Pennsylvania Act 2024-109 — HEALTH CARE FACILITIES ACT - CERTIFIED MEDICATION AIDES AND IMPOSING DUTIES ON THE DEPARTMENT OF HEALTH

Act text

Session of 2024

No. 2024-109

SB 668

AN ACT

Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An act relating to health care; prescribing the powers and duties of the Department of Health; establishing and providing the powers and duties of the State Health Coordinating Council, health systems agencies and Health Care Policy Board in the Department of Health, and State Health Facility Hearing Board in the Department of Justice; providing for certification of need of health care providers and prescribing penalties," providing for certified medication aides; and imposing duties on the Department of Health.

The General Assembly of the Commonwealth of Pennsylvania hereby enacts as follows:

Section 1. The act of July 19, 1979 (P.L.130, No.48), known as the Health Care Facilities Act, is amended by adding a chapter to read:

CHAPTER 8-C

CERTIFIED MEDICATION AIDES

Section 801-C. Definitions.

The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Certified medication aide." An individual certified under section 804-C.

"Department." The Department of Health of the Commonwealth.

"Instructor." A registered nurse approved by the department to train and certify medication aides under section 804-C.

"Long-term care nursing facility." As defined in section 802.1.

"Medication aide training program." The program developed by the department under section 804-C(a) for certification as a medication aide.

"Nurse aide." As defined in 42 CFR 483.5 (relating to definitions).

"Pro re nata medication." The prescription of medications whose administration should be based on patients' immediate needs rather than at predetermined administration times.

Section 802-C. Requirements.

(a) Qualifications.--To be a certified medication aide, an individual must:

(1) Be a nurse aide currently listed on the Pennsylvania Nurse Aide Registry, be eligible for hiring as a nurse aide under 42 CFR 483.12(a)(3)(ii) (relating to freedom from abuse, neglect, and exploitation) and not have had a certification under this chapter revoked. A nurse aide who has successfully had a neglect annotation removed from the nurse aide's listing on the Pennsylvania Nurse Aide Registry under 42 U.S.C. § 1396r(g)(1)(D) (relating to requirements for nursing facilities) shall not be prohibited from being eligible for certification.

(2) During the previous two years, have at least 1,000 hours of experience working as a nurse aide in a single long-term care nursing facility.

(3) Receive a formal written recommendation for certified medication aide training by the director of nursing of the long-term care facility identified in paragraph (2), and submit the recommendation to the department. The recommendation must include a statement certifying that the individual has satisfied the experience requirement under paragraph (2).

(4) Have successfully completed the medication aide training program and met the requisite training and competency evaluation requirements.

(b) Certification by instructor.--To practice as a certified medication aide, an individual must meet the qualifications under subsection (a) and be certified by an instructor as provided under section 804-C.

Section 803-C. Administration of medication.

(a) Permissible medication delivery.--A certified medication aide may administer, under the supervision of a physically on-site registered nurse or licensed practical nurse authorized by a registered nurse, oral, transdermal, ophthalmic, otic, inhaled or topical medication to a resident of a long-term care nursing facility. The following apply:

(1) The supervising registered nurse or licensed practical nurse authorized by a registered nurse shall be physically on-site and available to the certified medication aide.

(2) The certified medication aide may only administer medications to a resident of a long-term care nursing facility whose clinical status is considered stable.

(3) No more than two certified medication aides may be supervised by a registered nurse or licensed practical nurse authorized by a registered nurse.

(4) A certified medication aide may administer a pro re nata medication according to a physician's, nurse practitioner's or physician assistant's orders with a registered nurse on-site. Certified medication aides shall document every administration of a pro re nata medication and symptoms precipitating administration.

(b) Impermissible medication delivery.--A certified medication aide may not:

(1) Administer a controlled substance under section 4 of the act of April 14, 1972 (P.L.233, No.64), known as The Controlled Substance, Drug, Device and Cosmetic Act.

(2) Administer medications by gastrostomy or jejunostomy tubes.

(3) Add fluid to established gastrostomy or jejunostomy tube feedings or change established tube feeding bags.

(4) Accept verbal or telephone orders for medication from a licensed health care professional who is authorized to independently diagnose and treat.

(5) Administer medication by the following routes:

(i) Central lines.

(ii) Colostomy.

(iii) Intramuscular.

(iv) Intrathecal.

(v) Intravenous.

(vi) Nasogastric.

(vii) Nonmetered inhaler.

(viii) Subcutaneous injection.

(ix) Intradermal.

(x) Urethral.

(xi) Epidural.

(xii) Endotracheal.

(xiii) Rectal.

(xiv) Vaginal.

(xv) Enteral.

(6) Administer the following kinds of medications:

(i) Barium and other diagnostic contrast media.

(ii) Chemotherapeutic agents, except oral maintenance chemotherapy.

(7) Administer medication by, nor assume responsibility for, medication pumps, including client-controlled analgesia.

(8) Act as a clinical teaching associate to a student in a medication aide training program.

(9) Administer the first dose of any new medication to a resident of a long-term care nursing facility.

(10) Calculate or adjust a medication dose prescribed by a physician, nurse practitioner or physician assistant.

(11) Delegate the administration of medication.

(12) Administer medication without the supervision of a registered nurse or a licensed practical nurse authorized by a registered nurse who is physically on-site and available to the certified medication aide.

Section 804-C. Medication aide training program and certification.

(a) Development.--The department shall develop a medication aide training program for an individual to become a certified medication aide, which may be offered by a long-term care nursing facility. Prior to operating a training program authorized under this section, a long-term care nursing facility shall contract with an instructor approved by the department. The department shall include input from industry stakeholders on the development and implementation of the program. The department shall consult with the State Board of Nursing to determine if a number of hours completed in the medication aide training program may be credited to a student in a practical nurse education program under the act of March 2, 1956 (1955 P.L.1211, No.376), known as the Practical Nurse Law. The program under this section must:

(1) Include a minimum of 80 hours of classroom instruction and training, exclusive of testing or instructor evaluation of whether the individual is competent.

(2) Include a minimum of 20 hours of skills and demonstration, which shall include:

(i) ten hours of clinical observation and skills demonstration under the direct supervision of a supervising registered nurse or licensed practical nurse authorized by a registered nurse in a long-term care nursing facility; and

(ii) ten hours in a skills demonstration laboratory.

(3) Be conducted by an approved instructor and utilize the State-approved written curriculum and test.

(4) Cover the following topics:

(i) The role, responsibilities and performance of the prescribing provider in the medication administration process.

(ii) The rights of the individual regarding accepting or refusing medications.

(iii) Principles of infection control as they relate to medication administration.

(iv) Categories of medications and their effects.

(v) Effective management of poisoning or medication overdose.

(vi) Storage and disposal of medications.

(vii) Communications with individuals or guardians, if applicable, about the individual's medications.

(viii) The six principles of medication administration, including:

(A) The correct medication.

(B) The correct dosage of the medication.

(C) The medication to the correct individual.

(D) The medication at the correct time.

(E) The medication to the individual by the correct method.

(F) The accurate documentation.

(5) Include a medication aide training examination that requires the demonstration of the requisite knowledge and skills to serve as a certified medication aide.

(b) Certification.--The department shall issue certification to an individual to practice as a certified medication aide if the individual:

(1) Successfully completes the medication aide training program.

(2) Scores 80% or higher on the examination under subsection (a)(5).

(3) Demonstrates knowledge of the following pertaining to administering medications:

(i) The name of the medication.

(ii) The reason for the medication's use.

(iii) Any side effects or adverse reactions.

(iv) Any special instructions such as giving certain fluids, checking pulse rate or monitoring blood levels.

(4) Following direct observation by an instructor, has been found competent to be authorized to administer medications.

(c) Renewal of certification.--A certified medication aide shall be required to renew a certification no less than every two years or by the last day of the 24th month from the date of the prior certification. The following shall apply:

(1) Renewal shall include:

(i) Proof of completion of 12 hours of continuing education per year, clinical competency demonstration and a medication errors prevention course which shall be developed by the department.

(ii) A recertification letter written by an instructor recommending the certified medication aide for renewal.

(2) A certified medication aide shall submit an online completed recertification application to the department.

(d) Authorization.--Authorization to practice as a certified medication aide shall be valid in any long-term care nursing facility.

(e) Certification sanction authorization.--The department may revoke or suspend a certified medication aide's certification, or otherwise sanction a certified medication aide for any of the following reasons:

(1) Failure to complete a timely renewal.

(2) Receiving an annotation on the nurse aide's listing on the Pennsylvania Nurse Aide Registry under 42 U.S.C. § 1396r(g)(1)(C) (relating to requirements for nursing facilities) for abuse, neglect or misappropriation.

(3) Failure to properly administer medication.

(4) Lack of physical or mental ability to provide adequate services.

(5) Deceptive or fraudulent procurement or representation of certification or for making misleading, deceptive or untrue representations to secure or aid or abet another individual to secure a certification.

(6) Willful or negligent misconduct in providing care or practicing beyond certification authorization.

(7) Practicing without a current certification.

(8) Conviction of any offense listed in 22 Pa. Code § 701.13 (relating to nonacceptance of certain applicants).

(9) Having a certification or other authorization to practice a profession or occupation revoked, suspended or subjected to other disciplinary sanction.

(f) Sanctions.--

(1) The department may order one or more of the following against a certified medication aide for a reason listed under subsection (e):

(i) Revoke a certification.

(ii) Require a certified medication aide to take educational courses.

(2) The department may impose a civil penalty not exceeding $500 on the facility for each incident in which the certified medication aide engages in conduct that constitutes a basis for discipline. Penalty money shall be treated in accordance with section 817(c).

(3) No disciplinary action against a certified medication aide shall prevent or otherwise prohibit the department from annotating a nurse aide under 42 U.S.C. § 1396r(g)(1)(C) for abuse, neglect or misappropriation.

(g) Suspension and termination of medication aide training program.--The department may suspend or terminate a long-term care nursing facility's medication aide training program for any of the following reasons:

(1) Failure to properly administer the training program.

(2) Failure to properly supervise a certified medication aide.

(3) Fraudulently certifying a medication aide.

(4) Failure to properly report to the department under section 805-C(c).

Section 805-C. Employment of certified medication aides.

(a) Authorization.--A long-term care nursing facility may employ a certified medication aide for the purpose of performing the technical aspects of the medication administration in accordance with this chapter. The following shall apply:

(1) The certified medication aide training program established under section 804-C(a) shall fulfill the requirements of medication administration training as specified in 55 Pa. Code §§ 2800.190(a) (relating to medication administration training) and 2600.190(a) (relating to medication administration training) for assisted living residences and personal care homes.

(2) An assisted living residence as defined in 55 Pa. Code § 2800.4 (relating to definitions) and personal care homes as defined in 55 Pa. Code § 2600.4 (relating to definitions) may employ a certified medication aide that has successfully completed the medication aide training program in accordance with this chapter.

(b) Competency review.--A long-term care nursing facility shall annually conduct a comprehensive clinical skills competency review of each certified medication aide employed by the long-term care nursing facility. The completed competency review shall be submitted to the department.

(c) Reporting.--A long-term care nursing facility that employs a certified medication aide shall report to the department any act committed by a certified medication aide which qualifies for discipline under section 804-C(e) and any act which is required to be reported under 28 Pa. Code § 51.3 (relating to notification).

(d) Computation.--A certified medication aide employed by a long-term care nursing facility shall:

(1) Be included in computing the hours of direct resident care under 28 Pa. Code § 211.12 (relating to nursing services).

(2) Not be included in the computing of nurse aide ratios, registered nurse ratios or licensed practical nurse ratios under 28 Pa. Code § 211.12.

(e) Registry.--Nurse aides meeting the eligibility criteria in section 802-C(a) shall be designated as certified medication aides on the Pennsylvania Nurse Aide Registry.

Section 806-C. Annual report.

(a) Submission.--The department shall submit an annual report to:

(1) The chairperson and minority chairperson of the Aging and Youth Committee of the Senate.

(2) The chairperson and minority chairperson of the Aging and Older Adult Services Committee of the House of Representatives.

(3) The chairperson and minority chairperson of the Health and Human Services Committee of the Senate.

(4) The chairperson and minority chairperson of the Health Committee of the House of Representatives.

(b) Contents.--The report shall include:

(1) The number and location of medication aide training programs approved by the department.

(2) The number of nurse aides currently certified as medication aides.

(3) The number of approved instructors available to support the program.

(4) Pass rates for the training examination.

(5) Recertification rates.

(6) The number of hours of training each program requires.

(c) Filing of report.--The department shall submit the annual report for a period of five years beginning one year after the effective date of this subsection.

Section 807-C. Regulations.

The department, in consultation with the Department of State, may promulgate regulations as necessary to implement this chapter.

Section 2. This act shall take effect in one year.

APPROVED--The 16th day of October, A.D. 2024.

JOSH SHAPIRO