BILL REQ. #:  S-3862.1 

Read first time 01/19/12.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to creating a medication assistant endorsement for certified nursing assistants who work in nursing homes; amending RCW 18.88A.040, 18.88A.050, 18.88A.060, 18.88A.120, 18.88A.130, 18.88A.150, and 18.130.040; reenacting and amending RCW 18.88A.020; adding a new section to chapter 18.88A RCW; creating a new section; and providing an effective date.

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

Sec. 1   RCW 18.88A.020 and 2010 c 169 s 2 are each reenacted and amended to read as follows:
     Unless the context clearly requires otherwise, the definitions in this section apply throughout this chapter.
     (1) "Alternative training" means a nursing assistant-certified program meeting criteria adopted by the commission under RCW 18.88A.087 to meet the requirements of a state-approved nurse aide competency evaluation program consistent with 42 U.S.C. Sec. 1395i-3(e) and (f) of the federal social security act.
     (2) "Approved training program" means a nursing assistant-certified training program approved by the commission to meet the requirements of a state-approved nurse aide training and competency evaluation program consistent with 42 U.S.C. Sec. 1395i-3(e) and (f) of the federal social security act. For community college, vocational-technical institutes, skill centers, and secondary school as defined in chapter 28B.50 RCW, nursing assistant-certified training programs shall be approved by the commission in cooperation with the board for community and technical colleges or the superintendent of public instruction.
     (3) "Commission" means the Washington nursing care quality assurance commission.
     (4) "Competency evaluation" means the measurement of an individual's knowledge and skills as related to safe, competent performance as a nursing assistant.
     (5) "Department" means the department of health.
     (6) "Health care facility" means a nursing home, hospital, hospice care facility, home health care agency, hospice agency, or other entity for delivery of health care services as defined by the commission.
     (7) "Medication assistant" means a nursing assistant-certified with a medication assistant endorsement issued under section 2 of this act who is authorized, in addition to his or her duties as a nursing assistant-certified, to administer certain medications and perform certain treatments in a licensed nursing home under the supervision of a licensed registered nurse under section 2 of this act.
     (8) "Nursing assistant" means an individual, regardless of title, who, under the direction and supervision of a registered nurse or licensed practical nurse, assists in the delivery of nursing and nursing-related activities to patients in a health care facility. The two levels of nursing assistants are:
     (a) "Nursing assistant-certified," an individual certified under this chapter; and
     (b) "Nursing assistant-registered," an individual registered under this chapter.
     (((8))) (9) "Secretary" means the secretary of health.

NEW SECTION.  Sec. 2   A new section is added to chapter 18.88A RCW to read as follows:
     (1) Beginning July 1, 2013, the secretary shall issue a medication assistant endorsement to any nursing assistant-certified who meets the following requirements:
     (a) Ongoing certification as a nursing assistant-certified in good standing under this chapter;
     (b) Completion of a minimum number of hours of documented work experience as a nursing assistant-certified in a long-term care setting as defined in rule by the commission;
     (c) Successful completion of an education and training program approved by the commission by rule, such as the model medication assistant-certified curriculum adopted by the national council of state boards of nursing. The education and training program must include training on the specific tasks listed in subsection (2) of this section as well as training on identifying tasks that a medication assistant may not perform under subsection (4) of this section;
     (d) Passage of an examination approved by the commission by rule, such as the medication aide competency examination available through the national council of state boards of nursing; and
     (e) Continuing competency requirements as defined in rule by the commission.
     (2)(a) Subject to subsection (3) of this section, a medication assistant may perform the following additional tasks:
     (i) The administration of medications orally, topically, and through inhalation;
     (ii) The performance of simple prescriber-ordered treatments, including blood glucose monitoring, noncomplex clean dressing changes, pulse oximetry reading, and oxygen administration, to be defined by the commission by rule; and
     (iii) The documentation of the tasks in this subsection (2) on applicable medication or treatment forms.
     (b) The commission may limit by rule the duties, within the scope of practice of a nursing assistant-certified, that a nursing assistant-certified may perform while functioning as a medication assistant.
     (3) A medication assistant may only perform the additional tasks in subsection (2) of this section:
     (a) In a licensed nursing home; and
     (b) Under the direct supervision of a designated registered nurse who is on-site and immediately accessible during the medication assistant's shift. The registered nurse shall assess the resident prior to the medication assistant administering medications or treatments and determine whether it is safe to administer the medications or treatments. The judgment and decision to administer medications or treatments is retained by the registered nurse.
     (4) A medication assistant may not:
     (a) Accept telephone or verbal orders from a prescriber;
     (b) Calculate medication dosages;
     (c) Inject any medications;
     (d) Perform any sterile task;
     (e) Administer medications through a tube;
     (f) Administer any Schedule I, II, or III controlled substance; or
     (g) Perform any task that requires nursing judgment.
     (5) Nothing in this section requires a licensed nursing home to employ a nursing assistant-certified with a medication assistant endorsement.
     (6) A medication assistant is responsible and accountable for his or her specific functions.
     (7) A medication assistant's employer may limit or restrict the range of functions permitted under this section, but may not expand those functions.

Sec. 3   RCW 18.88A.040 and 1991 c 16 s 4 are each amended to read as follows:
     (1) No person may practice or represent himself or herself as a nursing assistant-registered by use of any title or description without being registered by the department pursuant to this chapter.
     (2) After October 1, 1990, no person may by use of any title or description, practice or represent himself or herself as a nursing assistant-certified without applying for certification, meeting the qualifications, and being certified by the department pursuant to this chapter.
     (3) After July 1, 2013, no person may practice, or represent himself or herself by any title or description, as a medication assistant without a medication assistant endorsement issued under section 2 of this act.

Sec. 4   RCW 18.88A.050 and 2010 c 169 s 5 are each amended to read as follows:
     In addition to any other authority provided by law, the secretary has the authority to:
     (1) Set all nursing assistant certification, registration, medication assistant endorsement, and renewal fees in accordance with RCW 43.70.250 and to collect and deposit all such fees in the health professions account established under RCW 43.70.320;
     (2) Establish forms, procedures, and the competency evaluation necessary to administer this chapter;
     (3) Hire clerical, administrative, and investigative staff as needed to implement this chapter;
     (4) Issue a nursing assistant registration to any applicant who has met the requirements for registration;
     (5) After January 1, 1990, issue a nursing assistant certificate to any applicant who has met the training, competency evaluation, and conduct requirements for certification under this chapter;
     (6) Issue a medication assistant endorsement to any applicant who has met the requirements of section 2 of this act;
     (7) Maintain the official record for the department of all applicants and persons with registrations ((and)), certificates, and medication assistant endorsements under this chapter;
     (((7))) (8) Exercise disciplinary authority as authorized in chapter 18.130 RCW;
     (((8))) (9) Deny registration to any applicant who fails to meet requirement for registration as a nursing assistant;
     (((9))) (10) Deny certification to applicants who do not meet the training, competency evaluation, and conduct requirements for certification as a nursing assistant; and
     (11) Deny medication assistant endorsement to applicants who do not meet the requirements of section 2 of this act.

Sec. 5   RCW 18.88A.060 and 2010 c 169 s 6 are each amended to read as follows:
     In addition to any other authority provided by law, the commission may:
     (1) Determine minimum nursing assistant education requirements and approve training programs;
     (2) Approve education and training programs and examinations for medication assistants as provided in section 2 of this act;
     (3) Define the prescriber-ordered treatments a medication assistant is authorized to perform under section 2 of this act;
     (4) Prepare, grade, and administer, or determine the nature of, and supervise the grading and administration of, the competency evaluation for applicants for nursing assistant certification, using the same competency evaluation for all applicants, whether qualifying to take the competency evaluation under an approved training program or alternative training;
     (((3))) (5) Establish forms and procedures for evaluation of an applicant's alternative training under criteria adopted pursuant to RCW 18.88A.087;
     (((4))) (6) Define and approve any experience requirement for nursing assistant certification;
     (((5))) (7) Adopt rules implementing a continuing competency evaluation program for nursing assistants; and
     (((6))) (8) Adopt rules to enable it to carry into effect the provisions of this chapter.

Sec. 6   RCW 18.88A.120 and 1996 c 191 s 74 are each amended to read as follows:
     Applications for registration ((and)), certification, and medication assistant endorsement shall be submitted on forms provided by the secretary. The secretary may require any information and documentation that reasonably relates to the need to determine whether the applicant meets the criteria for registration ((and)), certification, and medication assistant endorsement credentialing provided for in this chapter and chapter 18.130 RCW. Each applicant shall comply with administrative procedures, administrative requirements, and fees determined by the secretary under RCW 43.70.250 and 43.70.280.

Sec. 7   RCW 18.88A.130 and 1996 c 191 s 75 are each amended to read as follows:
     Registrations ((and)), certifications, and medication assistant endorsements shall be renewed according to administrative procedures, administrative requirements, and fees determined by the secretary under RCW 43.70.250 and 43.70.280.

Sec. 8   RCW 18.88A.150 and 1991 c 16 s 7 are each amended to read as follows:
     The uniform disciplinary act, chapter 18.130 RCW, governs unregistered ((or)), uncertified, or unendorsed practice, issuance of certificates ((and)), registrations, and medication assistant endorsements, and the discipline of persons registered or with certificates under this chapter. The secretary shall be the disciplinary authority under this chapter.

Sec. 9   RCW 18.130.040 and 2011 c 41 s 11 are each amended to read as follows:
     (1) This chapter applies only to the secretary and the boards and commissions having jurisdiction in relation to the professions licensed under the chapters specified in this section. This chapter does not apply to any business or profession not licensed under the chapters specified in this section.
     (2)(a) The secretary has authority under this chapter in relation to the following professions:
     (i) Dispensing opticians licensed and designated apprentices under chapter 18.34 RCW;
     (ii) Midwives licensed under chapter 18.50 RCW;
     (iii) Ocularists licensed under chapter 18.55 RCW;
     (iv) Massage operators and businesses licensed under chapter 18.108 RCW;
     (v) Dental hygienists licensed under chapter 18.29 RCW;
     (vi) East Asian medicine practitioners licensed under chapter 18.06 RCW;
     (vii) Radiologic technologists certified and X-ray technicians registered under chapter 18.84 RCW;
     (viii) Respiratory care practitioners licensed under chapter 18.89 RCW;
     (ix) Hypnotherapists and agency affiliated counselors registered and advisors and counselors certified under chapter 18.19 RCW;
     (x) Persons licensed as mental health counselors, mental health counselor associates, marriage and family therapists, marriage and family therapist associates, social workers, social work associates--advanced, and social work associates -- independent clinical under chapter 18.225 RCW;
     (xi) Persons registered as nursing pool operators under chapter 18.52C RCW;
     (xii) Nursing assistants registered or certified or medication assistants endorsed under chapter 18.88A RCW;
     (xiii) Health care assistants certified under chapter 18.135 RCW;
     (xiv) Dietitians and nutritionists certified under chapter 18.138 RCW;
     (xv) Chemical dependency professionals and chemical dependency professional trainees certified under chapter 18.205 RCW;
     (xvi) Sex offender treatment providers and certified affiliate sex offender treatment providers certified under chapter 18.155 RCW;
     (xvii) Persons licensed and certified under chapter 18.73 RCW or RCW 18.71.205;
     (xviii) Denturists licensed under chapter 18.30 RCW;
     (xix) Orthotists and prosthetists licensed under chapter 18.200 RCW;
     (xx) Surgical technologists registered under chapter 18.215 RCW;
     (xxi) Recreational therapists (([under chapter 18.230 RCW])) under chapter 28.230 RCW;
     (xxii) Animal massage practitioners certified under chapter 18.240 RCW;
     (xxiii) Athletic trainers licensed under chapter 18.250 RCW;
     (xxiv) Home care aides certified under chapter 18.88B RCW; and
     (xxv) Genetic counselors licensed under chapter 18.290 RCW.
     (b) The boards and commissions having authority under this chapter are as follows:
     (i) The podiatric medical board as established in chapter 18.22 RCW;
     (ii) The chiropractic quality assurance commission as established in chapter 18.25 RCW;
     (iii) The dental quality assurance commission as established in chapter 18.32 RCW governing licenses issued under chapter 18.32 RCW and licenses and registrations issued under chapter 18.260 RCW;
     (iv) The board of hearing and speech as established in chapter 18.35 RCW;
     (v) The board of examiners for nursing home administrators as established in chapter 18.52 RCW;
     (vi) The optometry board as established in chapter 18.54 RCW governing licenses issued under chapter 18.53 RCW;
     (vii) The board of osteopathic medicine and surgery as established in chapter 18.57 RCW governing licenses issued under chapters 18.57 and 18.57A RCW;
     (viii) The board of pharmacy as established in chapter 18.64 RCW governing licenses issued under chapters 18.64 and 18.64A RCW;
     (ix) The medical quality assurance commission as established in chapter 18.71 RCW governing licenses and registrations issued under chapters 18.71 and 18.71A RCW;
     (x) The board of physical therapy as established in chapter 18.74 RCW;
     (xi) The board of occupational therapy practice as established in chapter 18.59 RCW;
     (xii) The nursing care quality assurance commission as established in chapter 18.79 RCW governing licenses and registrations issued under that chapter;
     (xiii) The examining board of psychology and its disciplinary committee as established in chapter 18.83 RCW;
     (xiv) The veterinary board of governors as established in chapter 18.92 RCW; and
     (xv) The board of naturopathy established in chapter 18.36A RCW.
     (3) In addition to the authority to discipline license holders, the disciplining authority has the authority to grant or deny licenses. The disciplining authority may also grant a license subject to conditions.
     (4) All disciplining authorities shall adopt procedures to ensure substantially consistent application of this chapter, the Uniform Disciplinary Act, among the disciplining authorities listed in subsection (2) of this section.

NEW SECTION.  Sec. 10   The department of health and the Washington nursing care quality assurance commission shall adopt any rules necessary to implement this act.

NEW SECTION.  Sec. 11   Sections 1 through 9 of this act take effect July 1, 2013.