HOUSE AMENDED
PRIOR PRINTER'S NOS. 695, 1180
PRINTER'S NO. 1460
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
668
Session of
2023
INTRODUCED BY J. WARD, COLLETT, SCHWANK, BOSCOLA, COMITTA,
HAYWOOD, BREWSTER, CAPPELLETTI, BAKER, ROBINSON AND STREET,
MAY 2, 2023
AS REPORTED FROM COMMITTEE ON HEALTH, HOUSE OF REPRESENTATIVES,
AS AMENDED, MARCH 27, 2024
AN ACT
Amending the act of July 19, 1979 (P.L.130, No.48), entitled "An
act relating to health care; prescribing the powers and
duties of the Department of Health; establishing and
providing the powers and duties of the State Health
Coordinating Council, health systems agencies and Health Care
Policy Board in the Department of Health, and State Health
Facility Hearing Board in the Department of Justice;
providing for certification of need of health care providers
and prescribing penalties," providing for certified
medication aides; and imposing duties on the Department of
Education.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of July 19, 1979 (P.L.130, No.48), known
as the Health Care Facilities Act, is amended by adding a
chapter to read:
CHAPTER 8-C
CERTIFIED MEDICATION AIDES
Section 801-C. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
context clearly indicates otherwise:
"Certified medication aide." An individual certified under
section 804-C.
"Department." The Department of Education of the
Commonwealth.
"Instructor." An individual trained to A REGISTERED NURSE
APPROVED BY THE DEPARTMENT TO TRAIN AND certify medication aides
under section 804-C.
"Long-term care nursing facility." As defined in section
802.1.
"Medication aide training program." The program developed by
the department under section 804-C(a) for certification as a
medication aide.
"NURSE AIDE." AS DEFINED IN 42 CFR 483.5 (RELATING TO
DEFINITIONS).
"PRO RE NATA MEDICATION." THE PRESCRIPTION OF MEDICATIONS
WHOSE ADMINISTRATION SHOULD BE BASED ON PATIENTS' IMMEDIATE
NEEDS RATHER THAN AT PREDETERMINED ADMINISTRATION TIMES.
Section 802-C. Requirements.
(a) Qualifications.--To be a certified medication aide, an
individual must:
(1) Be a nurse aide with a valid listing on the
Pennsylvania Nurse Aide Registry.
(2) Have at least one year of consecutive experience
working as a nurse aide in a single long-term care nursing
facility .
(1) BE A NURSE AIDE CURRENTLY LISTED ON THE PENNSYLVANIA
NURSE AIDE REGISTRY, BE ELIGIBLE FOR HIRING AS A NURSE AIDE
UNDER 42 CFR 483.12(A)(3)(II) (RELATING TO FREEDOM FROM
ABUSE, NEGLECT AND EXPLOITATION) AND NOT HAVE HAD A
20230SB0668PN1460 - 2 -
<--
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
CERTIFICATION UNDER THIS CHAPTER REVOKED. A NURSE AIDE WHO
HAS SUCCESSFULLY HAD A NEGLECT ANNOTATION REMOVED FROM THE
NURSE AIDE'S LISTING ON THE PENNSYLVANIA NURSE AIDE REGISTRY
UNDER 42 U.S.C. § 1396R(G)(1)(D) (RELATING TO REQUIREMENTS
FOR NURSING FACILITIES) SHALL NOT BE PROHIBITED FROM BEING
ELIGIBLE FOR CERTIFICATION.
(2) DURING THE PREVIOUS TWO YEARS, HAVE AT LEAST 1,000
HOURS OF EXPERIENCE WORKING AS A NURSE AIDE IN A SINGLE LONG-
TERM CARE NURSING FACILITY.
(3) RECEIVE A FORMAL WRITTEN RECOMMENDATION FOR
CERTIFIED MEDICATION AIDE TRAINING BY THE DIRECTOR OF NURSING
OF THE LONG-TERM CARE FACILITY IDENTIFIED IN PARAGRAPH (2),
AND SUBMIT THE RECOMMENDATION TO THE DEPARTMENT. THE
RECOMMENDATION MUST INCLUDE A STATEMENT CERTIFYING THAT THE
INDIVIDUAL HAS SATISFIED THE EXPERIENCE REQUIREMENT UNDER
PARAGRAPH (2).
(3) (4) Have successfully completed the medication aide
training program and met the requisite training and
competency evaluation requirements.
(b) Certification by instructor.--To practice as a certified
medication aide, an individual must meet the qualifications
under subsection (a) and be certified by an instructor as
provided under section 804-C.
Section 803-C. Administration of medication.
(a) Permissible medication delivery.--A certified medication
aide may administer oral, transdermal, opthalmic, otic, rectal,
vaginal, inhaled, enteral or topical medication to a resident of
a long-term care nursing facility.
(A) PERMISSIBLE MEDICATION DELIVERY.--A CERTIFIED MEDICATION
AIDE MAY ADMINISTER, UNDER THE SUPERVISION OF A PHYSICALLY ON-
20230SB0668PN1460 - 3 -
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
SITE REGISTERED NURSE OR LICENSED PRACTICAL NURSE AUTHORIZED BY
A REGISTERED NURSE, ORAL, TRANSDERMAL, OPHTHALMIC, OTIC, INHALED
OR TOPICAL MEDICATION TO A RESIDENT OF A LONG-TERM CARE NURSING
FACILITY. THE FOLLOWING APPLY:
(1) THE SUPERVISING REGISTERED NURSE OR LICENSED
PRACTICAL NURSE AUTHORIZED BY A REGISTERED NURSE SHALL BE
PHYSICALLY ON-SITE AND AVAILABLE TO THE CERTIFIED MEDICATION
AIDE.
(2) THE CERTIFIED MEDICATION AIDE MAY ONLY ADMINISTER
MEDICATIONS TO A RESIDENT OF A LONG-TERM CARE NURSING
FACILITY WHOSE CLINICAL STATUS IS CONSIDERED STABLE.
(3) NO MORE THAN TWO CERTIFIED MEDICATION AIDES MAY BE
SUPERVISED BY A REGISTERED NURSE OR LICENSED PRACTICAL NURSE
AUTHORIZED BY A REGISTERED NURSE.
(4) A CERTIFIED MEDICATION AIDE MAY ADMINISTER A PRO RE
NATA MEDICATION ACCORDING TO A PHYSICIAN'S, NURSE
PRACTITIONER'S OR PHYSICIAN ASSISTANT'S ORDERS WITH A
REGISTERED NURSE ON-SITE. CERTIFIED MEDICATION AIDES SHALL
DOCUMENT EVERY ADMINISTRATION OF A PRO RE NATA MEDICATION AND
SYMPTOMS PRECIPITATING ADMINISTRATION.
(b) Impermissible medication delivery.--A certified
medication aide may not:
(1) Administer a controlled substance under section 4 of
the act of April 14, 1972 (P.L.233, No.64), known as The
Controlled Substance, Drug, Device and Cosmetic Act.
(2) Administer medications by gastronomy GASTROSTOMY or
jejunostomy tubes.
(3) Add fluid to established gastronomy GASTROSTOMY or
jejunostomy tube feedings or change established tube feeding
bags.
20230SB0668PN1460 - 4 -
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(4) Accept verbal or telephone orders for medication
from a licensed health care professional who is authorized to
independently diagnose and treat.
(5) Administer medication by the following routes:
(i) Central lines.
(ii) Colostomy.
(iii) Intramuscular.
(iv) Intrathecal.
(v) Intravenous.
(vi) Nasogastric.
(vii) Nonmetered inhaler.
(viii) Subcutaneous injection.
(ix) Intradermal.
(x) Urethral.
(xi) Epidural.
(xii) Endotracheal.
(XIII) RECTAL.
(XIV) VAGINAL.
(XV) ENTERAL.
(6) Administer the following kinds of medications:
(i) Barium and other diagnostic contrast media.
(ii) Chemotherapeutic agents, except oral
maintenance chemotherapy.
(7) Administer medication by, nor assume responsibility
for, medication pumps, including client-controlled analgesia.
(8) Act as a clinical teaching associate to a student in
a medication aide training program.
(9) ADMINISTER THE FIRST DOSE OF ANY NEW MEDICATION TO A
RESIDENT OF A LONG-TERM CARE NURSING FACILITY.
(10) CALCULATE OR ADJUST A MEDICATION DOSE PRESCRIBED BY
20230SB0668PN1460 - 5 -
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
A PHYSICIAN, NURSE PRACTITIONER OR PHYSICIAN ASSISTANT.
(11) DELEGATE THE ADMINISTRATION OF MEDICATION.
(12) ADMINISTER MEDICATION WITHOUT THE SUPERVISION OF A
REGISTERED NURSE OR A LICENSED PRACTICAL NURSE AUTHORIZED BY
A REGISTERED NURSE WHO IS PHYSICALLY ON-SITE AND AVAILABLE TO
THE CERTIFIED MEDICATION AIDE.
Section 804-C. Medication aide training program and
certification.
(a) Development.--The department shall develop a medication
aide training program for an individual to become a certified
medication aide, which may be offered by a long-term care
nursing facility. PRIOR TO OPERATING A TRAINING PROGRAM
AUTHORIZED UNDER THIS SECTION, A LONG-TERM CARE NURSING FACILITY
SHALL CONTRACT WITH AN INSTRUCTOR APPROVED BY THE DEPARTMENT.
The department shall include input from industry stakeholders on
the development and implementation of the program. The program
under this section must:
(1) Include a minimum of 40 80 hours of classroom and
clinical INSTRUCTION AND training, exclusive of testing or
instructor evaluation of whether the individual is competent.
(2) INCLUDE A MINIMUM OF 20 HOURS OF SKILLS AND
DEMONSTRATION, WHICH SHALL INCLUDE:
(I) TEN HOURS OF CLINICAL OBSERVATION AND SKILLS
DEMONSTRATION UNDER THE DIRECT SUPERVISION OF A
SUPERVISING REGISTERED NURSE OR LICENSED PRACTICAL NURSE
AUTHORIZED BY A REGISTERED NURSE IN A LONG-TERM CARE
NURSING FACILITY; AND
(II) TEN HOURS IN A SKILLS DEMONSTRATION LABORATORY.
(2) (3) Be conducted by an approved instructor and
utilize the State-approved written curriculum and test.
20230SB0668PN1460 - 6 -
<--
<--
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(3) (4) Cover the following topics:
(i) The role, responsibilities and performance of
the prescribing provider in the medication administration
process.
(ii) The rights of the individual regarding
accepting or refusing medications.
(iii) Principles of infection control as they relate
to medication administration.
(iv) Categories of medications and their effects.
(v) Effective management of poisoning or medication
overdose.
(vi) Storage and disposal of medications.
(vii) Communications with individuals or guardians,
if applicable, about the individual's medications.
(viii) The six principles of medication
administration, including:
(A) The correct medication.
(B) The correct dosage of the medication.
(C) The medication to the correct individual.
(D) The medication at the correct time.
(E) The medication to the individual by the
correct method.
(F) The accurate documentation.
(4) (5) Include a medication aide training examination
that requires the demonstration of the requisite knowledge
and skills to serve as a certified medication aide.
(b) Certification.-- An instructor THE DEPARTMENT OF HEALTH
shall issue certification to an individual to practice as a
certified medication aide if the individual:
(1) Successfully completes the medication aide training
20230SB0668PN1460 - 7 -
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
program.
(2) Scores 80% or higher on the examination under
subsection (a)(4) (A)(5) .
(3) Demonstrates knowledge of the following pertaining
to administering medications:
(i) The name of the medication.
(ii) The reason for the medication's use.
(iii) Any side effects or adverse reactions.
(iv) Any special instructions such as giving certain
fluids, checking pulse rate or monitoring blood levels.
(4) Following direct observation by an instructor, has
been found competent to be authorized to administer
medications.
(c) Reauthorization.--A certified medication aide shall be
reauthorized to administer medications at least every two years
or by the last day of the 24th month from the date of the prior
authorization. Reauthorization of a certified medication aide
shall include:
(1) Annual completion of 12 hours of continuing
education, clinical competency demonstration and a medication
errors prevention course , which shall be developed by the
department.
(2) A written reauthorization by an instructor.
(C) RENEWAL OF CERTIFICATION.--A CERTIFIED MEDICATION AIDE
SHALL BE REQUIRED TO RENEW A CERTIFICATION NO LESS THAN EVERY
TWO YEARS OR BY THE LAST DAY OF THE 24TH MONTH FROM THE DATE OF
THE PRIOR CERTIFICATION. THE FOLLOWING SHALL APPLY:
(1) RENEWAL SHALL INCLUDE:
(I) PROOF OF COMPLETION OF 12 HOURS OF CONTINUING
EDUCATION PER YEAR, CLINICAL COMPETENCY DEMONSTRATION AND
20230SB0668PN1460 - 8 -
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
A MEDICATION ERRORS PREVENTION COURSE WHICH SHALL BE
DEVELOPED BY THE DEPARTMENT.
(II) A RECERTIFICATION LETTER WRITTEN BY AN
INSTRUCTOR RECOMMENDING THE CERTIFIED MEDICATION AIDE FOR
RENEWAL.
(2) A CERTIFIED MEDICATION AIDE SHALL SUBMIT AN ONLINE
COMPLETED RECERTIFICATION APPLICATION TO THE DEPARTMENT OF
HEALTH.
(d) Authorization.--Authorization to practice as a certified
medication aide shall be valid in any long-term care nursing
facility.
(e) Suspension of medication aide training program.--
(1) A long-term care nursing facility's medication aide
training program may be suspended for cause based on the
adequacy and effectiveness of the medication aide training
program.
(2) A long-term care nursing facility's medication aide
training program may not be suspended based on surveys or
operations of the long-term care nursing facility.
(E) CERTIFICATION SANCTION AUTHORIZATION.--THE DEPARTMENT OF
HEALTH MAY REVOKE OR SUSPEND A CERTIFIED MEDICATION AIDE'S
CERTIFICATION, OR OTHERWISE SANCTION A CERTIFIED MEDICATION AIDE
FOR ANY OF THE FOLLOWING REASONS:
(1) FAILURE TO COMPLETE A TIMELY RENEWAL.
(2) RECEIVING AN ANNOTATION ON THE NURSE AIDE'S LISTING
ON THE PENNSYLVANIA NURSE AIDE REGISTRY UNDER 42 U.S.C. §
1396R(G)(1)(C) (RELATING TO REQUIREMENTS FOR NURSING
FACILITIES) FOR ABUSE, NEGLECT OR MISAPPROPRIATION.
(3) FAILURE TO PROPERLY ADMINISTER MEDICATION.
(4) LACK OF PHYSICAL OR MENTAL ABILITY TO PROVIDE
20230SB0668PN1460 - 9 -
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
ADEQUATE SERVICES.
(5) DECEPTIVE OR FRAUDULENT PROCUREMENT OR
REPRESENTATION OF CERTIFICATION OR FOR MAKING MISLEADING,
DECEPTIVE OR UNTRUE REPRESENTATIONS TO SECURE OR AID OR ABET
ANOTHER INDIVIDUAL TO SECURE A CERTIFICATION.
(6) WILLFUL OR NEGLIGENT MISCONDUCT IN PROVIDING CARE OR
PRACTICING BEYOND CERTIFICATION AUTHORIZATION.
(7) PRACTICING WITHOUT A CURRENT CERTIFICATION.
(8) CONVICTION OF ANY OFFENSE LISTED IN 22 PA. CODE §
701.13 (RELATING TO NONACCEPTANCE OF CERTAIN APPLICANTS).
(9) HAVING A CERTIFICATION OR OTHER AUTHORIZATION TO
PRACTICE A PROFESSION OR OCCUPATION REVOKED, SUSPENDED OR
SUBJECTED TO OTHER DISCIPLINARY SANCTION.
(F) SANCTIONS.--
(1) THE DEPARTMENT OF HEALTH MAY ORDER ONE OR MORE OF
THE FOLLOWING AGAINST A CERTIFIED MEDICATION AIDE FOR A
REASON LISTED UNDER SUBSECTION (E):
(I) REVOKE A CERTIFICATION.
(II) REQUIRE A CERTIFIED MEDICATION AIDE TO TAKE
EDUCATIONAL COURSES.
(III) IMPOSE A CIVIL PENALTY NOT EXCEEDING $500 ON
THE FACILITY FOR EACH INCIDENT IN WHICH THE CERTIFIED
MEDICATION AIDE ENGAGES IN CONDUCT THAT CONSTITUTES A
BASIS FOR DISCIPLINE. PENALTY MONEY SHALL BE TREATED AS
CIVIL MONEY PENALTIES.
(2) NO DISCIPLINARY ACTION AGAINST A CERTIFIED
MEDICATION AIDE SHALL PREVENT OR OTHERWISE PROHIBIT THE
DEPARTMENT OF HEALTH FROM ANNOTATING A NURSE AIDE UNDER 42
U.S.C. § 1396R(G)(1)(C) FOR ABUSE, NEGLECT OR
MISAPPROPRIATION.
20230SB0668PN1460 - 10 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(G) SUSPENSION AND TERMINATION OF MEDICATION AIDE TRAINING
PROGRAM.--THE DEPARTMENT MAY SUSPEND OR TERMINATE A LONG-TERM
CARE NURSING FACILITY'S MEDICATION AIDE TRAINING PROGRAM FOR ANY
OF THE FOLLOWING REASONS:
(1) FAILURE TO PROPERLY ADMINISTER THE TRAINING PROGRAM.
(2) FAILURE TO PROPERLY SUPERVISE A CERTIFIED MEDICATION
AIDE.
(3) FRAUDULENTLY CERTIFYING A MEDICATION AIDE.
(4) FAILURE TO PROPERLY REPORT TO THE DEPARTMENT OF
HEALTH UNDER SECTION 805-C(C).
Section 805-C. Employment of certified medication aides.
(a) Authorization.--A long-term care nursing facility may
employ a certified medication aide for the purpose of performing
the technical aspects of the medication administration in
accordance with this chapter. The following shall apply:
(1) The certified medication aide training program
established under section 804-C(a) shall fulfill the
requirements of medication administration training as
specified in 55 Pa. Code §§ 2800.190(a) (relating to
medication administration training) and 2600.190(a) (relating
to medication administration training) for assisted living
residences and personal care homes.
(2) An assisted living residence as defined in 55 Pa.
Code § 2800.4 (relating to definitions) and personal care
homes as defined in 55 Pa. Code § 2600.4 (relating to
definitions) may employ a certified medication aide that has
successfully completed the medication aide training program
in accordance with this chapter.
(b) Competency review.--A long-term care nursing facility
shall annually conduct a comprehensive clinical skills
20230SB0668PN1460 - 11 -
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
competency review of each certified medication aide employed by
the long-term care nursing facility. THE COMPLETED COMPETENCY
REVIEW SHALL BE SUBMITTED TO THE DEPARTMENT OF HEALTH.
(C) REPORTING.--A LONG-TERM CARE NURSING FACILITY THAT
EMPLOYS A CERTIFIED MEDICATION AIDE SHALL REPORT TO THE
DEPARTMENT OF HEALTH ANY ACT COMMITTED BY A CERTIFIED MEDICATION
AIDE WHICH QUALIFIES FOR DISCIPLINE UNDER SECTION 804-C(E) AND
ANY ACT WHICH IS REQUIRED TO BE REPORTED UNDER 28 PA. CODE §
51.3 (RELATING TO NOTIFICATION).
(c) (D) Computation.--A certified medication aide employed
by a long-term care nursing facility shall:
(1) Be included in computing the hours of direct
resident care under 28 Pa. Code § 211.12 (relating to nursing
services).
(2) Not be included in the computing of nurse aide
ratios and , REGISTERED NURSE RATIOS OR licensed practical
nurse ratios under 28 Pa. Code § 211.12.
(d) (E) Registry.--Nurse aides meeting the eligibility
criteria in section 802-C(a) shall be designated as certified
medication aides on the Pennsylvania Nurse Aide Registry.
Section 806-C. Annual report.
(a) Submission.--The department shall submit an annual
report to:
(1) The chairperson and minority chairperson of the
Aging and Youth Committee of the Senate.
(2) The chairperson and minority chairperson of the
Aging and Older Adult Services Committee of the House of
Representatives.
(3) The chairperson and minority chairperson of the
Health and Human Services Committee of the Senate.
20230SB0668PN1460 - 12 -
<--
<--
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
(4) The chairperson and minority chairperson of the
Health Committee of the House of Representatives.
(b) Contents.--The report shall include:
(1) The number and location of medication aide training
programs approved by the department.
(2) The number of nurse aides currently certified as
medication aides.
(3) The number of approved instructors available to
support the program.
(4) Pass rates for the training examination.
(5) Recertification rates.
(6) The number of hours of training each program
requires.
(C) FILING OF REPORT.--THE DEPARTMENT SHALL SUBMIT THE
ANNUAL REPORT FOR A PERIOD OF FIVE YEARS BEGINNING ONE YEAR
AFTER THE EFFECTIVE DATE OF THIS SUBSECTION.
SECTION 807-C. REGULATIONS.
THE DEPARTMENT, IN CONSULTATION WITH THE DEPARTMENT OF HEALTH
AND THE DEPARTMENT OF STATE, MAY PROMULGATE REGULATIONS AS
NECESSARY TO IMPLEMENT THIS CHAPTER.
Section 2. This act shall take effect in 180 days ONE YEAR.
20230SB0668PN1460 - 13 -
<--
<--
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21