions, or privileges of
11 11 employment, who in good faith, individually, or in conjunction
11 12 with another person or persons does any of the following:
11 13 a. Reports a violation or suspected violation of this
11 14 chapter to a public regulatory agency, a private accreditation
11 15 body, or management personnel of the health facility.
11 16 b. Initiates, cooperates with, or otherwise participates
11 17 in an investigation or proceeding brought by a regulatory
11 18 agency or private accreditation body concerning matters
11 19 covered by this chapter.
11 20 c. Informs or discusses with other employees, with a
11 21 representative of the employees, with patients or a patient
11 22 representative, or with the public, violations or suspected
11 23 violations of this chapter.
11 24 d. Otherwise avails the nurse of the rights established in
11 25 this chapter.
11 26 2. For the purposes of this section, a health facility
11 27 nurse is deemed to act in good faith if the nurse reasonably
11 28 believes all of the following:
11 29 a. That the information reported or disclosed is true.
11 30 b. That a violation has occurred or may occur.
11 31 Sec. 8. NEW SECTION. 137M.8 VIOLATIONS == RELIEF.
11 32 1. Any health facility that violates section 135M.5,
11 33 135M.6, or 135M.7 may be held liable to any nurse affected in
11 34 an action brought in a court of competent jurisdiction for
11 35 such legal or equitable relief as may be appropriate to
12 1 effectuate the purposes of this chapter, including but not
12 2 limited to reinstatement, promotion, payment of lost wages and
12 3 benefits, and payment of compensatory and consequential
12 4 damages resulting from the violation together with an equal
12 5 amount in liquidated damages. The court in such action shall,
12 6 in addition to any judgment awarded to the plaintiff, award
12 7 reasonable attorney fees and costs of action to be paid by the
12 8 defendant.
12 9 2. The nurse's right to institute a private action under
12 10 this section is not limited by any other rights granted under
12 11 this chapter.
12 12 Sec. 9. NEW SECTION. 135M.9 ENFORCEMENT == PENALTIES.
12 13 1. A health facility shall post in a conspicuous place
12 14 readily accessible to the general public, a notice prepared by
12 15 the department of inspections and appeals specifying in
12 16 summary form the mandatory provisions of this chapter.
12 17 2. Mandatory and actual nurse staffing levels in each
12 18 nursing department or unit shall be posted daily in a
12 19 conspicuous place readily accessible to the general public.
12 20 3. a. Upon request, the health facility shall make copies
12 21 of the staffing plan, filed with the department of inspections
12 22 and appeals, available to the general public.
12 23 b. Each nursing department or unit within a health
12 24 facility shall post or otherwise make readily available to the
12 25 nursing staff, during each work shift, all of the following:
12 26 (1) A copy of the current staffing plan for that
12 27 department or unit.
12 28 (2) Documentation of the number of direct=care nursing
12 29 staff required to be present during the shift, based on the
12 30 approved adopted acuity system.
12 31 (3) Documentation of the actual number of direct=care
12 32 nursing staff present during the shift.
12 33 4. The department of inspections and appeals shall enforce
12 34 this chapter and shall adopt rules necessary for enforcement.
12 35 At a minimum, the rules shall provide for:
13 1 a. Unannounced, random compliance site visits to health
13 2 facilities.
13 3 b. An accessible and confidential system for the public
13 4 and nursing staff to report a health facility's failure to
13 5 comply with this chapter.
13 6 c. A systematic means for investigating and correcting
13 7 violations of this chapter.
13 8 d. Public access to information regarding reports of
13 9 inspections, results, deficiencies, and corrections.
13 10 e. A process for imposing penalties for violations of the
13 11 staffing requirements of this chapter.
13 12 5. The department of inspections and appeals and the
13 13 department of workforce development shall have concurrent
13 14 jurisdiction to ensure compliance with this chapter and to
13 15 implement rules and regulations as necessary or appropriate to
13 16 carry out this function.
13 17 6. A determination that a health facility has violated
13 18 this chapter may result in revocation of the health facility's
13 19 licensure.
13 20 7. a. A health facility that violates any staffing
13 21 requirements specified section 135M.4 is subject to a fine of
13 22 not less than fifteen thousand dollars per day, per violation,
13 23 for each day that the violation occurs or continues.
13 24 b. A health facility that fails to post a notice required
13 25 under this chapter is subject to a fine of one thousand
13 26 dollars per day for each day that the required notice is not
13 27 posted.
13 28 c. A health facility that violates the mandatory overtime
13 29 provisions of section 135M.5, the work assignment provisions
13 30 of section 135M.6, or the nurses' rights provisions of section
13 31 135M.7 is subject to a fine of fifteen thousand dollars per
13 32 violation.
13 33 d. A person or health facility that fails to report or
13 34 falsifies information, or coerces, threatens, intimidates, or
13 35 otherwise influences another person to fail to report or to
14 1 falsify information required to be reported under this
14 2 chapter, is subject to a fine of up to fifteen thousand
14 3 dollars for each such incident.
14 4 8. Upon investigation, the department of inspections and
14 5 appeals shall notify the health facility of all deficiencies
14 6 in the facility's compliance with this chapter and the rules
14 7 adopted under this chapter. The notice may include an order
14 8 to take corrective action within a specified time period,
14 9 including but not limited to any of the following:
14 10 a. Revising the facility staffing plan.
14 11 b. Reducing the number of patients within a nursing
14 12 department or unit.
14 13 c. Temporarily closing a nursing department or unit to any
14 14 further patient admissions until corrections are made.
14 15 d. Temporarily transferring patients to another nursing
14 16 department or unit within the facility until corrections are
14 17 made.
14 18 9. a. The department of inspections and appeals may issue
14 19 an order of correction as follows:
14 20 (1) On an emergency basis, without prior notice or
14 21 opportunity for a hearing, if an investigation determines that
14 22 patient care is being compromised in a manner that poses an
14 23 immediate jeopardy to the health or safety of patients.
14 24 (2) In accordance with the provisions for suspension of
14 25 licensure of a health facility in chapter 135B.
14 26 b. The order of correction shall be in writing and shall
14 27 contain a statement of the reasons for the order.
14 28 c. Upon the failure of a health facility to comply with an
14 29 order of correction in a timely manner, the department of
14 30 inspections and appeals may take such action the department
14 31 deems appropriate, including but not limited to:
14 32 (1) Appointing an administrative overseer for the
14 33 facility.
14 34 (2) Closing the facility or unit to patient admissions.
14 35 (3) Placing the health facility's emergency room on bypass
15 1 status.
15 2 (4) Revoking the health facility's license.
15 3 10. Any person who willfully violates this chapter in a
15 4 manner that evidences a pattern or practice of violations
15 5 which is likely to have a serious and adverse impact on
15 6 patient care or the potential for serious injury or death for
15 7 patients or employees is guilty of an aggravated misdemeanor.
15 8 11. a. A determination that a health facility has
15 9 violated the provisions of this chapter shall result in an
15 10 order of reimbursement to the medical assistance program or in
15 11 termination from participation in the medical assistance
15 12 program for a period of time to be determined by the
15 13 department of inspections and appeals in consultation with the
15 14 department of human services.
15 15 b. A health facility that falsifies or causes to be
15 16 falsified documentation required by this chapter shall be
15 17 prohibited from receiving any medical assistance reimbursement
15 18 for a period of six months.
15 19 EXPLANATION
15 20 This bill relates to staffing requirements for health
15 21 facilities. For the purposes of the bill, "health facility"
15 22 means an acute care hospital, an outpatient surgical facility,
15 23 or an institution operating as a psychiatric hospital or
15 24 operating a designated psychiatric unit, regulated by the
15 25 department of inspections and appeals.
15 26 The bill specifies nurse staffing standards, prohibits
15 27 mandatory overtime, specifies maximum hours that a health
15 28 facility nurse may work or be on duty, provides for exceptions
15 29 under a state of emergency, establishes requirements for a
15 30 direct=care nurse work assignment policy, establishes rights
15 31 for health facility nurses, and protects health facility
15 32 nurses from retaliation for reporting or otherwise publicizing
15 33 violations or suspected violations.
15 34 The bill provides for a private right of action for a nurse
15 35 if a health facility violates the provisions of the bill,
16 1 provides for public disclosure of violations of the bill,
16 2 provides for regulatory oversight by the department of
16 3 inspections and appeals, provides civil penalties, and
16 4 provides a criminal penalty of an aggravated misdemeanor which
16 5 carries with it a maximum penalty not to exceed two years and
16 6 a fine of at least $500 but not to exceed $5,000 for a willful
16 7 violation of the Code chapter that evidences a pattern or
16 8 practice of violation and is likely to have serious and
16 9 adverse impact on patient care or the potential for serious
16 10 injury or death for patients or employees. The bill also
16 11 provides for the loss of reimbursement for a health facility
16 12 under the medical assistance program for violation of the Code
16 13 chapter.
16 14 LSB 2290HH 81
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