Report Title:

Nurse Aides; Certification

 

Description:

Establishes certification procedures for nurse aides employed in state-licensed or state-certified health care settings and medicare or medicaid facilities.  (HB71 HD2)

 


HOUSE OF REPRESENTATIVES

H.B. NO.

71

TWENTY-FOURTH LEGISLATURE, 2007

H.D. 2

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT


 

 

ReLATING TO nurse aides.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


     SECTION 1.  The legislature recognizes that 42 United States Code Sections 1395i‑3 and 1396r require nurse aides working in nursing facilities participating in medicare and medicaid programs to be certified.

     The purpose of this Act is to provide for the certification and recertification of nurse aides who work in nursing facilities participating in medicare or medicaid programs and in other state-licensed or state-certified health care settings.  Certifying these nurse aides will allow the department of commerce and consumer affairs, the department of human services, and the department of health to monitor and evaluate the quality and competency of these nurse aides practicing in the state.

     SECTION 2.  Chapter 321, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

     "§321-      Certified nurse aides; enforcement.  (a)  The department of health shall adopt rules pursuant to chapter 91 related to investigations of abuse, neglect, and misappropriation of an individual's property by certified nurse aides working in health care settings licensed or certified by the department of health, and actions to be taken against certified nurse aides as a result of these investigations.

     (b)  For the purposes of this section:

     "Abuse" means actual or imminent physical injury, psychological abuse or neglect, sexual abuse, financial exploitation, negligent treatment, or maltreatment.

     "Neglect" means the reckless disregard for the health, safety, or welfare of another that results in injury, loss, or damage."

     SECTION 3.  Chapter 346, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows:

     "§346-      Certified nurse aides; training programs and testing requirements.  The director shall be responsible for approving:

     (1)  Training programs for nurse aides, and ensuring that these programs comply with all applicable federal and state requirements;

     (2)  The recertification process for nurse aides who work in state-licensed or state-certified health care settings; and

(3)  Recertification examinations for nurse aides who work in state-licensed or state-certified health care settings and arranging for the examinations.

     §346-      Certified nurse aides; enforcement.  (a)  The department shall adopt rules pursuant to chapter 91 related to investigations of abuse, neglect, and misappropriation of an individual's property by certified nurse aides working in health care settings licensed or certified by the department, and actions to be taken against certified nurse aides as a result of these investigations.

     (b)  For the purposes of this section:

     "Abuse" means actual or imminent physical injury, psychological abuse or neglect, sexual abuse, financial exploitation, negligent treatment, or maltreatment.

     "Neglect" means the reckless disregard for the health, safety, or welfare of another that results in injury, loss, or damage."

     SECTION 4.  Chapter 457A, Hawaii Revised Statutes, is amended by adding four new sections to be appropriately designated and to read as follows:

     "§457A-A  Definitions.  As used in this chapter, unless the context clearly indicates otherwise:

     "Certified nurse aide" means a nurse aide who has met the requirements for certification under section 457A-C or 457A-D.

     "Director" means the director of commerce and consumer affairs.

     "Medicare or medicaid certified nursing facility" means an intermediate care facility or skilled nursing facility licensed pursuant to the provisions of section 321-11(10) and certified by the department of health in accordance with 42 United States Code Sections 1395i-3 and 1396r.

     "Medicare or medicaid nurse aide" means a certified nurse aide who works in a medicare or medicaid certified nursing facility.

     "Nurse aide" means a person who performs a variety of duties relating to patients and patient care working under the supervision of a nurse, including but not limited to assisting patients in all activities of daily living such as serving and collecting food trays, helping patients get out of bed, bathe, and dress.  A nurse aide may also assist a nurse by changing bed linens, delivering messages, and sterilizing instruments.

     "State-licensed or state-certified health care settings" means settings, other than medicare or medicaid certified nursing facilities, that are regulated by the department of health or the department of human services.

     "Substantiated findings" means the documentation of an investigation by the State that leads the State to conclude that an allegation against an individual is valid, including:

     (1)  The nature of the allegation and the evidence supporting the conclusion;

     (2)  The date and outcome of any hearing of the allegation requested by the individual;

     (3)  Any statement of the individual disputing the allegation; or

     (4)  A criminal conviction for the alleged act.

     §457A-B  Certification required.  Except as otherwise provided in this chapter, it shall be unlawful to:

(1)  Represent one's self as a certified nurse aide;

(2)  In any manner imply that one's self is a certified nurse aide; or

(3)  Use the abbreviation "C.N.A." or any other words, letters, signs, or devices,

to identify one's self as a certified nurse aide, without having first obtained certification as provided in this chapter.

     §457A-C  Medicare or medicaid nurse aide certification.  (a)  To be certified as a medicare or medicaid nurse aide, an applicant shall successfully complete a training program and nurse aide examination approved by the director.

     (b)  No person shall be permitted to take the examination who has not complied with the training requirements established by the director of human services in accordance with 42 United States Code Sections 1395i-3 and 1396r.

     (c)  Reciprocity shall be granted to nurse aides who have completed a state-approved training program where the requirements of that program meet both federal and state nurse aide training requirements.

     (d)  Nurse aides employed in medicare or medicaid certified nursing facilities shall meet both federal and state requirements.

     (e)  Persons certified as a medicare or medicaid nurse aide shall be recertified on a biennial basis.  Recertification requirements shall include in-service training and employment in a medicare or medicaid certified nursing facility as required by federal and state law.

     §457A-D  Certification for nurse aides working in state-licensed or state-certified facilities.  (a)  Nurse aides working in state-licensed and state-certified health care settings shall be certified under this section.

     (b)  Applicants for certification under this section shall successfully complete:

(1)  A training program approved under section 346-     ; and

(2)  A nurse aide examination approved by the director.

     (c)  The director may impose fees for services provided under this section.

     (d)  Reciprocity shall be granted to qualified nurse aides who have completed a state-approved program where the requirements are comparable to the requirements of this chapter.

     (e)  Persons certified under this section shall be recertified on a biennial basis.  Recertification requirements shall include a competency evaluation approved by the director of human services and employment in a state-licensed or state-certified health care setting."

     SECTION 5.  Section 457A-1, Hawaii Revised Statutes, is amended to read as follows:

     "§457A-1  Findings and purpose.  (a)  The legislature recognizes that 42 United States Code [§1395i-3 and §1396R] Sections 1395i-3 and 1396r require nurse aides working in certified nursing facilities participating in medicare and medicaid programs to be certified.

     (b)  The legislature also recognizes that nurse aides who work in state-licensed or state-certified health care settings should be certified for the purpose of consumer safety and held to similar standards of competency and evaluation appropriate for these facilities.  This chapter implements 42 United States Code [§1395i-3 and §1396R] Sections 1395i-3 and 1396r with respect to:

     (1)  Establishing the State's regulatory scheme for certifying nurse aides;

     (2)  Defining the scope of regulation;

     (3)  Establishing standards for certification and biennial recertification; and

     (4)  Establishing an interagency agreement between the state agencies responsible for various aspects of the program.

     [(b)  As used in this chapter, "nurse aide" means a person who performs a variety of duties relating to patients and patient care working under the supervision of a nurse, including but not limited to assisting patients in all activities of daily living such as serving and collecting food trays, and helping patients get out of bed, bathe, and dress.  A nurse aide may also assist a nurse by changing bed linens, delivering messages, and sterilizing instruments.]"

     SECTION 6.  Section 457A-2, Hawaii Revised Statutes, is amended to read as follows:

     "§457A-2  Implementation.  (a)  The director [of commerce and consumer affairs] shall implement the provisions of 42 United States Code [§1395i-3 and §1396R] Sections 1395i-3 and 1396r and this chapter, as they relate only to establishing:

     (1)  The minimum requirements and standards necessary for certification as a nurse aide;

     (2)  Examination requirements, including the passing score;

     (3)  Maintenance requirements for continued certification on a biennial basis; and

     (4)  Implementation of a certified nurse aide registry.

     (b)  The director of health shall implement the provisions of 42 United States Code Sections 1395i-3 and 1396r and this chapter, as they relate to disciplining of nurse aides certified under this chapter, who are employed in health care settings licensed or certified by the department of health.

     (c)  The director of human services shall implement the provisions of 42 United States Code Sections 1395i-3 and 1396r and this chapter, as they relate to training programs for nurse aides and recertification, and to disciplining of certified nurse aides who are certified under this chapter and employed in health care settings licensed or certified by the department of human services."

     SECTION 7.  Section 457A-3, Hawaii Revised Statutes, is amended to read as follows:

     "§457A-3  Power of director.  (a)  The director, in accordance with chapters 91 and 92, shall adopt rules that may be necessary to implement the provisions of this chapter and 42 United States Code [§1395i-3 and §1396R] Sections 1395i-3 and 1396r, as well as the federal regulations adopted pursuant thereto, as they relate only to establishing:

     (1)  The minimum requirements necessary for certification as a nurse aide;

     (2)  Examination requirements, including the passing score and provisions for contesting examination results;

     (3)  Maintenance requirements for continued certification; and

     (4)  Implementation and maintenance of a [nurse aide] registry[.] of certified nurse aides employed in medicare or medicaid certified nursing facilities and certified nurse aides employed in other state-licensed and state-certified health care settings.

     (b)  The director shall issue certificates to qualified nurse aides and shall be responsible for maintenance of an up-to-date nurse aide registry which shall include the names of certified nurse aides, their places of employment, and [disciplinary actions.  Disciplinary actions] all information that is required to be reported by the department of health and the department of human services.  The director  shall [be limited to the placement of substantiated findings from the department of health] place into the nurse aide registry [within ten working days of court settlement.] all substantiated findings from the department of health and department of human services, as required by 42 United States Code Sections 1395i-3 and 1396r within ten working days of the substantiated findings and shall remain in the registry permanently, unless the findings were made in error, the individual was found not guilty in a court of law, or the State is notified of the individual's death.  No charge shall be imposed on nurse aides for the maintenance of the nurse aide registry."

     SECTION 8.  Any nurse aide employed in a state-licensed or state-certified health care setting and who has been recertified before July 1, 2007, may be recertified on a biennial basis under chapter 457A, Hawaii Revised Statutes, if the nurse aide passes, by December 31, 2008, a proficiency evaluation approved by the department of human services.  If the nurse aide fails to pass the evaluation, the nurse aide shall instead apply for certification as a new applicant and undergo certification as required under chapter 457A, Hawaii Revised Statutes.

     SECTION 9.  In codifying the new sections added by section 4 of this Act, the revisor of statutes shall substitute appropriate section numbers for the letters used in designating the new sections in this Act.

     SECTION 10.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 11.  This Act shall take effect upon its approval.