MINUTES OF THE HEALTH CARE ADMINISTRATION BOARD MEETING Thursday, September 18, 2008

Transcription

1 MINUTES OF THE HEALTH CARE ADMINISTRATION BOARD MEETING Thursday, September 18, 2008 MEMBERS PRESENT: Ruth Charbonneau Christine Stearns Mary Kay Roberts (via teleconference) Gregory Marks (via teleconference) Judith Persichilli (via teleconference) Ellsworth Havens Anastasius Efstratiades EXCUSED: Michael Malloy Joseph Roth STAFF: Michael Kennedy, DAG Michele Stark CALL TO ORDER Ellsworth Havens, Chair opened the meeting on Thursday, September 18, 2008 at 9:20 a.m. located at the New Jersey Department of Health and Senior Services, Health and Agriculture Building, Boardroom, 1 st Floor, Trenton New Jersey.

2 MOTION SUMMARY 1. Approval of the Proposed for New Rules at N.J.A.C. 8:43J, Standards for Licensure of Pediatric Medical Daycare Facilities Motion Ms. Stearns, Second Mr. Efstratiades 2. Adjournment (voice vote) SEPTEMBER 18, 2008 HEALTH CARE ADMINISTRATION BOARD VOTING RECORD VOTING BOARD MEMBER ROLL 1 2 Ms. Charbonneau X Y Y Mr. Malloy Mr. Baker X Y Y Ms. Roberts ** X - - Mr. Havens X Y Y Mr. Efstratiades X Y - Mr. Marks * X Y Y Ms. Persichilli X Y Y Mr. Roth Ms. Stearns X Y Y Ms. Wachter X Y - TOTAL TOTAL Absent 9 2-(-) 8-Y 0-A 0-N 3-(-) 8-Y 0-A 0-N 3-(-) KEY: Y=YES N=NO A=ABSTAIN ( - )=ABSENT * Arrived after roll call ** Left before voting DETAILED MINUTES TAKEN FROM TRANSCRIPT OF SEPTEMBER 18, 2008 ATTACHED

3 CHAIRMAN HAVENS: Good morning, everyone, and thank you for being here. I'd like to call the meeting to order. Michele, if you could read the statement. MS. STARK: This is a formal meeting of the Healthcare Administration Board. Adequate notice of this meeting has been published in accordance with the provisions of Chapter 231, Public Law 1975, c-10:4.10 of the State of New Jersey entitled, "Open Public Meetings Act." Notice was sent to the Secretary of State, who posted the notice in a public place. Notices were forwarded to 17 New Jersey newspapers, 2 New York newspapers, 2 wire services, 2 Philadelphia newspapers, and the New Jersey Public Broadcasting Television Station. I'll call roll. Ms. Charbonneau? MS. CHARBONNEAU: Yes. MS STARK: Mr. Malloy is absent. Mr. Marks is currently absent. Ms. Persichilli? MS. PERSICHILLI: Yes. MS. STARK: Mr. Havens? CHAIRMAN HAVENS: Yes. MS. STARK: Mr. Roth is absent. Mr. Efstratiades? MR. EFSTRATIADES: Yes. MS. STARK: Ms. Stearns? MS. STEARNS: Yes.

4 MS. STARK: Ms. Wachter? MS. WACHTER: Yes. MS. STARK: Ms. Roberts? MS. ROBERTS: Yes. MS. STARK: Mr. Baker? MR. BAKER: Yes. MS. STARK: Eight members of the board are present, which does constitute a quorum. CHAIRMAN HAVENS: Thank you very much. The Chairperson's Report -- there is no report from the Chair this month. We'll go on to the Commissioner's Report. MS. CHARBONNEAU: The department yesterday released a quality report, the 2008 Hospital Performance Report. Members present at the meeting have copies, and we will mail copies to the other members participating by telephone. The Commissioner also had a press availability yesterday, and it was widely covered in the press today, indicating that overall there's been a significant improvement in the measured indicators. New Jersey is now ranked, in terms of national reviews, second amongst all states, in terms of many of these performance measures. So it's a significant improvement over the past several years since we've been reporting on hospital performance. We've also released, early this month, the Commissioner's Report from the Prenatal Task Force. That has been an active committee that the Commissioner has been involved in since her early months here at the department. It published a series of recommendations for prenatal care, and for access issues, including reaching out to the minority communities. So that report is also available on the department's website.

5 Lastly, this is Minority and Multicultural Month, which the department works on every September. There are a series of events, in terms of visits by the Commissioner, as well as various grants that are awarded, in terms of minority communities, including recent grants that went out from the Minority and Multicultural office this week. With that, I think that is all that I have to report on. CHAIRMAN HAVENS: Thank you very much. Any questions on the Commissioner's Report? (No response). CHAIRMAN HAVENS: Next on the meeting agenda is the proposal for new rules at N.J.A.C. 8:43J, Standards for Licensure of Pediatric Medical Daycare Facilities. MR. BRENYCZ: Thank you. Good morning, my name is Eugene Brenycz; I'm a Program Specialist in the Office of Certificate of Need and Healthcare Facility Licensure. This morning, I'm going to be asking for your approval to submit to OAL publication amendments to the Standards for Licensure of Adult and Pediatric Day Health Services Facilities, before 8:43J. And these new standards for the licensure of pediatric medical daycare facilities, which are proposed to be published at 8:43J, 8:43F was the department proposal. The department is proposing new rules for the licensure of pediatric medical daycare facilities, currently referred to and licensed as pediatric day health services facilities, with the N.J.A.C. 8:43J, Standards for Licensure of Pediatric and Medical Daycare Facilities. What I'm going to go over today are the changes from the existing rules, because what we've done here is we've taken the pediatric rules out of 8:43F. And 8:43F is going to be a freestanding adult health service facilities licensure chapter, while 8:43J will now be a standard chapter just for the licensure of pediatric medical daycare facilities. And that's the first change that we're going over; the name of the facility is being changed to more reflect the type of services being offered. It's not as much a daycare facility; this is a medical facility that's being licensed. These proposed new rules will provide the basis for licensure for the 17 pediatric medical daycare facilities currently operating in New Jersey, as well as any pediatric medical daycare facilities that may apply for licensure in the future.

6 Currently, there is a moratorium on licensing new pediatric medical daycare facilities. The moratorium remains in effect at the moment, as well as these rules, that also affect these facilities. N.J.A.C. 8:86 provides the standards for Medicaid eligibility for adult and pediatric day health services, participants, and facilities. The Medicaid office is doing the same thing that we're doing; they're splitting the pediatric rules off from the adult day rules. Those are going to be proposed at the same time as these rules, and it is going to codify N.J.A.C. 8:87, Pediatric Medical Daycare Services. This is going to result in the clear-up of some confusion that results in those chapters, whether it applies to adult versus pediatric services. The purpose of pediatric medical daycare is to provide an alternative to private duty nursing, prolonged hospitalization, and institutional long-term care for primarily technologydependent and medically fragile children. Back in 2006, it was before the Board to propose a Notice of Proposal to re-adopt N.J.A.C. 8:43F. At that time, the department reported that it was conducting a study of pediatric day health services, and planned to propose a comprehensive revision of the rules governing pediatric day health services in the future. That was at 38 N.J.R. 3115A, and that was August 7, What I'm presenting before you today is that proposal. The department-designated study team visited nine facilities, and reviewed 185 individual records of the children attending those facilities. This Notice of Proposal reflects the study team's analysis of these facilities, and its recommendation for improvements of licensure. There are some significant changes in Subchapter 1, which will maintain the general provisions. Among them is the definition of child. Previously, enrollment was limited to a child who was six years of age or younger, who is technologically-dependent and/or medically unstable, as defined in the New Jersey Administrative Code at 8:86-1.5G. Those are the Medicaid rules, and it was required that continuous nursing services be available in a pediatric daycare services facility. This proposal would now provide that a child's age to the last day prior to his or her sixth birthday and is either medically complex, which is a term defined as a child who exhibits a very in-depth illness that requires ongoing skilled nursing intervention or a technology-dependent child, which is defined as a child who requires a specific class 3

7 medical device to compensate for the loss of a vital body function to avert death and future disability, and ongoing skilled nursing intervention in the use of the device. Subchapter 2 deals with licensure procedures. We are proposing no new requirements on licensees that are already not present in N.J.A.C. 8:43F. There's one change taking place at proposed N.J.A.C. 8:43J-2.5, which requires criminal background investigations for all employees, owners, or other individuals who have contact with children in pediatric medical daycare facilities. What we're doing is consistent with the statute, granting the authority for the criminal background investigations, providing that employees who are awaiting the results of their fingerprinting be permitted to work in a pediatric medical daycare facility, as long as they are not unsupervised. That means as long as they are in the presence of an employee who already has passed a criminal background investigation, they will be permitted to start employment in the facility as they're awaiting their results. There is a change in Subchapter 5, which addresses child assessment and interdisciplinary plan of care. At N.J.A.C. 8:43J-5.3, which establishes the process and content of the initial assessment and initial plan of care, the current requirement is that a child has to have a physical within 60 days. The proposed rule would change that to 30 days. This is necessary, because these are children whose medical condition can change constantly, and it can see some rapid improvement in many cases. So a more current physical examination from their healthcare provider is necessary to ensure that they are appropriate to receive services in the facility. The next rule at proposed N.J.A.C. 8:43J-5.4, which would establish the requirements for the development and implementation of the interdisciplinary plan of care, and also would address discharged planning. The current provision is that a child needs to be re-assessed every 90 days. Again, as for the prior change in the physical rule, we are going to require that the reassessments occur every 60 days, because the condition of the child can change quite rapidly. At proposed new N.J.A.C. 8:43J-6.2, which provides staffing requirements, which are in part based on attendance at the facility, the provision requires that -- let me give you the present requirements.

8 First, they require that two RNs be available at the facility, with one registered nurse on the site at all times, and one staff person for every three children. The proposed requirements would require a minimum of two registered professional nurses on-site at all times when children are present in the facility. We continue the requirement for one direct care staff member to every three children in attendance. And within that 1-3 ratio would require a ratio of one licensed nurse, which includes registered nurses or licensed professional nurses for every six children in attendance. The study team deems this necessary due to what should be the condition of the children in these facilities. Their healthcare needs would need to be met by the staffing level. In Subchapter 7, the subchapter addresses nursing changes, which is a proposed N.J.A.C. 8:43J-7.2, which would establish the minimum qualification for nursing directors. The current standard for a nursing director is a registered nurse with at least one year of fulltime experience in nursing supervision and pediatric experience. The proposed rules, recognizing the healthcare needs of the children in these facilities, would require a registered nurse with at least one year of full-time experience in nursing supervision, and who has three years of pediatric nursing experience, of which at least one year in the last three years should have been in a Pediatric ICU (PICU), Neo-natal ICU (NICU), pediatric nursing home, pediatric homecare, or a pediatric medical daycare facility. Subchapter 9 addresses pharmaceutical services. There is a change from the existing rules at proposed N.J.A.C. 8:43J-9.1, which establishes requirements for the provision of pharmaceutical services, and requires facilities to designate a consultant pharmacist. The consultant pharmacist would now be required to review the child's medical records to determine the appropriateness of the pharmaceuticals received by the child every 60 days, instead of every 90 days. Again, this is due to the fact that the healthcare needs of the children may change rapidly, and it's more appropriate to do it every two months, instead of every three months. Also, in Subchapter 9, which is a changed proposed that N.J.A.C. 8:43J-9.4, which addresses pharmacy control policies and procedures. Previously, these facilities were required to get all their medication from a provider pharmacy. The proposed rules would have the parents provide the medication, and the facility would receive the medical orders from the healthcare provider.

9 Subchapter 10 deals with dietary services. Proposed N.J.A.C. 8:43J-10.1 provides the general requirements for dietary services. The current requirement is that parents are not allowed to bring food in for their child in the facility. This change would allow it appropriate for the parent to bring the child's food in for the day or a week's worth of supplies. Subchapter 11 addresses developmental and rehabilitation services. There is a change from the current rules, which is proposed at N.J.A.C. 8:43J-11.2, which requires the facilities to provide rehabilitation services. The current rules provide the facility may take the child off-site for rehab services. The study team on, examination of that, felt that it was inappropriate for the child to be removed from the facility at some point, on a bus for half an hour or an hour, and then have to come back to the facility. And the facilities would be required to provide rehab services on-site. Subchapter 12 addresses social work services, and there is a change in the standards at proposed N.J.A.C. 8:43J-12.1, which establishes the minimum qualifications of social workers. The rule, as a requirement, is that the social worker for the facility has one year experience working with children. Proposed Subchapter 13 addresses the physical plant requirements, and there is a change at proposed N.J.A.C. 8:43J-13.1, which establishes the physical plant requirements for the rule. Presently, the rules do not provide a requirement for any sort of emergency generator or power supply. The proposed rules would establish a standard, which would require the facility to have an emergency generator capable of providing power for two hours. This is necessary, because we have children in the facility on ventilators, and other type of healthcare equipment. This would provide a window, during a power outage, to have the child either sent home or sent to another facility. Also in Subchapter 13, there is a change proposed at N.J.A.C. 8:43J-13.8, which provides standards for childcare areas. The present standard is 30 square feet for each child in the facility. The study team determined it is appropriate to follow established national guidelines, which require 35 square23 feet for each child.

10 And also, the physical plant standards is an entirely new requirement at N.J.A.C. 8:43J-13.10, which would provide the standards for the facility to have an outdoor play area or some sort of area for children where it is appropriate medically appropriate -- to go outside for certain hours during the day. There are also a few more changes in Subchapter 16, which continues to address transportation services. Proposed new N.J.A.C. 8:43J-16.1 provides the standards for transportation services. Currently, there are no staffing requirements -- excuse me, this provides new standards for the type of transportation vehicle the child can be in. The current standards don't establish any sort of standards, and we've discovered facilities are transporting these children in a standard school bus. Upon review, the study team determined that it is more appropriate to adopt the EMS standard for transportation vehicles that is proposed in the Rules of Transport of this sort of health condition. That's in 16.1 and Staffing levels were not addressed in the prior rules. At this time, the proposed rules would require at least one staff member, in addition to the bus driver, to be present on the vehicle. And also establish the standard there at 16.2, which would require that it establishes the nurse also, as well as when a staff member does require that the nursing director determine if it is appropriate to have a trained level of staff or additional staff members, based on the healthcare of the child. Thank you. And those are really where, under the four-page document before you, where the rules differ from the current standards. If you have any questions, I'm here to answer them for you. And we also have a member of the study team here, if there is a question that I can't deal with. CHAIRMAN HAVENS: How do these regulations overlap with the state educational laws and regulations? MR. BRENYCZ: What we've done here, as in the past, we incorporated the requirements for the children family services requirement for medical daycare or daycare service in here. As far as the education requirements go, these facilities are capping the child's age as they are prior to their sixth birthday, because it was determined at that point it is the educational system that is responsible for the child's care. CHAIRMAN HAVENS: That's my understanding. They're in New Jersey, there are laws on preschool education requirements and open access for all children, regardless of handicapped

11 status. They're all entitled to the same level of education on a pre-school basis. I didn't know how these regulations -- there's no reference to education here, yet I believe New Jersey law requires education for all children, regardless of status. MR. BRENYCZ: We'd have to look at that. That is not something that we've discussed. CHAIRMAN HAVENS: I know it is New Jersey Law. MR. BRENYCZ: We'll look into what the standards require. I'll meet with the study team and discuss the issue. CHAIRMAN HAVENS: Sometimes it's on the medical side, and we forget that there's other elements; right. MS. WACHTER: I have a question. When you reviewed all the existing 17 pediatric medical daycare centers; what is the highest census? Is it usually like around six, or is there as many as 20 participants in each -- in a facility? MR. BRENYCZ: The majority of the facilities are capped at 27. Dr. Zanna, do we have an accurate census number? DR. ZANNA: There were some that were at a higher census, but they were asked to trim. There has been some movement downward. CHAIRMAN HAVENS: If you could introduce yourself, and give your name for the record, please. DR. ZANNA: I'm Dr. Martin Zanna, and I was on the study team. Actually, our other member would have been here, Dr. Buzdygan is a pediatrician, and normally -- they had to return to Child Health for Medicaid. She's very knowledgeable about these issues. Basically there were -- because we didn't -- we eventually will have her authorization in the Medicaid role. But some of the facilities have more children, and we wanted to enforce the regulations. So there was a movement to have the facilities atrit to lower levels, and a number of them have been successful.

12 CHAIRMAN HAVENS: What would be the effective range and size of the facilities; from what to what? DR. ZANNA: I think some at one point were at over 60, a couple, but they're down now. MS. WACHTER: Correct me if I'm wrong, it's Mary again, some of these facilities have children that according to the -- it sounds like it's going to be the soon-to-be Medicaid criteria for eligibility. We probably need that; is that correct? DR. ZANNA: Correct. MS. WACHTER: So do you anticipate that once these licensures are adopted, and once the Medicaid eligibility criteria is adopted, that you'll see an increase in the number of these facilities, or a decrease? DR. ZANNA: Well, right now there's a moratorium. Right now, we have more facilities concentrated into the south, and we'd like to eventually -- we'd like to have a service in other parts of the state that don't have this service. And with the eligibility criteria being clarified and prior authorization, we'll have no appropriate utilization, based on the definitions. MS. WACHTER: And of the children of the participants that are in the current facilities, are most of them on Medicaid, or is there a fair split between Medicaid and private? Dr. ZANNA: Over 90 percent are Medicaid. MS. WACHTER: How soon do you expect the Medicaid eligibility regulations to be proposed? DR. ZANNA: Actually, there's going to be a companion document when the licensing goes MS. WACHTER: That's right, yes. DR. ZANNA: They should be viewed, in fact, as people read it, and right at their hand and glove, and if they go together.

13 MR. BRENYCZ: We'll be adopting and speaking to licensing. You know, I am still fielding some phone calls from people interested in opening these facilities, and they need to inform them there's a moratorium in place. MS. WACHTER: Yes. MR. BRENYCZ: There is an interest out there. MS. WACHTER: Once they meet Medicaid eligibility criteria, they need to decide if there's any financial sense for them to open it. It's just my guess. MS. CHARBONNEAU: Mary, this is Ruth. I think both Dr. Zanna and Eugene have expressed that we have a direction that this is going in. These rules focus on appropriate utilization for medically complex pediatrics and children. We believe that the sort of moving forward that we'll see is sort of a more appropriate usage of this type of facility. MS. WACHTER: Okay. Well put. I have a couple of other questions. For children between the ages of 6 and 16, that's the school's responsibility? That's sort of a tag-on to the question that someone asked earlier. MR. BRENYCZ: Yes. MS. WACHTER: The Subchapter 4, on page 105, is the Child's Right. I was just curious how those were created, or if they're modeled after it, or if they're parts of the Patient's Rights? MR. BRENYCZ: We did use the Patient's Bill of Rights as the model for these rules. MS. WACHTER: Okay. Hang on, I'll just go through the rest of my questions. I've been writing them according to the page numbers. On page 114, which is under discharge planning, I think so, D. It talks about the issues for the discharge plan of care, the changing in the clinical and the financial status, and they expect the child to continue eligibility. So I guess a facility that has the ability to sort -- if a patient has been on Medicaid, for example, and they continue to pay, just

14 because, maybe, their private insurance has been terminated, they're able to discharge participants based on their ability to pay; correct? MR. BRENYCZ: I believe so, yes. I believe D -- there is more in taking into account the Medicaid standards. As far as if you might be on Medicaid, the patient no longer is financially eligible, so there would be a discharge at that point; yes. MS. WACHTER: Medicaid participant is no longer financially eligible. So in other words, someone is no longer eligible for Medicaid, but they may not have an ability to pay, and so the facility is able to discharge them from care of their ability to pay? MR. BRENYCZ: Yes -- MS. WACHTER: Inability to pay. And how often do you think that -- well, I guess you don't know, because most of the participants currently are Medicaid beneficiaries. MR. BRENYCZ: Yes. MS. WACHTER: That will be interesting to see how that works. What is the participant's average length of study? MR. BRENYCZ: Turning to Dr. Zanna again. MS. WACHTER: I mean, you may not know that. I'm just wondering if you have any kind of idea. I'm assuming these are probably long-term. DR. ZANNA: We went out several years ago, and the condition the kids were in -- and they were reaching out. But when the rules are implemented, we're hoping that there will be -- we'll have to see what it turns out to be. Will it be desirable to be two years? We're doing our review. They were coming in, and they were staying until they aged-out. MS. WACHTER: I was thinking that they were probably Medicaid pediatric participants. DR. ZANNA: We didn't see a lot of those --

15 MS. WACHTER: That are there, and until they turned school age, I guess. DR. ZANNA: But the medically complex, you can tune them up, a lot of the kids really improve. This is one item that Dr. Buzdygan, our pediatrician, said that the allure of pediatrics is that you can really impact on kids, and they can get better. MS. WACHTER: Good. The next, page 115, the general services talks about the minimum of six comprehensive hours per day that they're operational. So if that's the case, the five days a week, is that for a full six hours each day that they're open? Or is there a number of days that they have to be open during the week? MR. BRENYCZ: I don't believe that we have set a standard on the number of days that they have to be open. This is a current standard that they need to be providing services at least six consecutive hours per day. MS. WACHTER: It may be that the participants certainly don't need to be there for six full hours. But as far as their plan of care, how many hours a day do they need to be there? MR. BRENYCZ: I believe -- it's for Medicaid purposes that they will need to receive six hours of services before you can release them on Medicaid. DR. ZANNA: On the Medicaid side, we're going to require that they can only bill five minutes of service per week, which means they'll get five days per week. MS. WACHTER: That's the maximum that they'll get, is six hours each day? DR. ZANNA: The maximum would be six hours. MS. WACHTER: And the maximum is six hours and the maximum is five days a week? Okay. The next, page 116, it talks about I think you might have said this already. I'm just trying to get clarification on this. The staffing requirements, is the director of nursing excluded from the -- if the nursing director is an RN, that's in addition to the requirement of two registered professional nurses?

16 MR. BRENYCZ: You're correct. The director of nursing is excluded, because she's not really considered medical, she's more of the administrator than providing hands-on care. MS. WACHTER: Sliding up in the rules a little bit; when I was reading through the requirements for the owner or operator, I'm just -- maybe you want to consider adding to that requirement, a reference to the section that talks about criminal background checks. Because, I think it's page 66 that includes the eligibility, when an individual is eligible to own or operate the facility. I guess maybe you did include it. I didn't look up N.J.A.C. 8 or 10, but does that reference the whole criminal history? MR. BRENYCZ: Yes. MS. WACHTER: The thought came in my mind, Oh God, I hope they don't allow convicted pedophiles, so that doesn't mention that there; all right. MR. BRENYCZ: I believe in 2.8 though, where it talks about the CBI, it requires an operator to have a criminal background investigation. MS. WACHTER: It did, and I didn't know if you wanted to reference -- MR. BRENYCZ: Cross-reference. MS. WACHTER: Right; in the area that specified the background, the criminal background. The nursing delegation section, on page 125, does that just reference the Board of Nursing, Nurse Delegation Clause? MR. BRENYCZ: Yes. MS. WACHTER: And on page 129, under medical equipment, did you come up with that list based on the review of the sites that you visited?

17 MR. BRENYCZ: I think it was based on what the eligibility standards -- see, the level of care needed by the children, that should be present in the facilities, and what type of equipment you would need to take care of those children. DR. ZANNA: We also had input from our EMS program. MS. WACHTER: Okay. A couple of more questions. On page 177, when you talk about the transport page, out of curiosity, do any of them currently transport a large number of participants at one time? MR. BRENYCZ: Yes, we have seen that. MS. WACHTER: So there could be as many as 5 children on one transportation vehicle. And the rules only require the driver of the bus, plus one direct-care staff person? DR. ZANNA: If you look at 16.1B, these vehicles used to transport the children, the Mobile Assistance Vehicle Standards, place a limit on the occupancy. MS. WACHTER: Okay. So that's how they handle that. DR. ZANNA: This was in reaction to an incident in the last year on a school bus. MS. WACHTER: Okay. I have my last two questions. I'm assuming the quality improvement is probably reflecting other licensing standards from other types of facilities? MR. BRENYCZ: Yes. It's a pretty standard subchapter. MS. WACHTER: And my last question is on page 182, when it talks about the use of restraints, and then it says pediatric safety guards. I didn't see the pediatric safety guards defined in the definitions, and I'm not really sure what that requires by restraint. DR. ZANNA: The pediatric safety guards could be -- we saw one of them in a facility where a child was in a crib. And they had an ability the child could climb out of the crib, but it didn't restrain the movement. It was like a little tented area.

18 MS. WACHTER: So like a playpen or somewhere where they are confined. DR. ZANNA: We should really define that, I guess. MS. WACHTER: You might want to just add that in their definition. MS. ROBERTS: I'm just clarifying, that I would assume -- I mean, perhaps rails prevent -- that if they're in a bed, that's considered a safety device for parents and toddlers, so they don't roll out of bed? DR. ZANNA: That would have to be such that they couldn't get caught in it. That would be another problem. CHAIRMAN HAVENS: I believe it also relates to wheelchairs in other facilities. DR. ZANNA: We don't use too many in this age group with wheelchairs, but there's strollers and things. CHAIRMAN HAVENS: At five years old you do. MS. WACHTER: So in other words, that section -- you know, the primary care healthcare provider needs to specifically order the use of a crib or a playpen or rail or something of that nature. MR. BRENYCZ: Yes. I think somewhere along the lines of the safety tent. MS. WACHTER: Yes, okay. MR. BRENYCZ: I think that most of the facilities are using cribs with rails, just as a general standard. MS. WACHTER: Those are all my questions, thanks. You did a good job, by the way. I know this is probably a major undertaking, and I thought that they looked really good.

19 MR. BRENYCZ: Thank you. The study team has been in the works for some time, just to hammer everything out right. CHAIRMAN HAVENS: Any other questions? MS. STEARNS: Could you just refresh my memory on who was part of your study team? DR. ZANNA: Dr. Daneta Buzdygan, Celeste Andriot Wood, with the Assistant Commissioner delegated a couple of maternal child health nurses, Pauline Lisciotto and Diane DiDonato. MS. STEARNS: I don't need actual -- DR. ZANNA: Pediatric nurses, pediatricians, so they were healthcare professionals. CHAIRMAN HAVENS: Any other questions from any other members of the board? Are there any questions from anyone in the audience, questions and/or comments? Please step forward, and state your name. MS. STENGART: My name is Marina Stengart, S-T-E-N-G-A-R-T. My first question is, what do homecare and the homecare agency consider healthcare experience? In healthcare organization experience, it mentions that the director of nursing or administrator should have experience in the healthcare facility. That's I think that's -- I believe exactly what it states. Is home care considered -- is a pediatric home care agency considered a healthcare facility? MR. BRENYCZ: It's a licensed healthcare facility. MS. STENGART: The word facility to me MR. BRENYCZ: Home healthcare agencies are licensed facilities, and we do specifically say in the requirements for the event that we reference home care. MS. STENGART: And another question, if I may. Can the facility itself, meeting the criteria of the space requirements and all the rest of the requirements, can the facility be shared with a pediatric -- a regular mainstream program, a nursery or kindergarten program?

20 CHAIRMAN HAVENS: I believe the answer is no. MR. BRENYCZ: It would be inappropriate to mix those children. MS. STENGART: Not being mixed, but they would, within the facility, be separated. MR. BRENYCZ: If you had to separate, not the MS. STENGART: Just sharing the employee bathrooms and the entrance area? MR. CALABRIA: My name is John Calabria, C-A-L-A-B-R-I-A. I'm the Director of Certificate Need of the healthcare facility licensure at the department. Those kinds of issues, sharing of common space, are handled on the case-by-case basis. We do offer a functional review, where some of the architectural plans and types we have are covered, for example, sharing a waiting room. We will not allow cross in clinical areas, so it's a case-by-case basis, depending on the layout of each facility, and what architectural plans look like. CHAIRMAN HAVENS: Thank you. MS. STENGART: I have a comment with the Board and everybody else. Being a director of a pediatric home care agency for 15 years, and servicing children in most areas of New Jersey, I would like to express the need for medical daycare centers -- pediatric medical daycare facilities, because a lot of the children are bed-ridden with service. It's really not that I feel the burden on Medicaid, because most of the children, a lot of them -- a good percentage of the children we service in the pediatric homecare agency were there because there were no facilities available in the area. The cost for nursing services is now between $40 and $50, I believe $38 an hour for the LPN and $50 an hour for RN services. Those children are receiving private nursing services, where they could receive and attend the program. I think the burden on Medicaid was tremendous, as opposed to $200, and I believe $20 to a day for the medical daycare facility. So that's just my comment on the need and I don't even know that there's the daycare facilities in a lot of counties, which is Bergen County, for example. So that needs to be taken into consideration, the severe shortage of the facilities. Thank you.

21 CHAIRMAN HAVENS: Thank you very much. MS. ROBERTS: I have to go into my meeting, but I wanted to leave my vote to approve the regulation. CHAIRMAN HAVENS: If there are no other comments from the audience, and no other comments or questions from the Board, I'd look for a motion on the regulations. Do I get a motion? MS. STEARNS: I move to propose the new regulations at N.J.A.C. 8:43J, Standards for Licensure of Pediatric Medical Daycare Facilities. CHAIRMAN HAVENS: Is there a second? MR. EFSTRATIADES: Yes. CHAIRMAN HAVENS: First, the roll call. MS. STARK: Ms. Charbonneau? MS. CHARBONNEAU: Yes. MS. STARK: Ms. Persichilli? MS. PERSICHILLI: Yes. MS. STARK: Mr. Marks? MR. MARKS: Yes. MS. STARK: Mr. Havens? CHAIRMAN HAVENS: Yes.

22 MS. STARK: Mr. Efstratiades? MR. EFSTRATIADES: Yes. MS. STARK: Ms. Stearns? MS. STEARNS: Yes. MS. STARK: Ms. Wachter? MS. WACHTER: Yes. MS. STARK: Ms. Roberts is absent. Mr. Baker? MR. BAKER: Yes. MS. STARK: Eight yes. Motion carries. CHAIRMAN HAVENS: Thank you very much. Is there any other business? Hearing none, we'll move for adjournment. Thank you. (Whereupon, the proceedings concluded at approximately 10:08 a.m.)