YEAR-END REPORT - 2019 Published 23-Dec-2019 HPTS Issue Brief 12-23-19.9 Health Policy Tracking Service - Issue Briefs Healthcare Providers & Facilities Medical Errors and Patient Safety Authored by Jeffrey Karberg, J.D., a member of the Maryland bar and a contributing writer. 12/23/2019 Reducing Medical Errors and Improving Patient Safety 2019 Federal Action 2019 CONG US S 1357 was introduced May 8, 2019. The proposed bill seeks to amend the Public Health Service Act to establish direct care registered nurse-to-patient staffing ratio requirements in hospitals, and for other purposes. The bill states that numerous studies have shown that patient outcomes are directly correlated to direct care registered nurse staffing levels, including a 2010 Health Services Research study that concluded that implementation of minimum nurse-to-patient staffing ratios in California has led to improved patient outcomes and nurse retention and a 2014 Agency for Healthcare Research and Quality study that concluded increases in nurse staffing and skill mix lead to improved quality and reduced length of stay at no additional cost. Further, requirements for direct care registered nurse staffing ratios will help address the registered nurse shortage in the United States by aiding in recruitment of new registered nurses and improving retention of registered nurses who are considering leaving direct patient care because of demands created by inadequate staffing. 2019 CONG US HCON 63 was introduced September 18, 2019. The proposed bill is a concurrent resolution expressing the sense of Congress that the Centers for Medicare & Medicaid Services should take action to ensure that home infusion therapy services are accessible to all Medicare beneficiaries. The resolution states that home infusion therapy services allow patients with congestive heart failure, immunologic diseases, cancer, and other conditions to remain home, away from the risk of hospital-acquired infections, where patients can resume their personal and professional activities. Additionally, home infusion therapy services are an extension of the health care continuum and serve as a safe, convenient, cost-effective alternative for patients to be administered infusion drugs when: • other settings are unnecessary, impractical, or unavailable; • transport outside the home is a burden to the patient or family; or • administration of infusion drugs at home can improve quality of life. 2019 CONG US S 2723 was introduced October 29, 2019. If passed, the proposed bill will amend the Federal Food, Drug, and Cosmetic Act to reduce drug shortages. The bill also requires a report regarding drug manufacturing. A copy of the report shall be sent promptly to the appropriate offices of the Food and Drug Administration with expertise regarding drug shortages. The offices must ensure timely and effective coordination regarding the reviews of such report and overseeing the alignment of any feedback regarding such report, or corrective or preventative actions, after consideration of the systematic benefits and risks to public health, patient safety, the drug supply and drug supply chain, and timely patient access to such drugs. 2019 State Action In Arkansas 2019 AR H.B. 1072 (NS) was prefiled December 21, 2018. If passed, the bill will create the Office of Health Information Technology is created within the Department of Health. The bill also states that: • the coordination of health information technology activities throughout Arkansas by the Office of Health Information Technology is necessary to obtain the maximum potential value from the investment of federal and state resources to increase the use of health information technology; and © 2020 Thomson Reuters. No claim to original U.S. Government Works. -1- • the exchange of health information made possible by the State Health Alliance for Records Exchange can improve the quality of health of Arkansas citizens by reducing the potential for medical errors, reducing the incidence of redundant tests and procedures, improving patient safety, and making the delivery of healthcare services more efficient and affordable. 2019 AR H.B. 1946 (NS) was filed March 27, 2019. The proposed bill is an act to require the reporting of certain events related to office based surgery. 2019 AR S.B. 252 (NS) was engrossed March 20, 2019. The bill will provide for insurance coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection and pediatric acute-onset neuropsychiatric syndrome. 2019 AR REG TEXT 529145 (NS) was published July 15, 2019. The regulation relates to the minimum licensure standards for adult developmental day treatment (ADDT) and early intervention day treatment (EIDT) centers. The Minimum Licensure Standards for Early Intervention Day Treatment (EIDT) Centers serve as the minimum licensure requirements for the new EIDT program developed by the Division of Developmental Disabilities Services. The EIDT program replaces the Developmental Day Treatment Clinic Services - Children program. In California 2019 CA A.B. 890 (NS) was, a previously introduced bill, was amended April 3, 2019. This bill, if passed, would authorize a nurse practitioner who holds a certification as a nurse practitioner from a national certifying body recognized by the board to practice without supervision by a physician and surgeon in accordance with specified conditions and requirements if the nurse practitioner has successfully completed a transition to practice program, as defined by the bill, and a supervising physician and surgeon at the facility at which the nurse practitioner completed the transition to practice program attests to the board that the nurse practitioner is proficient in competencies established by the board by regulation. 2019 CA A.B. 1519 (NS), a previously introduced bill, was amended July 2, 2019. The Dental Practice Act requires an applicant for licensure as a registered dental assistant to meet specified eligibility requirements, such as satisfactory performance on a written examination in law and ethics, and to provide evidence of successful completion of specified board-approved courses, including in radiation safety and coronal polishing. If passed, this bill would instead require satisfactory performance on the Registered Dental Assistant Combined Written and Law and Ethics Examination, and would require an applicant to additionally provide evidence of successfully completing board-approved courses in infection control, the Dental Practice Act, including the Dental Practice Act for Dental Assisting Jurisprudence, and basic life support. 2019 CA S.B. 322 (NS) was enrolled July 1, 2019. Existing law provides for the licensure and regulation of health facilities by the State Department of Public Health. Existing law prohibits a health facility from discriminating or retaliating against a patient, employee, member of the medical staff, or other health care worker of the health facility because that person has presented a grievance, complaint, or report to the facility, or has initiated, participated, or cooperated in an investigation or administrative proceeding related to the quality of care, services, or conditions at the facility. This bill would provide an employee or the employee's representative with the right to discuss possible regulatory violations or patient safety concerns with the department's inspector privately during the course of an investigation or inspection by the department. By creating this right, the violation of which would be a crime, this bill would impose a state-mandated local program. 2019 CA S.R. 60 (NS) was introduced August 20, 2019. The bill relates to Sepsis Awareness Month. The federal Centers for Disease Control and Prevention (CDC) has nationally recognized the month of September as Sepsis Awareness Month to bring awareness to the serious and potentially fatal medical condition known as sepsis. Sepsis results from an overwhelming immune response to infection, whereby immune chemicals released into the blood to combat infection trigger widespread inflammation. Common infections such as pneumonia, influenza, and urinary tract infections can result in sepsis, and Sepsis can be treated with immediate diagnosis and care, but must be treated as a medical emergency, as it contributes to tissue damage and organ failure. In California, infants under one year of age have the highest mortality rate amongst the pediatric population at 12 percent, and individuals over 85 years of age have the highest mortality rate of 22 percent due to sepsis. Eighty-six percent of sepsis cases in California developed outside of the hospital and were diagnosed upon hospital admission, with 27,000 of those cases in 2017 resulting in death. 2019 CA S.B. 305 (NS), a previously introduced bill, was amended August 12, 2019. Existing law generally requires the licensure and regulation of various health care facilities, including, among others, a hospice facility. The Compassionate Use Act of 1996, an initiative measure enacted by the approval of Proposition 215 at the November 5, 1996, statewide general election, prohibits specified criminal penalties from being imposed on a patient or a patient's primary caregiver who possesses or cultivates cannabis for the personal medical purposes of the patient upon the written or oral recommendation or approval of a physician. This bill, the Compassionate Access to Medical Cannabis Act or Ryan's Law, would prohibit specified types of health care facilities from prohibiting or interfering with a terminally ill patient's use of medical cannabis within the health care facility, subject to certain restrictions. The bill would require a patient to provide the health care facility with a copy of their medical marijuana card or written documentation that the use of medical cannabis is recommended by a physician. The bill would authorize a health care facility to reasonably restrict the manner in which a patient stores and uses medical cannabis to ensure the safety of other patients, guests, and employees of the health care facility, compliance with other state laws, and the safe operations of the health care facility. © 2020 Thomson Reuters. No claim to original U.S. Government Works. -2- 2019 CA A.B. 538 (NS) was adopted October 10, 2019. Existing law requires a qualified health care professional who conducts an examination for evidence of a sexual assault or an attempted sexual assault to use the standard form and to make those observations and perform those tests required to record the data required by the form. Existing law defines qualified health care professional for this purpose to include a physician and surgeon and a currently licensed nurse who is working in consultation with a physician and surgeon who conducts examinations or provides treatment in a general acute care hospital or in a physician and surgeon's office. This bill would include in the definition of “qualified health care professional” a currently licensed nurse practitioner or a physician assistant who is working in consultation with a physician and surgeon and who conducts examinations or provides treatment in a general acute care hospital or in a physician and surgeon's office. This bill also authorizes sexually transmitted infection testing and presumptive treatment to be provided, if indicated by the history of the contact. The bill requires that specimens for a pregnancy test be taken if indicated by the history of contact and age of the victim. The bill would require baseline testing for sexually transmitted infections to be done for a child, a person with a disability, or a person who is residing in a long-term care facility, if forensically indicated. The bill would also require, for victims of sexual assault with an assault history of strangulation, best practices to be followed for a complete physical examination and diagnostic testing to prevent adverse outcomes or morbidity and documentation on a supplemental medical evidentiary examination form. 2019 CA S.B. 697 (NS) was adopted October 9, 2019. This bill removes the requirement that the Physician Assistant Board make recommendations to the Medical Board of California concerning the formulation of guidelines for the consideration and approval of applications by licensed physicians and surgeons to supervise physician assistants. The bill also removes the requirements that the medical record identify the responsible supervising physician and surgeon and that those written guidelines for adequate supervision be established. The bill would instead authorize a physician assistant to perform medical services authorized by the act as amended by this bill if certain requirements are met, including that the medical services are rendered pursuant to a practice agreement, as defined, and the physician assistant is competent to perform the medical services. The bill would also require a practice agreement between a physician assistant and a physician and surgeon to meet specified requirements, and would require a practice agreement to establish policies and procedures to identify a physician and surgeon supervising a physician assistant rendering services in a general acute care hospital. 2019 CA S.B. 156 (NS) was adopted October 12, 2019. Existing law requires the State Department of Public Health to license and regulate various health facilities, including general acute care hospitals. Existing regulations generally require emergency medical services and care to be provided within a hospital. Existing law provides that a special permit issued under these provisions expires on the expiration date of the license, which occurs 12 months from the date of the issuance of the license. This bill makes legislative findings relating to the impact of the Camp Fire in 2018 on the County of Butte, including the destruction of Feather River Hospital in that county. Pursuant to those provisions, the bill requires the department to issue a special permit to allow a general acute care hospital to offer emergency stabilization services at a location that is neither inside nor contiguous to the hospital if the hospital provides satisfactory evidence to the department that, among other things, the hospital has a written transfer agreement with the hospital closest to the location where emergency stabilization services will be provided, and satisfactory evidence to the department that this location meets certain requirements, including that the location is in the town of Paradise within the County of Butte and serves the same area previously served by Feather River Hospital. In Colorado 2019 CO S.B. 193 (NS) was enrolled May 13, 2019. The bill relates to the continuation of the “Colorado Medical Practice Act”, and, in connection therewith, continuing the Colorado medical board, eliminating the sixty-day limit on the pro bono license, and repealing the requirement that a letter of admonition be sent to licensees by certified mail. In Connecticut 2019 CT S.B. 622 (NS) was introduced January 25, 2019. If passed, the bill will create a sustainable working environment for nurses and maximize patient safety and care. The bill will also include a maximum number of patients a nurse in each nursing specialty and discipline may attend to during each shift and a maximum number of hours a nurse may work per shift. 2019 CT H.B. 7338 (NS), a previously introduced bill, was amended April 8, 2019. The proposed bill seeks to increase funding for elderly nutrition, ensure equitable rates for providers of meals on wheels and collect and analyze data on malnutrition. 2019 CT H.B. 7163 (NS) was enrolled June 24, 2019. The bill is an act concerning the department on aging and disability services and meals on wheels. The Department of Rehabilitation Services, in consultation with the five area agencies on aging, will be required to review the specified method of allocation and report any findings or recommendations, as well as data on service levels and costs, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services. Providers of meals under the department's elderly nutrition program must annually provide the department with data on service levels and costs. The department must develop the following for the quality of care program: • comparable performance measures to be reported; • selection of patient satisfaction survey measures and instruments; • methods and format of standardized data collection; © 2020 Thomson Reuters. No claim to original U.S. Government Works. -3- • format for a public quality performance measurement report; • human resources and quality measurements; • medical error reduction methods; • systems for sharing and implementing universally accepted best practices; • systems for reporting outcome data; and • systems for continuum of care. In Delaware 2019 DE S.C.R. 30 (NS) was adopted April 18, 2019. The bill establishes the non-acute patient medical guardianship task force to study and make findings and recommendations regarding the needs and options of non-acute hospital patients in need of medical guardianship services. The Task Force will study the needs and options of non-acute hospital patients in need of medical guardianship services, including funding, legal, regulatory, and policy changes that would allow for medical guardians to be immediately available when a non-acute patient is in need of guardianship in order to transition from an acute care setting to an appropriate location and level of care and report its findings and recommendations. The bill states that it is not in the best health interests of non-acute patients to stay in hospitals beyond their period of acute need because hospital stays can expose individuals to increased risk of infection, will result in patients being confined to a smaller space than often afforded individuals who receive appropriate non-acute care at home or at a long-term care facility, will deny such patients the opportunity for programming and interactions available to individuals in long-term care facilities, and often mean that such patients do not venture out-of-doors for extended periods of time. In Florida 2019 FL H.B. 319 (NS), a previously introduced bill, was amended February 13, 2019. If passed, the bill will require hospitals to provide specified information and data relating to patient safety and quality measures to patient under certain circumstances or to any person upon request; requires hospitals and ambulatory surgical centers to submit patient safety culture survey data to AHCA. 2019 FL S.B. 1194 (NS) was filed February 19, 2019. The bill seeks to require the Agency for Health Care Administration to develop surveys to assess patient safety culture in certain health care facilities. The bill also seeks to revise requirements for the submission of health care data to the agency. 2019 FL H.B. 933 (NS) was introduced March 5, 2019. The proposed bill seeks to revise the definition of term “ambulatory surgical center”. The bill also: • revises provisions related to duties of DOH, registration, office surgery center requirements, certificates of registration, prohibited physician activities, level III procedure requirements, & fines and penalties; and • authorizes department to adopt rules relating to registration, inspection, and safety of centers. 2019 FL S.R. 1814 (NS) was introduced April 24, 2019. The proposed bill seeks to recognizing April 21-27, 2019, as “Health Information Technology Week” in Florida. The proposed bill recognizes that comprehensive health care reform is not possible without the systemwide adoption of health information technology, which improves the quality of health care delivery, increases patient safety, decreases the number of medical errors, controls costs, strengthens the interaction between patients and health care providers, and expands access to care. 2019 FL H.B. 843 (NS), a previously introduced bill, was adopted June 25, 2019.The bill establishes the Dental Student Loan Repayment Program to support dentists who practice in public health programs located in certain underserved areas. The bill also: • requires the Department of Health to establish the Donated Dental Services Program to provide comprehensive dental care to certain eligible individuals; • requires a hospital to notify a patient's primary care provider within a specified timeframe after the patient's admission; • requires a licensed facility, upon placing a patient on observation status, to immediately notify the patient of such status using a specified form; • prohibits certain health maintenance organizations from employing step-therapy protocols under certain circumstances. 2019 FL REG TEXT 523510 (NS) was published July 16, 2019. The regulation relates to the continuing education requirements for nurses. The following continuing education courses are a mandatory part of the specified required hours at the stated time periods: • a two hour course in prevention of medical errors each biennium; • a one hour course in HIV/AIDS in the first biennium only; • a two hour course in Florida laws and rules each biennium; • a two hour course in recognizing impairment in the workplace every other biennium thereafter; • or biennial renewal on or after January 1, 2019, a two hour course on human trafficking, and each biennium thereafter; © 2020 Thomson Reuters. No claim to original U.S. Government Works. -4- • a course in domestic violence every third biennium. 2020 FL H.B. 6503 (NS) was filed September 16, 2019. The proposed bill, if passed, will provide for relief of Rafael Rodriguez by Hendry County Hospital Authority. The bill also seeks to provide appropriation to compensate Rafael Rodriguez for injuries sustained from Hendry County Hospital Authority employee negligence, as well as a limitation on attorney fees. 2020 FL S.B. 230 (NS), a previously introduced bill, was amended October 15, 2019. The proposed bill seeks to: • require the Department of Health to develop strategies to maximize federal-state partnerships that provide incentives for physicians to practice in medically underserved or rural areas; • revise licensure requirements for a person seeking licensure or certification as an osteopathic physician; • extend through 2025 the Florida Center for Nursing's responsibility to study and issue an annual report on the implementation of nursing education programs; and • require dentists and certified registered dental hygienists to report in writing certain adverse incidents to the department within a specified timeframe. In Georgia 2019 GA H.R. 447 (NS) was introduced March 5, 2019. The bill seeks to fund a study of the causes of infant and maternal mortality in Georgia. 2019 GA S.B. 115 (NS) was enrolled April 9, 2019. The bill is titled the “Medical Practice Act of the State of Georgia.” The bill: • relates to telemedicine licenses for physicians in other states; • engage in the practice of medicine with patients in this state through telemedicine; • provides for requirements for issuance of a telemedicine license; • provides for restrictions; • provides for notice of restrictions placed on a license by another state; and • provides for the removal of the geographic limitation on pharmacists. In Hawaii 2019 HI S.B. 1406 (NS) was adopted July 2, 2019. This bill requires supervision of physician assistants by physician groups. The bill also: • permits supervising physicians or groups to establish practice-appropriate record review policies; and • establishes continuing education requirements and authorizes audits to enforce compliance. Clarifies provisions relating to forfeiture and reinstatement of a license. The legislature finds that physician assistants undergo rigorous medical training. Physician assistants graduate from an accredited program and must pass a national certification exam to be licensed to practice medicine with collaboration of a licensed physician. Physician assistants work in various clinical settings, locations, and specialties. Like physicians and advanced practice registered nurses, physician assistants must also complete extensive continuing medical education throughout their careers. Studies have shown that when physician assistants practice to the full extent of their abilities and training, hospital readmission rates and lengths of stay decrease and infection rates go down. In Illinois 2019 IL H.B. 2431 (NS) was filed February 13, 2019. The proposed bill seeks to amend the University of Illinois Hospital Act and the Hospital Licensing Act. If passed, it will require hospitals to require an intern, resident, or physician who provides medical services at the hospital to have proper credentials and any required certificates for ongoing training at the time the intern, resident, or physician renews his or her license. The bill also seeks to amend the Hospital Report Card Act which, if passed, will require hospitals to include in their quarterly reports the number of female patients who have died within the reporting period, the number of female patients who have died of a preventable cause within the reporting period and the number of those preventable deaths that the hospital has otherwise reported within the reporting period, and the number of physicians who were required by the hospital to undergo any amount or type of retraining during the reporting period. 2019 IL S.B. 1779 (NS) was filed February 15, 2019. The bill seeks to create the No Taxpayer Funding for Abortion Act. If passed, the bill will provide that that neither the State nor any of its subdivisions may authorize the use of, appropriate, or expend funds to pay for an abortion or to cover any part of the costs of a health plan that includes coverage of abortion or to provide or refer for an abortion, unless a woman who suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death if an abortion is not performed. © 2020 Thomson Reuters. No claim to original U.S. Government Works. -5- 2019 IL H.B. 3 (NS) was enrolled May 30, 2019. The bill amends the Hospital Report Card Act to require that each hospital include in its quarterly report instances of preterm infants, infant mortality, and maternal mortality. The bill also requires the reporting of racial and ethnic information of the infants' mothers, along with the disparity of occurrences across different racial and ethnic groups. In Kentucky 2019 KY S.B. 227 (NS) was introduced February 15, 2019. If passed, the bill will prohibit a person from denying or depriving an infant of nourishment with the intent to cause or allow the death of an infant. The proposed bill also seeks to: • prohibit a person from denying or depriving an infant of medically appropriate and reasonable medical care, medical treatment, or surgical care; • require a physician performing an abortion to take all medically appropriate and reasonable steps to preserve the life and health of a born alive infant; • provide that a born alive infant shall be treated as a legal person under the laws of Kentucky. In Maryland 2019 MD H.B. 15 (NS) was introduced January 9, 2019. If passed, the bill will require the Maryland Medical Assistance Program, beginning on January 1, 2020, to provide services for certain pediatric autoimmune neuropsychiatric disorders under certain circumstances. The bill will also require insurers, nonprofit health service plans, and health maintenance organizations that provide certain health insurance benefits under certain insurance policies or contracts to provide coverage for certain diagnosis, evaluation, and treatment of certain pediatric autoimmune neuropsychiatric disorders. 2019 MD S.B. 869 (NS) was introduced February 6, 2019. The proposed bill seeks to establish a system for adjudication of a claim involving a birth-related neurological injury. The bill also seeks to: • provide for certain benefits and compensation of a claimant under the Act; • establish the Maryland No-Fault Birth Injury Fund to provide compensation and benefits to eligible claimants; • provide for certain premiums and insurance surcharges to be used to finance and administer the Fund; • require the Maryland Patient Safety Center to convene a certain Perinatal Clinical Advisory Committee. 2019 MD H.B. 1320 (NS) was introduced February 15, 2019. The proposed bill seeks to establish a system for adjudication of a claim involving a birth-related neurological injury. The bill also seeks to: • Proved for certain benefits and compensation of a claimant; • establish the Maryland No-Fault Birth Injury Fund to provide compensation and benefits to eligible claimants; • provide for certain premiums and insurance surcharges to be used to finance and administer the Fund; and • require the Maryland Patient Safety Center to convene a certain Perinatal Clinical Advisory Committee. 2019 MD S.B. 657 (NS) was engrossed March 14, 2019. The bill establishes the Pilot Program for Preventing HIV Infection for Rape Victims to prevent HIV infection for victims of an alleged rape or sexual offense or victims of alleged child sexual abuse. The bill will also: • require the Governor's Office of Crime Control and Prevention to administer the program; • requiring that a victim of an alleged rape or sexual offense or a victim of alleged child sexual abuse be provided with a full course of treatment and follow-up care for postexposure prophylaxis for the prevention of HIV infection. In Massachusetts 2019 MA H.B. 3801 (NS) was introduced April 25, 2019. The bill requires the health policy commission, in consultation with the department of public health and the Betsy Lehman center for patient safety and medical error reduction, to implement a 2-year pilot program to reduce pregnancy-related deaths and improve pregnancy outcomes in the commonwealth. The commission must consider evidence-based practices from successful programs implemented nationally and internationally in the development of the program. The department of public health must also provide relevant data to the commission in order to determine scope and scale of the program, including data on volume and prevalence of pregnancy-related deaths. 2019 MA H.B. 4134 (NS) was introduced October 18, 2019. The proposed bill seeks to create a task force to make recommendations on aligned measures of health care provider quality and health system performance to ensure consistency in the use of quality measures in contracts between payers, including the commonwealth and carriers, and health care providers in Massachusetts, ensure consistency in methods for evaluating providers for tiered network products, reduce administrative burden, improve transparency for consumers, improve health system monitoring and oversight by relevant state agencies and improve quality of care. In Michigan 2017 MI H.B. 6016 (NS) was adopted December 27, 2018. The bill relates to the definition of HIV infections. © 2020 Thomson Reuters. No claim to original U.S. Government Works. -6- 2017 MI H.B. 6022 (NS) was adopted December 27, 2018. The bill requires a physician or an individual otherwise authorized by law to provide medical treatment to a pregnant woman to take or cause to be taken at the time of the woman's initial examination test specimens of the woman for the purpose of performing tests for HIV, syphilis, and hepatitis B, and take or cause to be taken during the third trimester of the woman's pregnancy test specimens of the woman for the purpose of performing tests for HIV, hepatitis B, and syphilis in accordance with guidelines established by the federal Centers for Disease Control and Prevention, and must submit the specimens to a clinical laboratory approved by the department for the purpose of performing tests approved by the department for the infections described above. The tests may not be performed if the tests are medically inadvisable or the woman does not consent to be tested. The woman may orally communicate her decision to decline the testing. 2017 MI S.B. 541 (NS) was adopted December 26, 2018. The bill provides for the licensing and regulation of dental therapists. 2019 MI S.R. 80 (NS) was introduced October 2, 2010. The proposed bill is a resolution to urge the United States Congress to increase funding for sickle cell disease research. In Missouri 2019 MO S.B. 435 (NS) was introduced February 25, 2019. The proposed bill relates to infection control data reporting. In Minnesota 2019 MN S.F. 8 (NS) was engrossed April 1, 2019. The includes a provision creating a resident quality of care and outcomes improvement task force. The commissioner must establish a resident quality of care and outcomes improvement task force to examine and make recommendations, on an ongoing basis, on how to apply proven safety and quality improvement practices and infrastructure to settings and providers that provide long-term services and supports. The task force shall include representation from: • nonprofit Minnesota-based organizations dedicated to patient safety or innovation in health care safety and quality; • Department of Health staff with expertise in issues related to safety and adverse health events; • consumer organizations; • direct care providers or their representatives; • organizations representing long-term care providers and home care providers in Minnesota; • national patient safety experts; and • other experts in the safety and quality improvement field. In Missouri 2019 MO H.B. 1057 (NS) was engrossed April 16, 2019. The bill changes provisions relating to infection control data reporting. The bill requires all health care providers to at least annually provide to the department charge data as required by the department. All hospitals must at least annually provide patient abstract data and financial data as required by the department. The department must collect data on the incidence of health care-associated infections from hospitals, ambulatory surgical centers, abortion facilities, and other facilities as necessary to generate the reports required by this section. Hospitals, ambulatory surgical centers, abortion facilities, and other facilities shall provide such data in compliance with this section. If the Centers for Medicare and Medicaid Services requires hospitals to submit health care-associated infection data, then hospitals and the department must not be required to comply with specified health care-associated infection data reporting requirements, except that the department must post a link on its website to publicly reported data by hospitals on the Centers for Medicare and Medicaid Services' Hospital Compare website, or its successor. 2019 MO S.B. 70 (NS), a previously introduced bill, was amended May 6, 2019. The proposed bill requires the department of health and senior services to collect data on the incidence of health care-associated infections from hospitals, ambulatory surgical centers, abortion facilities, and other facilities as necessary to generate certain specified required reports. Hospitals, ambulatory surgical centers, abortion facilities, and other facilities must provide such data in compliance with specified requirements. In order to streamline government and to eliminate duplicative reporting requirements, if the Centers for Medicare and Medicaid Services, or its successor entity, requires hospitals to submit health care-associated infection data, then hospitals and the department must not be required to comply with the health care-associated infection data reporting requirements; except that, the department shall post a link on its website to publicly reported data by hospitals on the Centers for Medicare and Medicaid Services' Hospital Compare website, or its successor. In Nebraska 2019 NE L.B. 25 (NS) was introduced January 10, 2019 The proposed bill seeks to provide for additional fees under the Uniform Credentialing Act and create the Patient Safety Cash Fund. The Patient Safety Cash Fund shall only be used to support the activities of a patient safety organization. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act. In New Hampshire 2019 NH H.B. 692 (NS) was adopted July 19, 2019. This bill authorizes the Medicaid managed care program to provide dental benefits to covered persons. Under this bill, the commissioner of the department of health and human services shall convene a working group to develop a value-based dental benefit. The Department of Health and Human Services, in consultation with the working group, © 2020 Thomson Reuters. No claim to original U.S. Government Works. -7- must prepare a plan for the implementation of an adult dental benefit into a value-based care platform. Each plan must include, at a minimum, a detailed description of the following: • eligibility and enrollment covered benefits and scope of services; • cost benefit analysis including projected expenditures and anticipated cost savings; • transition planning; • credentialing; • quality metrics and outcome measurements; • patient safety; and • the incorporation of the services into a value-based care platform to achieve the legislative intent of providing value, quality, efficiency, innovation, and savings. In New Jersey 2018 NJ S.B. 3373 (NS) was introduced January 24, 2019. If passed, the bill will establish training protocols and treatment guidelines for general hospitals providing maternity care. The bill is modeled off of maternal patient safety bundles established by the Council on Patient Safety in Women's Health Care's and the Alliance for Innovation on Maternal Health. The patient safety bundles provide a standardized approach to move established guidelines into practice. They ensure: • that healthcare providers have standard protocols in place to ensure the readiness of health care systems, teams, and patients; • recognition of an issue; and • a process in place to track the issue for quality improvement and reporting. 2018 NJ S.B. 3571 (NS) was introduced March 7, 2019. The proposed bill seeks to require health benefits coverage for rapid diagnostic testing for influenza A and B viruses. A hospital service corporation contract providing hospital or medical expense benefits and is delivered, issued, executed or renewed in this State, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance must provide coverage for expenses incurred in the use of rapid diagnostic testing to screen for influenza A and B virus infections. 2018 NJ A.B. 2692 (NS) was introduced February 1, 2019. The proposed bill clarifies that apologies by health care facilities and professionals to patients or their representatives for adverse events disclosed under “Patient Safety Act” are excluded from discovery and inadmissible in legal actions involving facilities and professionals. In New Mexico 2019 NM H.B. 178 (NS) was prefiled January 4, 2019. The proposed bill is an act relating to health care. The proposed bill seeks to enact the Patient Safe Staffing Act, which will: • require hospitals to establish staffing levels for hospital nursing units; • give a nurse the right to refuse an assignment under certain circumstances; • require hospitals to post and report their daily hospital nursing unit patient census and staffing levels; • make the Department of Health responsible for posting hospital reports on the department of health's website for consumers; • authorize the Department of Health to enforce compliance with the patient safe staffing act through penalties and corrective action; and • provide whistleblower protection to employees who file a grievance or complaint under the patient safe staffing act. In New York 2019 NY A.B. 73 (NS) was prefiled January 2, 2019. If passed, the bill will prohibit the sale of information listed on prescriptions that identifies specific patients or persons legally authorized to issue a prescription. 2019 NY S.B. 1279 (NS) was introduced January 14, 2019. If passed, the bill will require all hospitals to establish, utilize and complete a checklist for each intensive care medical procedure performed in the hospital. 2019 NY S.B. 1306 (NS) was introduced January 14, 2019. The proposed bill relates to tick-borne disease testing in children by launching a pilot program for Lyme and tick-borne disease testing in children. 2019 NY A.B. 973 (NS) was introduced January 14, 2019. The proposed bill relates to treatment for sexually transmitted diseases to minors without a parent's or guardian's consent. 2019 NY A.B. 2954 (NS) was introduced January 28, 2019. If passed, the proposed bill will enact the ‘safe staffing for quality care act’. 2019 NY S.B. 2563 (NS) was introduced January 28, 2019. If passed, the bill will establish certification procedures for the profession of nurse anesthesia. In the proposed bill, the legislature stated that certified registered nurse anesthetists are highly educated and © 2020 Thomson Reuters. No claim to original U.S. Government Works. -8- trained advanced practice nurses who hold a national professional certification, and whose competency in the professional practice of nurse anesthesia in hospitals, free-standing ambulatory surgery centers, clinics, professional offices and other facilities is well known. Nurse anesthetists are integral to the continued professional delivery of services in such health care facilities throughout the state. The legislature also stated that statutory recognition of nurse anesthetists will further enhance patient safety by codifying their professional scope of practice that is currently governed in this state by regulations promulgated pursuant to the public health law in the case of hospitals and ambulatory surgery centers. 2019 NY S.B. 3276 (NS) was introduced February 5, 2019. The proposed bill will, if passed, provide for notification to hospital patients upon intake of reports of hospital-acquired infections. 2019 NY A.B. 4962 (NS) was introduced February 6, 2019. The proposed bill relates to requiring insurance coverage for pre-exposure prophylaxis and post-exposure prophylaxis to prevent HIV infection. 2019 NY S.B. 3796 (NS) was introduced February 14, 2019. The proposed bill seeks to enact the ‘Nurse of Tomorrow Act of 2019’ to provide for grants to certain hospitals, schools and other entities for nurse recruitment, education and retention. 2019 NY S.B. 3158 (NS) was introduced February 4, 2019. If passed, the bill will provide a premium reduction for physicians and licensed midwives who complete a risk management strategies course. 2019 NY S.B. 4501 (NS) was introduced March 13, 2019. The proposed bill relates to the time to commence certain medical malpractice actions. The proposed bill also seeks to provide that actions related to acts or omissions of hospitals where an incident report is required to be filed may be filed within one year of the required filing. 2019 NY A.B. 6566 (NS), a previously introduced bill, was amended April 5, 2019. The proposed bill relates to the geriatric demonstration program to promote mental health and home care collaboration. The bill also seeks to authorize the commissioner of mental health and the commissioner of health to waive rules and regulations to address barriers to collaboration by mental health providers and providers of home care services. The bill states that regulations pertaining to patient safety may not be waived, nor shall any regulations be waived if such waiver would risk patient safety. 2019 NY A.B. 7292 (NS) was introduced April 22, 2019. If passed, the bill will provide for notification to hospital patients upon intake of reports of hospital-acquired infections. The proposed bill seeks to require each general hospital to notify patients as a component of prebooking, intake and registration of the hospital-acquired infections that occurred in the hospital for the prior thirty day period. Such notification must be updated on a daily basis and shall be accomplished through the conspicuous posting of signs, which are easily understandable by the general public, and must include directions on how to obtain additional information. To the degree practicable, the format of such signs must be consistent with the format of the summary table. Upon request the hospital must provide a patient with an individual copy of the information contained on such sign. 2019 NY A.B. 7380 (NS) was introduced April 29, 2019. The proposed bill relates to the licensure of dietitians and nutritionists. Every licensed nutritionist, and licensed dietitian/nutritionist practicing in the state must complete course work or training appropriate to the professional's practice approved by the department regarding infection control, which must include sepsis, and barrier precautions, including engineering and work practice controls, in accordance with regulatory standards promulgated by the department, in consultation with the department of health, which shall be consistent, as far as appropriate, with such standards adopted by the department of health pursuant specified requirements to prevent the transmission of HIV, HBV, HCV and infections that could lead to sepsis in the course of professional practice. 2019 NY S.B. 5186 (NS), a previously introduced bill, was amended May 22, 2019. The proposed bill relates to persons designated by a general hospital to identify infectious disease processes. The bill defines “infection preventionist” to mean a person designated by a general hospital to identify infectious disease processes, conduct surveillance and epidemiologic investigations, and develop plans to prevent and control the transmission of infectious agents within general hospitals. A general hospital that employs or contracts with an infection preventionist shall, upon request of another general hospital, or upon request of an infection preventionist employed by, formerly employed by or contracted to perform as an infection preventionist at such general hospital, verify the dates of employment or contract of such person. 2019 NY A.B. 5499 (NS), a previously introduced bill, was amended July 8, 2019. The proposed bill adds athletic trainers to the list of persons and officials required to report cases of suspected child abuse or maltreatment. The bill also states that every dentist, registered nurse, licensed practical nurse, podiatrist, optometrist, athletic trainer and dental hygienist practicing in the state must complete course work or training appropriate to the professional's practice approved by the department regarding infection control, which must include sepsis, and barrier precautions, including engineering and work practice controls, in accordance with regulatory standards promulgated by the department, in consultation with the department of health, which must be consistent, as far as appropriate, with such standards adopted by the department of health pursuant specified law to prevent the transmission of HIV, HBV, HCV and infections that could lead to sepsis in the course of professional practice. 2019 NY A.B. 8640 (NS) was introduced October 2, 2019. The proposed bill, if passed, will direct the commissioner of health to establish a standard protocol for the diagnosis and treatment of Lyme disease and other tick borne diseases identified by such commissioner. The protocol must require the provision of written notification to each patient being treated for Lyme disease or other tick borne diseases relating to symptoms, risk factors, diagnosis and other information relating to such diseases. © 2020 Thomson Reuters. No claim to original U.S. Government Works. -9- 2019 NY S.B. 3872 (NS), a previously introduced bill, was amended March 25, 2019. The proposed bill relates to the geriatric demonstration program to promote mental health and home care collaboration; authorizes the commissioner of mental health and the commissioner of health to waive rules and regulations to address barriers to collaboration by mental health providers and providers of home care services. The bill also provides further that regulations pertaining to patient safety may not be waived, nor shall regulations be waived if such waiver would risk patient safety. In North Carolina 2019 NC S.B. 361 (NS) was engrossed August 12, 2019. The bill is an act to enact the psychology interjurisdictional compact, allow licensed marriage and family therapists to conduct first-level commitment examinations, eliminate redundancy in adult care home inspections, raise awareness of lupus and create the lupus advisory council, ensure the proper administration of step therapy protocols, ensure equal coverage for oral anticancer drugs, modernize Medicaid telemedicine policies, increase access to telehealth services, and create the North Carolina healthcare solutions task force. In Ohio 2019 OH S.B. 117 (NS) was introduced March 22, 2019. If passed, the bill will require hospitals to provide specified services to victims of sexual assault. 2019 OH H.B. 292 (NS) was introduced June 19, 2019. The proposed bill seeks to establish and operate the Ohio Health Care Plan to provide universal health care coverage to all Ohio residents. The health care plan includes a requirement that the executive director, in consultation with the technical and medical advisory board, must determine the duties of the administrator of quality assurance. Those duties shall include the following: • studying and reporting on the efficacy of health care treatments and medications for particular conditions; • identifying causes of medical errors and devising procedures to decrease medical errors; • establishing an evidence-based formulary; • identifying treatments and medications that are unsafe or have no proven value; • establishing a process for soliciting information on medical standards from providers and consumers. In Oklahoma 2019 OK S.B. 220 (NS) was prefiled January 11, 2019. The proposed bill relates to modifying reporting requirements of sexually transmitted infection. Any physician who makes a diagnosis or treats a case of a sexually transmitted infection (STI), and every superintendent or manager of a hospital, dispensary or charitable or penal institution in which there is a case of an STI, must report such case immediately, in writing, or electronically. In Oregon 2019 OR H.B. 2692 (NS) was adopted May 13, 2019. The bill relates to the Practitioner-Managed Prescription Drug Plan. The director may allow the immediate implementation of specified recommendations described in this section if the director determines that immediate implementation is necessary to protect patient safety or to comply with state or federal requirements. 2019 OR H.B. 2717 (NS) was engrossed April 16, 2019. The bill eliminates requirement for ambulatory surgical centers and extended stay centers to file ambulatory surgery discharge abstract records with Oregon Health Authority. The bill also requires authority to adopt rules, in collaboration with representatives of ambulatory surgical centers, for data reporting by ambulatory surgical centers and extended stay centers. Additionally, the bill authorizes Oregon Patient Safety Commission to share with authority data reported to commission by ambulatory surgical centers and extended stay centers. In Pennsylvania 2019 PA S.R. 20 (NS) was adopted February 5, 2019. The bill is a resolution directing the Legislative Budget and Finance Committee to conduct a study of the impact of venue for medical professional liability actions on access to medical care and maintenance of health care systems in Pennsylvania and requesting that the Pennsylvania Supreme Court delay action on a specified proposed amendment. 2019 PA H.B. 1004 (NS) was introduced April 8, 2019. The proposed bill is an act amending the Medical Care Availability and Reduction of Error (Mcare) Act, in patient safety, further providing for definitions, for powers and duties of Patient Safety Authority, for patient safety committee and for confidentiality and compliance. 2019 PA H.B. 1419 (NS) was introduced May 15, 2019. The proposed bill is an act amending the Medical Care Availability and Reduction of Error (Mcare) Act, in medical professional liability, providing for use of Department of Health surveys or inspections. 2019 PA H.R. 504 (NS) was introduced September 19, 2019. The proposed bill is a resolution seeking to recognize September 30, 2019, as “NICU Awareness Day” in Pennsylvania. 2019 PA H.R. 506 (NS) was adopted October 21, 2019. The bill is a resolution designating the month of September 2019 as “Sepsis Awareness Month” in Pennsylvania. In South Carolina © 2020 Thomson Reuters. No claim to original U.S. Government Works. -10- 2019 SC S.B. 132 (NS) was adopted May 13, 2019. The bill relates to physician supervision of certain practitioners, so as to make various changes concerning scope of practice guidelines. A physician or medical staff who are engaged in practice with a PA, NP, CNM, or CNS must not enter into scope of practice guidelines or practice agreements with more than the equivalent of six full-time PAs, NPs, CNMs, or CNSs and must not practice in a situation in which the number of NPs, CNMs, or CNSs providing clinical services with whom the physician is working, combined with the number of PAs providing clinical services whom the physician is supervising, is greater than six individuals at any one time, provided, however, that the board may approve an exception to these requirements upon application by the physician, if the board determines that an exception is warranted and that quality of care and patient safety will be maintained. In Texas 2019 TX S.B. 384 (NS) was introduced January 18, 2019. The proposed bill relates to the reporting of health care-associated infections and preventable adverse events at health care facilities. 2019 TX H.B. 762 (NS) was introduced January 11, 2019. The proposed bill relates to HIV and AIDS tests and to health benefit plan coverage of HIV and AIDS tests. 2019 TX H.R. 614 (NS) was introduced February 26, 2019. The proposed bill seeks to recognize July 2019 as Medical Malpractice Awareness Month. 2019 TX S.B. 384 (NS) was enrolled May 22, 2019. The bill relates to the reporting of health care-associated infections and preventable adverse events at health care facilities. Health care facilities must report to the department each health care-associated infection including the causative pathogen if the infection is laboratory-confirmed, occurring in the facility and that the federal Centers for Medicare and Medicaid Services requires a facility participating in the Medicare program to report through the federal Centers for Disease Control and Prevention's National Healthcare Safety Network. 2019 TX S.B. 384 (NS) was adopted June 7, 2019. The bill relates to the reporting of health care-associated infections and preventable adverse events at health care facilities. In 2007 Texas became a leader by establishing the Texas Health Care-Associated Infections (HAIs) reporting requirements for health care facilities based on recommendations from an advisory panel composed of health care representatives and stakeholders. Subsequently, Centers for Medicare & Medicaid Services (CMS) rolled out their HAI reporting requirement for facilities wishing to receive full Medicare reimbursements. Facilities must report different infections to the state and CMS, causing confusion and inefficiency. This bill aligns the state reporting requirements for health care-associated infections for health care facilities with those currently in place from CMS. In Virginia 2018 VA H.B. 2425 (NS), a previously introduced bill, was amended January 31, 2019. The proposed bill, if passed, will provide for the release of data on health care-associated infections (HAIs) to the National Healthcare Safety Network (NHSN) by health care facilities located in Virginia. The data must also be released to the Virginia Department of Health, either by the health care facility or through the NHSN, and to the public upon request. 2018 VA H.B. 1998 (NS) was adopted February 15, 2019. The bill requires a general district court to hold a hearing within 48 hours of a petition being filed seeking to compel collection of a blood specimen for testing for human immunodeficiency virus or the hepatitis B or C viruses when exposure to bodily fluids occurs between a person and any health care provider, person employed by or under the direction and control of a healthcare provider, law-enforcement officer, firefighter, emergency medical services personnel, person employed by a public safety agency, or school board employee and the person whose blood specimen is sought refuses to consent to providing such specimen. Additionally, the bill directs the Office of the Executive Secretary of the Supreme Court of Virginia to publish a petition form for such filing. In Washington 2019 WA H.B. 1239 (NS), a previously introduced bill, was amended February 6, 2019. The proposed bill seeks to protect the confidentiality of health care quality and peer review discussions to support effective patient safety. In West Virginia 2019 WV H.B. 2611 (NS) was introduced January 23, 2019. The proposed bill is entitled the “Ensuring Patient Safety Act.” The proposed bill, if passed, will: • Create an acuity-based patient classification system; • direct hospitals to establish an acuity standard; • establish minimum direct-care registered nurse to patient ratios; • provide additional conditions for licensing; • prohibit assignment of unlicensed personnel to perform licensed nurse functions; and • require a full-time registered nurse executive leader. In Wisconsin © 2020 Thomson Reuters. No claim to original U.S. Government Works. -11- 2019 WI S.B. 515 (NS) was introduced October 18, 2019. The proposed bill relates to the regulation of physician assistants. The bill also seeks to: • create a Physician Assistant Examining Board; • extend the time limit for emergency rule procedures; and • provide an exemption from emergency rule procedures, granting rule-making authority, and providing a penalty. 2019 WI A.B. 575 (NS) was introduced October 25, 2019. The proposed bill relates to the regulation of physician assistants. The bill also seeks to create a Physician Assistant Examining Board. The bill allows physician assistants to provide expedited partner therapy if a patient is diagnosed as infected with a chlamydial infection, gonorrhea, or trichomoniasis and the patient has had sexual contact with a sexual partner during which the chlamydial infection, gonorrhea, or trichomoniasis may have been transmitted to or from the sexual partner. © Copyright Thomson/West - NETSCAN's Health Policy Tracking Service Produced by Thomson Reuters Accelus Regulatory Intelligence 04-Feb-2020 © 2020 Thomson Reuters. 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