S0668B1180A03757 NES:AAS 03/26/24 #90 A03757
AMENDMENTS TO SENATE BILL NO. 668
Sponsor: REPRESENTATIVE FRANKEL
Printer's No. 1180
Amend Bill, page 2, line 6, by striking out "An individual
trained to" and inserting
A registered nurse approved by the department to train and
Amend Bill, page 2, by inserting between lines 12 and 13
"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.
Amend Bill, page 2, lines 16 through 20, by striking out all
of said lines and inserting
(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).
Amend Bill, page 2, line 21, by striking out "(3)" and
inserting
2024/90NES/SB0668A03757 - 1 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
(4)
Amend Bill, page 2, lines 29 and 30; page 3, lines 1 and 2;
by striking out all of said lines on said pages and inserting
(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.
Amend Bill, page 3, line 8, by striking out "gastronomy" and
inserting
gastrostomy
Amend Bill, page 3, line 10, by striking out "gastronomy" and
inserting
gastrostomy
Amend Bill, page 3, by inserting between lines 27 and 28
(xiii) Rectal.
(xiv) Vaginal.
(xv) Enteral.
Amend Bill, page 4, by inserting between lines 5 and 6
(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
2024/90NES/SB0668A03757 - 2 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
registered nurse or a licensed practical nurse authorized by
a registered nurse who is physically on-site and available to
the certified medication aide.
Amend Bill, page 4, line 11, by inserting after "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.
Amend Bill, page 4, line 14, by striking out "40" and
inserting
80
Amend Bill, page 4, lines 14 and 15, by striking out "and
clinical" and inserting
instruction and
Amend Bill, page 4, by inserting between lines 16 and 17
(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.
Amend Bill, page 4, line 17, by striking out "(2)" and
inserting
(3)
Amend Bill, page 4, line 19, by striking out "(3)" and
inserting
(4)
Amend Bill, page 5, line 12, by striking out "(4)" and
inserting
(5)
Amend Bill, page 5, line 15, by striking out "An instructor"
and inserting
The Department of Health
Amend Bill, page 5, line 21, by striking out "(a)(4)" and
2024/90NES/SB0668A03757 - 3 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
inserting
(a)(5)
Amend Bill, page 6, lines 2 through 11, by striking out all
of said lines and inserting
(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 of
Health.
Amend Bill, page 6, lines 15 through 22, by striking out all
of said lines and inserting
(e) Certification sanction authorization.--The Department of
Health 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.--
2024/90NES/SB0668A03757 - 4 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
(1) The Department of Health 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.
(iii) 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 as
civil money penalties.
(2) No disciplinary action against a certified
medication aide shall prevent or otherwise prohibit the
Department of Health 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 of
Health under section 805-C(c).
Amend Bill, page 7, line 14, by inserting after "facility."
The completed competency review shall be submitted to the
Department of Health.
(c) Reporting.--A long-term care nursing facility that
employs a certified medication aide shall report to the
Department of Health 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).
Amend Bill, page 7, line 15, by striking out "(c)" and
inserting
(d)
Amend Bill, page 7, line 21, by striking out "and" and
inserting
, registered nurse ratios or
Amend Bill, page 7, line 23, by striking out "(D)" and
inserting
(e )
2024/90NES/SB0668A03757 - 5 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
Amend Bill, page 8, by inserting between lines 18 and 19
(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 Health
and the Department of State, may promulgate regulations as
necessary to implement this chapter.
Amend Bill, page 8, line 19, by striking out "180 days" and
inserting
one year
2024/90NES/SB0668A03757 - 6 -
1
2
3
4
5
6
7
8
9
10
11