Date: 01/14/2009

Final
Sunset Review of Nurse Aide Certification Program

SENATE COMMITTEE ON HEALTH AND HUMAN SERVICES

Votes: View--> Action Taken:
Adopt prepared amendment L.001 (Attachment G). Th
Amend the draft bill to add language to section 24
Amend the draft bill (Attachment F), to change the
Introduce the draft bill (Attachment ), as amended
Pass Without Objection
Pass Without Objection
Pass Without Objection
PASS



11:45 AM -- Sunset Review of Nurse Aide Certification Program

Brian Tobias, Department of Regulatory Agencies, discussed the Sunset Review of the Nurse Aide Certification Program (Attachment E) and the draft bill containing the recommendations of the department with regard to the program (Attachment F). He walked the committee through draft bill, and described DORA's recommendations. These recommendations include: Recommendation 1 - continue the regulation of certified nurse aides through July 1, 2020; Recommendation 2 - change the composition of the Nurse Aide Advisory Committee (advisory committee) to allow a professional nurse or practical nurse who supervises CNAs to serve on the committee and simplify the requirements for those members of the committee who represent the public; Recommendation 3 - change the make-up of the advisory committee and authorize members of the advisory committee to receive a per diem; Recommendation 4 - repeal the Medication Administration Advisory Committee; Recommendation 5 - clarify the ground for discipline regarding drug use and add failure to respond to the State Board of Nursing and the failure to report a criminal conviction as the grounds for discipline; Recommendation 6 - consolidate language regarding unauthorized nurse aide practice; Recommendation 7 - allow the Board of Nursing to require a CNA to undergo a physical or mental health examination by a licensed health care provider other than a physician; Recommendation 8 - repeal the requirement that proceedings related to complaints where formal charges were filed be subject to the open records law; Recommendation 9 - repeal the statutes specifying the scope of practice, education, and experience requirements for certification as a medication aide and require the Board of Nursing to promulgate rules in these areas; Recommendation 10 - authorize the board to require CNA training programs to include up to 25 percent more hours than the minimum federal requirements; Recommendation 11 - specify that the four months that a CNA may work without certification must be consecutive; Recommendation 12 - extend the waiting period for a CNA whose certification has been denied, revoked, or surrendered from one year to two years before the Board of Nursing may reinstate the certification; and Recommendation 13 - repeal the section in the "Nurse Practice Act" that prohibits a registered nurse from delegating the authority to select medications to another person if the person is not otherwise authorized to select medications.

09SenateHHS0114AttachE.pdf

11:58 AM

Senator Carroll discussed recommendation 8, which concerns a repeal of the requirement that proceedings related to complaints where formal charges are filed be subject to the open records law. She stated her belief that disciplinary actions should be open for public inspection. Mr. Tobias clarified that the documentation of the CNA's disciplinary action is still public and that the only thing that the recommendation changes is that the discussions related to the disciplinary action would be closed.

12:02 PM --
Susan Miller, Board of Nursing, came to the table to discuss recommendation 8. She stated that all disciplinary actions and formal charges filed are public, and the recommendation does not change that requirement. Ms. Miller explained that when the Board of Nursing meets to consider cases in which formal charges are filed, because the discussions are related to pending litigation and are protected by attorney client privilege, the board often goes into an executive session, which the public cannot attend. Therefore, the requirement that the meetings be open gives the public the impression that the meetings will be open when, in fact, they are often closed by executive session. Ms. Miller stated that the recommendation is not an attempt to make the process less transparent, but is aimed at improving administrative processes. Senator Carroll asked why the Board of Nursing needs to go into executive session when considering charges, and Ms. Miller explained why the board might enter into an executive session with its attorney. Senator Carroll and Ms. Miller dialogued on the need for executive sessions to protect attorney client privilege in situations in which formal charges against a nurse have been filed.


12:12 PM

Senator Tochtrop asked if the language regarding disciplinary proceedings for other professions is similar to that contained in recommendation 8 and Ms. Miller responded that the language in the draft bill was mirrored on language from the Dental Practice Act.


12:14 PM

Mr. Tobias continued his discussion of the recommendations contained in the sunset report. He discussed the recommendation that the Board of Nursing be authorized to require more training hours than those required by federal law. Mr. Tobias responded to questions from Senator Newell regarding recommendation 7, which allows the Board of Nursing to require a CNA to undergo a physical or mental examination by a licensed health care provider other than a physician. Mr. Tobias responded to questions from Senator Schultheis regarding the recommendation that the members of the advisory committee be permitted to receive a per diem of $50 for their services, noting that the program is funded through licensing fees which would be the source of funding for the per diem.

12:24 PM --
Joyce Humiston, Colorado Health Care Association, testified regarding her involvement with the advisory committee on medication aides. She testified that nobody is employing medication aides currently. She testified in support of recommendation 9, stating that the Board of Nursing should have the authority over the medication aide program. She stated that 26 states currently use medication aides, and that when Colorado passed its medication aide law, it was one of the most stringent in the country. She discussed the training requirements for CNAs employed by the nursing homes that she oversees, stating that the training hours required by her facility exceed federal standards. She discussed recommendation 11, which specifies that the four months that a CNA may work without certification must be consecutive. She requested that there be a waiver for the four-month certification period, noting that CNAs in rural areas often have difficulty complying with the requirement.


12:30 PM

Kristen Forrestal, Office of Legislative Legal Services, came to the table to address the draft bill (Attachment F). She explained that all sunset bills are required to have a safety clause, so that they take effect before program expires on July 1 of any year. She suggested that the committee could adopt an amendment to the sunset statute, section 24-34-104, C.R.S., which would permit future sunset bills to contain an effective date clause.

09SenateHHS0114AttachF.pdf
BILL:Sunset Review of Nurse Aide Certification Program
TIME: 12:30:37 PM
MOVED:Boyd
MOTION:Amend the draft bill to add language to section 24-35-104.5, C.R.S., which would permit future sunset bills to contain an effective date clause rather than a safety clause. The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


12:33 PM

Ms. Forrestal explained amendment L.001 (Attachment G). The amendment changes language implementing recommendation 5 concerning drug abuse as a grounds for discipline of a CNA.

09SenateHHS0114AttachG.pdf

BILL:Sunset Review of Nurse Aide Certification Program
TIME: 12:33:39 PM
MOVED:Boyd
MOTION:Adopt prepared amendment L.001 (Attachment G). The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection


12:34 PM

Senator Boyd discussed a possible amendment to create a waiver to the four month period during which a CNA may work without being certified. She stated that she will work with interested parties and offer that amendment when the draft bill is introduced and returns to the Senate Health and Human Services Committee for consideration. Senator Schultheis discussed the number of training hours required for CNAs, and Senator Tochtrop noted that the language regarding training for CNAs is permissive.
BILL:Sunset Review of Nurse Aide Certification Program
TIME: 12:38:29 PM
MOVED:Boyd
MOTION:Introduce the draft bill (Attachment F), as amended. The motion passed on a 4-0 roll call vote, with 3 members excused.
SECONDED:
VOTE
Carroll M.
Excused
Mitchell
Excused
Morse
Excused
Newell
Yes
Schultheis
Yes
Tochtrop
Yes
Boyd
Yes
Final YES: 4 NO: 0 EXC: 3 ABS: 0 FINAL ACTION: PASS


12:39 PM

Senator Boyd agreed to be the prime sponsor of the bill, and Senator Tochtrop and Senator Newell were added as cosponsors.


01:03 PM

Kristen Forrestal, Office of Legislative Legal Services, returned to the table to advise the committee that the sunset date of the program should be moved from July 1 to September 1 if the committee wished to allow for the use of an effective date clause rather than a safety clause in future sunset bills regarding the program.
BILL:Sunset Review of Nurse Aide Certification Program
TIME: 01:04:59 PM
MOVED:Boyd
MOTION:Amend the draft bill (Attachment F), to change the future sunset date from July 1, 2020, to September 1, 2020. The motion passed without objection.
SECONDED:
VOTE
Carroll M.
Mitchell
Morse
Newell
Schultheis
Tochtrop
Boyd
Not Final YES: 0 NO: 0 EXC: 0 ABS: 0 FINAL ACTION: Pass Without Objection