(a) The following definitions of medical facilities, based on standards approved by the commissioner, shall apply to this Chapter unless the context otherwise requires:

1. (1) Accredited hospital or other accredited medical facility, as defined in article 28 of the Public Health Law, shall mean a hospital or facility which has been accredited by an accreditation agency to which the Centers for Medicare and Medicaid Services has granted deeming status and which the commissioner has determined has accrediting standards sufficient to assure the commissioner that hospitals or facilities so accredited are in compliance with operational standards under this Chapter.

2. (2) Emergency room or department shall mean a designated area of a hospital that includes one or more reception and treatment rooms appropriately staffed and equipped to provide prompt and efficient care of emergency patients in accordance with the provisions of Subchapter C of this Chapter.

   1. (i) Existing hospital or other existing medical facility shall mean a facility which, on the day prior to the effective date of this subparagraph, had a valid operating certificate under article 28 of the Public Health Law.

   2. (ii) New hospital or other new medical facility shall mean that physical area included in a project for which, both on and after the effective date of this subparagraph, an application is submitted under provisions of Part 710 of Subchapter B of this Title, and which encompasses any or all of the following:

      1. (a) change in scope of services of an existing facility;
      2. (b) acquisition of a physical plant, which was not previously operated as a health care facility for the same level of care, as is proposed;
      3. (c) acquisition of property and construction of a new physical plant;
      4. (d) construction of a new physical plant on property already owned by an established facility;

      5. (e) renovations and/or alterations to an existing facility, which involve:

         1. (1) major physical and/or structural changes;
         2. (2) major fixed equipment changes, other than replacements;
         3. (3) the classification as a new medical facility shall be limited only to those sections and/or wings of an existing facility, for which such renovation, alterations and/or equipment changes are approved;
      6. (f) one or more additions to an existing facility. The classification as a new medical facility shall be limited to the additions.
   3. (iii) The provisions of clause (ii)(e) of this paragraph shall not apply to an existing hospital or medical facility, as defined by subparagraph (i) of this paragraph which does not meet the minimum requirements of sections 711.4, 711.5, 711.6, 711.7 and 711.8 of this Title, because of life safety, structural, physical, mechanical and/or electrical deficiencies, and which is approved to perform such alterations, renovations and/or fixed equipment changes as are necessary to achieve compliance with the aforementioned sections.

   (3)

3. (4) Health-related facility shall mean a facility, institution, intermediate care facility, or a separate or distinct part thereof, providing therein lodging, board and social and physical care, including but not limited to the recording of health information, dietary supervision and supervised hygienic services incident to such care to six or more residents not related to the operator by marriage or by blood within the third degree of consanguinity.

4. (5) Hospital shall mean an institution with beds for one or more inpatients not related to the operator which is primarily engaged in providing services and facilities to inpatients by or under the supervision of a physician, and which meets the following requirements:

   1. (i) provides diagnostic and therapeutic services for medical diagnosis, treatment and care of injured and sick persons and has, as a minimum, laboratory and radiology services and organized departments of medicine and surgery;
   2. (ii) has an organized medical staff which may include, in addition to doctors of medicine, doctors of osteopathy and dentistry;
   3. (iii) has bylaws, rules and regulations pertaining to standards of medical care and service rendered by its medical staff;
   4. (iv) maintains medical records for all patients;
   5. (v) has a requirement that every patient be under the care of a member of the medical staff;
   6. (vi) provides 24-hour patient services;
   7. (vii) has in effect a written, currently applicable utilization review plan, acceptable to the department, which provides for utilization review studies designed to evaluate the appropriateness of admissions to the hospital, lengths of stay, discharge practices, use of medical and hospital services and all related factors which may contribute to the efficient provision of hospital and physician services;
   8. (viii) has in effect agreements with a home health agency for referral and transfer of patients to home health agency care when such service is appropriate to meet the patient's requirements.
5. (6) Home care services agency shall mean an organization primarily engaged in arranging and/or providing, directly or through contract arrangement, one or more of the following: nursing services, home health aide services, advanced home health aide services, medical supplies, equipment and appliances, and other therapeutic and related services which may include, but shall not be limited to, physical and occupational therapy, speech pathology, nutritional services, medical social services, personal care services, homemaker services and housekeeper services which may be of a preventive, therapeutic, rehabilitative, health guidance and/or supportive nature to persons at home.
6. (7) Certified home health agency shall mean a home care services agency which possesses a valid certificate of approval issued pursuant to the provisions of article 36 of the Public Health Law, or a residential health care facility or hospital possessing a valid operating certificate issued under article 28 of the Public Health Law which is authorized under article 36 to provide a long term home health care program. Such an agency or program must participate as a home health agency under the provisions of titles XVIII and XIX of the Federal Social Security Act.

7. (8) Long term home health care program shall mean a coordinated plan of care and services provided at home to invalid, infirm or disabled persons who are medically eligible for placement in a hospital or residential health care facility, and who would require such placement for an extended period of time if such program were unavailable.

   1. (i) Such program shall be provided in the person's home or in the home of a responsible relative or other responsible adult.
   2. (ii) Such program shall be provided in adult care facilities, other than shelters for adults, certified pursuant to section 460-b of the Social Services Law, provided that the person meets the admission and continued-stay criteria for such facility. Services provided by the program shall not duplicate or replace those which the facility is required by law or regulation to provide.
   3. (iii) Approved long term home health care program providers may include, as part of their long term home health care program, upon approval by the commissioner, a discrete AIDS home care program as defined in this section.
   4. (iv) A long term home health care program that does not obtain authorization to provide an AIDS home care program shall not be precluded from providing services within its existing authority to patients who are diagnosed as having AIDS, or are deemed by a physician, within his judgment, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.
8. (9) The terms treatment center and diagnostic centershall mean a medical facility with one or more organized health services not part of an inpatient hospital facility or vocational rehabilitation center primarily engaged in providing services and facilities to out-of-hospital or ambulatory patients by or under the supervision of a physician or, in the case of a dental service or dispensary, of a dentist, for the prevention, diagnosis and, in the case of a treatment center, treatment of human disease, pain, injury, deformity or physical condition, not including the individual or group private practice of medicine.

9. (10) Narcotic addiction rehabilitation center shall mean an institution with beds for one or more inpatients, not related to the operator, which is primarily engaged in providing facilities and services by or under the supervision of a physician to patients addicted to narcotic drugs, and which meets the following requirements:

   1. (i) provides rehabilitation services for individuals addicted to narcotic drugs, pursuant to the provisions of article 9 of the Mental Hygiene Law;
   2. (ii) has an organized rehabilitation staff which shall include, but not be limited to, physicians, dentists and narcotic rehabilitation officers;
   3. (iii) has rules and regulations pertaining to standards of rehabilitation services rendered by its rehabilitation staff approved by the department;
   4. (iv) maintains medical and rehabilitation records for all clinical patients;
   5. (v) provides 24-hour patient services; and
   6. (vi) has in effect a utilization review plan approved by the department and an affiliation agreement with an accredited hospital for the provisions of those hospital services not provided by the center.
10. (11) Nursing home shall mean a facility, institution, or portion thereof, providing therein, by or under the supervision of a physician, nursing care and other health, health-related and social services as specified in this Chapter for 24 or more consecutive hours to three or more nursing home patients who are not related to the operator by marriage or by blood within the third degree of consanguinity, including, but not limited to, an infirmary section which is identifiable as a nursing home unit in a special area, wing or separate building of a public or voluntary home or of a general or special hospital.
11. (12) [Reserved]
12. (13) Outpatient department shall mean a hospital division or department primarily engaged in providing services for ambulatory patients, by or under the supervision of a physician, for the prevention, diagnosis or treatment of human disease, pain, injury, deformity or physical condition.
13. (14) Patient care unit or nursing unit shall mean a designated area, including a group of patient rooms with adequate supporting rooms, areas, facilities, services and personnel providing nursing care and management of patients, which is planned, organized, operated and maintained to function as a unit so as to encourage the efficient delivery of patient services and effective observation of and communication with patients.

14. (15) Multiphasic health screening facility shall mean a treatment center or diagnostic center wherein a battery of tests is performed for the purpose of discovering the presence or absence of clinical findings which may be indicators of early disease and which may provide physicians with a base line of clinical data useful in the medical care and follow-up of patients.

    (16)-(18) [Reserved]

15. (19) Cardiac surgical center shall mean an inpatient care unit of a hospital which shall be approved as such by the department and shall be appropriately staffed and equipped to provide both diagnostic and surgical services.
16. (20) A cardiac diagnostic center shall mean an inpatient care unit of a hospital, approved by the department, which may exist independent of a complete cardiac surgical service. The diagnostic center shall be appropriately staffed and equipped to provide a full range of diagnostic services, including coronary arteriography and/or other cardiac invasive diagnostic procedures.

17. (21) Rural hospital shall mean any hospital as defined in this subdivision, which does no meet any of the absolute criteria of subparagraph (ii) of this paragraph and which, when assessed against the weighted criteria of subparagraph (i), achieves a total score greater than or equal to six points. Facilities which meet the definition are expected to develop appropriate linkages with hospitals providing a greater range of services and/or medical equipment. Identification as a rural hospital shall not be construed as diminishing the need for such planning efforts.

    1. (i) Weighted criteria.

       1. (a) Size. Facility size shall be measured by capacity as listed on the operating certificate. A certified capacity of 75 beds or less shall be worth 3 points; a certified capacity of greater than 75 and less than or equal to 100 beds shall be worth 2 points; a certified capacity of greater than 100 beds shall be worth 0 points.
       2. (b) Population density. Population density shall be measured by use of the most recently used New York State Economic Development Board statistics. Location of the facility in a county which has a population density of 100 persons per square mile or less shall be worth 3 points; location in a county with a population density of greater than 100 and less than or equal to 150 persons per square mile shall be worth 2 points; location in a county with a population density of greater than 150 persons per square mile shall be worth 0 points.
       3. (c) Facility budget. The size of the facility budget shall be measured by base year financial and statistical data submitted to the department pursuant to Subpart 86-1 of this Title. A budget of $6,500,000 or less shall be worth 2 points; a budget of greater than $6,500,000 but less than or equal to $7,500,000 shall be worth 1 point; a budget of greater than $7,500,000 shall be worth 0 points.
       4. (d) Admissions. The number of admissions shall be measured by base year financial and statistical data submitted to the department pursuant to Subpart 86-1 of this Title. Total base year admissions of less than or equal to 4,000 shall be worth 2 points; total base year admissions of greater than 4,000 but less than or equal to 4,500 shall be worth 1 point; total base year admissions of greater than 4,500 shall be worth 0 points.

    2. (ii) Absolute criteria. A facility which meets any of these criteria shall not be a rural hospital if:

       1. (a) the facility is located in New York City, or in the counties of Monroe, Erie, Nassau, Suffolk, Albany, Westchester, Orange, Schenectady, Rensselaer, Onondaga and Oneida;
       2. (b) the facility is the subject of an action by the commissioner seeking revocation, suspension, limitation or annulment of its operating certificate for structural or operational deficiencies;
       3. (c) the commissioner has found, after considering public need, that suspension, limitation modification or revocation of the facility's operating certificate is consistent with the public interest in conservation of health resources;
       4. (d) the facility is a specialty hospital; or
       5. (e) the facility is located within five miles of an existing acute care unit.
18. (22) Part-time clinic site shall mean an ambulatory care program site operated less than 60 hours per month (as determined by the aggregate hours of program site operation) by a general hospital or a diagnostic or treatment center which is approved to operate part-time clinics. A part-time clinic site is a site other than the primary delivery site(s) listed on the primary facility's operating certificate; provided, however, that any health care services provided in elementary or secondary schools to students during regular school hours shall not qualify as part-time clinic sites under this Title.
19. (23) Hospice shall mean a coordinated program of home and inpatient care which treats the terminally ill patient and family as a unit, employing an interdisciplinary team acting under the direction of an autonomous hospice administration. The program provides palliative and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses which are experienced during the final stages of illness, and during dying and bereavement.
20. (24) Outpatient surgery is a service organized to provide those surgical procedures of less intensity than ambulatory surgery which are performed in an outpatient treatment room for patients at low risk, require minimal pre- and post-procedure observation and treatment, are not likely to be time-consuming or followed by complications, are not associated with a condition which would require hospitalization and includes those procedures listed in section 85.6 of this Title.

21. (25) Licensed home care services agency means a home care services agency issued a license pursuant to article 36 of the Public Health Law.

    1. (i) AIDS home care program means a coordinated plan of care and services provided at home to persons who are medically eligible for placement in a hospital or residential health care facility and who: Such program shall be provided by a long term home health care program specifically authorized pursuant to article 36 of the Public Health Law to provide an AIDS home care program; or an AIDS center, as defined in Part 405 of this Title, specifically authorized pursuant to article 36 of the Public Health Law to provide an AIDS home care program. Such program shall be provided in the person's home or in the home of a responsible relative, other responsible adult, adult care facilities specifically approved to admit or retain residents for such program, or in other residential settings as approved by the commissioner in conjunction with the Commissioner of Social Services. Such program shall provide services, including but not limited to the full complement of health, social and environmental services provided by long term home health care programs in accordance with regulations promulgated by the commissioner. Such programs shall also provide such other services as required by the commissioner to assure appropriate care at home for persons eligible under such program.

       1. (a) are diagnosed by a physician as having acquired immune deficiency syndrome (AIDS); or
       2. (b) are deemed by a physician, within his judgment, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.
    2. (ii) A long term home health care program that does not obtain authorization to provide an AIDS home care program shall not be precluded from providing services within its existing authority to patients who are diagnosed as having AIDS, or are deemed by a physician, within his judgment, to be infected with the etiologic agent of acquired immune deficiency syndrome, and who have an illness, infirmity or disability which can be reasonably ascertained to be associated with such infection.

    (26)

22. (27) Hospice residence shall mean a hospice operated home which is residential in character and physical structure, and operated for the purpose of providing more than two hospice patients, but not more than 16 hospice patients, with hospice care.
23. (28) Dually certified hospice residence bed shall mean a bed located in a hospice residence that has been approved by the department to be used alternately for residential hospice care and inpatient hospice care.

(b) The following definitions of medical staff and paramedical personnel, based on standards approved by the commissioner, shall apply to this Chapter unless the context otherwise requires:

1. (1) Associate narcotic rehabilitation counsellor shall mean a person who:

   1. (i) has a master's degree from a college or university approved by the Education Department; or
   2. (ii) has had three years' experience, one year of which must have been in a supervisory capacity, in social casework, guidance counseling, vocational rehabilitation, or an appropriate subject-matter program in a social science field.
2. (2) Audiologist shall mean a person who is licensed as required by article 159 of the New York State Education Law.
3. (3) Auxiliary nursing personnel shall mean unlicensed, nonprofessional workers employed to assist registered professional nurses in hospitals.
4. (4) Dietician shall mean a person who has received a baccalaureate degree with major studies in food and nutrition from a college or university approved by the Education Department and is registered or is eligible for registration by The American Dietetic Association, or has the equivalent of such training and experience and who participates annually in continuing dietetic education.
5. (5) [Reserved]
6. (6) Full-time health officer shall mean the county, part-county or city health commissioner in cities of 50,000 population or over, or the district health officer, having jurisdiction in the geographic area in which the medical facility is located.
7. (7) Medical staff shall mean all physicians and dentists appointed by the governing authority and responsible to such authority for the adequacy and quality of the medical care rendered to patients in a medical facility.
8. (8) Narcotic rehabilitation chief officer shall mean a person who has a bachelor's degree from a college or university approved by the Education Department or holds a license as a registered professional nurse and has had two years' supervisory experience in custodial care of inmates or patients or who has four years' experience in professional nursing or custodial care of inmates or patients, two years of which must have been in a supervisory capacity.
9. (9) Home health aide shall mean a person who carries out health care tasks under the supervision of a registered nurse or licensed therapist and who may also provide assistance with personal hygiene, housekeeping and other related supportive tasks to a patient with health care needs in his/her home. Home health aides shall have successfully completed a basic training program in home health aide services or an equivalent exam approved by the department and possess written evidence of such completion.
10. (10) Nurse aide shall mean any nonlicensed or noncertified person who provides direct personal patient/resident services, including safety, comfort, personal hygiene or patient/resident protection services under the supervision of a registered professional nurse or licensed practical nurse in a residential health care facility.
11. (11) Occupational therapist shall mean a person who is registered with the American Occupational Therapy Association, or either a graduate of a program in occupational therapy approved by the Council on Medical Education of the American Medical Association in collaboration with the American Occupational Therapy Association or a graduate of a curriculum in occupational therapy which is recognized by The World Federation of Occupational Therapists and is eligible for registration with the American Occupational Therapy Association.
12. (12) Occupational therapy assistant shall mean a person who is certified by and currently registered with the New York State Education Department. When working in an occupational therapy program, approved by the department, the assistant must work under the supervision of an occupational therapist who is licensed by and currently registered with the New York State Education Department.
13. (13) Personal attendant shall mean a person who assists residents of a health-related facility with carrying out daily activities related to personal hygiene and social fellowship under satisfactory supervision.

14. (14) Personal care aide shall mean a person who, under professional supervision, provides patients assistance with nutritional and environmental support and personal hygiene, feeding and dressing and/or, as an extension of self-directed patients, selects health-related tasks. A personal care aide shall have successfully completed:

    1. (i) a training program in home health aide services or equivalent exam as specified in paragraph (9) of this subdivision; or
    2. (ii) one full year of experience in providing personal care services through a home care services agency within three years preceding the effective date of an initial license issued pursuant to article 36 of the Public Health Law: or
    3. (iii) a training program in personal care services as specified in 18 NYCRR 505.14(a) and (e). A copy of 18 NYCRR 505.14(a) and (e) is available for inspection and copying at the offices of the records access officer, Department of Health, Corning Tower, Empire State Plaza, Albany; and
    4. (iv) in those instances where the personal care aide is to be providing assistance with health-related tasks, such aide shall be trained as in subparagraph (iii) of this paragraph and training in health-related tasks shall be completed in full prior to the personal care aide's assignment to any patient, as evidenced by written documentation of such completion.
15. (15) Homemaker shall mean a person who meets standards established by the Department of Social Services and assists and instructs persons at home because of illness, incapacity or absence of a caretaker relative in managing and maintaining a household, dressing, feeding and incidental household tasks.
16. (16) Housekeeper shall mean a person who meets the standards established by the Department of Social Services and, in situations in which services of a trained homemaker are not required, does light work or household tasks for persons at home because of iilness, incapacity or the absence of a caretaker relative.

17. (17) Qualified hospital administrator shall mean a person who:

    1. (i) holds a degree of doctor of medicine or a master's degree or its equivalent in hospital administration, public health, science, administrative medicine, or business administration when granted for a program in hospital administration, from a college or university approved by the Education Department or whose program is approved by the Association of University Programs of Hospital Administration, and has served a minimum of two years as the administrator, associate or assistant administrator of an accredited hospital or in health service administration acceptable to the commissioner; or
    2. (ii) is a registered professional nurse who has served a minimum of three years as an administrator, associate or assistant administrator of an accredited hospital; or
    3. (iii) holds a bachelor's degree from a college or university approved by the Education Department and has served a minimum of five years as an administrator, associate or assistant administrator in an accredited hospital; or
    4. (iv) is, or has been prior to January 1, 1968, the administrator of a hospital, or has served a minimum of seven years as an associate or assistant administrator of a hospital with a valid hospital operating certificate; or, prior to February 1, 1966, the administrator of a hospital, or has served a minimum of seven years as an associate or assistant administrator of a hospital which would meet the standards for hospital certification.

18. (18) A community health nurse shall mean a nurse whose primary functions, under qualified nursing supervision, are to plan, provide, direct and evaluate nursing care in a variety of settings and offer instruction and guidance in health practice for individuals and families. Such nurse shall be licensed and currently registered and shall have the following additional qualifications:

    1. (i) baccalaureate degree in nursing from an approved program; or
    2. (ii) a baccalaureate degree in nursing from a nonapproved program supplemented by content which can be equated to the approved program; or

    3. (iii) be a registered professional nurse with:

       1. (a) a baccalaureate degree in a health or human services field; or
       2. (b) two years' experience in home care.

19. (19) A supervising community health nurse shall mean a liensed and currently registered professional nurse whose primary functions are to supervise, instruct and guide nursing and auxiliary personnel in providing high quality nursing services. Such nurse shall have the following qualifications:

    1. (i) a baccalaureate degree in nursing or a health or human services field and two years' experience in home care; or

    2. (ii) the following combination of education, experience and/or training:

       1. (a) four years' experience in home care; and
       2. (b) six credit hours, or the equivalent, of education/training in public health and principles of management.

20. (20) Director of patient services shall mean a licensed and currently registered nurse who is responsible for clinical direction and supervision of patient care services. Such individual shall meet the following qualifications:

    1. (i) two years as a supervising community health nurse; or
    2. (ii) two years of home care nursing experience plus a masters degree in nursing, public health, business administration or another health-related field.

21. (21) Certified home health agency administrator shall mean a person who is responsible to the governing authority for the administrative operation of a certified home health agency and who meets the following minimum qualifications:

    1. (i) is a licensed physician;
    2. (ii) is a registered professional nurse; or
    3. (iii) is a person who has training and experience in health services administration and at least one year of supervisory or administrative experience in home health care or related health programs.

22. (22) A certified registered nurse anesthetist or registered nurse anesthetist or nurse anesthetist shall mean a registered professional nurse licensed and currently registered with the New York State Education Department who:

    1. (i) has satisfactorily completed a prescribed course of study in a school of nurse anesthesia accredited by the Council on Accreditation of Nurse Anesthesia Education Programs/Schools or other accrediting body which the commissioner finds to be substantially equivalent;
    2. (ii) has passed the national certifying examination given by the Council on Certification of Nurse Anesthetists or other certifying examination which the commissioner finds to be substantially equivalent; and

    3. (iii) is currently certified by the Council on Certification of Nurse Anesthetists or by the Council on Recertification of Nurse Anesthetists or other accrediting body which the commissioner finds to be substantially equivalent.

       A registered professional nurse licensed and currently registered with the New York State Education Department who does not meet the requirements as set forth in subparagraphs (i), (ii) and (iii) of this paragraph, shall be permitted to continue the practice of nurse anesthesia only under the supervision of a qualified anesthesiologist until one year after the effective date of these regulations.

23. (23) Qualified radiation physicist shall mean a graduate physicist who has been certified, by the American Board of Radiology, by the American Board of Industrial Hygiene or by the American Board of Health Physics, as a qualified radiation physicist.
24. (24) Qualified social worker shall mean a person who holds a master's degree in social work after successfully completing a prescribed course of study at a graduate school of social work accredited by the Council on Social Work Education and the Education Department, and who is certified or licensed by the Education Department to practice social work in the State of New York. When employed by a certified home health agency, long-term home health care program or hospice, such social worker must have had one year of social work experience in a health care setting.

25. (25) Qualified specialist shall mean a physician who holds a current license to practice medicine in the State of New York, and who:

    1. (i) is a diplomate of the appropriate American board or who has been certified as a specialist by the American osteopathic specialty board for the respective specialty; or
    2. (ii) has been notified of admissibility to examination by such board, or presents evidence of completion of an approved qualifying residency in such specialty; or
    3. (iii) holds the rank of attending or associate attending specialist in an accredited voluntary or governmental hospital which is approved for training in the specialty in which the physician has privileges; or
    4. (iv) holds an appropriate specialist rating granted by the Workers' Compensation Board after May 1960, provided the award is based on training approved by the respective specialty board.
26. (26) Recreation assistant shall mean an individual who has an associate degree in recreation supervision from an approved two-year college curriculum or from a New York State community college, which training shall include or be supplemented by one or more credit courses relative to the aging process and related disabilities.

27. (27) Therapeutic recreation specialist shall mean a person who, prior to the effective date of this paragraph, was approved by the department as a qualified therapeutic recreationist, or, on or after its effective date:

    1. (i) holds a master's degree with a major in therapeutic recreation and has one year of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or
    2. (ii) holds a master's degree with a major in general recreation and has two years of full- time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or
    3. (iii) holds a master's degree in a field allied to therapeutic recreation and has three years of full-time, paid work experience in an activities program for the ill, aged and handicapped in a health care setting; or
    4. (iv) holds a baccalaureate degree with a major in therapeutic recreation and has three years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or
    5. (v) holds a baccalaureate degree in general recreation and has four years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; or
    6. (vi) holds a baccalaureate degree in a field allied to therapeutic recreation and has five years of full-time, paid work experience in an activities program for the aged, ill and handicapped in a health care setting; and
    7. (vii) has submitted credentials to the department which shall include an application for verification of qualifications, official college transcripts, and resume of work experience, including name and address of facility or agency, dates of employment, job description and job title.
28. (28) Social work assistant or case aide shall mean a person who holds a baccalaureate degree in social work from a college or university having a course of study accredited by the Council on Social Work Education, or an associate degree in the human services, or who has had four years of full-time, paid experience in social work in a social agency adhering to acceptable standards, or who has an equivalent combination of the foregoing education and experience satisfactory to the department.
29. (29) Speech pathologist shall mean a person who is licensed as required by article 159 of the New York State Education Law.

30. (30) Activities director shall mean a person who, prior to the effective date of this paragraph, was approved by the department as a qualified trained activities leader, or, on or after its effective date:

    1. (i) is a qualified occupational therapist; or
    2. (ii) is a qualified therapeutic recreation specialist; or
    3. (iii) is a qualified occupational therapy assistant; or
    4. (iv) is a qualified recreation assistant; or
    5. (v) has a minimum of two years' full-time, paid experience, acceptable to the department, in an activities program in a health care setting.
31. (31) Activities program consultant shall mean a person who is qualified either as an occupational therapist or as a therapeutic recreation specialist as defined in this Subchapter.
32. (32) Physical therapist assistant shall mean an individual who is licensed by and currently registered with the New York State Education Department, or who has been issued a valid limited permit by that department. The assistant must work under the supervision of a physical therapist who is licensed by and currently registered with the New York State Education Department.
33. (33) Physical therapy aide shall mean a nonprofessional person who assists with the implementation of a physical therapy program under the supervision of a physical therapist who is licensed by and currently registered with the New York State Education Department.
34. (34) Registered physician's assistant shall mean an individual who has completed a program for the education and training of physician's assistants, or its equivalent, approved by the New York State Education Department, and who is currently registered as a physician's assistant by the New York State Education Department.
35. (35) Registered specialist's assistant shall mean an individual who has completed a program for the education and training of specialist's assistants, or its equivalent, approved by the New York State Education Department, and who is currently registered as a specialist's assistant by the New York State Education Department.
36. (36) Licensed midwife shall mean an individual licensed by the State Education Department under article 140 of the Education Law to practice midwifery.
37. (37) Respiratory therapist shall mean a person who is licensed and currently registered as a respiratory therapist pursuant to article 164 of the New York State Education Law.

38. (38) Dietetic service supervisor shall mean a person who:

    1. (i) is a dietician; or
    2. (ii) has a baccalaureate degree with major studies in food and nutrition, dietetics or food service management, has one year of supervisory experience in the dietetic service of a health care institution; or
    3. (iii) is a graduate of a dietetic technician training program, corresponding or classroom, approved by the American Dietetic Association; or
    4. (iv) is a graduate of a State-approved course that provided 90 or more hours of classroom instruction in food service supervision and has experience as a supervisor in a health care institution with consultation from a dietician; and
    5. (v) has submitted credentials to the department for verification of qualifications.

39. (39) Supervising nurse in a skilled nursing facility shall mean a person who is currently registered as a licensed professional nurse in New York State, and who:

    1. (i) is responsible for the supervision of more than one nursing unit and is not assigned simultaneously head nurse and/or charge nurse functions;
    2. (ii) critically observes the courses of actions of nursing personnel and is free to move from place to place in the facility in order to do so; and
    3. (iii) is responsible for teaching, counseling and developing the skills of nursing personnel in relation to diagnosing the nursing care problems of patients, to treating patients in emergency situations and to providing that care which requires the knowledge and skill of a registered professional nurse as so defined.

40. (40) Head nurse shall mean a person who:

    1. (i) is currently registered as a licensed professional nurse in New York State; and
    2. (ii) is responsible for diagnosing nursing needs of patients and for planning, coordinating and evaluating patient care on one nursing unit for a 24-hour period.

41. (41) Charge nurse shall mean a person who is:

    1. (i) currently registered in New York State either as a:

       1. (a) licensed professional nurse; or
       2. (b) licensed practical nurse who has licensure by successful completion of the New York State licensure examination or, if licensed previously in another state, has licensure in New York State on the basis of successfully completing the examinations in the other state; and
    2. (ii) responsible for nursing activities on one tour of duty on one nursing unit.
42. (42) Registered professional nurse shall mean a person who is licensed and currently registered as a registered professional nurse pursuant to article 139 of the New York State Education Law.
43. (43) Licensed practical nurse shall mean a person who is licensed and currently registered as a licensed practical nurse pursuant to article 139 of the New York State Education Law.
44. (44) Physical therapist shall mean a person who is licensed by and currently registered with the New York State Education Department or who has been issued a valid limited permit by that department.
45. (45) Acting leisure-time activities director shall mean a person who is in the process of completing any of the requirements for that of a qualified leisure-time activities director.

46. (46) Medical record practitioner shall mean a person who:

    1. (i) is eligible for certification as a registered record administrator (RRA) or an accredited record technician (ART), by the American Medical Record Association under its requirements in effect; or
    2. (ii) is a graduate of a school of medical record science that is accredited jointly by the Council on Medical Education of the American Medical Association and the American Medical Record Association.
47. (47) Hospice administrator shall mean a person who possesses a baccalaureate or higher degree from a regionally accredited college or university or one approved by the New York State Education Department, and has a minimum of two years of professional experience in the delivery of health care services, which shall include at least one year in a responsible administrative position.
48. (48) Hospice medical director shall mean a physician who is licensed and currently registered to practice medicine in the State of New York.

49. (49) Hospice nurse coordinator shall mean a registered professional nurse who is currently licensed and registered in the State of New York and:

    1. (i) possesses a baccalaureate degree in nursing and has a minimum of four years of professional experience in the delivery of nursing services which shall include at least two years in a supervisory or administrative position; or
    2. (ii) has a minimum of six years of professional experience in the delivery of nursing services which shall include at least two years in a supervisory or administrative position.
50. (50) Pastoral care coordinator shall mean a person who has had a minimum of one year of training and experience in pastoral/spiritual counseling, and has a baccalaureate degree from a regionally accredited college or university or one recognized by the New York State Education Department.
51. (51) Coordinator of hospice volunteer services shall mean a person who has demonstrated, to the satisfaction of the hospice administrator, the ability to organize and coordinate volunteer services.
52. (52) Hospice volunteer shall mean a lay or professional person who contributes time and talent to a hospice program without economic remuneration and is considered one of the hospice's personnel.
53. (53) Respiratory therapy technician shall mean a person who is licensed and currently registered as a respiratory therapy technician pursuant to article 164 of the New York State Education Law.
54. (54) Advanced home health aide shall mean a certified home health aide who has satisfied all requirements to perform advanced tasks set forth in subdivision (2) of section 6908 of the Education Law and regulations issued by the State Education Department thereunder and who is currently listed in the home care worker registry maintained by the department pursuant to subdivision (9) of section 3613 of the Public Health Law as having satisfied all applicable requirements for performing advanced tasks as an advanced home health aide. An advanced home health aide shall have successfully completed a training program for advanced home health aides that is approved by the department or the State Education Department.

(c) The following general definitions, based on standards approved by the commissioner, shall apply to this Chapter, unless the context otherwise requires:

1. (1) Ambulant patient shall mean a person who has the ability to walk on level surfaces and to negotiate stairs and ramps independent of human assistance or supervision, using the following mechanical devices or aids when necessary: prosthesis, brace, cane or handrail.
2. (2) Applicant shall mean a government agency, corporation or individual or partnership of individuals established or incorporated as required by the Public Health Law proposing to construct or operate a medical facility who has submitted an application for such construction or an operating certificate to the department.
3. (3) Board shall mean the provision of food and drink appropriate for the physical needs and medical conditions of hospital patients and residents, including the provision of therapeutic diets appropriate for individual patients and residents.
4. (4) Commissioner shall mean the State Commissioner of Health.
5. (5) Council shall mean the State Hospital Review and Planning Council.
6. (6) Department shall mean the New York State Department of Health.
7. (7) [Reserved]
8. (8) Governing authority or operator shall mean the policy-making body of a government agency, the board of directors or trustees of a corporation or the proprietor or proprietors of a proprietary facility, agency or program to which the department has issued an operating certificate, certificate of approval or license.

9. (9) A health-related facility resident shall mean a person who, because of social, physical, developmental or mental condition, requires institutional care and services above the level of room and board in order to secure basic services necessary to function, but who does not require the inpatient care and services provided by a hospital or skilled nursing facility and, in addition, may have one or more of, but is not limited to, the following characteristics:

   1. (i) possesses a degree of functional capacity permitting varied degrees of independence that reflect chronic disease conditions which may be stabilized, or mental and emotional impairment requiring medications and a range of care and services which stress health and social maintenance and prevention of further deterioration;
   2. (ii) whose stay in the health-related facility is usually long-term and whose admission, which is not for social reasons alone, reflects the absence of alternate community, family or personal resources to meet the individual's needs;
   3. (iii) needs a planned program of care and supervision on a continuous 24-hour-a-day basis emphasizing personal care and services under the direction of a physician;
   4. (iv) needs assistance in securing planned, basic recreational and diversional activities and services of other disciplines such as nutritional and social work counseling, through coordinated resident care plans which also include sustaining contacts with the community and which support the need and desire to function as independently as possible and prevent withdrawal and other symptoms of early deterioration;
   5. (v) needs health services which are under the direct supervision of a registered nurse or other health professionals who have responsibility for developing and coordinating nursing care and resident care plans and who periodically review and revise such plans;
   6. (vi) needs periodic or intermittent skilled nursing care and services but not continuous skilled services which in the aggregate require the direct supervision by licensed nursing personnel; and
   7. (vii) requires services which can usually be delivered by nonlicensed personnel and are primarily support kinds of services such as assistance with activities of daily living.
10. (10) Lodging shall mean the provision of a clean, safe, healthy, sheltered environment suitably equipped and staffed for the residential and protective care of patients and residents.
11. (11) Nonambulant patient shall mean a person who is bedfast, chairfast or roombound, or who can sit in, but not propel, a wheelchair.

12. (12) Nursing home patient shall mean a person:

    1. (i) diagnosed by a physician as having one or more clinically determined illnesses or conditions that cause the person to be so incapacitated, sick, invalid, infirm, disabled or convalescent as to require at least medical and nursing care; and

    2. (ii) whose assessed health care needs, in the professional judgment of his physician or a medical team:

       1. (a) do not require care or active treatment of the patient in a general or special hospital in or near his community;
       2. (b) cannot be met satisfactorily in the person's own home or home substitute through providing such home health services, including medical and other health and health-related services as are available in or near his community; and
       3. (c) cannot be met satisfactorily in a physician's office, hospital clinic or other ambulatory care setting because of the unavailability of medical and other health and health-related services for the person in such setting in or near his community.
13. (13) [Reserved]

14. (14) Home care services shall mean one or more of the following services provided to persons at home:

    1. (i) those services provided by a home care services agency;
    2. (ii) home health aide services;
    3. (iii) personal care services;
    4. (iv) advanced home health aide services;
    5. (v) homemaker services; or
    6. (vi) housekeeper services.
15. (15) Home health aide services shall mean health care tasks, personal hygiene services, housekeeping tasks and other related supportive services essential to the patient's health.
16. (16) Personal care services shall mean assistance to the patient with personal hygiene, dressing, feeding and household tasks essential to his/her health.
17. (17) Advanced home health aide services shall mean assistance to the patient with advanced tasks defined in subdivision (2) of section 6908 of the Education Law and regulations issued by the State Education Department thereunder and assigned by the supervising registered professional nurse.
18. (18) Homemaker services shall mean assistance and instruction in managing and maintaining a household, dressing, feeding and incidental household tasks for persons at home because of illness, incapacity or the absence of a caretaker relative. Such services shall be provided by persons who meet the standards established by the Department of Social Services.
19. (19) Housekeeper services shall mean the provision of light work or household tasks which do not require the services of a trained homemaker. Such services may be provided, for persons at home because of illness, incapacity or the absence of a caretaker relative, by persons who meet the standards established by the Department of Social Services.
20. (20) Government funds shall mean funds provided under the provisions of title 11 of article 5 of the Social Services Law.
21. (21) [Reserved]
22. (22) Personal service shall mean the service provided to each resident of a health-related facility which contributes to a clean, safe, healthy and attractive environment, and which provides supervision or assistance in daily activities in order to maintain an optimal state of health and physical and emotional well-being and safe-guard the individual rights and privileges of the resident.
23. (23) [Reserved]

24. (24) Semiambulant patient shall mean a person who is not an ambulant or a nonambulant patient and who:

    1. (i) can walk assisted by crutches only, or who has the ability to walk on level surfaces independently, but needs human assistance or supervision when negotiating stairs;
    2. (ii) can move from place to place by using a walker or by propelling a wheelchair; or
    3. (iii) needs human assistance or supervision for walking on a level surface.
25. (25) Sponsor shall mean the agency and/or the person or persons, other than the patient or resident, responsible in whole or in part for the financial support of the patient or resident including the costs of care in the medical facility.
26. (26) Activities program shall mean a planned schedule of recreational, social and other purposeful activity for nursing home patients designed to make their life more meaningful; to stimulate and support the desire to use their physical and mental capabilities to the fullest extent; to enable them to maintain a sense of usefulness and self-respect, but not specifically designed to correct or remedy any disability.
27. (27) Hospital ambulance service means the service of a hospital, as defined in article 28 of the Public Health Law, in transporting sick, disabled or injured persons by motor vehicle or other forms of transport to and from facilities or institutions providing hospital service when such service is provided by a hospital operating such service, or contracting therefor.
28. (28) Ambulance means a motor vehicle, or other form of transport, equipped to transport sick, disabled or injured individuals.
29. (29) [Reserved]
30. (30) Rehabilitation therapy services shall include but not be limited to audiology, occupational therapy, physical therapy, speech pathology and audiology.

31. (31) Verification of qualifications shall mean a department review and approval of the education, related experience and, where required, licensure, registration or certification of each occupational and physical therapist, speech pathologist, audiologist, occupational therapy assistant, physical therapist's assistant, recreation assistant, activities director and therapeutic recreation specialist providing service to health facilities certified by the department.

    (32)-(33) [Reserved]

32. (34) Nutritional services shall mean the:

    1. (i) assessment of nutritional needs and food patterns;
    2. (ii) planning for and/or the provision of foods and drink appropriate for the individual's physical and medical needs and environmental conditions; and

    3. (iii) providing nutrition education and counseling to meet normal and therapeutic needs.

       (35)-(41) [Reserved]

33. (42) Restraint shall mean a physical device or chemical used to limit, restrict or keep under control patient movements.

34. (43) Family planning shall mean the planning for children, including the spacing and limiting of childbirth by medical means and the overcoming of involuntary infertility.

    (44)-(46) [Reserved]

35. (47) Leisure-time activities department shall mean a department whose personnel are responsible for working with the healthy aspects of residential health-care facility patients/ residents by making available a planned, scheduled program of diverse and meaningful activities to meet residents' needs and interests. These activities can be pursued on a voluntary basis individually, independently, in a group, and at group functions. These activities are designed to ensure continuity of the resident's prior lifestyle, but are not specifically designed to correct or remedy any physical or mental disability or dysfunction.
36. (48) Verification of qualifications shall mean a department review and approval of the education and related experience of each leisure-time activities director, acting leisure-time activities director, leisure-time activities consultant, and physical therapist's assistant providing services to health facilities certified by the department.
37. (49) Rehabilitation therapy (skilled therapy) is administered by a qualified professional to restore physical function insofar as possible and/or help patients adjust or compensate for loss of function. These objectives should be accomplished within a reasonable length of time.
38. (50) A maintenance program is established and monitored by the qualified occupational therapist or physical therapist. This program helps the patient/resident retain an existing level of function and may be continued for an undetermined period of time. In general, maintenance is not skilled therapy. With few exceptions, it is carried out by supportive personnel.
39. (51) Medical social services shall mean the identification, assessment and management of social problems related to illness, the receipt of medical care and the attainment and maintenance of health as performed by qualified social workers.
40. (52) Medical supplies, equipment and appliances shall mean those items primarily and customarily used to serve a medical purpose and which are generally not useful to a person in the absence of an injury or illness.
41. (53) State health planning and development agency shall mean the State health planning and development agency designated pursuant to the National Health Planning and Resources Development Act of 1974, and any amendments thereto.
42. (54) Autonomous hospice administration shall mean a identifiable administrative group that has a distinct organizational structure, accountable to the hospice's governing authority either directly or through the governing authority's chief executive officer, for all aspects of the hospice.
43. (55) Hospice patient shall mean a person in the terminal stage of illness, with a life expectancy of approximately 12 months or less, who, alone or in conjunction with designated family member(s), has voluntarily requested admission and has been accepted into a hospice for which the department has issued a certificate of approval; provided, however, that nothing herein shall be construed to require provision of services to a patient that are not covered by the patient’s payment source.
44. (56) Hospice patient's family shall mean the hospice patient's immediate relations, including a spouse, brother, sister, child or parent. In addition, other relations and individuals with significant personal ties to the hospice patient may be designated as members of the hospice patient's family by mutual agreement among the hospice patient, the relation or individual and the hospice.
45. (57) Bereavement services shall mean those supportive services provided to the family to assist them in coping with the death of the patient.
46. (58) Palliative and supportive care shall mean services provided to a hospice patient for the reduction and abatement of pain and other symptoms and stresses associated with terminal illness and dying.
47. (59) Pastoral care shall mean services provided for the spiritual, religious and emotional support of the patient and family.
48. (60) Palliative care shall mean active, interdisciplinary care provided to a patient and/or a hospice patient with advanced, life-limiting illness, focusing on relief of distressing physical and psychosocial symptoms and meeting spiritual needs with the goal of achievement of the best quality of life for patients and families.