New Jersey-2018-A3587-Introduced

An Act concerning health care industry representatives and supplementing Title 45 of the Revised Statutes.

Be It Enacted by the Senate and General Assembly of the State of New Jersey:

1. This act shall be known and may be cited as the "Health Care Industry Representative Certification Act."

2. The Legislature finds and declares that:

a. Health care industry representatives (HCIRs), also known as vendors, are individuals and companies that visit health care facilities for the purpose of providing a wide range of services, including clinical education and in-services, technical support, training, administrative support, and product sales and services.

b. HCIR credentialing requirements were originally established as a means to control access to health care facilities and to protect patient safety and privacy.

c. Over the past decade, the requirements for HCIR credentialing have expanded dramatically, with multiple credentialing entities operating in New Jersey and many facilities establishing their own individual conditions on access. These requirements can include online courses, specific training and educational requirements, mandatory vaccinations, and the payment of access and testing fees.

d. The costs of meeting these various credentialing requirements can total thousands of dollars per facility per year for each HCIR. For HCIRs representing small and mid-sized businesses, these costs can serve as a barrier to access and put them at a competitive disadvantage against larger entities, which are better able to absorb the expense.

e. The lack of standardized requirements has resulted in a complex, confusing, and occasionally arbitrary credentialing system.

f. It is therefore necessary and appropriate for the State to establish a standardized system of HCIR credentialing that will facilitate and streamline HCIR access to facilities, limit the cost to HCIRs of doing business in New Jersey, maintain facility security, ensure the confidentiality of patient records, and preserve high standards for patient safety and quality of care.

3. As used in P.L. , c. (C. ) (pending before the Legislature as this bill):

"Board" means the State Board of Health Care Industry Representatives established pursuant to section 4 of P.L. , c. (C. ) (pending before the Legislature as this bill).

"Disqualifying offense" means an offense in New Jersey or any other jurisdiction involving a crime of the fourth degree or higher that implicates the health and safety of patients or staff at a health care facility. The board shall designate by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), crimes and offenses which shall be deemed "disqualifying" for the purposes of this section.

"Health care facility" means an acute care hospital licensed by the Department of Health pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.).

"Health care industry representative" or "HCIR" means any supplier, vendor, sales representative, or any other business partner who markets, promotes, or sells products, services, and technologies, or who provides education, in-services, or technical advice on specific products.

"Tier One HCIR" means an HCIR who enters a health care facility for administrative purposes which involve no direct access to, or contact with, patients or clinical areas. For the purposes of this section, "administrative purposes" shall include business meetings to discuss a business relationship, contractual issues, financial issues, and any other such matters as the board deems to be administrative in nature. "Administrative purposes" shall additionally include entering a health care facility for the purpose of delivering pharmaceutical samples and holding appropriate discussions pertaining to the nature, use, administration, and contraindications with regard to the samples, provided that such deliveries and discussions do not take place in any clinical areas of the facility, in the presence of any patients, or in any areas of the facility designated as sterile or restricted.

"Tier Two HCIR" means an HCIR who enters a health care facility to provide technical support, provide education and consultation services, conduct product and service marketing, promotion, or sales, or operate equipment. A Tier Two HCIR may have direct access to any area of the facility that is not designated as sterile or restricted, but shall not, while at the facility, operate clinical equipment used in patient care or for treatment purposes, have direct contact with any patient for purposes associated with the care or treatment of the patient, or otherwise access any area of the facility designated as sterile or restricted.

"Tier Three HCIR" means an HCIR who enters a health care facility for purposes which may include: direct access to patient care environments and clinical care areas, including sterile or restricted areas; direct contact with patients, including contact for purposes associated with the care or treatment of a patient; or the operation of clinical equipment used in patient care or for treatment purposes.

4. a. There is established in the Division of Consumer Affairs in the Department of Law and Public Safety the State Board of Health Care Industry Representatives. The board shall be responsible for the implementation and enforcement of P.L. , c. (C. ) (pending before the Legislature as this bill).

b. The board shall consist of nine members: the Director of the Division of Consumer Affairs in the Department of Law and Public Safety, or a designee, who shall serve ex officio, and eight public members, to be appointed by the Governor. The public members appointed by the Governor shall include four HCIRs and four representatives of health care facilities.

c. The public members shall serve for a term of five years, except that, of the members first appointed, two shall serve for a term of two years, two shall serve for a term of three years, two shall serve for a term of four years, and two shall serve for a term of five years. Vacancies in the membership shall be filled in the same manner as the original appointments. Public members who are appointed to fill vacancies which occur prior to the expiration of a former public member's full term shall serve the unexpired portion of that term. Each public member shall serve until a successor is appointed and qualified. Public members of the board shall be eligible for reappointment. The members of the board shall serve without compensation, but may be reimbursed for reasonable expenses incurred in the course of their official duties, within the limits of such funds as are made available for that purpose.

d. The board shall organize upon the appointment of its members, and shall select a chairperson and a vice-chairperson from among the members. The chairperson shall appoint a secretary, who need not be a member of the board.

e. The board shall meet at least twice per year, and shall additionally meet at the call of the chairperson. A majority of the membership of the board shall constitute a quorum for the purposes of transacting official business.

f. The Division of Consumer Affairs in the Department of Law and Public Safety shall provide staff and administrative support for the board.

5. a. (1) The board shall establish by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), standards and requirements for the certification of Tier Two HCIRs and Tier Three HCIRs. No certification shall be required for a Tier One HCIR, who shall have access to a given health care facility subject to the same terms and conditions as apply to other visitors with general access to the facility.

(2) A Tier Two or Tier Three HCIR certification issued pursuant to section 6 of P.L. , c. (C. ) (pending before the Legislature as this bill) shall be valid at every health care facility in the State, and, except as provided in paragraph (3) of this subsection, no facility shall establish, as a requirement to provide goods or services or conduct business at the facility, any training, certification, or other requirements that are in addition to the requirements established pursuant to this section.

(3) (a) A health care facility may require an HCIR to be escorted by a security officer or an appropriate staff member employed by the facility at such times as the HCIR is present in a secure area of the facility, provided that the health care facility shall be solely responsible for any costs associated with implementing an escort requirement pursuant to this paragraph.

(b) A health care facility may require an HCIR to comply with the facility's code of conduct while the HCIR is present at the facility, provided that such code of conduct shall be limited to requirements concerning the HCIR's personal behavior and interactions with other individuals while at the facility.

(4) Nothing in P.L. , c. (C. ) (pending before the Legislature as this bill) shall be construed to prevent a health care facility from granting limited or full access to the facility to any individual who is not certified as an HCIR, or from granting a Tier Three level of access to a Tier Two HCIR. Facilities may establish terms and conditions for such access, provided that in no case may a facility establish additional requirements for a certified HCIR to access the facility to the extent authorized by the HCIR's level of certification if such requirements would violate paragraph (2) of this subsection.

b. The standards and requirements for Tier Two HCIR certification and Tier Three HCIR certification shall be as follows:

(1) To qualify for Tier Two HCIR certification, the applicant shall submit to the board the following:

(a) certification from the applicant's employer that the applicant has completed all applicable product and service training and any safety modules appropriate to the HCIR's duties, functions, and level of access while in a health care facility;

(b) certification from the applicant's employer that the employer has completed a criminal history record background check of the applicant within one year of the date of the application, and that the criminal history record background check has not disclosed any criminal charges or convictions involving a disqualifying offense;

(c) certification that the applicant has successfully completed appropriate training in compliance with the federal privacy rule established pursuant to the "Health Insurance Portability and Accountability Act of 1996" (HIPAA), Pub. L. 104-191;

(d) certification that the applicant has successfully completed appropriate precautionary training in antiseptic techniques;

(e) certification that the applicant has successfully completed appropriate precautionary training in preventing the spread of bloodborne pathogens;

(f) certification that the applicant has successfully completed appropriate training in fire safety protocols;

(g) proof of the applicant's employer's general liability insurance and workers' compensation insurance, when applicable;

(h) if the applicant falls within a specific HCIR category identified by the board pursuant to subsection d. of this section, certification that the applicant falls within that category, is exempt from any certification requirements waived by the board pursuant to subsection d. of this section, and has met any additional certification requirements established by the board pursuant to subsection d. of this section;

(i) proof of negative tests for tuberculosis, which shall be completed annually;

(j) proof that the applicant has received the current influenza vaccine or has been granted an exemption from receiving the vaccine pursuant to subsection c. of this section; and

(k) vaccination records that include proof the applicant is currently vaccinated against measles, mumps, rubella, varicella, tetanus, diphtheria, pertussis, and hepatitis B, or, if the applicant is not current with one or more of the vaccines required pursuant to this subparagraph, proof that the applicant has been granted an exemption from receiving that vaccine pursuant to subsection c. of this section. The board may, in its discretion, revise the list of diseases for which vaccinations are required pursuant to this subparagraph at any time to add a new vaccination requirement for a particular disease or to remove an existing vaccination requirement for a particular disease, provided that any such revisions apply equally to all applicants for HCIR certification. Health care facilities may petition the board to require certified HCIRs to receive additional vaccinations as a condition of accessing that facility, which petition may be granted at the discretion of the board.

(2) To qualify for Tier Three HCIR certification, the applicant shall submit to the board the following:

(a) all materials described in paragraph (1) of this subsection;

(b) certification that the applicant has successfully completed appropriate training in operating room protocols consistent with current guidelines issued by the American College of Surgeons (ACS) and the Association of periOperative Registered Nurses (AORN); and

c. (1) The board may grant an exemption from receiving any vaccine required for HCIR certification under subsection b. of this section if the applicant submits a written statement by a licensed physician indicating:

(a) that the vaccine is medically contraindicated;

(b) the specific period of time for which the vaccine is contraindicated, if the medical contraindication is of limited duration; and

(c) the reasons for the medical contraindication, which shall be based on one or more valid medical reasons, as authorized by the board by regulation pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.).

(2) Notwithstanding paragraph (1) of this subsection and except as provided in paragraph (4) of this subsection, the board may deny any application for HCIR certification submitted pursuant to this section if the board determines that, because an applicant has not received a vaccine required under subsection b. of this section, the applicant would pose a risk to the health and safety of patients.

(3) In determining whether to grant an exemption requested pursuant to paragraph (1) of this subsection, the board may consult with a physician or other health care professional if the board determines such consultation to be necessary and appropriate.

(4) For the purposes of paragraph (1) of this subsection, pregnancy shall constitute a valid medical reason for granting an exemption from receiving one or more required vaccines, subject to the following requirements:

(a) The pregnancy exemption shall expire following the end of the pregnancy and a reasonable postpartum period;

(b) If the individual is applying for HCIR certification, the board shall not deny the individual's application solely on the basis of the pregnancy exemption, provided that the individual promptly receives any vaccines subject to the exemption upon the expiration of the exemption;

(c) If the individual is certified as an HCIR, the individual shall, while at a health care facility, comply with any additional safety protocols required by the board for HCIRs with a pregnancy exemption, unless the facility waives compliance with such additional protocols; and

(d) A health care facility may restrict or deny the individual's access to all or part of the facility if the facility determines that, because the individual has not received one or more mandatory vaccines on the basis of a pregnancy exemption, the individual would pose a risk to the health and safety of patients.

d. The board may, in its discretion, identify specific categories of Tier Two HCIRs and Tier Three HCIRs for which the standards and requirements set forth in subsection b. of this section are not reflective of the goods or services provided by that category of HCIRs. For any such category identified by the board, the board may waive any standards or requirements set forth in subsection b. of this section that it determines are inapplicable or irrelevant to that category, or establish, by regulation, additional standards and requirements for the certification of HCIRs who fall within that category. Any standards and requirements that are waived or established for a category of HCIRs pursuant to this subsection shall be universally applied to each HCIR who falls within that category.

6. a. (1) The board shall issue a Tier Two HCIR certification to any applicant who submits the materials required pursuant to paragraph (1) of subsection b. of section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill), and a Tier Three HCIR certification to any applicant who submits the materials required pursuant to paragraph (2) of subsection b. of section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill), provided the applicant has met any additional requirements for certification established by the board. The board shall provide each certified HCIR with an identification badge that includes the HCIR's name and employer, a photo of the HCIR, the HCIR's authorized tier level, the date on which the HCIR's current certification expires, and a barcode, microprocessor chip, magnetic stripe, or similar feature that allows facilities to easily scan the badge for the purpose of checking the HCIR into and out of the facility.

(2) The board may charge a reasonable fee for the issuance or renewal of an HCIR certification and identification badge. Any fees collected by the board pursuant to this paragraph shall be retained by the board for the purposes of implementing and administering the provisions of P.L. , c. (C. ) (pending before the Legislature as this bill), and in no case shall the fees be remitted to the General Fund.

(3) An HCIR certification shall be valid for three years.

b. The board shall approve HCIR training programs and establish a schedule of the maximum fees that the programs may charge to HCIRs.

c. (1) The board shall establish and maintain a secure online database of current HCIR certifications, which shall be made accessible to health care facilities for the purposes of verifying an HCIR's certification status. The information available through the online database shall include the HCIR's current vaccination status and any mandatory vaccines the HCIR did not receive pursuant to an authorized exemption, but shall not disclose the nature or details of the exemption or any other health information about the HCIR. The board may contract with a third-party provider to establish and maintain the online database.

(2) The online database required pursuant to paragraph (1) of this subsection shall be established and functional no later than three years after the effective date of this act. If the database is to be established and maintained by a third-party provider, the board shall take all such actions as shall be necessary to ensure the third-party provider establishes the database within three years after the effective date of this act.

d. The board shall, at least biennially, review the standards and requirements for HCIR certification established pursuant to section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill) to determine if the standards and requirements are consistent with national standards and current trends in HCIR certification. In conducting this review, the board shall consider, at a minimum, any recommendations or guidance issued by the federal Centers for Medicare and Medicaid Services and by the Joint Commission. The board may submit to the Legislature recommendations for any legislation or other legislative action concerning HCIR certification as the board deems necessary and appropriate.

e. The board shall establish by regulation, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), standards, protocols, and procedures for the enforcement of the requirements of P.L. , c. (C. ) (pending before the Legislature as this bill), which shall include, but shall not be limited to, standards, protocols, and procedures for: reporting complaints and alleged violations; conducting appropriate investigations and hearings; conducting mediations or other appropriate dispute resolution proceedings; assessing penalties, imposing disciplinary actions, and ordering any other remedial relief as may be appropriate; and appealing determinations made pursuant to this subsection.

7. a. (1) Except as provided in paragraph (3) of this subsection, a criminal history record background check required pursuant to subparagraph (b) of paragraph (1) of subsection b. of section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill) shall be completed by providing to the Division of State Police the name, address, fingerprints, and written consent for a criminal history record background check of the HCIR or HCIR applicant. The Division of State Police may exchange fingerprint data with, and receive criminal history record information from, the Federal Bureau of Investigation for use in determining whether an HCIR or HCIR applicant has been charged with, or convicted of, a disqualifying offense.

(2) An entity that employs HCIRs or HCIR applicants may apply to the Attorney General for approval of a method for the employer, or a designated third party, to complete criminal history record background checks of HCIRs and HCIR applicants. The Attorney General shall not approve a method for conducting criminal history record background checks pursuant to this paragraph unless:

(a) the employer applies to the Attorney General for approval of the method in such form and manner as may be required by the Attorney General by regulation;

(b) the method includes a search of a multi-state and multi-jurisdictional criminal records locator or similar commercial nationwide database with validation; and

(c) the method includes a search of the United States Department of Justice's Dru Sjodin National Sex Offender Public Website.

(3) If the Attorney General approves a method that an employer proposes, pursuant to paragraph (2) of this subsection, to conduct criminal history record background checks, the employer, or a designated third party if approved by the Attorney General, may use the method to satisfy the criminal history record background check requirement set forth in subparagraph (b) of paragraph (1) of subsection b. of section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill). If the Attorney General has not approved any method proposed by the employer, the employer shall satisfy the criminal history record background check requirement by conducting the criminal history record background check in accordance with the requirements of paragraph (1) of this subsection.

b. An HCIR who is certified pursuant to section 6 of P.L. , c. (C. ) (pending before the Legislature as this bill) shall promptly notify the HCIR's employer and the board in the event that the HCIR is charged with or convicted of a crime or offense in New Jersey or any other jurisdiction. The certification of an HCIR who fails to report a charge or conviction pursuant to this subsection shall be immediately revoked, and, if the unreported charge or conviction involves a disqualifying offense, the individual shall be permanently disqualified from certification as an HCIR in this State.

c. The employer of an HCIR who is certified pursuant to section 6 of P.L. , c. (C. ) (pending before the Legislature as this bill) shall promptly notify the board in the event that a criminal history record background check of the HCIR discloses that the HCIR has been charged with or convicted of a crime or offense in New Jersey or any other jurisdiction. An employer that fails to report a charge or conviction pursuant to this subsection shall be subject to such disciplinary action as the board deems appropriate, including, but not limited to, revoking the certification of any other HCIRs employed by that employer.

d. The Division of State Police shall promptly notify the board in the event that an applicant who was the subject of a criminal history record background check pursuant to subparagraph (b) of paragraph (1) of subsection b. of section 5 of P.L. , c. (C. ) (pending before the Legislature as this bill), which was completed pursuant to paragraph (1) of subsection a. of this section, is charged with or convicted of a crime or offense in this State after the date the criminal history record background check was completed. The Division of State Police shall not be required to provide notice under this subsection in the event that the criminal history record background check of an applicant was completed pursuant to paragraph (3) of subsection a. of this section.

e. No HCIR or employer shall be subject to disciplinary action for failure to report a charge or conviction pursuant to this section unless the HCIR or employer has been afforded the opportunity to challenge the accuracy of the criminal history record background information giving rise to the disciplinary action. The board may impose a lesser penalty in the event the unreported charge or conviction does not involve a disqualifying offense.

8. This act shall take effect immediately.

STATEMENT

This bill, the "Health Care Industry Representative Act," establishes standardized requirements for the certification of health care industry representatives (HCIRs), who are individuals who enter health care facilities, which are defined under the bill to mean licensed acute care hospitals, to provide a variety of services.

Specifically, the bill establishes, in the Division of Consumer Affairs in the Department of Law and Public Safety, the State Board of Health Care Industry Representatives (board), which will be responsible for implementing and enforcing the standards established under the bill. The board will consist of nine members, including the Director of the Division of Consumer Affairs in the Department of Law and Public Safety and eight public members appointed by the Governor. The public members are to include four HCIRs and four representatives of health care facilities. The public members will serve for a term of five years, will be eligible for reappointment, and will serve without compensation. The board is to meet at least twice per year and additionally at the call of the board chair. A majority of the membership will constitute a quorum for the purposes of transacting official business. The Division of Consumer Affairs in the Department of Law and Public Safety will provide staff and administrative support for the board.

The bill identifies three HCIR tiers, based on the level of access and patient contact the individual has while at a health care facility:

(1) A Tier One HCIR is an HCIR who enters a facility for administrative purposes that involve no direct access to, or contact with, patients or clinical areas. "Administrative purposes" includes business meetings to discuss a business relationship, contractual issues, financial issues, and any other such matters as the commissioner deems to be administrative in nature, as well as entering a facility for the purpose of delivering pharmaceutical samples and holding appropriate discussions pertaining to the samples, provided that such deliveries and discussions do not take place in any clinical areas of the facility, in the presence of any patients, or in any areas of the facility designated as sterile or restricted;

(2) A Tier Two HCIR is an HCIR who enters a facility to provide technical support, provide education and consultation services, conduct product and service sales, or operate equipment. Tier Two HCIRs will have direct access to any area of the facility that is not designated as sterile or restricted, but may not, while at the facility, operate clinical equipment used in patient care or for treatment purposes, have any direct contact with patients for purposes associated with the treatment or care of patients, or otherwise access any area of the facility designated as sterile or restricted; and

(3) A Tier Three HCIR is an HCIR who enters a facility for purposes which may include: direct access to patient care environments and clinical care areas, including sterile or restricted areas; direct contact with patients, including contact for purposes associated with the care or treatment of a patient; or the operation of clinical equipment used in patient care or for treatment purposes.

The board is to establish, by regulation, standards and requirements for the certification of Tier Two HCIRs and Tier Three HCIRs. No certification will be required for Tier One HCIRs, who will have access to a given health care facility subject to the same terms and conditions as apply to other visitors with general access to the facility.

Specifically, to become certified as a Tier Two HCIR, an applicant is to submit to the board: certifications from the applicant's employer that the applicant has completed all appropriate product and service training and safety modules, and that the employer has completed a criminal history record background check of the applicant within one year of the date of the application; certification that the applicant has successfully completed training in compliance with the federal privacy rule established pursuant to the "Health Insurance Portability and Accountability Act of 1996" (HIPAA), Pub. L. 104-191; certification that the applicant has successfully completed training in antiseptic techniques, in preventing the spread of bloodborne pathogens, and in fire safety protocols; proof of the employer's general liability insurance and workers' compensation insurance, when applicable; proof of negative tests for tuberculosis; and proof that the applicant has received the current influenza vaccine and is currently vaccinated against measles, mumps, rubella, varicella, tetanus, diphtheria, pertussis, and hepatitis B, or that the applicant has been granted an exemption from receiving one or more of the required vaccines.

To qualify for Tier Three HCIR certification, an applicant is required to submit all the materials required for Tier Two HCIR certification, as well as certification that the applicant has successfully completed appropriate training in operating room protocols and proof of a negative screening or test for illegal drug use.

The board is to approve HCIR training programs and establish a schedule of the maximum fees that the programs may charge.

The board will be permitted to identify specific categories of Tier Two HCIRs and Tier Three HCIRs that it determines provide goods or services that are not reflected in the standard certification requirements. For any such category, the board may waive any of the standard certification requirements that it determines are inapplicable or irrelevant, and may establish additional, category-specific certification requirements. Any waivers or additional certification requirements for a specific category of HCIRs are to be universally applied to each HCIR who falls within that category. An HCIR applicant who falls within a designated category is to certify to meeting any waivers requirements and any additional certification requirements.

The board is additionally authorized to revise the list of mandatory vaccines to add a new vaccination requirement for a particular disease or to remove an existing vaccination requirement for a particular disease, provided that any such revisions apply equally to all HCIR applicants. Further, health care facilities may petition the board to require HCIRs to receive additional vaccinations that are not included on the list as a condition of accessing that particular facility.

HCIR applicants may apply for a waiver from receiving a mandatory vaccine by submitting a written statement from a licensed physician indicating that the vaccine is medically contraindicated, specifying a board-approved medical reason for the contraindication, and specifying the period of time the medical contraindication will last, if it is of limited duration. In determining whether to grant an exemption, the board may consult with a physician or other health care professional if the board determines such consultation to be necessary and appropriate. The board will be permitted to deny any application for HCIR certification if it determines that, because an applicant has not received a mandatory vaccine, the applicant would pose a risk to the health and safety of patients. Pregnancy will constitute a valid, board-approved medical reason for granting a medical contraindication exemption, provided that a pregnancy exemption will expire at the end of the pregnancy, the applicant will be required to promptly receive any vaccines that were subject to the exemption upon its expiration, facilities will be permitted to establish additional safety protocols for HCIRs with a pregnancy exemption, and facilities may limit or deny access to the facility if the HCIR's vaccination status would pose a risk to the health as safety of patients.

The bill provides that criminal history record background checks may be completed by the Division of State Police or by an alternate method approved by the Attorney General. An alternate method proposed by an employer will not be approved unless it includes a search of a multi-state and multi-jurisdictional criminal records locator and a search of the federal sex offender registry. HCIRs are required to notify their employers and the board if the HCIR is arrested for, or convicted of, any offense, and employers are to notify the board if a criminal history record background check identifies any such arrests or convictions. The failure to report an arrest or conviction will result in various disciplinary actions, including revocation of the HCIR's certification; however, HCIRs and their employers will have the opportunity to challenge the accuracy of the information giving rise to the disciplinary action. If the Division of State Police conducts the background check of an HCIR, it is to notify the board of any subsequent arrests or convictions. The bill defines "disqualifying offense" to mean an offense involving a crime of the fourth degree or higher that implicates the health or safety of patients or staff at a health care facility.

Tier Two and Tier Three HCIR certifications will be valid at every health care facility in the State, and facilities will be prohibited from establishing any training, certification, or other requirements that are in addition to the requirements established under the bill. Facilities may require an HCIR to be escorted by a security officer or appropriate staff member at such times as the HCIR is present in a secure area of the facility, provided that the facility is solely responsible for any costs associated with implementing the escort requirement. Facilities may additionally require HCIRs to comply with the facility's code of conduct while present at the facility, provided that the code of conduct is limited to requirements concerning the HCIR's personal behavior and interactions with other individuals while at the facility. Nothing the bill will prevent a health care facility from granting limited or full access to the facility to any individual who is not certified as an HCIR, or from granting a Tier Three level of access to an individual holding Tier Two HCIR certification. Facilities may establish terms and conditions for such access, provided that in no case may a facility establish requirements for a certified HCIR to access the facility to the extent authorized by the HCIR's level of certification that are in addition to those established under the bill.

The board is to provide each certified HCIR with an identification badge that includes the HCIR's name and employer, a photo of the HCIR, the HCIR's authorized tier level, the date on which the HCIR's current certification expires, and a barcode, microprocessor chip, magnetic stripe, or similar feature that allows facilities to easily scan the badge for the purpose of checking the HCIR into and out of the facility. The board may charge a reasonable fee for the issuance or renewal of an HCIR certification and identification badge; any fees collected are to be retained by the board for the purposes of implementing and administering the provisions the bill, and are not to be remitted to the General Fund. An HCIR certification will be valid for three years.

The board will be required to establish and maintain a secure online database of current HCIR certifications, which is to be made accessible to health care facilities for the purposes of verifying an HCIR's certification status. The information available through the online database will include the HCIR's current vaccination status and any mandatory vaccines the HCIR did not receive pursuant to an authorized exemption, but will not disclose the nature or details of the exemption or any other health information about the HCIR. The board may contract with a third-party provider to establish and maintain the online database. The bill requires that database be established and functional no later than three years after the effective date of the bill; if the board uses a third party provider to establish and maintain the database, the board is to take all necessary actions to ensure the third party provider meets the deadline.

The board will be required to biennially review the standards and requirements for HCIR certification to determine if they are consistent with national standards and current trends in HCIR certification. In conducting this review, the board is to consider, at a minimum, any recommendations or guidance issued by the federal Centers for Medicare and Medicaid Services and by the Joint Commission. The board may submit to the Legislature recommendations for any legislation or other legislative action concerning HCIR certification as the board deems necessary and appropriate.

The board will be required to adopt regulations establishing standards, protocols, and procedures for: reporting complaints and alleged violations; conducting appropriate investigations and hearings; conducting mediations or other appropriate dispute resolution proceedings; assessing penalties, imposing disciplinary actions, and ordering any other remedial relief as may be appropriate; and appealing board determinations.