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                                                       PRINTER'S NO. 197



No. 171 Session of 2007


           FEBRUARY 1, 2007

                                     AN ACT

     1  Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
     2     act relating to health care; prescribing the powers and
     3     duties of the Department of Health; establishing and
     4     providing the powers and duties of the State Health
     5     Coordinating Council, health systems agencies and Health Care
     6     Policy Board in the Department of Health, and State Health
     7     Facility Hearing Board in the Department of Justice;
     8     providing for certification of need of health care providers
     9     and prescribing penalties," further providing for purposes,
    10     for definitions, for powers of the Department of Health, for
    11     administration and for licensure; providing for compliance
    12     with staffing plans and recordkeeping, for work assignment
    13     policies and for public disclosure of staffing requirements;
    14     further providing for license standards, reliance on
    15     accrediting agencies and Federal Government, for medical
    16     assistance payments and for civil penalties; and providing
    17     for private cause of action and for grants and loan programs
    18     for nurse recruitment.

    19     The General Assembly of the Commonwealth of Pennsylvania
    20  hereby enacts as follows:
    21     Section 1.  Section 102 of the act of July 19, 1979 (P.L.130,
    22  No.48), known as the Health Care Facilities Act, is amended to
    23  read:

     1  Section 102.  Purposes.
     2     The General Assembly finds [that] as follows:
     3         (1)  That the health and welfare of Pennsylvania citizens
     4     will be enhanced by the orderly and economical distribution
     5     of health care resources to prevent needless duplication of
     6     services. Such distribution of resources will be further by
     7     governmental involvement to coordinate the health care
     8     system. Such a system will enhance the public health and
     9     welfare by making the delivery system responsive and adequate
    10     to the needs of its citizens, and assuring that new health
    11     care services and facilities are efficiently and effectively
    12     used; that health care services and facilities continue to
    13     meet high quality standards; and, that all citizens receive
    14     humane, courteous and dignified treatment. In developing such
    15     a coordinated health care system, it is the policy of the
    16     Commonwealth to foster responsible private operation and
    17     ownership of health care facilities, to encourage innovation
    18     and continuous development of improved methods of health care
    19     and to aid efficient and effective planning using local
    20     health systems agencies. It is the intent of the General
    21     Assembly that the Department of Health foster a sound health
    22     care system which provides for quality care at appropriate
    23     health care facilities throughout the Commonwealth.
    24         (2)  That a substantial interest exists in assuring that
    25     delivery of health care services to patients in health care
    26     facilities located within this Commonwealth is adequate and
    27     safe and that health care facilities retain sufficient
    28     nursing staff so as to promote optimal health care outcomes.
    29     Inadequate hospital staffing results in dangerous medical
    30     errors and patient infections. Registered nurses constitute
    20070H0171B0197                  - 2 -     

     1     the highest percentage of direct health care staff in acute
     2     care facilities and have a central role in health care
     3     delivery. To ensure the adequate protection and care for
     4     patients in health care facilities it is essential that
     5     qualified registered nurses be accessible and available to
     6     meet the nursing needs of patients. Inadequate and poorly
     7     monitored nurse staffing practices which result in having too
     8     few registered nurses providing care jeopardize delivery of
     9     quality health care services and adversely impact the health
    10     of patients who enter hospitals and outpatient emergency and
    11     surgical centers. The basic principles of staffing in health
    12     care facilities should be focused on patient health care
    13     needs and based on consideration of patient acuity levels and
    14     services that need to be provided to ensure optimal outcomes.
    15  While the focus of this act is on registered nurses who are
    16  principal caregivers, safe staffing practices recognize the
    17  importance of all health care workers in providing quality
    18  patient care. The setting of staffing standards for registered
    19  nurses is not to be interpreted as justifying the understaffing
    20  of other critical health care workers, including licensed
    21  practical nurses, social workers and unlicensed assistive
    22  personnel. Indeed, the availability of these other health care
    23  workers enables registered nurses to focus on the nursing care
    24  functions that only registered nurses, by law, are permitted to
    25  perform and thereby helps to ensure adequate staffing levels.
    26  Establishing staffing standards for registered nurses in acute
    27  care facilities ensures that health care facilities throughout
    28  this Commonwealth operate in a manner that guarantees the public
    29  safety and the delivery of quality health care services. In
    30  order to meet these standards incentives must be created to
    20070H0171B0197                  - 3 -     

     1  increase the number of registered nurses within this
     2  Commonwealth.
     3     Section 2.  Section 103 of the act is amended by adding
     4  definitions to read:
     5  Section 103.  Definitions.
     6     The following words and phrases when used in this act shall
     7  have, unless the context clearly indicates otherwise, the
     8  meanings given to them in this section:
     9     * * *
    10     "Acuity system."  An established measurement instrument that:
    11         (1)  Predicts nursing care requirements for individual
    12     patients based on severity of patient illness, need for
    13     specialized equipment and technology, intensity of nursing
    14     interventions required and the complexity of clinical nursing
    15     judgment needed to design, implement and evaluate the
    16     patient's nursing care plan.
    17         (2)  Details the amount of nursing care needed, both in
    18     number of direct care nurses and in skill mix of nursing
    19     personnel required on a daily basis for each patient in a
    20     nursing department or unit.
    21         (3)  Is stated in terms that readily can be used and
    22     understood by direct-care nurses. The acuity system shall
    23     take into consideration the patient care services provided
    24     not only by registered nurses but also by licensed practical
    25     nurses and other health care personnel.
    26     "Assessment tool."  A measurement system that compares the
    27  staffing level in each nursing department or unit against actual
    28  patient nursing care requirements in order to review the
    29  accuracy of an acuity system.
    30     * * *
    20070H0171B0197                  - 4 -     

     1     "Direct-care nurse."  A registered nurse who has direct
     2  responsibility to oversee or directly carry out medical
     3  regimens, nursing or other bedside care for one or more
     4  patients.
     5     "Documented staffing plan."  A detailed written plan setting
     6  forth the minimum number and classification of direct-care
     7  nurses required in each nursing department or unit in the health
     8  facility for a given year, based on reasonable projections
     9  derived from the patient census and average acuity level within
    10  each department or unit during the prior year, the department or
    11  unit size and geography, the nature of services provided and any
    12  foreseeable changes in department or unit size or function
    13  during the current year.
    14     "Extended care facility."  A home health care agency, a
    15  hospice or a long-term care nursing facility.
    16     * * *
    17     "Nurse" or "registered nurse."  An individual licensed to
    18  practice professional nursing under the act of May 22, 1951
    19  (P.L.317, No.69), known as "The Professional Nursing Law."
    20     "Nursing care."  Care that falls within the scope of practice
    21  as prescribed by State law or otherwise encompassed within
    22  recognized professional standards of nursing practice, including
    23  assessment, nursing diagnosis, planning, intervention,
    24  evaluation and patient advocacy.
    25     * * *
    26     "Staffing level."  The actual numerical nurse-to-patient
    27  ratio within a nursing department or unit.
    28     * * *
    29     "Unit."  A patient care component within a facility as
    30  defined by the Department of Health.
    20070H0171B0197                  - 5 -     

     1     Section 3.  Section 803 of the act, added July 12, 1980
     2  (P.L.655, No.136), is amended to read:
     3  Section 803.  Powers of the Department of Health.
     4     The Department of Health shall have the power and its duty
     5  shall be:
     6         (1)  to promulgate, after consultation with the policy
     7     board, the rules and regulations necessary to carry out the
     8     purposes and provisions of this chapter[; and], including
     9     regulations defining terms, setting forth direct-care nurse-
    10     to-patient ratios and prescribing the process for approving
    11     acuity systems;
    12         (2)  to assure that the provisions of this chapter and
    13     all rules and regulations promulgated under this chapter are
    14     enforced[.]; and
    15         (3)  to promulgate, within six months of the effective
    16     date of this paragraph, regulations providing for an
    17     accessible and confidential system to report the failure to
    18     comply with requirements of this chapter and public access to
    19     information regarding reports of inspections, results,
    20     deficiencies and corrections under this chapter.
    21     Section 4.  Sections 804 and 806 of the act are amended by
    22  adding subsections to read:
    23  Section 804.  Administration.
    24     * * *
    25     (e)  Approval of acuity system.--The department shall adopt
    26  regulations prescribing the method by which it will approve a
    27  facility's acuity system. The regulations may include a system
    28  for class approval of acuity systems.
    29  Section 806.  Licensure.
    30     * * *
    20070H0171B0197                  - 6 -     

     1     (h)  Staffing requirements.--Each health care facility, other
     2  than an extended care facility, licensed pursuant to this act
     3  shall ensure that it is staffed in a manner that provides
     4  sufficient, appropriately qualified direct-care nurses in each
     5  department or unit within the facility in order to meet the
     6  individualized care needs of its patients and to meet all of the
     7  following requirements:
     8         (1)  As a condition of licensing, each facility annually
     9     shall submit to the department a documented staffing plan
    10     together with a written certification that the staffing plan
    11     is sufficient to provide adequate and appropriate delivery of
    12     health care services to patients for the ensuing year and
    13     does all of the following:
    14             (i)  meets the minimum requirements of paragraph (2);
    15             (ii)  meets any additional requirements of other laws
    16         or regulations;
    17             (iii)  employs and identifies an approved acuity
    18         system for addressing fluctuations in actual patient
    19         acuity levels and nursing care requirements requiring
    20         increased staffing levels above the minimums set forth in
    21         the plan;
    22             (iv)  factors in other unit or department activity
    23         such as discharges, transfers and admissions,
    24         administrative and support tasks that are expected to be
    25         done by direct-care nurses in addition to direct nursing
    26         care;
    27             (v)  factors in the staffing level of and services
    28         provided by other health care personnel in meeting
    29         patient care needs, except that the staffing plan may not
    30         incorporate or assume that nursing care functions
    20070H0171B0197                  - 7 -     

     1         required by licensing law or regulations or accepted
     2         standards of practice to be performed by a registered
     3         nurse are to be performed by other personnel;
     4             (vi)  identifies the assessment tool used to validate
     5         the acuity system relied on in the plan;
     6             (vii)  identifies the system that will be used to
     7         document actual staffing on a daily basis within each
     8         department or unit;
     9             (viii)  includes a written assessment of the accuracy
    10         of the prior year's staffing plan in light of actual
    11         staffing needs;
    12             (ix)  identifies each nurse staff classification
    13         referenced in the plan together with a statement setting
    14         forth minimum qualifications for each classification; and
    15             (x)  is produced in consultation with a majority of
    16         the direct-care nurses within each department or unit or,
    17         where applicable, with the recognized or certified
    18         collective bargaining representative or representative of
    19         the direct-care nurses.
    20         (2)  The staffing plan must incorporate, at a minimum,
    21     the following direct-care nurse-to-patient ratios:
    22             (i)  One nurse to one patient: operating room and
    23         trauma emergency units.
    24             (ii)  One nurse to two patients: all critical care
    25         areas including emergency critical care and all intensive
    26         care units, labor and delivery units and postanesthesia
    27         units.
    28             (iii)  One nurse to three patients: antepartum,
    29         emergency room, pediatrics, step-down and telemetry
    30         units.
    20070H0171B0197                  - 8 -     

     1             (iv)  One nurse to four patients: intermediate care
     2         nursery, and medical/surgical and acute care psychiatric
     3         units.
     4             (v)  One nurse to five patients: rehabilitation
     5         units.
     6             (vi)  One nurse to six patients: postpartum (three
     7         couplets) and well-baby nursery units.
     8             (vii)  For any units not listed above, including
     9         psychiatric units in facilities other than acute care
    10         hospitals, such direct-care nurse-to-patient ratio as
    11         established by the department.
    12         (3)  The ratios set forth in paragraph (2) shall
    13     constitute the maximum number of patients that may be
    14     assigned to each direct-care nurse in a unit during one
    15     shift. A nurse, including a nurse administrator or
    16     supervisor, who does not have principal responsibility as a
    17     direct-care nurse for a specific patient shall not be
    18     included in the calculation of the nurse-to-patient ratio.
    19         (4)  Nothing shall preclude the department from
    20     establishing and requiring a staffing plan to have higher
    21     nurse-to-patient ratios than those set forth in paragraph
    22     (2).
    23         (5)  The staffing plan may not incorporate or assume that
    24     nursing care functions required by licensing law or
    25     regulations or accepted standards of practice to be performed
    26     by a registered nurse are to be performed by other personnel.
    27     Section 5.  The act is amended by adding sections to read:
    28  Section 806.5.  Compliance with staffing plan and recordkeeping.
    29     (a)  Plan.--As a condition of licensing, a health care
    30  facility required to have a staffing plan under section 806(h)
    20070H0171B0197                  - 9 -     

     1  shall at all times staff in accordance with its staffing plan
     2  and the staffing standards set forth under section 806(h),
     3  provided that nothing herein shall be deemed to preclude any
     4  such health care facility from implementing higher direct-care
     5  nurse-to-patient staffing levels, nor shall the requirements set
     6  forth be deemed to supersede or replace any higher requirements
     7  otherwise mandated by law, regulation or contract.
     8     (b)  Appropriate license required.--For purposes of
     9  compliance with the minimum staffing requirements standards set
    10  forth under section 806(h), no nurse shall be assigned, or
    11  included in the count of assigned nursing staff in a nursing
    12  department or unit or a clinical area within the health facility
    13  unless that nurse has an appropriate license under the
    14  applicable registered nurse law, received prior orientation in
    15  that clinical area sufficient to provide competent nursing care
    16  to the patients in that area, and has demonstrated current
    17  competence in providing care in that area. Hospitals that
    18  utilize temporary nursing agencies shall have and adhere to a
    19  written procedure to orient and evaluate personnel from these
    20  sources to ensure adequate orientation and competency prior to
    21  inclusion in the nurse-to-patient ratio.
    22     (c)  Daily records.--As a condition of licensure, each health
    23  care facility required to have a staffing plan under section
    24  806(h) shall maintain accurate daily records showing:
    25         (1)  The number of patients admitted, released and
    26     present in each nursing department or unit within the
    27     facility.
    28         (2)  The individual acuity level of each patient present
    29     in each nursing department or unit within the facility.
    30         (3)  The identity and duty hours of each direct-care
    20070H0171B0197                 - 10 -     

     1     nurse in each nursing department or unit within the facility.
     2     (d)  Daily statistics.--As a condition of licensure, each
     3  health care facility required to have a staffing plan under
     4  section 806(h) shall maintain daily statistics, by nursing
     5  department and unit, of mortality, morbidity, infection,
     6  accident, injury and medical errors.
     7     (e)  Records retention.--All records required to be kept
     8  under this section shall be maintained for a period of seven
     9  years.
    10     (f)  Availability of records.--All records required to be
    11  kept under this section shall be made available upon request to
    12  the department and to the public, provided that information
    13  released to the public shall comply with applicable patient
    14  privacy laws and regulations.
    15  Section 806.6.  Work assignment policy.
    16     (a)  Written policy.--As a condition of licensure, each
    17  health care facility other than an extended care facility shall
    18  adopt, disseminate to direct-care nurses and comply with a
    19  written policy that meets the requirements of this section,
    20  detailing the circumstances under which a direct-care nurse may
    21  refuse a work assignment.
    22     (b)  Minimum conditions.--At a minimum, the work assignment
    23  policy shall permit a direct-care nurse to refuse an assignment
    24  for which:
    25         (1)  The nurse is not prepared by education, training or
    26     experience to safely fulfill the assignment without
    27     compromising or jeopardizing patient safety, the nurse's
    28     ability to meet foreseeable patient needs or the nurse's
    29     license.
    30         (2)  The assignment otherwise would violate requirements
    20070H0171B0197                 - 11 -     

     1     under this act.
     2     (c)  Minimum procedures.--At a minimum, the work assignment
     3  policy shall contain procedures for the following:
     4         (1)  Reasonable requirements for prior notice to the
     5     nurse's supervisor regarding the nurse's request and
     6     supporting reasons for being relieved of the assignment or
     7     continued duty.
     8         (2)  Where feasible, an opportunity for the supervisor to
     9     review the specific conditions supporting the nurse's
    10     request, and to decide whether to remedy the conditions, to
    11     relieve the nurse of the assignment or to deny the nurse's
    12     request to be relieved of the assignment or continued duty.
    13         (3)  A process that permits the nurse to exercise the
    14     right to refuse the assignment or continued on-duty status
    15     when the supervisor denies the request to be relieved if:
    16             (i)  the supervisor rejects the request without
    17         proposing a remedy or the proposed remedy would be
    18         inadequate or untimely;
    19             (ii)  the complaint and investigation process with a
    20         regulatory agency would be untimely to address concern;
    21         and
    22             (iii)  the employee in good faith believes that the
    23         assignment meets conditions justifying refusal.
    24         (4)  A nurse who refuses an assignment pursuant to a work
    25     assignment policy established in this section shall not be
    26     deemed, by reason thereof, to have engaged in negligent or
    27     incompetent action, patient abandonment or otherwise to have
    28     violated applicable nursing law.
    29  Section 806.7.  Public disclosure of staffing requirements.
    30     As a condition of licensing, a health care facility required
    20070H0171B0197                 - 12 -     

     1  to have a staffing plan under section 806(h) shall:
     2         (1)  Post in a conspicuous place readily accessible to
     3     the general public a notice prepared by the department
     4     setting forth the mandatory provisions of this act relating
     5     to staffing together with a statement of the mandatory and
     6     actual daily nurse staffing levels in each nursing department
     7     or unit.
     8         (2)  Upon request, make copies of the staffing plan filed
     9     with the department available to the public.
    10         (3)  Make readily available to the nursing staff with a
    11     department or unit, during each work shift, the following
    12     information:
    13             (i)  A copy of the current staffing plan for that
    14         department or unit.
    15             (ii)  Documentation of the number of direct-care
    16         nurses required to be present during the shift based on
    17         the approved adopted acuity system.
    18             (iii)  Documentation of the actual number of direct-
    19         care nurses present during the shift.
    20     Section 6.  Section 808(a) of the act, amended December 18,
    21  1992 (P.L.1602, No.179), is amended to read:
    22  Section 808.  Issuance of license.
    23     (a)  Standards.--The department shall issue a license to a
    24  health care provider when it is satisfied that the following
    25  standards have been met:
    26         (1)  that the health care provider is a responsible
    27     person;
    28         (2)  that the place to be used as a health care facility
    29     is adequately constructed, equipped, maintained and operated
    30     to safely and efficiently render the services offered;
    20070H0171B0197                 - 13 -     

     1         (3)  that the health care facility provides safe and
     2     efficient services which are adequate for the care, treatment
     3     and comfort of the patients or residents of such facility;
     4         (4)  that there is substantial compliance with the rules
     5     and regulations adopted by the department pursuant to this
     6     act; [and]
     7         (5)  that a certificate of need has been issued if one is
     8     necessary[.]; and
     9         (6)  that in the case of a health care facility required
    10     to have a staffing plan under section 806(h), the facility
    11     has submitted a documented staffing plan and is operating in
    12     compliance with the requirements of this chapter and
    13     applicable regulations.
    14     * * *
    15     Section 7.  Section 810 of the act is amended by adding a
    16  subsection to read:
    17  Section 810.  Reliance on accrediting agencies and Federal
    18                 Government.
    19     * * *
    20     (d)  Delegation prohibited.--This section shall not be
    21  construed to permit the department to delegate any of its
    22  functions with respect to the staffing requirements of this
    23  chapter.
    24     Section 8.  Section 815(c) of the act, added July 12, 1980
    25  (P.L.655, No.136), is amended to read:
    26  Section 815.  Effect of departmental orders.
    27     * * *
    28     (c)  Medical assistance payments.--Orders of the department,
    29  to the extent that they are sustained by the board, which fail
    30  to renew a license or which suspend or revoke a license, shall
    20070H0171B0197                 - 14 -     

     1  likewise revoke or suspend certification of the facility as a
     2  medical assistance provider, and no medical assistance payment
     3  for services rendered subsequent to the final order shall be
     4  made during the pendency of an appeal for the period of
     5  revocation or suspension without an order of supersedeas by the
     6  appellate court. Any health care facility that falsifies or
     7  causes to be falsified documentation required by this act shall
     8  be prohibited from receiving any medical assistance payment for
     9  a period of six months subsequent to the final order of
    10  violation.
    11     Section 9.  Section 817(b) of the act, amended December 18,
    12  1992 (P.L.1602, No.179), is amended and the section is amended
    13  by adding subsections to read:
    14  Section 817.  Actions against violations of law, rules and
    15                 regulations.
    16     * * *
    17     (b)  Civil penalty.--
    18         (1)  Any person, regardless of whether such person is a
    19     licensee, who has committed a violation of any of the
    20     provisions of this chapter or of any rule or regulation
    21     issued pursuant thereto, including failure to correct a
    22     serious licensure violation (as defined by regulation) within
    23     the time specified in a deficiency citation, may be assessed
    24     a civil penalty by an order of the department of up to $500
    25     for each deficiency for each day that each deficiency
    26     continues[.], provided that a health care facility required
    27     to have a staffing plan under section 806(h) that fails to
    28     comply with the requirements of section 806.5(c) and
    29     reporting requirements of this act may be assessed a civil
    30     penalty by an order of the department of up to $10,000 for
    20070H0171B0197                 - 15 -     

     1     each day of noncompliance. Civil penalties shall be collected
     2     from the date the facility receives notice of the violation
     3     until the department confirms correction of such violation.
     4         (2)  Any personal or health care facility that fails to
     5     report or falsifies information, or coerces, threatens,
     6     intimidates or otherwise influences another person to fail to
     7     report or to falsify information required to be reported
     8     under this chapter may be assessed a penalty of up to $10,000
     9     for each such incident.
    10     * * *
    11     (e)  Discharge or discrimination.--No person shall discharge,
    12  discriminate or in any manner retaliate against any employee
    13  because the employee has filed a complaint or instituted or
    14  caused to be instituted a proceeding under or related to this
    15  act or has testified or is about to testify in any such
    16  proceeding or because of the exercise by such employee on behalf
    17  of himself or others of any right afforded by this act.
    18     (f)  Private right of action.--Any health care facility other
    19  than an extended care facility that violates the rights of an
    20  employee set forth in subsection (e) or under an adopted work
    21  assignment policy under section 806.6 may be held liable to the
    22  employee in an action brought in a court of competent
    23  jurisdiction for such legal or equitable relief as may be
    24  appropriate to effectuate the purposes of this act, including,
    25  but not limited to, reinstatement, promotion, lost wages and
    26  benefits and compensatory and consequential damages resulting
    27  from the violations together with an equal amount in liquidated
    28  damages. The court in such action shall, in addition to any
    29  judgment awarded to the plaintiffs, award reasonable attorney
    30  fees and costs of action to be paid by the defendants. The
    20070H0171B0197                 - 16 -     

     1  employee's right to institute a private action is not limited by
     2  any other rights granted under this act.
     3     Section 10.  The act is amended by adding a section to read:
     4  Section 902.2.  Nurse recruitment.
     5     (a)  Nurse recruitment grant program.--
     6         (1)  The department shall award grants as provided herein
     7     to increase nursing education opportunities.
     8         (2)  Eligible entities to whom grants may be provided
     9     include the following: a health care facility, a labor
    10     organization representing registered nurses in this
    11     Commonwealth, or an approved nursing education program for
    12     the preparation of professional registered nurses in
    13     accordance with the requirements of the professional nursing
    14     law.
    15         (3)  Grants shall be available to:
    16             (i)  Support outreach programs at elementary and
    17         secondary schools that inform guidance counselors and
    18         students of education opportunities regarding nursing.
    19             (ii)  Create demonstration programs to provide
    20         mentors for high school students designed to encourage
    21         them to enter a career in professional nursing.
    22             (iii)  Provide scholarships and/or tuition
    23         reimbursement to Pennsylvania residents from diverse
    24         racial and ethnic backgrounds who want to become
    25         registered nurses. To be eligible for a scholarship or
    26         tuition reimbursement, students shall meet designated
    27         academic criteria and be accepted into an approved
    28         nursing program. Scholarships and/or tuition
    29         reimbursement may be conditioned on a commitment of paid
    30         service up to three years. Preference for scholarships
    20070H0171B0197                 - 17 -     

     1         shall be given to students who are from under-represented
     2         ethnic and minority backgrounds or who are otherwise
     3         under-represented in the profession of nursing. Students
     4         who are awarded the scholarships owe the hospital three
     5         years of service at full pay or face a penalty of treble
     6         the scholarship amount plus interest.
     7     (b)  Career ladder grant program.--
     8         (1)  The department shall award grants to health care
     9     facilities to assist in creating career ladder programs that
    10     will encourage employees to obtain the education required to
    11     become registered nurses. In making such awards, preference
    12     shall be given to health care facilities that have active
    13     labor management cooperative programs.
    14         (2)  Grants provided under this subsection shall be used
    15     to cover costs incurred by employees of the health care
    16     facility who enroll in an approved program to become
    17     registered nurses, including tuition costs, work release time
    18     and dependent care costs.
    19     (c)  Nursing facility loan program.--The department shall
    20  establish and implement a grant program designed to encourage
    21  health care facilities to loan professional nursing staff to
    22  serve as faculty at approved nursing schools and/or nursing
    23  education programs.
    24     Section 11.  This act shall take effect as follows:
    25         (1)  The addition of section 902.2 of the act shall take
    26     effect in 90 days.
    27         (2)  This section shall take effect immediately.
    28         (3)  The remainder of this act shall take effect in one
    29     year.

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