HOUSE JUDICIARY COMMITTEE SUBSTITUTE FOR

HOUSE BILL 72

57th legislature - STATE OF NEW MEXICO - first session, 2025

 

 

 

 

 

 

 

AN ACT

RELATING TO HEALTH CARE; REQUIRING THE HEALTH CARE AUTHORITY TO PROMULGATE AND ENFORCE MINIMUM LICENSED NURSE-TO-PATIENT STAFFING RATIOS IN LICENSED HOSPITALS; CREATING THE STATEWIDE STAFFING ADVISORY COMMITTEE; REQUIRING LICENSED HOSPITALS TO DEVELOP AND IMPLEMENT POLICIES AND PROCEDURES; PROVIDING ADMINISTRATIVE PENALTIES.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--DEFINITIONS.--As used in Sections 1 through 5 of this 2025 act:

          A. "critical access hospital" means a hospital that:

                (1) provides twenty-four-hour emergency department services;

                (2) has an average length of stay no longer than ninety-six hours;

                (3) has fewer than twenty-five acute care inpatient beds; and

                (4) is located at least thirty-five miles from the closest hospital;

          B. "critical care unit" means a unit that is established to treat patients whose severity of medical conditions require continuous monitoring and complex intervention by licensed nurses;

          C. "hospital" means any public, private for-profit or not-for-profit acute care, rehabilitation, limited services, critical access, general or specific facility offering inpatient services, nursing and overnight care seven days per week on a twenty-four-hour basis that is capable of treating no fewer than three patients for the purposes of diagnosing, treating and providing medical, psychological or surgical care for physical or mental illness, disease, injury, rehabilitative conditions and pregnancies. "Hospital" does not include clinics or outpatient departments that do not provide inpatient or emergency services;

          D. "hospital network committee" means a staffing committee established in a network of hospitals that are owned or operated by the same entity;

          E. "hospital staffing committee" means a staffing committee established in a single hospital;

          F. "hospital unit" includes critical care units, burn units, labor and delivery rooms, post-anesthesia service areas, emergency departments, operating rooms, pediatric units, step-down or intermediate care units, specialty care units, telemetry units, general medical care units, subacute care units and transitional inpatient care units;

          G. "rural" means a rural county or unincorporated area of a partially rural county, as designated by the health resources and services administration of the United States department of health and human services; and

          H. "staffing committee" means nurse-led groups that create staffing plans for hospital units based upon patient population, acuity and needs and the skills and experience of the hospital's staff."

     SECTION 2. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--STATEWIDE STAFFING ADVISORY COMMITTEE--CREATION--ORGANIZATION.--

          A. The "statewide staffing advisory committee" is created for the purpose of advising the authority on matters related to nurse staffing as provided in this 2025 act. The committee consists of fourteen members that reflect a geographic representation of the state, appointed by the authority as follows:

                (1) two members shall be private hospital directors of nursing or chief nursing officers;

                (2) two members shall be public hospital directors of nursing or chief nursing officers;

                (3) two members shall be rural hospital directors of nursing or chief nursing officers;

                (4) two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care;

                (5) two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care;

                (6) two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of rural hospitals involved in direct patient care;

                (7) one member shall represent nursing faculty from a public university or community college; and

                (8) one member shall represent the authority and serve as chair.

          B. Except as provided in Subsection C of this section, the members of the statewide staffing advisory committee shall serve for terms of two years and no more than three terms. A member appointed by the committee to fill a vacancy shall serve the remainder of the term.

          C. Term-length conditions for voting members appointed to the statewide staffing advisory committee are:

                (1) for initial appointments, five members shall serve for three-year terms, four members shall serve for two-year terms and four members shall serve for one-year terms;

                (2) for regular appointments after the initial appointments, two-year terms;

                (3) for a vacancy appointment, the balance of the term; and

                (4) a committee member shall continue to serve on the committee until a replacement is appointed.

          D. The authority shall make all initial appointments to the statewide staffing advisory committee by September 1, 2025.

          E. The statewide staffing advisory committee shall elect other officers as the committee determines to be necessary.

          F. The statewide staffing advisory committee shall meet at a frequency necessary for the committee to advise and provide data for the authority to use in promulgating rules pursuant to Section 3 of this 2025 act. The initial meeting of the statewide staffing advisory committee shall occur no later than October 1, 2025.

          G. A majority of the statewide staffing advisory committee members currently serving constitutes a quorum.

          H. The authority may remove from office a member of the statewide staffing advisory committee for neglect of duties."

     SECTION 3. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITALS--LICENSED NURSE-TO-PATIENT STAFFING RATIOS--AUTHORITY--COMMITTEE--POWERS AND DUTIES.--

          A. Each hospital or hospital network may establish a staffing committee or network staffing committee to evaluate the hospital's staffing needs and make staffing recommendations. Each hospital that establishes a staffing committee or network staffing committee shall report the staffing committee's recommendations to the statewide staffing advisory committee for consideration.

          B. The authority, with the advice of the statewide staffing advisory committee, may:

                (1) ensure that licensed nurse-to-patient staffing ratios promulgated by the authority are maintained by a hospital;

                (2) consider unlicensed personnel that provide direct patient care as a factor when setting licensed nurse-to-patient staffing ratios;

                (3) waive licensed nurse-to-patient staffing ratios for rural general acute care and critical access hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and

                (4) seek injunctive relief for violations of this 2025 act.

          C. By October 1, 2026, the authority, with the advice of the statewide staffing advisory committee, shall hold hearings to promulgate rules regarding:

                (1) minimum, specific and numerical licensed nurse-to-patient staffing ratios for hospitals licensed by the authority pursuant to the Health Care Code, which shall include licensed nurse-to-patient staffing ratios by licensed nurse classification and hospital unit. The authority may consider unlicensed personnel that provide direct patient care as a factor when setting licensed nurse-to-patient staffing ratios;

                (2) rural general acute care and critical access hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs;

                (3) emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients. The authority may consider unlicensed personnel that provide direct patient care as a factor when setting licensed nurse-to-patient staffing ratios;

                (4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the:

                     (a) severity of the illness to be treated;

                     (b) need for specialized equipment and technology;

                     (c) complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and

                     (d) licensure of the personnel required for care; and

                (5) circumstances in which it is permissible for a hospital to be outside of the established licensed nurse-to-patient staffing ratios, including:

                     (a) when the number of patients in a hospital exceeds the licensed nurse-to-patient staffing ratios, but only due to there being a patient or patients who: 1) have been cleared for discharge but have not yet been discharged; or 2) are awaiting transfer to another facility;

                     (b) when a nurse calls out of a shift or must leave a shift early; and

                     (c) the duration of time in which a hospital unit may be outside of the established nurse-to-patient staffing ratios in one shift to allow time to bring in on-call nurses and unlicensed employees to meet the hospital unit's licensed nurse-to-patient staffing ratio.

          D. The rules promulgated by the authority pursuant to Subsection C of this section shall not replace existing nurse-to-patient staffing ratios and unlicensed employee-to-patient staffing ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.

          E. The authority, in consultation with the statewide staffing advisory committee, shall review the rules adopted pursuant to Subsection C of this section after five years following the adoption of the rules.

          F. The initial licensed nurse-to-patient staffing ratios established by the authority shall become effective no later than one hundred eighty days after the ratios are adopted by rule; provided that the licensed nurse-to-patient staffing ratios established by the authority shall not apply to emergency departments until at least eighteen months after the initial ratios are adopted by rule; and provided further that an emergency department shall not be prevented from implementing the licensed nurse-to-patient staffing ratios earlier than eighteen months after the initial ratios are adopted by rule."

     SECTION 4. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--HOSPITAL POLICIES AND PROCEDURES--TRAINING.-- 

          A. A hospital shall:

                (1) be staffed at a level to meet the staffing ratios established by the authority, which shall be the minimum number of registered and licensed nurses involved in direct patient care;

                (2) adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require:

                     (a) training and orientation for providing direct patient care;

                     (b) orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and

                     (c) temporary personnel orientation and competency evaluation; and

                (3) submit a semiannual report, completed by the hospital's chief nursing officer or director of nursing, to the statewide advisory staffing committee and the authority. The report shall document the hospital's plans and efforts to meet staffing ratios recommended by the statewide staffing advisory committee.

          B. A hospital may have additional staff in accordance with a documented patient classification system.

          C. A hospital shall not:

                (1) assign unlicensed personnel to perform nursing functions in lieu of a registered nurse; or

                (2) allow unlicensed personnel under the direct clinical supervision of a registered nurse to perform functions that require a substantial amount of scientific knowledge and technical skills, including:

                     (a) administration of medication;

                     (b) intravenous therapy;

                     (c) parenteral or tube feedings;

                     (d) invasive procedures, including inserting nasogastric tubes and tracheal suctioning;

                     (e) assessment of the condition of a patient; and

                     (f) educating patients and their families concerning the patient's health care problems, including post-discharge care.

          D. All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care. No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area. The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel shall receive orientation and be subject to competency validation.

          E. Nothing in this section precludes a licensed or registered nurse from working within that person's scope of practice."

     SECTION 5. A new section of the Health Care Code is enacted to read:

     "[NEW MATERIAL] HOSPITAL STAFFING RATIOS--VIOLATION--ENFORCEMENT--REMEDIES.--

          A. A hospital shall provide written notice to the authority and the statewide staffing advisory committee whenever there are seven deviations from any staffing ratios established by the authority pursuant to this 2025 act during a rolling ninety-day period. The written notice shall:

                (1) be provided within ten days of a seventh deviation from the staffing ratios established by the authority pursuant to this 2025 act;

                (2) explain the cause of the deviations; and

                (3) provide a plan to prevent future deviations.

          B. No later than October 1, 2026, the authority, with the advice of the statewide staffing advisory committee, shall hold a hearing to promulgate rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules shall:

                (1) specify reporting requirements for deviations consistent with this section;

                (2) allow for the acceptance, investigation and resolution of complaints from hospital staff, exclusive representatives of hospital staff or members of the public; and

                (3) provide an administrative appeals process for hospitals that are determined by the authority to be in violation of the hospital staffing requirements. A hospital shall have the right to judicial review of any final decision made by the authority pursuant to this section.

          C. If the authority determines, whether through a complaint process, hospital reporting or the authority's own independent investigation, that a hospital has engaged in a violation of staffing requirements, the authority shall:

                (1) issue a warning for the first violation in a one-year period;

                (2) impose a civil penalty not to exceed one thousand seven hundred fifty dollars ($1,750) for the second violation of the same provision in a one-year period;

                (3) impose a civil penalty not to exceed two thousand five hundred dollars ($2,500) for the third violation of the same provision in a one-year period; and

                (4) impose a civil penalty not to exceed five thousand dollars ($5,000) for the fourth and subsequent violations of the same provision in a one-year period.

          D. If the authority finds that a hospital has committed multiple violations of the staffing ratio requirements of a similar nature, it shall require the hospital to submit a corrective action plan for approval. If a hospital does not follow the corrective action plan approved by the authority, the hospital shall be fined in an amount not to exceed fifty thousand dollars ($50,000) every thirty days until the hospital complies.

          E. The requirements of this section or any rules adopted pursuant to this 2025 act may be enforced by a civil action brought by any interested person or organization for injunctive relief to enforce the provisions of this section or any rules adopted hereunder. In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.

          F. A hospital is not required to follow the staffing ratios established by the authority in the event of:

                (1) a national or state emergency requiring the implementation of a facility disaster plan;

                (2) sudden and unforeseen adverse weather conditions;

                (3) mass casualty incidents;

                (4) pandemic, epidemic or endemic illnesses;

                (5) circumstances that make staffing ratio requirements unreasonable or unattainable due to limitations in the workforce; or

                (6) a staffing ratio conflicting with federal or state law regarding the governance requirements of a hospital.

          G. The authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff."

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