1. 11/15/2018
County Local Mental Hygiene Directors (CLMHD) Update on Nurse Practice Act Changes
September 16, 2015

2. Purpose of the Briefing
11/15/2018
Purpose of the Briefing
Update CLMHD to MHL Changes to Nurse Practice Act Exemption
AND
Impact of these changes for local offices in terms of Certificate of Need (CON) applications

3. Nurse Practice Act Exemption Changes
11/15/2018
Nurse Practice Act Exemption Changes
The Nurse Practice Act Exemption Clause for OPWDD was enacted by Chapter 58 of the Laws of 2014
It expanded the exemption for the provision of certain nursing tasks performed by direct support professionals (DSPs) to include programs approved funded/and/or authorized by OPWDD (in addition to the already existing exemption for certified residential settings).
The Enacted Budget included additional changes necessary to fully implement the NPA Exemption Clause in community based settings throughout OPWDD’s service system.

4. Implications of 2015-16 MHL Changes to Waiver Service Providers
11/15/2018
Implications of MHL Changes to Waiver Service Providers
The MHL changes require OPWDD to commence the issuance of operating certificates for all waiver services by converting existing approved Provider Agreements to operating certificates, and,
To authorize through operating certificates qualified providers’ to deliver nursing services under certain waiver services in community based settings (non-certified sites/settings) where such waiver services are delivered to individuals with these nursing needs.
ADM # – Registered nurses supervision of unlicensed direct care staff in residential facilities CERTIFIED by the Office of Mental Retardation and Developmental Disabilities (now OPWDD)
NEW: MOU between OPWDD And SED
NEW: ADM # – Registered professional nurse supervision of unlicensed direct support professionals in programs approved by the Office for People with Developmental Disabilities (in certain NON-certified sites).

5. Community Habilitation/Habilitation Services Respite Services
11/15/2018
Waiver Services where Routine Nursing Services May Be Provided Upon Authorization in Community
Community Habilitation/Habilitation Services
Respite Services
Day Habilitation provided in the community

6. Tasks that can be Delegated in writing by an RN to a DSP:
11/15/2018
Tasks that can be Delegated in writing by an RN to a DSP:
Bladder catheterization and care (except for insertion or removal of indwelling catheters or procedures requiring sterile techniques);
Non-sterile dressing changes;
Glucose monitoring tests using medical devices approved by the FDA for over-the-counter use, if used for a single individual

7. Tasks that can be Delegated in writing by an RN to a DSP:
11/15/2018
Tasks that can be Delegated in writing by an RN to a DSP:
Respiratory care tasks, such as basic spirometry, oxygen administration, and nebulizer treatments;
Permanent gastrostomy or jejunostomy tube feedings;
Colostomy care that does not require sterile techniques;
Basic medication administration tasks
Subcutaneous injections of diabetes-related medications and emergency injections (including but not limited to, epinephrine, narcan, glucagon)

8. Tasks that Can NOT be delegated:
11/15/2018
Tasks that Can NOT be delegated:
Activities outside scope of practice of a licensed practical nurse;
Administration of meds or fluids parenterally (except for subcontaneous injections or diabetes-related medications or emergency injections)
Services that are inconsistent with care ordered or prescribed by a physician, physician assistant, nurse practitioner, dentist or podiatrist
Administration of controlled substances, except for federal Schedule IV and Schedule V prescribed to treat seizure disorders or another developmental disability

9. Tasks that Can NOT be Delegated:
11/15/2018
Tasks that Can NOT be Delegated:
Insertion or removal of indwelling catheters;
Services requiring sterile techniques; and
Any nursing care that requires professional nursing judgment, including the assessment of the medication needs of an individual served by OPWDD.

10. Procedures and Requirements
11/15/2018
Procedures and Requirements
Initial Assessment
Delegation Decisions
Documentation of Delegation Decisions
RN Supervision of DSPs
Training
Ratios of Available RNs to DSPs
Frequency of Visits
Plan of Nursing Services
Clinical Performance Evaluations of DSPs by RN

11. 11/15/2018
Implementation
Certificate of Need (CON) Applications required for all Waiver Services and to add nursing service delivery in the community
OPWDD review of provider qualifications and policies and procedures to add nursing services and determination of whether to authorize
OPWDD is in the process of implementing the most recent changes to the NPA exemption clause so that providers can begin to deliver routine nursing services in the community

12. 11/15/2018
Implementation
A framework of training material and expectations needs to be developed for delivering routine nursing services in community based settings.
AMAP curriculum changes to be developed and implemented
Including medication on the go
Controlled substances
Medication storage
Administrative Memorandum and other guidance outlining expectations and standards to be issued
Contents of policies and procedures that providers must have in place to be authorized to deliver nursing services in community based settings.

13. 11/15/2018
Role of Local Offices for initial conversion to operating certificates for all waiver services
Local offices will receive all CON Applications for the conversion from provider agreements to operating certificates (routine pro-forma as OPWDD is required to notify as a result of the regulations)
If no action/objection within ten days, OPWDD will proceed with approval process.

14. Role of Local Offices—Ongoing
11/15/2018
Role of Local Offices—Ongoing
A CON APPLICATION is REQUIRED:
For any new HCBS waiver provider or current waiver provider opting to add or remove waiver services
For those waiver providers who wish to offer nursing services (e.g., medication administration) to individuals who are receiving habilitation services in a non-traditional/community-based settings.

15. 11/15/2018
Tentative Timelines
Initial Conversion of Waiver Services to Operating Certificates

16. 11/15/2018
Questions?