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F I S C A L I M P A C T R E P O R T

SPONSOR Picraux

DATE TYPED 02/03/05 HB 639

SHORT TITLE

Permanent Nursing Practice Programs

SB

ANALYST Moser

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

NFI

NFI

NFI

NFI

NFI

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

REVENUE

Estimated Revenue

Subsequent

Years Impact

Recurring

or Non-Rec

Fund

Affected

FY05

FY06

None

Unable to ascertain

at this time

Recurring

Other state funds

(Parenthesis ( ) Indicate Revenue Decreases)

Duplicates and may conflict with SB 119

SOURCES OF INFORMATION

LFC Files

Responses Received From

Board of Nursing

Miners Colfax Medical Center

SUMMARY

Synopsis of Bill

HB 639 amends the Nursing Practice Act to unify Certified Medication Aide (CMA) programs

into one statewide program/statute, under the regulatory control of the Board of Nursing. Defini-

tions, including specific program definitions for Certified Medication Aides and Certified Hemo-

dialysis Technicians (CHT) are updated.

House Bill 639 -- Page 2

HB 639 empowers the Board of Nursing to continue to set standards and adopt rules governing

the certification of medication aides and hemodialysis technicians, as well as medication aide

and hemodialysis technician training programs.

HB 639 further establish new maximum allowable fees for CMA and CHT certification, training

program approval and periodic evaluation, as well as establishment of maximum allowable fees

for licensed nurses. HB 639 deletes language that is contrary to interstate COMPACT licensure.

HB639 also eliminates the “sunset” provision.

Significant Issues

The Board of Nursing has recently concluded “pilot” programs in both the Long Term Care and

Public School settings and reported to the legislature that these programs were positive in show-

ing the medication aide model could be used successfully with licensed nursing oversight in dif-

ferent settings. HB 639 allows for the expansion of Certified Medication Aide programs that

meet regulatory standards and requirements thus allowing entities not yet in these programs to

apply for recognition without the need to amend the statute each time a new “pilot” is estab-

lished.

By setting a reasonable “ceiling” for fees the board will be able to meet its fiscal responsibility in

regulation of these programs, certificate holders and licensees. Revenue estimates cannot be

made until the Board determines the fees to be charged within the discretion granted. The board

of nursing’s revenue comes from fees it collects. The board receives no general fund money.

Certified Medication Aides are the only unlicensed assistive personnel that nurses can legally

delegate medication administration. The requested amendments will enable those

certified medication aides in many settings to administer routine medications, under strict super-

visory control and at the direction of a registered nurse. The Board feels that this will allow the

nurse the additional time to do professional care that is distinctly “nursing”, and do it within the

standards and scope as allowed by law.

Repeal of 61-3-24.3 is essential to maintain the integrity of “Compact” language throughout the

country. The inclusion of 61-3-24.3 in current statute is contrary to national compact language

and would preclude New Mexico as a COMPACT state, immediately affecting thousands of

nurses’ ability to work in New Mexico under other state COMPACT licenses.

The board of nursing requests the repeal of 61-3-31, sunset provision, as any termination of

agency life, however brief and for whatever reason, would not be conducive to the safety of the

citizens of New Mexico as it would disallow NM nurses from practicing in other states, includ-

ing those bordering states that many are currently practicing in; and, it would preclude any other

nurses from coming in to NM to work without a current statute in place.

The Board also argues for enactment of an emergency clause in order to allow the medication

aides currently certified under the “pilot” statue and rules to continue in their work settings with-

out a disruption. It is not clear as to why it is necessary to impose this requirement immediately.

Waiting until a July 1, 2006 effective date would have no adverse impact.

House Bill 639 -- Page 3

PERFORMANCE IMPLICATIONS

HB 639 directly impacts the operational functions of the Board of Nursing in that there will be

additional responsibilities addressing increases in training, certification process and program re-

view in the areas of medication aides.

FISCAL IMPLICATIONS

The Board of Nursing receives its revenue from licensing and certification fees. By having the

minimum “ceiling” increased in statute, the Board will be able to evaluate and implement any

possible fee increases that may need to be made in order to do the regulatory work.

ADMINISTRATIVE IMPLICATIONS

The anticipated increase in the number of medication aides can be supported by existing staff.

The increase needed in resources to maintain testing, certification, recertification, auditing and

survey evaluation will also be able to be maintained within current budget. If growth expands at

a faster rate than anticipated there may be additional FTE requirements.

By placing these aides under the supervision and direction of licensed nurses collective bargain-

ing relationships with nurses who are currently represented by unions may be impacted because

of these supervisory duties and responsibilities.

CONFLICT, DUPLICATION, COMPANIONSHIP, RELATIONSHIP

SB 119 duplicates and conflicts with this bill.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL.

The Board of Nursing feels that if this bill is not enacted the medication aides that have been in

the “pilot” programs in long term care and public schools would no longer be able to practice in

those settings. Other entities that may wish to apply for certified medication aide program status

would be unable to do so without more expense and legislation to enact another “pilot” program.

A dire consequence of not enacting this bill pertains specifically to the interstate COMPACT. If

this language is not repealed the practice of many nurses in healthcare settings throughout the

state would be in jeopardy.

GM/sb:lg