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

SPONSOR Nava

DATE TYPED 02/22/05 HB

SHORT TITLE Unify Nursing Medication Aides Program

SB 119/aSEC

ANALYST Moser

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

NFI

(Parenthesis ( ) Indicate Expenditure Decreases)

SOURCES OF INFORMATION

LFC Files

Responses Received From:

Board of Nursing

Department of Health

SUMMARY

Synopsis of Amendment

The amendment adds an emergency clause making the bill if passed effective upon signing into

law.

Synopsis of Bill

Senate Bill 119 (SB 119) would amend the Nursing Practice Act to unify Certified Medication

Aide (CMA) programs that currently operate in a variety of settings into one statewide program,

under the regulatory control of the Board of Nursing. SB 119 would empower the Board of

Nursing to set standards and adopt rules governing the certification of medication aides, as well

as medication aide training programs. SB 119 further would establish new maximum allowable

fees for CMA certification and CMA training program approval and periodic evaluation.

Significant Issues

SB 119 would expand the Nursing Practice Act to allow for the use of CMAs in provider sys-

tems that are impacted by the shortage of licensed nurses, beyond their use in licensed intermedi-

Senate Bill 119/aSEC-- Page 2

ate care facilities for the mentally retarded and consumers served under the Medicaid waiver for

the developmentally disabled.

The School Medication Aide program was established as a pilot under HB 528 of the 2004 Leg-

islature. The Board of Nursing Task Force overseeing this pilot found that Certified Medication

Aides can safely and efficiently administer routine medications in public school settings, pro-

vided that there are qualified nurses available to appropriately delegate and evaluate medication

delivery.

Regulatory oversight of CMA programs that would be established by SB 119, would allow exist-

ing programs to continue and new programs to be initiated. This would make the CMA option

available to school districts and other healthcare providers utilizing these care givers across the

state.

PERFORMANCE IMPLICATIONS

SB 119 impacts the Board of Nursing through the expansion of the current Developmental Dis-

abled/Intermediate Care Facility Medication Aide programs to include other health care settings

that can utilize medication aides such as public schools and long term care facilities under the

supervision of a registered nurse.

SB 119 supports the Department of Health (DOH) Strategic Plan:

•

Program Area 1: Prevention and Disease Control, Strategic Direction: Improve the Health

of New Mexicans.

Objective 6: Prevent and control chronic disease.

•

Program Area 2: Health Care Delivery, Strategic Direction: Improve access to health ser-

vices.

Objective 2: Improve access to health services at agency-funded school-based health

centers.

•

Program Area 6: Los Lunas Community Program and Residential Care Facilities,

Strategic Direction: Promote a continuum of high quality community based long-term

care options for eligible persons.

FISCAL IMPLICATIONS

The New Mexico Board of Nursing is not a general fund agency. The expansion of this certifica-

tion program will generate additional revenue for the agency through testing, recertification, sur-

vey evaluations and survey visits. Agencies and individuals requesting medication aide status

will be charged the appropriate fees.

ADMINISTRATIVE IMPLICATIONS

Increasing the number of medication aides can be currently supported by existing Board of Nurs-

ing staff. This includes testing, initial certification, recertification, and survey evaluation visits.

Dependent upon the growth of the program additional staff may eventuaully be needed.

OTHER SUBSTANTIVE ISSUES

According to the Department of Health, Certified Medication Aides are the only unlicensed per-

Senate Bill 119/aSEC-- Page 3

sons to whom nurses can legally delegate the task of medication administration. Given the num-

ber of routine medications required by students in schools and the lack of sufficient school

nurses to administer those medications in every school building every day, Board of Nursing

Certified Medication Aides are a valuable and needed adjunct to nursing services in New Mexico

schools.

New Mexico nursing homes, like other healthcare providers, work hard to deliver care and ser-

vices in an environment of scarce and shrinking resources.

The New Mexico Department of

Health’s Long-Term Regulatory Cabinet subcommittee has analyzed data that suggests the

shortage of nurses available for employment in nursing homes may be understated by as much as

one-third. Many essentials of resident care prescribed by a physician or demanded by regulatory

guidelines can only be delivered by a Licensed Practical Nurse or Registered Nurse. SB 119

would have the effect of easing care delivery obstacles by allowing for the continuation and ex-

pansion of the Certified Medication Aide program, thus freeing the nurses to deliver the care

only they are permitted to do. There are many states that have successfully incorporated the Cer-

tified Medication Aide into the hierarchy of nursing staff providing care to the aged infirm in

nursing homes. Certified Medication Aides pass a very limited group of medications; they give

no injections, they do not administer controlled substances and, they do not administer any medi-

cation that requires assessment or judgments.

ALTERNATIVES

An alternative to SB 119 could be amending the Nursing Practice Act to add language allowing

for a School Medication Aide Program and a Nursing Home Medication Aide Program, in addi-

tion to those specified for Developmentally Disabled Waiver and Intermediate Care Facilities for

the Mentally Retarded.

WHAT WILL BE THE CONSEQUENCES OF NOT ENACTING THIS BILL.

The Board of Nursing concludes that as different agencies look to expand to the use of medica-

tion aides, they would need to request from legislature a pilot project to review/determine the

need for medication aides in their agencies. An example would be the Corrections Industry. By

ensuring these changes the Board of Nursing would be able to determine the need to expand ap-

propriate regulate medication aides in various health care settings in New Mexico always look-

ing to public safety first.

The Department of Health concludes that the School Certified Medication Aide Program would

have to be discontinued. This would have the effect of leaving schools that do not have a full

time school nurse without a safe and legal mechanism for the delegation of medication admini-

stration to unlicensed staff.

In nursing facilities, nurses will have less time for direct patient care.

EM/lg/njw