HOUSE BILL No. 4463 March 13, 2001, Introduced by Reps. Phillips, Kilpatrick, Jamnick, Hale, Clark, Kolb, McConico, Anderson, Plakas, Rich Brown, Hardman, Daniels, Quarles, Clarke, Rison, Reeves, Adamini, Gieleghem, Whitmer, Bernero, Spade, Williams, O'Neil, Murphy, Lockwood, Woodward, Wojno, Stallworth, Garza, Minore and Lemmons and referred to the Committee on Senior Health, Security and Retirement. A bill to amend 1978 PA 368, entitled "Public health code," by amending section 21720a (MCL 333.21720a). THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 21720a. (1)ATHE DEPARTMENT SHALL NOT LICENSE A 2 nursing homeshall not be licensedunder this part unless 3thatTHE nursing home has on its staff at least 1 registered 4 PROFESSIONAL nurse LICENSED UNDER ARTICLE 15 with specialized 5 training or relevant experience in the area of gerontology, who 6shall serveSERVES as the director of nursing, and whoshall7beIS responsible for planning and directing nursing care. The 8 nursing home shall have at least 1licensed nurseREGISTERED 9 PROFESSIONAL NURSE OR LICENSED PRACTICAL NURSE LICENSED UNDER 10 ARTICLE 15 on duty at all times and shall employ additional 11 registered PROFESSIONAL NURSES and licensed practical nursesin01117'01 CPD 2 1accordanceAS NECESSARY TO COMPLY with subsection (2).This2subsection shall not take effect until January 1, 1980.3 (2) A nursing home shall employnursing personnelDIRECT 4 PATIENT CARE PROVIDERS sufficient to provide continuous 24-hour 5 nursing care and services sufficient to meet the needs of each 6 patient in the nursing home.Nursing personnelDIRECT PATIENT 7 CARE PROVIDERS employed in the nursing home shall be under the 8 supervision of the director of nursing.A licensee shall main-9tain a nursing home staff sufficient to provide not less than102.25 hours of nursing care by employed nursing care personnel per11patient per day. The ratio of patients to nursing care personnel12during a morning shift shall not exceed 8 patients to 1 nursing13care personnel; the ratio of patients to nursing care personnel14during an afternoon shift shall not exceed 12 patients to 1 nurs-15ing care personnel; and the ratio of patients to nursing care16personnel during a nighttime shift shall not exceed 15 patients17to 1 nursing care personnel and there shall be sufficient nursing18care personnel available on duty to assure coverage for patients19at all times during the shift. An employee designated as a20member of the nursing staff shall not be engaged in providing21basic services such as food preparation, housekeeping, laundry,22or maintenance services, except in an instance of natural23disaster or other emergency reported to and concurred in by the24department. In a nursing home having 30 or more beds, the direc-25tor of nursing shall not be included in counting the minimum26ratios of nursing personnel required by this subsection.SUBJECT 27 TO SUBSECTION (4) AND EXCEPT AS OTHERWISE PROVIDED IN SUBSECTION 01117'01 3 1 (8), A LICENSEE SHALL MAINTAIN A NURSING HOME STAFF-TO-PATIENT 2 RATIO SUFFICIENT TO PROVIDE NOT LESS THAN 3.0 HOURS OF DIRECT 3 PATIENT CARE BY A DIRECT PATIENT CARE PROVIDER PER PATIENT PER 4 DAY. THE STAFF-TO-PATIENT RATIO REQUIRED UNDER THIS SUBSECTION 5 SHALL BE COMPUTED ON A 24-HOUR BASIS SO THAT AT NO TIME DURING 6 THE 24-HOUR PERIOD DOES THE STAFF-TO-PATIENT RATIO FALL BELOW 1 7 DIRECT PATIENT CARE PROVIDER TO 15 NURSING HOME PATIENTS. 8(3) In administering this section, the department shall9take into consideration a natural disaster or other emergency.10 (3) EXCEPT AS OTHERWISE PROVIDED IN THIS SUBSECTION AND SUB- 11 SECTION (4), A NURSING HOME SHALL NOT USE AN INDIVIDUAL WHO IS 12 NOT A DIRECT PATIENT CARE PROVIDER IN COMPUTING THE 13 STAFF-TO-PATIENT RATIO AND HOURS-PER-PATIENT-PER-DAY REQUIREMENT 14 UNDER SUBSECTION (2). HOWEVER, THE NURSING HOME MAY USE SUCH AN 15 INDIVIDUAL TO PROVIDE SOME TYPES OF DIRECT PATIENT CARE, IF THE 16 NURSING HOME PROVIDES THE INDIVIDUAL WITH THE TRAINING REQUIRED 17 UNDER SECTION 21795 FOR EACH TYPE OR ELEMENT OF DIRECT PATIENT 18 CARE PROVIDED. A NURSING HOME MAY, FOR PURPOSES OF COMPUTING THE 19 STAFF-TO-PATIENT RATIO AND HOURS-PER-PATIENT-PER-DAY REQUIREMENT 20 UNDER SUBSECTION (2), USE AN INDIVIDUAL WHO HAS COMPLETED THE 21 APPLICABLE TRAINING REQUIRED UNDER TITLE XVIII OR TITLE XIX, BUT 22 HAS NOT YET BEEN TESTED AS REQUIRED UNDER TITLE XVIII AND TITLE 23 XIX, AS LONG AS NOT MORE THAN 120 DAYS HAVE ELAPSED SINCE THE 24 INDIVIDUAL COMPLETED THE TRAINING. 25 (4) IN COMPUTING THE STAFF-TO-PATIENT RATIO AND THE 26 HOURS-PER-PATIENT-PER-DAY REQUIREMENT UNDER SUBSECTION (2) DURING 27 AN EMERGENCY, A NURSING HOME MAY USE A NURSING HOME STAFF MEMBER 01117'01 4 1 WHO IS A REGISTERED PROFESSIONAL NURSE OR A LICENSED PRACTICAL 2 NURSE LICENSED UNDER ARTICLE 15 AND IS NOT NORMALLY USED IN COM- 3 PUTING THE RATIO AND REQUIREMENT BECAUSE THE STAFF MEMBER PER- 4 FORMS PRIMARILY ADMINISTRATIVE FUNCTIONS, IF THE STAFF MEMBER 5 PROVIDES DIRECT PATIENT CARE DURING THE EMERGENCY, BUT ONLY FOR 6 AS LONG AS THE EMERGENCY EXISTS. 7 (5) FOR PURPOSES OF SUBSECTION (2), FROM OCTOBER 1, 2001 TO 8 APRIL 1, 2002, A LICENSEE SHALL ASSURE THAT THE NUMBER OF HOURS 9 OF DIRECT PATIENT CARE BY A DIRECT PATIENT CARE PROVIDER PER 10 PATIENT PER DAY IN THE NURSING HOME IS NOT LESS THAN 2.75. FROM 11 APRIL 2, 2002 TO OCTOBER 1, 2002, A LICENSEE SHALL ASSURE THAT 12 THE NUMBER OF HOURS OF DIRECT PATIENT CARE BY A DIRECT PATIENT 13 CARE PROVIDER PER PATIENT PER DAY IN THE NURSING HOME IS NOT LESS 14 THAN 2.85. AFTER OCTOBER 1, 2002, A LICENSEE SHALL ASSURE THAT 15 THE NUMBER OF HOURS OF DIRECT PATIENT CARE BY A DIRECT PATIENT 16 CARE PROVIDER PER PATIENT PER DAY IN THE NURSING HOME IS NOT LESS 17 THAN 3.0. 18 (6) IF A DIRECT PATIENT CARE PROVIDER PERFORMS DUTIES OTHER 19 THAN DIRECT PATIENT CARE DURING HIS OR HER SHIFT, THE NURSING 20 HOME MAY COUNT THE NUMBER OF DIRECT PATIENT CARE HOURS PROVIDED 21 BY THE DIRECT PATIENT CARE PROVIDER DURING THE SHIFT IN COMPUTING 22 COMPLIANCE WITH SUBSECTION (2) OR SUBSECTION (5), OR BOTH. A 23 NURSING HOME MAY USE THE TIME A DIRECT PATIENT CARE PROVIDER 24 SPENDS IN DOCUMENTING THE DIRECT PATIENT CARE THAT HE OR SHE PRO- 25 VIDED IN COMPUTING COMPLIANCE WITH SUBSECTION (2) OR SUBSECTION 26 (5), OR BOTH. 01117'01 5 1 (7) A DIRECT PATIENT CARE PROVIDER SHALL NOT PROVIDE 2 SERVICES OTHER THAN DIRECT PATIENT CARE TO PATIENTS IN A NURSING 3 HOME, INCLUDING, BUT NOT LIMITED TO, FOOD PREPARATION, HOUSEKEEP- 4 ING, LAUNDRY, AND MAINTENANCE SERVICES, EXCEPT IN TIME OF NATURAL 5 DISASTER OR OTHER EMERGENCY CIRCUMSTANCES THAT ARE REPORTED TO 6 AND CONCURRED IN BY THE DEPARTMENT. A NURSING HOME MAY DIRECT A 7 NURSING HOME EMPLOYEE WHO IS NOT QUALIFIED AS A DIRECT PATIENT 8 CARE PROVIDER TO PROVIDE DIRECT PATIENT CARE IN TIME OF NATURAL 9 DISASTER OR OTHER EMERGENCY CIRCUMSTANCES THAT ARE REPORTED TO 10 AND CONCURRED IN BY THE DEPARTMENT. A NURSING HOME MAY USE THE 11 HOURS OF DIRECT PATIENT CARE PROVIDED UNDER THIS SUBSECTION IN 12 COMPUTING COMPLIANCE WITH SUBSECTION (2) OR SUBSECTION (5), OR 13 BOTH. 14 (8) SUBJECT TO SUBSECTION (9), IF A NURSING HOME'S COSTS OF 15 OPERATION ARE INCREASED AS A RESULT OF ITS COMPLIANCE WITH THE 16 AMENDATORY ACT THAT ADDED THIS SUBSECTION, THE NURSING HOME MAY 17 ADVISE THE DEPARTMENT IN WRITING OF THE INCREASED OPERATIONAL 18 COSTS. THE NURSING HOME MAY INCLUDE IN THE WRITTEN ADVISORY A 19 REQUEST FOR REIMBURSEMENT FROM THE DEPARTMENT FOR THE INCREASED 20 COSTS. UPON RECEIPT OF A WRITTEN ADVISORY FROM A NURSING HOME 21 UNDER THIS SUBSECTION THAT INCLUDES A REQUEST FOR REIMBURSEMENT, 22 THE DEPARTMENT SHALL IMMEDIATELY ADJUST THE NURSING HOME'S PER 23 DIEM REIMBURSEMENT UNDER TITLE XVIII IN AN AMOUNT SUFFICIENT TO 24 REIMBURSE THE NURSING HOME FOR THE INCREASED COSTS. THE DEPART- 25 MENT SHALL INCREASE THE NURSING HOME'S PER DIEM REIMBURSEMENT 26 RATE UNDER THIS SUBSECTION REGARDLESS OF PREVIOUSLY APPLIED COST 27 LIMITS. IF THE DEPARTMENT FAILS TO ADJUST A NURSING HOME'S PER 01117'01 6 1 DIEM REIMBURSEMENT RATE UNDER THIS SUBSECTION WITHIN 30 DAYS 2 AFTER RECEIVING A WRITTEN ADVISORY THAT INCLUDES A REQUEST FOR 3 REIMBURSEMENT UNDER THIS SUBSECTION, THEN ALL OF THE FOLLOWING 4 SHALL OCCUR: 5 (A) THE NURSING HOME IS EXEMPT FROM THE STAFF-TO-PATIENT 6 RATIOS AND THE HOURS-PER-PATIENT-PER-DAY REQUIREMENTS OF THIS 7 SECTION UNTIL THE DEPARTMENT ADJUSTS THE NURSING HOME'S PER DIEM 8 REIMBURSEMENT RATE UNDER THIS SUBSECTION. 9 (B) THE NURSING HOME SHALL PROVIDE EACH PATIENT WITH NOT 10 LESS THAN 2.25 HOURS OF DIRECT PATIENT CARE BY A DIRECT PATIENT 11 CARE PROVIDER AND SHALL MAINTAIN THE STAFF-TO-PATIENT RATIO 12 REQUIRED UNDER THIS SECTION BEFORE IT WAS AMENDED BY THE AMENDA- 13 TORY ACT THAT ADDED THIS SUBSECTION. 14 (C) WITHIN 30 DAYS AFTER BEING NOTIFIED BY THE DEPARTMENT 15 THAT THE NURSING HOME'S STATUS HAS CHANGED AND THAT THE NURSING 16 HOME WILL BE REIMBURSED AT THE APPROPRIATE LEVEL, THE NURSING 17 HOME SHALL RETURN TO THE STAFF-TO-PATIENT RATIO AND THE 18 HOURS-PER-PATIENT-PER-DAY REQUIREMENT REQUIRED BY THE AMENDATORY 19 ACT THAT ADDED THIS SUBSECTION. 20 (9) SUBSECTION (8) IS NOT INTENDED AS A REMEDY THAT ALLOWS 21 THE DEPARTMENT TO REIMBURSE A NURSING HOME AT A RATE THAT ALLOWS 22 THE NURSING HOME TO MAINTAIN A NURSING HOME STAFF-TO-PATIENT 23 RATIO THAT IS NOT SUFFICIENT TO PROVIDE AT LEAST 3.0 HOURS OF 24 DIRECT PATIENT CARE BY A DIRECT PATIENT CARE PROVIDER PER PATIENT 25 PER DAY AS REQUIRED UNDER SUBSECTION (2). IT IS THE INTENT OF 26 THE LEGISLATURE THAT THE DEPARTMENT REIMBURSE NURSING HOMES UNDER 27 TITLE XVIII IN AN AMOUNT SUFFICIENT TO MAINTAIN THE 01117'01 7 1 STAFF-TO-PATIENT RATIO AND THE NUMBER OF DIRECT PATIENT CARE 2 HOURS PER PATIENT PER DAY REQUIRED UNDER SUBSECTION (2). IF THE 3 DEPARTMENT FAILS TO ADJUST A NURSING HOME'S REIMBURSEMENT RATE 4 UNDER SUBSECTION (8) WITHIN THE 30-DAY TIME PERIOD REQUIRED UNDER 5 SUBSECTION (8), THE DEPARTMENT IMMEDIATELY SHALL FILE A WRITTEN 6 REPORT WITH THE STANDING APPROPRIATIONS COMMITTEES OF THE SENATE 7 AND THE HOUSE OF REPRESENTATIVES AND WITH THE APPROPRIATE 8 SUBCOMMITTEES. THE DEPARTMENT SHALL INCLUDE IN THE REPORT ITS 9 REASONS FOR FAILING TO ADJUST THE NURSING HOME'S REIMBURSEMENT 10 RATE IN COMPLIANCE WITH THIS SECTION. 11 (10) THE DEPARTMENT SHALL DETERMINE WHETHER A NURSING HOME'S 12 OPERATIONAL COSTS WERE ACTUALLY INCREASED AS DESCRIBED IN SUBSEC- 13 TION (8) DURING THE DEPARTMENT'S AUDIT OF THE NURSING HOME'S 14 ANNUAL COST REPORT. IF THE DEPARTMENT DETERMINES AS A RESULT OF 15 THE AUDIT THAT THE NURSING HOME'S COSTS WERE NOT IN FACT 16 INCREASED, THE DEPARTMENT MAY RETROACTIVELY DISALLOW THE 17 INCREASED COSTS CLAIMED BY THE NURSING HOME IN AN AMOUNT EQUAL TO 18 THE AMOUNT OF COSTS DETERMINED BY THE DEPARTMENT NOT TO HAVE BEEN 19 INCURRED BY THE NURSING HOME. A RETROACTIVE DISALLOWANCE BY THE 20 DEPARTMENT UNDER THIS SUBSECTION IS AN "ADVERSE ACTION" AS THAT 21 TERM IS DEFINED IN R 400.3401 OF THE MICHIGAN ADMINISTRATIVE CODE 22 AND IS SUBJECT TO APPEAL UNDER R 400.3401 TO R 400.3425 OF THE 23 MICHIGAN ADMINISTRATIVE CODE. 24 (11) A NURSING HOME MAY FILE WITH THE DEPARTMENT A PETITION 25 FOR TEMPORARY, EMERGENCY RATE RELIEF FROM THE STAFF-TO-PATIENT 26 RATIO AND THE DIRECT PATIENT CARE HOURS-PER-PATIENT-PER-DAY 27 REQUIREMENT OF SUBSECTION (2) OR THE MINIMUM HOURS OF DIRECT 01117'01 8 1 PATIENT CARE REQUIRED UNDER SUBSECTION (5), OR BOTH. THE 2 DEPARTMENT MAY GRANT THE NURSING HOME'S PETITION FOR TEMPORARY, 3 EMERGENCY RATE RELIEF IF THE NURSING HOME DEMONSTRATES TO THE 4 SATISFACTION OF THE DEPARTMENT THAT THE STAFF-TO-PATIENT RATIO 5 AND THE DIRECT PATIENT CARE HOURS-PER-PATIENT-PER-DAY REQUIREMENT 6 OF SUBSECTION (2) OR THE MINIMUM NUMBER OF HOURS OF DIRECT 7 PATIENT CARE REQUIRED UNDER SUBSECTION (5), OR BOTH, HAS A SUB- 8 STANTIAL EFFECT ON THE NURSING HOME'S OPERATING COSTS. THE 9 DEPARTMENT SHALL ISSUE A DECISION ON A PETITION FILED UNDER THIS 10 SUBSECTION WITHIN 90 DAYS AFTER RECEIPT OF THE PETITION. IF THE 11 DEPARTMENT DENIES THE PETITION, THE DEPARTMENT SHALL PROVIDE THE 12 NURSING HOME, IN WRITING, WITH THE REASONS FOR THE DENIAL. IF 13 THE DEPARTMENT FAILS TO ISSUE A DECISION ON A PETITION WITHIN THE 14 90-DAY TIME LIMIT, THE PETITION IS GRANTED. 15 (12) A NURSING HOME MAY APPEAL A DENIAL OF A PETITION FOR 16 TEMPORARY, EMERGENCY RATE RELIEF UNDER SUBSECTION (11). THE 17 DEPARTMENT SHALL HOLD A HEARING ON THE APPEAL. THE DEPARTMENT OR 18 THE DEPARTMENT'S DESIGNEE SHALL CONDUCT THE HEARING IN A LESS 19 FORMAL MANNER THAN IT WOULD CONDUCT A CONTESTED CASE HEARING 20 UNDER THE ADMINISTRATIVE PROCEDURES ACT OF 1969. THE DEPARTMENT 21 SHALL ALLOW A REPRESENTATIVE OF THE NURSING HOME TO PRESENT 22 INFORMATION, DATA, AND OTHER EVIDENCE IN SUPPORT OF GRANTING THE 23 PETITION UNDER SUBSECTION (11). THE DEPARTMENT OR THE 24 DEPARTMENT'S DESIGNEE SHALL PRESENT THE DEPARTMENT'S REASONS FOR 25 DENYING THE PETITION. THE DEPARTMENT SHALL ISSUE A WRITTEN DECI- 26 SION ON THE APPEAL WITHIN 30 DAYS AFTER THE HEARING HELD UNDER 27 THIS SUBSECTION. THE DEPARTMENT SHALL INCLUDE IN THE WRITTEN 01117'01 9 1 DECISION THE REASONS FOR DENYING THE APPEAL. A DENIAL OF AN 2 APPEAL BY THE DEPARTMENT UNDER THIS SUBSECTION HAS THE EFFECT OF 3 CREATING AN EMERGENCY UNDER SECTION VII, ENTITLED "EXCEPTION 4 PROCEDURE", OF THE POLICY AND METHODS FOR ESTABLISHING PAYMENT 5 RATES IN THE STATE PLAN REQUIRED UNDER TITLE XIX, WHICH DOCUMENT 6 IS INCORPORATED BY REFERENCE FOR PURPOSES OF THIS SUBSECTION. 7 (13) A NURSING HOME MAY APPEAL AN ADVERSE DECISION UNDER 8 SUBSECTION (12) TO THE CIRCUIT COURT FOR THE COUNTY IN WHICH THE 9 NURSING HOME IS LOCATED OR THE CIRCUIT COURT FOR INGHAM COUNTY. 10 IF THE NURSING HOME PREVAILS ON THE APPEAL, THE COURT MAY AWARD 11 COMPENSATORY DAMAGES TO THE NURSING HOME FOR THE COST OF PROVID- 12 ING CARE TO ITS RESIDENTS DURING THE PERIOD FROM THE FILING OF A 13 PETITION WITH THE DEPARTMENT UNDER SUBSECTION (11) TO THE DECI- 14 SION ON THE APPEAL UNDER THIS SUBSECTION. THE COURT MAY ALSO 15 AWARD COSTS TO THE NURSING HOME IF IT PREVAILS ON THE APPEAL. 16 (14) IN ORDER TO NOTIFY PATIENTS AND THEIR FAMILIES IN 17 REGARDING THE REQUIREMENTS OF THIS SECTION, A NURSING HOME SHALL 18 POST THE NAME OF THE DIRECT PATIENT CARE PROVIDER WHO IS ASSIGNED 19 TO A PARTICULAR PATIENT EITHER IN A CONSPICUOUS PLACE NEAR THE 20 NURSES' STATION OR OUTSIDE THE PATIENT'S DOOR NEAR THE PATIENT'S 21 NAME. 22 (15) AS USED IN THIS SECTION: 23 (A) "COMPETENCY-EVALUATED NURSE ASSISTANT" MEANS A NURSE'S 24 AIDE OR NURSE ASSISTANT TRAINED AS REQUIRED UNDER SECTION 25 1819(b)(5) OF TITLE XIII, 42 U.S.C. 1395i-3, AND UNDER SECTION 26 1919(b)(5) OF TITLE XIX, 42 U.S.C. 1396r. 01117'01 10 1 (B) "DIRECT PATIENT CARE" MEANS 1 OR MORE OF THE FOLLOWING 2 ACTIVITIES OR SERVICES PROVIDED BY A DIRECT PATIENT CARE PROVIDER 3 TO A PATIENT IN A NURSING HOME AS REQUIRED BY THE PATIENT'S CARE 4 PLAN: 5 (i) PERSONAL CARE, INCLUDING, BUT NOT LIMITED TO, ALL OF THE 6 FOLLOWING: BATHING A PATIENT WHILE ENCOURAGING THE PATIENT'S 7 INDEPENDENCE; SUPPORTIVE AND PREVENTATIVE SKIN CARE; ROUTINE 8 MORNING AND EVENING MOUTH CARE; HAIR AND NAIL CARE; SHAVING; 9 DRESSING AND UNDRESSING, WITH EMPHASIS ON ENCOURAGING AND MAIN- 10 TAINING THE PATIENT'S INDEPENDENCE; ASSISTING IN THE USE OF PROS- 11 THETIC DEVICES; AND OTHER MATTERS OF PERSONAL HYGIENE. 12 (ii) NUTRITION, INCLUDING, BUT NOT LIMITED TO, ALL OF THE 13 FOLLOWING: MAKING MEALTIME A PLEASANT EXPERIENCE; MEASURING AND 14 RECORDING THE PATIENT'S FOOD INTAKE; ASSISTING THE PATIENT IN 15 INCREASING OR REDUCING FLUID INTAKE; ASSISTING THE PATIENT IN 16 EATING, WITH EMPHASIS ON ENCOURAGING THE PATIENT'S INDEPENDENCE 17 AND DIGNITY. 18 (iii) ELIMINATION, INCLUDING, BUT NOT LIMITED TO, ALL OF THE 19 FOLLOWING: ENCOURAGING AND MAINTAINING THE PATIENT'S INDEPEN- 20 DENCE IN TOILET, BEDPAN, AND URINAL USE; CATHETER CARE; PREVENT- 21 ING INCONTINENCE; THE PREVENTION OF CONSTIPATION; PERINEAL CARE; 22 MEASURING AND RECORDING BLADDER OUTPUT; URINE TESTING; AND BOWEL 23 AND BLADDER TRAINING. 24 (iv) RESTORATION AND REHABILITATION, INCLUDING, BUT NOT 25 LIMITED TO, ALL OF THE FOLLOWING: ASSISTANCE AND ENCOURAGEMENT 26 WITH AMBULATION, WALKING, AND TRANSFERRING FROM LOCATION TO 27 LOCATION OR FROM POSITION TO POSITION; TURNING A PATIENT; 01117'01 11 1 MAINTAINING PROPER BODY ALIGNMENT; RANGE OF MOTION EXERCISES; THE 2 USE OF AMBULATION AIDS, SUCH AS WHEELCHAIRS, WALKERS, CANES, AND 3 CRUTCHES; UTILIZING TRANSFER TECHNIQUES AND THE PROPER BODY 4 MECHANICS INVOLVED IN LIFTING A PATIENT OR AN OBJECT; USING BED 5 BOARDS, FOOT BOARDS, FOOT STOOLS, TROCHANTER ROLLS, PILLOWS FOR 6 POSITIONING, AND ORTHOTIC DEVICES. 7 (v) FEEDING AND CLOTHING PATIENTS AND MAKING AND CHANGING 8 BEDS. 9 (vi) ADMINISTRATION OF MEDICATIONS AND TREATMENTS. 10 (vii) OTHER ACTIVITIES OR SERVICES, OR BOTH, PERFORMED WITH 11 OR FOR THE DIRECT PATIENT CARE PROVIDER'S ASSIGNED PATIENT THAT 12 ENHANCES THAT PATIENT'S QUALITY OF LIFE. 13 (C) "DIRECT PATIENT CARE PROVIDER" MEANS AN INDIVIDUAL WHO 14 IS A REGISTERED PROFESSIONAL NURSE LICENSED UNDER ARTICLE 15 OR A 15 LICENSED PRACTICAL NURSE LICENSED UNDER ARTICLE 15 AND WHOSE PRI- 16 MARY FUNCTION IS AS A NURSE, OR AN INDIVIDUAL WHO IS CERTIFIED, 17 AT A MINIMUM, AS A COMPETENCY-EVALUATED NURSE ASSISTANT, WHO IS 18 EMPLOYED BY OR UNDER CONTRACT TO A NURSING HOME, AND WHO PROVIDES 19 DIRECT PATIENT CARE IN THE NURSING HOME. DIRECT PATIENT CARE 20 PROVIDER DOES NOT INCLUDE THE FOLLOWING: 21 (i) THE DIRECTOR OF NURSING FOR A NURSING HOME. 22 (ii) A QUALITY ASSURANCE NURSE FOR A NURSING HOME. 23 (iii) A STAFF DEVELOPMENT NURSE FOR A NURSING HOME. 24 (iv) A PHYSICAL THERAPIST LICENSED UNDER ARTICLE 15. 25 (v) A CERTIFIED SPEECH AND LANGUAGE THERAPIST. 26 (vi) AN OCCUPATIONAL THERAPIST REGISTERED UNDER ARTICLE 15. 01117'01 12 1 (vii) AN ACTIVITIES DIRECTOR OR ACTIVITIES STAFF. 2 (viii) AN INDIVIDUAL WHO IS HIRED AND PAID PRIVATELY BY A 3 PATIENT OR THE PATIENT'S FAMILY AND WHO WORKS ONLY WITH THAT 4 PATIENT. 5 (D) "TITLE XVIII" MEANS TITLE XVIII OF THE SOCIAL SECURITY 6 ACT, CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1395 TO 1395b, 1395b-2, 7 1395b-6 TO 1395b-7, 1395c TO 1395i, 1395i-2 TO 1395i-5, 1395j TO 8 1395t, 1395u TO 1395w, 1395w-2 TO 1395w-4, 1395w-21 TO 1395w-28, 9 1395x TO 1395yy, AND 1395bbb TO 1395ggg. 10 (E) "TITLE XIX" MEANS TITLE XIX OF THE SOCIAL SECURITY ACT, 11 CHAPTER 531, 49 STAT. 620, 42 U.S.C. 1396 TO 1396r-6, AND 1396r-8 12 TO 1396v. 13 (16) THE AMENDATORY ACT THAT ADDED THIS SUBSECTION DOES NOT 14 LIMIT, MODIFY, OR OTHERWISE AFFECT THE PRACTICE OF NURSING AS 15 THAT TERM IS DEFINED IN SECTION 17201. 16 Enacting section 1. This amendatory act takes effect July 17 1, 2001. 01117'01 Final page. CPD