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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2023

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A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF NURSING SERVICE

AGENCIES

     Introduced By: Senators McKenney, and Ruggerio

     Date Introduced: April 06, 2023

     Referred To: Senate Labor

     It is enacted by the General Assembly as follows:

     SECTION 1. Sections 23-17.7.1-3, 23-17.7.1-10 and 23-17.7.1-11 of the General Laws in

Chapter 23-17.7.1 entitled "Licensing of Nursing Service Agencies" are hereby amended to read

as follows:

     23-17.7.1-3. Licensing of nursing service agencies — Rules governing establishment

of fees.

     (a) The director may establish reasonable fees for the licensure application, licensure

renewal, and administrative actions under this chapter. Annual licensure fees shall be five hundred

dollars ($500) per licensee.

     (b) Not later than October 1, 2023, the department of health (DOH) shall develop a system

that allows a temporary nursing services agency that provides services in the state to register

annually with the department of health.

     (c) The DOH may assess an annual licensure fee of one thousand dollars ($1,000) per

licensee not later than January 1, 2024, no temporary nursing services agency shall provide

temporary nursing services in the state unless it is registered pursuant to subsection (b) of this

section.

     (b)(d) The department of health shall promulgate licensure standards, and rules and

regulations governing the operation of nursing service agencies to protect the health and welfare of

patients. These regulations shall include, but not be limited to, employee bonding, maintenance of

service records, and appropriate staff professional registration and certification, licensure training,

supervision, health screening and liability insurance.

     23-17.7.1-10. Regulations, inspections, and investigations.

     (a) The licensing agency shall, after a public hearing pursuant to chapter 35 of title 42, give

notice, adopt, amend, promulgate, and enforce any rules and regulations and standards with respect

to nursing service agencies to be licensed under this chapter that may be designed to further the

accomplishment of the purposes of this chapter in promoting safe and adequate care of individuals

receiving nursing and nursing assistant services, in the interest of public health, safety, and welfare.

All licensed nursing service agencies shall be required to protect clients by insuring that all persons

whom it employs receive training and/or competency evaluation pursuant to the provisions of §§

23-17.9-3 and 23-17.7-11. The licensing agency shall make or cause to be made any inspections

and investigations that it deems necessary including service records.

     (b) A nursing service agency's maximum rate for services provided to a client, including,

but not limited to, a nursing facility and or assisted living residence, by a nurse or certified nurse

assistant shall not exceed two hundred percent (200%) of the regional hourly wage of each position.

The licensing agency shall use and publish the most current median hourly wage data reported by

the United States Department of Labor Bureau of Labor Statistics (BLS) Wage Estimates for the

state. These positions shall include registered nurses, licensed practical nurses, certified nurse

assistants, and medication aides. The maximum rate shall include all charges for administrative

fees, contract fees, or other special charges in addition to the hourly rates for the temporary nursing

pool personnel supplied to a client.

     (c) Records of required health inspections and investigations shall be kept confidential as

well as all required medical records including COVID-19 testing results, and all other required

vaccinations required by the department.

     (d) The personnel file and folder for each employee shall be kept confidential, including

documented evidence of credentials and other appropriate data, including documentation of

orientation, and quarterly in-service education, records of completion of required training and

educational programs, medical records, and criminal background checks.

     (e) The staffing agency shall maintain insurance coverage for workers' compensation for

all nurses, med technicians, certified nursing assistants, therapists and therapist aides provided or

procured by the agency.

     (f) Records of violations of public health code by all agency staff shall be tracked and made

a public record.

     (g) The long-term care coordinating council (LTCC) shall develop standards for nurse staff

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agencies and a ranking formula to track all agencies for public accountability.

     (h) If an employee of a staffing agency is directly connected to a quality of care or a

substandard quality of care deficiency in a facility, a subsequential investigation by the licensing

agency shall be conducted at the nursing service agency in which that individual is employed.

     23-17.7.1-11. Training and/or competency evaluation program for nursing assistants.

     (a) Every individual who is employed to provide nursing assistant services shall be required

to be registered as required by chapter 17.9 of this title.

     (b) An in-service educational program for direct patient care personnel shall be provided

on an ongoing basis which shall include orientation for new personnel and periodic programs

consisting of three (3) hours per quarter at a minimum for the continued improvement and

development of skills of direct care personnel, including competency training and department

required training based on licensure.

     SECTION 2. Chapter 23-17.7.1 of the General Laws entitled "Licensing of Nursing

Service Agencies" is hereby amended by adding thereto the following sections:

     23-17.7.1-22. Employment prohibitions.

     (a) No nursing service agency shall recruit and/or hire potential employees from a client to

which it actively provides services in any contract.

     (b) The nursing service agency shall not, in any contract with any employee of a client,

require the payment of liquidated damages, employment fees or other compensation should the

employee be hired as a permanent employee of a client facility.

     23-17.7.1-23. Annual reporting requirements.

     (a) The agency shall submit an annual statistical report to the department of health

including, but not limited to:

     (1) Mean, median, and average salaries and hourly pay rates of employees, by employment

type;

     (2) Number of employees;

     (3) Number of employees terminated;

     (4) Number of employees reported to the office of the attorney general; and

     (5) Number of employees reported to the department for abuse, neglect, misappropriation,

and job abandonment.

     (b) For every person placed for employment, or temporary performance of services by an

employment agency with a healthcare provider employer, the employment agency shall annually

report:

     (1) The amount charged for each person;

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     (2) The amount paid to each person;

     (3) The amount of payment received that is retained by the employment agency;

     (4) Any other information that the department, in conjunction with the department of

human services, determines relevant to determine how much health care provider employers who

participate in Medicare and Medicaid are charged by employment agency services.

     (c) Reports under this section shall be submitted by the employment agencies no later than

thirty (30) days after the end of the calendar year.

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     SECTION 3. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- LICENSING OF NURSING SERVICE

AGENCIES

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     This act would establish a cap on the rates that nursing service agencies can charge. The

act also would protect clients from having their staff recruited and hired by a nursing service agency

while providing services to them. Lastly, the act would update some training, reporting, and other

administrative details.

     This act would take effect upon passage.

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