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| 7 | 7 | | LC002689/SUB A |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S TATE OF RHODE IS LAND |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2023 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HEALTH AND SAFETY -- LICENSING OF NURSING SERVICE |
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| 16 | 16 | | AGENCIES |
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| 17 | 17 | | Introduced By: Senators McKenney, and Ruggerio |
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| 18 | 18 | | Date Introduced: April 06, 2023 |
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| 19 | 19 | | Referred To: Senate Labor |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Sections 23-17.7.1-3, 23-17.7.1-10 and 23-17.7.1-11 of the General Laws in 1 |
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| 24 | 24 | | Chapter 23-17.7.1 entitled "Licensing of Nursing Service Agencies" are hereby amended to read 2 |
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| 25 | 25 | | as follows: 3 |
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| 26 | 26 | | 23-17.7.1-3. Licensing of nursing service agencies — Rules governing establishment 4 |
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| 27 | 27 | | of fees. 5 |
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| 28 | 28 | | (a) The director may establish reasonable fees for the licensure application, licensure 6 |
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| 29 | 29 | | renewal, and administrative actions under this chapter. Annual licensure fees shall be five hundred 7 |
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| 30 | 30 | | dollars ($500) per licensee. 8 |
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| 31 | 31 | | (b) Not later than October 1, 2023, the department of health (DOH) shall develop a system 9 |
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| 32 | 32 | | that allows a temporary nursing services agency that provides services in the state to register 10 |
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| 33 | 33 | | annually with the department of health. 11 |
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| 34 | 34 | | (c) The DOH may assess an annual licensure fee of one thousand dollars ($1,000) per 12 |
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| 35 | 35 | | licensee not later than January 1, 2024, no temporary nursing services agency shall provide 13 |
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| 36 | 36 | | temporary nursing services in the state unless it is registered pursuant to subsection (b) of this 14 |
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| 37 | 37 | | section. 15 |
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| 38 | 38 | | (b)(d) The department of health shall promulgate licensure standards, and rules and 16 |
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| 39 | 39 | | regulations governing the operation of nursing service agencies to protect the health and welfare of 17 |
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| 40 | 40 | | patients. These regulations shall include, but not be limited to, employee bonding, maintenance of 18 |
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| 41 | 41 | | |
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| 42 | 42 | | |
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| 43 | 43 | | LC002689/SUB A - Page 2 of 6 |
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| 44 | 44 | | service records, and appropriate staff professional registration and certification, licensure training, 1 |
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| 45 | 45 | | supervision, health screening and liability insurance. 2 |
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| 46 | 46 | | 23-17.7.1-10. Regulations, inspections, and investigations. 3 |
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| 47 | 47 | | (a) The licensing agency shall, after a public hearing pursuant to chapter 35 of title 42, give 4 |
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| 48 | 48 | | notice, adopt, amend, promulgate, and enforce any rules and regulations and standards with respect 5 |
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| 49 | 49 | | to nursing service agencies to be licensed under this chapter that may be designed to further the 6 |
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| 50 | 50 | | accomplishment of the purposes of this chapter in promoting safe and adequate care of individuals 7 |
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| 51 | 51 | | receiving nursing and nursing assistant services, in the interest of public health, safety, and welfare. 8 |
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| 52 | 52 | | All licensed nursing service agencies shall be required to protect clients by insuring that all persons 9 |
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| 53 | 53 | | whom it employs receive training and/or competency evaluation pursuant to the provisions of §§ 10 |
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| 54 | 54 | | 23-17.9-3 and 23-17.7-11. The licensing agency shall make or cause to be made any inspections 11 |
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| 55 | 55 | | and investigations that it deems necessary including service records. 12 |
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| 56 | | - | (b) A nursing service agency's maximum rate for services provided to a nursing facility 13 |
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| 57 | | - | and or assisted living residence, by a nurse or certified nurse assistant shall not exceed two hundred 14 |
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| 58 | | - | percent (200%) of the regional hourly wage of each position. The licensing agency shall use and 15 |
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| 59 | | - | publish the most current median hourly wage data reported by the United States Department of 16 |
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| 60 | | - | Labor Bureau of Labor Statistics (BLS) Wage Estimates for the state. These positions shall include 17 |
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| 61 | | - | registered nurses, licensed practical nurses, certified nurse assistants, and medication aides. The 18 |
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| 62 | | - | maximum rate shall include all charges for administrative fees, contract fees, or other special 19 |
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| 63 | | - | charges in addition to the hourly rates for the temporary nursing pool personnel supplied to a client. 20 |
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| 64 | | - | (c) Records of required health inspections and investigations shall be kept confidential as 21 |
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| 65 | | - | well as all required medical records including COVID-19 testing results, and all other required 22 |
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| 66 | | - | vaccinations required by the department. 23 |
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| 67 | | - | (d) The personnel file and folder for each employee shall be kept confidential, including 24 |
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| 68 | | - | documented evidence of credentials and other appropriate data, including documentation of 25 |
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| 69 | | - | orientation, and quarterly in-service education, records of completion of required training and 26 |
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| 70 | | - | educational programs, medical records, and criminal background checks. 27 |
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| 71 | | - | (e) The staffing agency shall maintain insurance coverage for workers' compensation for 28 |
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| 72 | | - | all nurses, med technicians, certified nursing assistants, therapists and therapist aides provided or 29 |
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| 73 | | - | procured by the agency. 30 |
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| 74 | | - | (f) Records of violations of public health code by all agency staff shall be tracked and made 31 |
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| 75 | | - | a public record. 32 |
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| 76 | | - | (g) The long-term care coordinating council (LTCC) shall develop standards for nurse staff 33 |
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| 77 | | - | agencies and a ranking formula to track all agencies for public accountability. 34 |
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| 56 | + | (b) A nursing service agency's maximum rate for services provided to a client, including, 13 |
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| 57 | + | but not limited to, a nursing facility and or assisted living residence, by a nurse or certified nurse 14 |
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| 58 | + | assistant shall not exceed two hundred percent (200%) of the regional hourly wage of each position. 15 |
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| 59 | + | The licensing agency shall use and publish the most current median hourly wage data reported by 16 |
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| 60 | + | the United States Department of Labor Bureau of Labor Statistics (BLS) Wage Estimates for the 17 |
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| 61 | + | state. These positions shall include registered nurses, licensed practical nurses, certified nurse 18 |
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| 62 | + | assistants, and medication aides. The maximum rate shall include all charges for administrative 19 |
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| 63 | + | fees, contract fees, or other special charges in addition to the hourly rates for the temporary nursing 20 |
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| 64 | + | pool personnel supplied to a client. 21 |
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| 65 | + | (c) Records of required health inspections and investigations shall be kept confidential as 22 |
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| 66 | + | well as all required medical records including COVID-19 testing results, and all other required 23 |
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| 67 | + | vaccinations required by the department. 24 |
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| 68 | + | (d) The personnel file and folder for each employee shall be kept confidential, including 25 |
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| 69 | + | documented evidence of credentials and other appropriate data, including documentation of 26 |
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| 70 | + | orientation, and quarterly in-service education, records of completion of required training and 27 |
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| 71 | + | educational programs, medical records, and criminal background checks. 28 |
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| 72 | + | (e) The staffing agency shall maintain insurance coverage for workers' compensation for 29 |
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| 73 | + | all nurses, med technicians, certified nursing assistants, therapists and therapist aides provided or 30 |
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| 74 | + | procured by the agency. 31 |
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| 75 | + | (f) Records of violations of public health code by all agency staff shall be tracked and made 32 |
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| 76 | + | a public record. 33 |
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| 77 | + | (g) The long-term care coordinating council (LTCC) shall develop standards for nurse staff 34 |
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| 81 | | - | (h) If an employee of a staffing agency is directly connected to a quality of care or a 1 |
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| 82 | | - | substandard quality of care deficiency in a facility, a subsequential investigation by the licensing 2 |
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| 83 | | - | agency shall be conducted at the nursing service agency in which that individual is employed. 3 |
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| 84 | | - | 23-17.7.1-11. Training and/or competency evaluation program for nursing assistants. 4 |
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| 85 | | - | (a) Every individual who is employed to provide nursing assistant services shall be required 5 |
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| 86 | | - | to be registered as required by chapter 17.9 of this title. 6 |
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| 87 | | - | (b) An in-service educational program for direct patient care personnel shall be provided 7 |
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| 88 | | - | on an ongoing basis which shall include orientation for new personnel and periodic programs 8 |
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| 89 | | - | consisting of three (3) hours per quarter at a minimum for the continued improvement and 9 |
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| 90 | | - | development of skills of direct care personnel, including competency training and department 10 |
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| 91 | | - | required training based on licensure. 11 |
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| 92 | | - | SECTION 2. Chapter 23-17.7.1 of the General Laws entitled "Licensing of Nursing 12 |
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| 93 | | - | Service Agencies" is hereby amended by adding thereto the following sections: 13 |
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| 94 | | - | 23-17.7.1-22. Employment prohibitions. 14 |
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| 95 | | - | (a) No nursing service agency shall recruit potential employees from a client to which it 15 |
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| 96 | | - | actively provides services in any contract. 16 |
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| 97 | | - | (b) The nursing service agency shall not, in any contract with any employee of a client, 17 |
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| 98 | | - | require the payment of liquidated damages, employment fees or other compensation should the 18 |
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| 99 | | - | employee be hired as a permanent employee of a client facility. 19 |
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| 100 | | - | 23-17.7.1-23. Annual reporting requirements. 20 |
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| 101 | | - | (a) The agency shall submit an annual statistical report to the department of health 21 |
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| 102 | | - | including, but not limited to: 22 |
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| 103 | | - | (1) Mean, median, and average salaries and hourly pay rates of employees, by employment 23 |
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| 104 | | - | type; 24 |
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| 105 | | - | (2) Number of employees; 25 |
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| 106 | | - | (3) Number of employees terminated; 26 |
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| 107 | | - | (4) Number of employees reported to the office of the attorney general; and 27 |
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| 108 | | - | (5) Number of employees reported to the department for abuse, neglect, misappropriation, 28 |
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| 109 | | - | and job abandonment. 29 |
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| 110 | | - | (b) For every person placed for employment, or temporary performance of services by an 30 |
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| 111 | | - | employment agency with a healthcare provider employer, the employment agency shall annually 31 |
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| 112 | | - | report: 32 |
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| 113 | | - | (1) The amount charged for each person; 33 |
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| 114 | | - | (2) The amount paid to each person; 34 |
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| 81 | + | agencies and a ranking formula to track all agencies for public accountability. 1 |
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| 82 | + | (h) If an employee of a staffing agency is directly connected to a quality of care or a 2 |
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| 83 | + | substandard quality of care deficiency in a facility, a subsequential investigation by the licensing 3 |
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| 84 | + | agency shall be conducted at the nursing service agency in which that individual is employed. 4 |
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| 85 | + | 23-17.7.1-11. Training and/or competency evaluation program for nursing assistants. 5 |
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| 86 | + | (a) Every individual who is employed to provide nursing assistant services shall be required 6 |
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| 87 | + | to be registered as required by chapter 17.9 of this title. 7 |
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| 88 | + | (b) An in-service educational program for direct patient care personnel shall be provided 8 |
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| 89 | + | on an ongoing basis which shall include orientation for new personnel and periodic programs 9 |
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| 90 | + | consisting of three (3) hours per quarter at a minimum for the continued improvement and 10 |
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| 91 | + | development of skills of direct care personnel, including competency training and department 11 |
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| 92 | + | required training based on licensure. 12 |
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| 93 | + | SECTION 2. Chapter 23-17.7.1 of the General Laws entitled "Licensing of Nursing 13 |
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| 94 | + | Service Agencies" is hereby amended by adding thereto the following sections: 14 |
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| 95 | + | 23-17.7.1-22. Employment prohibitions. 15 |
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| 96 | + | (a) No nursing service agency shall recruit and/or hire potential employees from a client to 16 |
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| 97 | + | which it actively provides services in any contract. 17 |
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| 98 | + | (b) The nursing service agency shall not, in any contract with any employee of a client, 18 |
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| 99 | + | require the payment of liquidated damages, employment fees or other compensation should the 19 |
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| 100 | + | employee be hired as a permanent employee of a client facility. 20 |
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| 101 | + | 23-17.7.1-23. Annual reporting requirements. 21 |
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| 102 | + | (a) The agency shall submit an annual statistical report to the department of health 22 |
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| 103 | + | including, but not limited to: 23 |
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| 104 | + | (1) Mean, median, and average salaries and hourly pay rates of employees, by employment 24 |
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| 105 | + | type; 25 |
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| 106 | + | (2) Number of employees; 26 |
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| 107 | + | (3) Number of employees terminated; 27 |
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| 108 | + | (4) Number of employees reported to the office of the attorney general; and 28 |
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| 109 | + | (5) Number of employees reported to the department for abuse, neglect, misappropriation, 29 |
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| 110 | + | and job abandonment. 30 |
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| 111 | + | (b) For every person placed for employment, or temporary performance of services by an 31 |
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| 112 | + | employment agency with a healthcare provider employer, the employment agency shall annually 32 |
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| 113 | + | report: 33 |
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| 114 | + | (1) The amount charged for each person; 34 |
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| 118 | | - | (3) The amount of payment received that is retained by the employment agency; 1 |
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| 119 | | - | (4) Any other information that the department, in conjunction with the department of 2 |
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| 120 | | - | human services, determines relevant to determine how much health care provider employers who 3 |
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| 121 | | - | participate in Medicare and Medicaid are charged by employment agency services. 4 |
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| 122 | | - | (c) Reports under this section shall be submitted by the employment agencies no later than 5 |
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| 123 | | - | thirty (30) days after the end of the calendar year. 6 |
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| 118 | + | (2) The amount paid to each person; 1 |
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| 119 | + | (3) The amount of payment received that is retained by the employment agency; 2 |
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| 120 | + | (4) Any other information that the department, in conjunction with the department of 3 |
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| 121 | + | human services, determines relevant to determine how much health care provider employers who 4 |
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| 122 | + | participate in Medicare and Medicaid are charged by employment agency services. 5 |
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| 123 | + | (c) Reports under this section shall be submitted by the employment agencies no later than 6 |
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| 124 | + | thirty (30) days after the end of the calendar year. 7 |
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