AB192: Bill Text

LRB-0284/2

DAK:kmg:cph

2003 - 2004 LEGISLATURE

2003 Assembly BILL 192

March 25, 2003 - Introduced by Representatives Krusick, Berceau, Black, Coggs, Colon, Lassa, J. Lehman, Morris, Sherman, Shilling, Sinicki, Turner, Young and Zepnick, cosponsored by Senators Robson and Carpenter, by request of Service Employees International Union - Wisconsin State Council, Coalition of Wisconsin Aging Groups, AARP, AFSCME Council 11, Wisconsin State AFL-CIO, Wisconsin Federation of Nurses and Health Professionals, Wisconsin Citizen Action and Allied Council of Senior Citizens of Wisconsin. Referred to Committee on Aging and Long-Term Care.

AB192,1,6 An Act to repeal 50.04 (2) (d); to amend 50.02 (2) (bn); and to create 13.94 (12), 49.45 (6m) (a) 3m., 49.45 (6m) (a) 4m., 49.45 (6m) (a) 6., 49.45 (6m) (m) and 50.04 (2) (e) of the statutes; relating to: minimum staffing requirements for nursing homes that do not primarily serve the developmentally disabled, requiring audits by the Legislative Audit Bureau, requiring reports, and requiring the exercise of rule-making authority.

Analysis by the Legislative Reference Bureau

Current law requires a nursing home that does not primarily serve the developmentally disabled to provide each resident of the nursing home a minimum number of hours of nursing care per day according to the level of nursing care that the resident requires. These minimum hours must be provided by a registered nurse, licensed practical nurse, or nurse's assistant.

This bill requires the Department of Health and Family Services (DHFS) to promulgate rules to specify minimum staffing standards that instead are based on ratios between the number of residents of a nursing home and the numbers of registered nurses, licensed practical nurses, and certified nurse's assistants (as defined in the bill) on duty in the nursing home during morning, afternoon, and evening shifts. By July 1, 2005, minimum nursing home staffing requirements under current law are eliminated, and DHFS must convert those minimum staffing requirements to the minimum staffing standards specified in the DHFS rules, must provide training to DHFS staff on enforcement of the standards, and must assist nursing homes in implementing the standards. DHFS must, by January 1, 2005, report to the governor and to the legislature concerning the status of the DHFS compliance with these requirements. By July 1, 2005, nursing homes must have on duty the number of registered nurses, licensed practical nurses, and certified nurse's assistants necessary to satisfy the minimum staffing standards specified in the DHFS rules. Support personnel and certain other nursing home staff may not be used for purposes of calculating the minimum staffing ratios.

Under the bill, DHFS must, by January 1, 2007, submit a report to the governor and to the legislature with recommendations as to methods by which nursing homes would be able more effectively to recruit and retain caregivers; proposed revised minimum nursing home staffing ratios that minimize additional state costs, maximize access to care, facilitate care of the highest quality, and take into account the levels of care for physical or mental conditions that nursing home residents require; and a proposed revised nursing home Medical Assistance Program reimbursement methodology. DHFS must develop the report after first referring to the most recent national research on nursing home staffing and consulting with specified persons and entities.

Also, under the bill, by July 1, 2006, and by July 1 every 48 months thereafter, the Legislative Audit Bureau must perform a performance evaluation audit of the nursing home staffing requirements, investigate whether the staffing requirements should be based in part on the level of care for physical or mental conditions that a nursing home resident requires, and file a report of the audit with the governor and the legislature.

Lastly, under the bill, DHFS must submit to the legislature by each January 1 from 2004 to 2007 a report that includes information from the preceding year for each nursing home on average wage and fringe benefit costs, costs of nonemployee purchased nursing services, staff turnover, total revenue and expenses, staff training and continuing education costs, and law violations and related information. Each report must also include recommendations by DHFS for ways by which nursing homes may reduce their reliance on nonemployee purchased nursing services.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB192, s. 1 Section 1. 13.94 (12) of the statutes is created to read:

AB192,3,10 13.94 (12) Nursing home staffing. By July 1, 2006, and by July 1 every 48 months thereafter, the legislative audit bureau shall perform a performance evaluation audit of the nursing home staffing requirements under s. 50.04 (2) and investigate whether the staffing requirements should be based in part on the level of care for physical or mental conditions that a nursing home resident requires. The legislative audit bureau shall consult advocates for nursing home residents, physicians, nurses, nursing home employees or their representatives, nursing home administrators, and other experts in the field of long-term care and shall consider current research and case data, as well as any other relevant resources, in assessing whether the staffing ratios are sufficient to meet the needs of nursing home residents. The legislative audit bureau shall file a report of each audit with the legislature under s. 13.172 (3) and with the governor no later than 30 days after completion of the audit.

AB192, s. 2 Section 2. 49.45 (6m) (a) 3m. of the statutes is created to read:

AB192,3,13 49.45 (6m) (a) 3m. "Licensed practical nurse" means a nurse who is licensed or has a temporary permit under s. 441.10.

AB192, s. 3 Section 3. 49.45 (6m) (a) 4m. of the statutes is created to read:

AB192,3,16 49.45 (6m) (a) 4m. "Nurse's assistant" has the meaning given in s. 146.40 (1) (d).

AB192, s. 4 Section 4. 49.45 (6m) (a) 6. of the statutes is created to read:

AB192,3,19 49.45 (6m) (a) 6. "Registered nurse" means a nurse who has a certificate of registration under s. 441.06 or a temporary permit order under s. 441.08.

AB192, s. 5 Section 5. 49.45 (6m) (m) of the statutes is created to read:

AB192,3,23 49.45 (6m) (m) By January 1, 2004, 2005, 2006, and 2007, the department shall submit a report to the chief clerk of each house of the legislature, for distribution to the legislature under s. 13.172 (2), that shall include all of the following:

AB192,3,24 1. For the preceding calendar year for each facility:

AB192,4,2 a. The staff turnover rate for registered nurses, licensed practical nurses, and nurse's assistants employed by the facility.

AB192,4,8 b. The average hourly wage and fringe benefit costs, including specific unemployment compensation and worker's compensation costs, for registered nurses, licensed practical nurses, nurse's assistants, dietary staff, housekeeping staff, and laundry staff employed by the facility and the average hourly cost for nonemployee purchased services, if any, of registered nurses, licensed practical nurses, and nurse's assistants.

AB192,4,12 c. Total revenues and expenses, total net income after taxes, expenses for each of the facility's cost centers under par. (am), the medical assistance reimbursement rate and method of calculation, the number of patient beds, and the number of patient days.

AB192,4,14 d. Total cost of recruiting, screening, educating, and training the nursing staff of the facility.

AB192,4,18 e. Any correlation that may be shown between the number of notices of violations for class "A," "B," or "C" violations received under s. 50.04 by a facility, if any, and the frequency of use by the facility of nonemployee purchased services of registered nurses, licensed practical nurses, or nurse's assistants.

AB192,4,21 2. Recommendations of the department for incentives for facilities to reduce reliance on nonemployee purchased services of registered nurses, licensed practical nurses, or nurse's assistants.

AB192, s. 6 Section 6. 50.02 (2) (bn) of the statutes is amended to read:

AB192,4,25 50.02 (2) (bn) The department may, by rule, increase the minimum hours of nursing home care per day staffing standards that are specified in s. 50.04 (2) (d) 1. to 3. (e).

AB192, s. 7 Section 7. 50.04 (2) (d) of the statutes is repealed.

AB192, s. 8 Section 8. 50.04 (2) (e) of the statutes is created to read:

AB192,5,3 50.04 (2) (e) 1. In this paragraph:

AB192,5,5 a. "Afternoon work shift" means the 8-hour work shift that begins immediately after the morning shift.

AB192,5,7 b. "Certified nurse's assistant" means a nurse's assistant who meets the requirements specified under 42 USC 1296r (b) (5) (A) to (E).

AB192,5,9 c. "Evening work shift" means the 8-hour work shift that begins immediately after the afternoon work shift.

AB192,5,11 d. "Morning work shift" means the first 8-hour work shift that begins after midnight.

AB192,5,20 2. The department shall promulgate rules that specify minimum staffing standards that are based on ratios between the numbers of registered nurses on duty in a nursing home per morning work shift, afternoon work shift, or evening work shift and the number of residents of the nursing home, between the numbers of licensed practical nurses on duty in a nursing home per morning work shift, afternoon work shift, or evening work shift and the number of residents of the nursing home, and between the numbers of certified nurse's assistants on duty in a nursing home per morning work shift, afternoon work shift, or evening work shift and the number of residents of the nursing home.

AB192,5,24 3. By July 1, 2005, the department shall convert the minimum staffing requirements specified in s. 50.04 (2) (d), 2001 stats., to the minimum staffing standards specified in subd. 2., shall provide training to staff on enforcement of the standards, and shall assist nursing homes in implementing the standards.

AB192,6,4 4. By July 1, 2005, a nursing home, other than a nursing home that primarily serves the developmentally disabled, shall have on duty the number of registered nurses, licensed practical nurses, and certified nurse's assistants necessary to satisfy the minimum staffing standards developed by the department under subd. 2.

AB192,6,12 5. A registered nurse, licensed practical nurse, or certified nurse's assistant who while on duty provides primarily support services, including food preparation, housekeeping, laundry, or maintenance services, may not be counted for purposes of calculating the minimum staffing ratios under subd. 2. A registered nurse who is employed as a director of nursing, as an assistant director of nursing, or as the charge nurse required under par. (b), may not be counted for purposes of calculating the minimum staffing requirements under subd. 2. while he or she is performing the duties of a director of nursing, assistant director of nursing, or charge nurse.

AB192,6,21 6. By January 1, 2007, after first referring to the most recent national research on nursing home staffing and consulting with representatives of the nursing home industry, labor unions that represent nursing home employees, advocates for elderly and disabled persons, recognized experts with experience in long-term care reimbursement, economists, the attorney general, the federal centers for medicare and medicaid services, and other interested parties, the department shall submit a report to the governor, and to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2). The report shall contain all of the following recommendations:

AB192,6,23 a. Proposed methods by which nursing homes are able more effectively to recruit and retain caregivers.

AB192,7,2 b. Proposed revised minimum nursing home staffing ratios that minimize additional state costs, maximize access to care, facilitate care of the highest quality, and take into account the levels of care for physical or mental conditions that nursing home residents require.

AB192,7,7 c. A proposed revised nursing home medical assistance reimbursement methodology that more effectively promotes resident care of high quality, advances wages and benefits for nursing home workers, supports nursing home provider compliance with applicable state statutes and rules and federal statutes and regulations, and encourages administrative efficiency.

AB192, s. 9 Section 9. Nonstatutory provisions.