,i #aac? ,,congress #a/ ,session ,h4 ,r4 #ahba ,,9 ,,! ,,h\se ,,( ,,repres5tatives ,april #cj1 #bjac ,mrs4 ,capps 7= h]self & ,mr4 ,joyce7 introduc$ ! foll[+ bill2 :i* 0 ref]r$ to ! ,committee on ,en]gy & ,comm]ce1 & 9 addition to ! ,committee on ,ways & ,means1 = a p]iod to be subsequ5tly det]m9$ by ! ,speak]1 9 ea* case = consid]ation ( su* provisions z fall )9 ! jurisdiction ( ! committee conc]n$ ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to provide = pati5t protection by e/abli%+ safe nurse /aff+ levels at c]ta9 ,m$ic>e provid]s1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,regi/]$ ,nurse ,safe ,/aff+ ,act ( #bjac4 #b4 ,f9d+s ,congress makes ! foll[+ f9d+s3 7#a7 ,rese>* %[s t pati5t safety 9 hospitals is directly proportionate to ! numb] ( regi/]$ nurses work+ 9 ! hospital4 ,high] /aff+ levels by exp]i5c$ regi/]$ nurses are relat$ to l[] rates ( negative pati5t outcomes4 7#b7 ,a #bjaa /udy on nurse /aff+ & inpati5t hospital mortality %[s t sub-optimal nurse /aff+ is l9k$ ) a great] likelihood ( pati5t dea? 9 ! hospital4 ,a #bjab /udy ( s]i\s pati5t ev5ts report$ to ! ,jo9t ,commission demon/rates t "o ( ! lead+ causes ( all hospital s5t9el ev5ts is human factors1 includ+ /aff+ & /aff+ skill mix4 7#c7 ,heal? c>e work] fatigue has be5 id5tifi$ z a major pati5t safety haz>d1 & appropriate /aff+ policies & practices are indicat$ z an effective /rategy to r$uce heal? c>e work] fatigue & to protect pati5ts4 ,a national survey ( regi/]$ nurses f\nd t #gd p]c5t exp]i5ce acute or *ronic effects ( /ress & ov]work4 7#d7 ,a /rategy t ensures optimal nurse /aff+ & skill mix greatly influ5ces pati5t satisfaction & results 9 great] ov]all sav+s to hospitals ?r\gh r$uctions 9 adv]se pati5t ev5ts4 7#e7 ,a #bjji /udy demon/rat$ t improv$ pati5t satisfaction due to increas$ & appropriate nurse /aff+ is reflect$ on hospital scores on ,,hcahps1 :i* is a key measure = value-bas$ paym5t programs "u ! ,m$ic>e program & us$ by o!r payors4 7#f7 ,regi/]$ nurses play a vital role 9 prev5t+ pati5t c>e errors4 ,a #bjji /udy f\nd t suffici5t /aff+ ( critical c>e nurses c prev5t adv]se pati5t ev5ts1 :i* c co/ any:]e f #b1bjj1jjj to #ac1bjj1jjj4 ,by contra/1 ! nurse /aff+ co/s 9 ! /udy "t p]iod 7 only #a1cfj1jjj4 7#g7 ,high] nurse /aff+ also g5]ates co/ sav+s to payors1 z demon/rat$ 9 a #bjaa co/-b5efit analysis t weigh$ regi/]$ nurs+ p]sonnel co/s aga9/ em]g5cy dep>tm5t utilization aft] pati5t dis*>ge f a hospital4 7#h7 ,a #bjab /udy ( ,p5nsylvania hospitals %[s t by r$uc+ nurse burn\t1 :i* is attribut$ 9 "p to poor nurse /aff+1 ^? hospitals c\ld prev5t an e/imat$ #d1afj infections ) an associat$ sav+s ( #da1jjj1jjj4 ,t /udy also f\nd t = ea* additional pati5t assign$ to a regi/]$ nurse = c>e1 !re is an incid5ce ( r\ghly "o additional ca!t]-acquir$ ur9>y tract infection p] #a1jjj pati5ts or #a1cea infections p] ye>1 co/+ ^? hospitals z mu* z #a1ajj1jjj annually4 7#i7 ,:5 hospitals employ insuffici5t numb]s ( nurs+ /aff1 regi/]$ nurses are be+ requir$ to p]=m pr(essional s]vices "u conditions t d n support quality heal? c>e or a heal?ful "w environm5t = regi/]$ nurses4 7#aj7 ,z a payor = inpati5t & outpati5t hospital s]vices furni%$ to ,m$ic>e b5efici>ies1 ! ,f$]al ,gov]nm5t has a compell+ int]e/ 9 promot+ ! safety ( ^! pati5ts by requir+ any hospital p>ticipat+ 9 ! ,m$ic>e program to e/abli% m9imum safe /aff+ levels = regi/]$ nurses4 #c4 ,e/abli%m5t ( safe nurse /aff+ levels by ,m$ic>e p>ticipat+ hospitals 7a7 ,requirem5t ( m$ic>e provid] agreem5t ,section #ahff7;a77#a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;cc7a77#a77 is am5d$-- 7#a7 9 subp>agraph 7,v71 by /rik+ & at ! end2 7#b7 9 subp>agraph 7,w71 z add$ by section #cjje ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7-- 7,a7 by mov+ su* subp>agraph #b ems to ! left2 & 7,b7 by /rik+ ! p]iod at ! end2 7#c7 9 subp>agraph 7,w71 z add$ by section #fdjf7;b7 ( ! ,pati5t ,protection & ,af=dable ,c>e ,act 7,public ,law #aaa-adh7-- 7,a7 by mov+ su* subp>agraph #b ems to ! left2 7,b7 by r$esignat+ su* subp>agraph z subp>agraph 7,x72 & 7,c7 by /rik+ ! p]iod at ! end & ins]t+ 1 &2 & 7#d7 by ins]t+ aft] subp>agraph 7,x71 z r$esignat$ by p>agraph 7#c77;,b71 ! foll[+ new subp>agraph3 7,y7 9 ! case ( a hospital 7z def9$ 9 section #ahfa7;e771 to meet ! requirem5ts ( section #ahii;,b4 4 7b7 ,requirem5ts ,title ,,xviii ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is am5d$ by add+ at ! end ! foll[+ new section3 #ahii;,b4 ,nurse /aff+ requirem5ts = ,m$ic>e p>ticipat+ hospitals 7a7 ,implem5tation ( nurse /aff+ plan 7#a7 ,9 g5]al ,ea* p>ticipat+ hospital %all implem5t a hospital-wide /aff+ plan = nurs+ s]vices furni%$ 9 ! hospital4 7#b7 ,requirem5t = developm5t ( /aff+ plan by hospital nurse /aff+ committee ,! hospital-wide /aff+ plan = nurs+ s]vices implem5t$ by a hospital pursuant to p>agraph 7#a7-- 7,a7 %all be develop$ by ! hospital nurse /aff+ committee e/abli%$ "u subsection 7b72 & 7,b7 %all require t an appropriate numb] ( regi/]$ nurses provide direct pati5t c>e 9 ea* unit & on ea* %ift ( ! hospital to ensure /aff+ levels t-- 7i7 address ! unique *>act]i/ics ( ! pati5ts & hospital units2 & 7ii7 result 9 ! deliv]y ( safe1 quality pati5t c>e1 consi/5t ) ! requirem5ts "u subsection 7c74 7b7 ,hospital nurse /aff+ committee 7#a7 ,e/abli%m5t ,ea* p>ticipat+ hospital %all e/abli% a hospital nurse /aff+ committee 7h]e9aft] 9 ?is section ref]r$ to z ! ,committee74 7#b7 ,composition ,a ,committee e/abli%$ pursuant to ?is subsection %all be compos$ ( memb]s z foll[s3 7,a7 ,m9imum #ee p]c5t nurse p>ticipation ,n less ?an #ee p]c5t ( ! memb]s ( ! ,committee %all be regi/]$ nurses :o provide direct pati5t c>e b :o are nei!r hospital nurse manag]s nor "p ( ! hospital adm9i/ration /aff4 7,b7 ,inclusion ( hospital nurse manag]s ,! ,committee %all include memb]s :o are hospital nurse manag]s4 7,c7 ,inclusion ( nurses f specialty units ,! memb]s ( ! ,committee %all include at lea/ #a regi/]$ nurse :o provides direct c>e f ea* nurse specialty or unit ( ! hospital 7ea* su* specialty or unit z det]m9$ by ! hospital74 7,d7 ,o!r hospital p]sonnel ,! ,committee %all include su* o!r p]sonnel ( ! hospital z ! hospital det]m9es to be appropriate4 7#c7 ,duties 7,a7 ,developm5t ( /aff+ plan ,! ,committee %all develop a hospital-wide /aff+ plan = nurs+ s]vices furni%$ 9 ! hospital consi/5t ) ! requirem5ts "u subsection 7c74 7,b7 ,review & modification ( /aff+ plan ,! ,committee %all-- 7i7 conduct regul>1 ongo+ monitor+ ( ! implem5tation ( ! hospital-wide /aff+ plan = nurs+ s]vices furni%$ 9 ! hospital2 7ii7 c>ry out evaluations ( ! hospital-wide /aff+ plan = nurs+ s]vices at lea/ annually2 & 7iii7 make su* modifications to ! hospital-wide /aff+ plan = nurs+ s]vices z may be appropriate4 7,c7 ,additional duties ,! ,committee %all-- 7i7 develop policies & proc$ures = ov]time requirem5ts ( regi/]$ nurses provid+ direct pati5t c>e & = appropriate "t & mann] ( relief ( su* regi/]$ nurses dur+ r\t9e abs5ces2 & 7ii7 c>ry out su* additional duties z ! ,committee det]m9es to be appropriate4 7c7 ,/aff+ plan requirem5ts 7#a7 ,plan requirem5ts ,subject to p>agraph 7#b71 a hospital-wide /aff+ plan = nurs+ s]vices develop$ & implem5t$ "u ?is section %all-- 7,a7 be bas$ ^u input f ! regi/]$ nurse /aff ( ! hospital :o provide direct pati5t c>e or _! exclusive repres5tatives1 z well z ! *ief nurse executive2 7,b7 be bas$ ^u ! numb] ( pati5ts & ! level & v>iability ( int5sity ( c>e to be provid$ to ^? pati5ts1 ) appropriate consid]ation giv5 to admissions1 dis*>ges1 & transf]s dur+ ea* %ift2 7,c7 take into acc\nt contextual issues affect+ nurse /aff+ & ! deliv]y ( c>e1 includ+ ar*itecture & geography ( ! environm5t & available te*nology2 7,d7 take into acc\nt ! level ( education1 tra9+1 & exp]i5ce ( ^? regi/]$ nurses provid+ direct pati5t c>e2 7,e7 take into acc\nt ! /aff+ levels & s]vices provid$ by o!r heal? c>e p]sonnel associat$ ) nurs+ c>e1 su* z c]tifi$ nurse assi/ants1 lic5s$ vocational nurses1 lic5s$ psy*iatric te*nicians1 nurs+ assi/ants1 aides1 & ord]lies2 7,f7 take into acc\nt /aff+ levels recomm5d$ by specialty nurs+ organizations2 7,g7 e/abli% upw>dly adju/able m9imum ratios ( direct c>e regi/]$ nurses to pati5ts = ea* unit & = ea* %ift ( ! hospital1 bas$ ^u an assessm5t by regi/]$ nurses ( ! level & v>iability ( int5sity ( c>e requir$ by pati5ts "u exi/+ conditions2 7,h7 take into acc\nt unit & facility level /aff+1 quality & pati5t outcome data1 & national comp>isons1 z available2 7,i7 ensure t a regi/]$ nurse %all n be assign$ to "w 9 a p>ticul> unit ( ! hospital )\t fir/ hav+ e/abli%$ ! ability to provide pr(essional c>e 9 su* unit2 & 7,j7 provide = exemptions f "s or all requirem5ts ( ! hospital-wide /aff+ plan = nurs+ s]vices dur+ a decl>$ /ate ( em]g5cy 7z def9$ 9 subsection 7l77#a77 if ! hospital is reque/$ or expect$ to provide an exceptional level ( em]g5cy or o!r m$ical s]vices4 7#b7 ,limitation ,a hospital-wide /aff+ plan = nurs+ s]vices develop$ & implem5t$ "u ?is section-- 7,a7 %all n preempt any regi/]$-nurse /aff+ levels e/abli%$ "u ,/ate law or regulation2 & 7,b7 may n utilize any m9imum numb] ( regi/]$ nurses e/abli%$ "u p>agraph 7#a77;,g7 z an upp] limit on ! nurse /aff+ ( ! hospital to :i* su* m9imum numb] applies4 7d7 ,report+ & release to public ( c]ta9 /aff+ in=mation 7#a7 ,requirem5ts = hospitals ,ea* p>ticipat+ hospital %all-- 7,a7 po/ daily = ea* %ift1 9 a cle>ly visible place1 a docum5t t specifies 9 a uni=m mann] 7z prescrib$ by ! ,secret>y7 ! curr5t numb] ( lic5s$ & unlic5s$ nurs+ /aff directly responsible = pati5t c>e 9 ea* unit ( ! hospital1 id5tify+ specifically ! numb] ( regi/]$ nurses2 7,b7 ^u reque/1 make available to ! public-- 7i7 ! nurs+ /aff in=mation describ$ 9 subp>agraph 7,a72 7ii7 a detail$ writt5 description ( ! hospital-wide /aff+ plan implem5t$ by ! hospital pursuant to subsection 7a72 & 7iii7 n lat] ?an #ij days aft] ! date on :i* an evaluation is c>ri$ out by ! ,committee "u subsection 7b77#c77;,b77ii71 a copy ( su* evaluation2 & 7,c7 n less frequ5tly ?an qu>t]ly1 submit to ! ,secret>y 9 a uni=m mann] 7z prescrib$ by ! ,secret>y7 ! nurs+ /aff in=mation describ$ 9 subp>agraph 7,a7 ?r\gh electronic data submission4 7#b7 ,secret>ial responsibilities ,! ,secret>y %all-- 7,a7 make ! in=mation submitt$ pursuant to p>agraph 7#a77;,c7 publicly available 9 a compreh5sible =mat 7z describ$ 9 subsection 7e77#b77;,d77ii771 includ+ by publication on ! ,hospital ,comp>e ,int]net ,web site ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices2 & 7,b7 provide = ! audit+ ( su* in=mation = accuracy z a "p ( ! process ( det]m9+ :e!r ! p>ticipat+ hospital is 9 compliance ) ! conditions ( its agreem5t ) ! ,secret>y "u section #ahff1 includ+ "u subsection 7a77#a77,y7 ( su* section4 7e7 ,recordkeep+2 collection & report+ ( quality data2 evaluation 7#a7 ,recordkeep+ ,ea* p>ticipat+ hospital %all ma9ta9 = a p]iod ( at lea/ #c ye>s 7or1 if long]1 until ! conclusion ( any p5d+ en=cem5t activities7 su* records z ! ,secret>y deems necess>y to det]m9e :e!r ! hospital has implem5t$ a hospital-wide /aff+ plan = nurs+ s]vices pursuant to subsection 7a74 7#b7 ,collection & report+ ( quality data on nurs+ s]vices 7,a7 ,9 g5]al ,! ,secret>y %all require ! collection1 aggregation1 ma9t5ance1 & report+ ( quality data relat+ to nurs+ s]vices furni%$ by ea* p>ticipat+ hospital4 7,b7 ,use ( endors$ measures ,9 c>ry+ out ?is p>agraph1 ! ,secret>y %all use only quality measures = nurs+-s5sitive c>e t are endors$ by ! cons5sus-bas$ entity ) a contract "u section #ahij7;a74 7,c7 ,use ( qualifi$ ?ird-p>ty entities = collection & submission ( data 7i7 ,9 g5]al ,a p>ticipat+ hospital may ent] into agreem5ts ) ?ird-p>ty entities t h demon/rat$ exp]tise 9 ! collection & submission ( quality data on nurs+ s]vices to collect1 aggregate1 ma9ta91 & report ! quality data ( ! hospital pursuant to subp>agraph 7,a74 7ii7 ,con/ruction ,no?+ 9 clause 7i7 %all be con/ru$ to excuse or exempt a p>ticipat+ hospital t has ent]$ into an agreem5t describ$ 9 su* clause f compliance ) requirem5ts = quality data collection1 aggregation1 ma9t5ance1 & report+ impos$ "u ?is p>agraph4 7,d7 ,report+ ( quality data 7i7 ,publication on hospital comp>e web site ,subject to ! succe$+ provisions ( ?is subp>agraph1 ! ,secret>y %all make ! data submitt$ pursuant to subp>agraph 7,a7 publicly available1 includ+ by publication on ! ,hospital ,comp>e ,int]net ,web site ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices4 7ii7 ,compreh5sible =mat ,data made available to ! public "u clause 7i7 %all be pres5t$ 9 a cle>ly und]/&able =mat t p]mits consum]s ( hospital s]vices to make mean+ful comp>isons among hospitals1 includ+ concise explanations 9 pla9 ,engli% ( h[ to int]pret ! data1 ( ! diff]5ce 9 types ( nurs+ /aff1 ( ! relation%ip betwe5 nurse /aff+ levels & quality ( c>e1 & ( h[ nurse /aff+ may v>y bas$ on pati5t case mix4 7iii7 ,opportunity to correct errors ,! ,secret>y %all e/abli% a process "u :i* p>ticipat+ hospitals may review data submitt$ to ! ,secret>y pursuant to subp>agraph 7,a7 to correct errors1 if any1 conta9$ 9 t data submission be=e mak+ ! data available to ! public "u clause 7i74 7#c7 ,evaluation ( data ,! ,secret>y %all provide = ! analysis ( quality data collect$ f p>ticipat+ hospitals "u p>agraph 7#b7 9 ord] to evaluate ! effect ( hospital-wide /aff+ plans = nurs+ s]vices implem5t$ pursuant to subsection 7a7 on-- 7,a7 pati5t outcomes t are nurs+ s5sitive 7su* z pressure ulc]s1 fall occurr5ce1 falls result+ 9 injury1 l5g? ( /ay1 & c5tral l9e ca!t] infections72 & 7,b7 nurs+ work=ce safety & ret5tion 7includ+ "w-relat$ injury1 /aff skill mix1 nurs+ c>e h\rs p] pati5t day1 vacancy & volunt>y turnov] rates1 ov]time rates1 use ( tempor>y ag5cy p]sonnel1 & nurse satisfaction74 7f7 ,refusal ( assignm5t ,a nurse may refuse to accept an assignm5t z a nurse 9 a p>ticipat+ hospital1 or 9 a unit ( a p>ticipat+ hospital1 if-- 7#a7 ! assignm5t is 9 violation ( ! hospital-wide /aff+ plan = nurs+ s]vices implem5t$ pursuant to subsection 7a72 or 7#b7 ! nurse is n prep>$ by education1 tra9+1 or exp]i5ce to fulfill ! assignm5t )\t compromis+ ! safety ( any pati5t or jeop>diz+ ! lic5se ( ! nurse4 7g7 ,en=cem5t 7#a7 ,responsibility ,! ,secret>y %all en=ce ! requirem5ts & prohibitions ( ?is section 9 accordance ) ! succe$+ provisions ( ?is subsection4 7#b7 ,proc$ures = receiv+ & inve/igat+ compla9ts ,! ,secret>y %all e/abli% proc$ures "u :i*-- 7,a7 any p]son may file a compla9t t a p>ticipat+ hospital has violat$ a requirem5t ( or a prohibition "u ?is section2 & 7,b7 su* compla9ts are inve/igat$ by ! ,secret>y4 7#c7 ,rem$ies ,except z provid$ 9 p>agraph 7#e71 if ! ,secret>y det]m9es t a p>ticipat+ hospital has violat$ a requirem5t ( ?is section1 ! ,secret>y-- 7,a7 %all require ! hospital to e/abli% a corrective action plan to prev5t ! recurr5ce ( su* violation2 & 7,b7 may impose civil money p5alties "u p>agraph 7#d74 7#d7 ,civil money p5alties 7,a7 ,9 g5]al ,9 addition to any o!r p5alties prescrib$ by law1 ! ,secret>y may impose a civil money p5alty ( n m ?an #aj1jjj = ea* kn[+ violation ( a requirem5t ( ?is section1 except t ! ,secret>y %all impose a civil money p5alty ( m ?an #aj1jjj = ea* su* violation 9 ! case ( a p>ticipat+ hospital t ! ,secret>y det]m9es has a patt]n or practice ( su* violations 7) ! am\nt ( su* additional p5alties be+ det]m9$ 9 accordance ) a s*$ule or me?odology specifi$ 9 regulations74 7,b7 ,proc$ures ,! provisions ( section #aabh;,a 7o!r ?an subsections 7a7 & 7b77 %all apply to a civil money p5alty "u ?is p>agraph 9 ! same mann] z su* provisions apply to a p5alty or proce$+ "u section #aabh;,a4 7,c7 ,public notice ( violations 7i7 ,int]net web site ,! ,secret>y %all publi% on an appropriate ,int]net ,web site ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices ! names ( p>ticipat+ hospitals on :i* civil money p5alties h be5 impos$ "u ?is section1 ! violation = :i* ! p5alty 0 impos$1 & su* additional in=mation z ! ,secret>y det]m9es appropriate4 7ii7 ,*ange ( own]%ip ,) respect to a p>ticipat+ hospital t _h a *ange 9 own]%ip1 z det]m9$ by ! ,secret>y1 p5alties impos$ on ! hospital :ile "u previ\s own]%ip %all no long] be publi%$ by ! ,secret>y ( su* ,int]net ,web site aft] ! #a-ye> p]iod beg9n+ on ! date ( ! *ange 9 own]%ip4 7#e7 ,p5alty = failure to collect & report quality data on nurs+ s]vices 7,a7 ,9 g5]al ,9 ! case ( a p>ticipat+ hospital t fails to comply ) requirem5ts "u subsection 7e77#b7 to collect1 aggregate1 ma9ta91 & report quality data relat+ to nurs+ s]vices furni%$ by ! hospital1 in/ead ( ! rem$ies describ$ 9 p>agraph 7#c71 ! provisions ( subp>agraph 7,b7 %all apply ) respect to ea* su* failure ( ! p>ticipat+ hospital4 7,b7 ,p5alty ,9 ! case ( a failure by a p>ticipat+ hospital to comply ) ! requirem5ts "u subsection 7e77#b7 = a ye>1 ea* su* failure %all be deem$ to be a failure to submit data requir$ "u section #ahcc7t77#ag77;,a71 section #ahhf7;b77#c77;,b77viii71 section #ahhf7;j77#g77;,a71 or section #ahhf7m77#e77;,a71 z ! case may be1 ) respect to ! p>ticipat+ hospital involv$ = t ye>4 7h7 ,:i/lebl[] protections 7#a7 ,prohibition ( discrim9ation & retaliation ,a p>ticipat+ hospital %all n discrim9ate or retaliate 9 any mann] aga9/ any pati5t or employee ( ! hospital because t pati5t or employee1 or any o!r p]son1 has pres5t$ a grievance or compla9t1 or has initiat$ or coop]at$ 9 any inve/igation or proce$+ ( any k9d1 relat+ to-- 7,a7 ! hospital-wide /aff+ plan = nurs+ s]vices develop$ & implem5t$ "u ?is section2 or 7,b7 any "r1 o!r requirem5t or prohibition "u ?is section1 includ+ a refusal to accept an assignm5t describ$ 9 subsection 7f74 7#b7 ,relief = prevail+ employees ,an employee ( a p>ticipat+ hospital :o has be5 discrim9at$ or retaliat$ aga9/ 9 employm5t 9 violation ( ?is subsection may initiate judicial action 9 a ,unit$ ,/ates di/rict c\rt & %all be entitl$ to re9/atem5t1 reimbursem5t = lo/ wages1 & "w b5efits caus$ by ! unlawful acts ( ! employ+ hospital4 ,prevail+ employees are entitl$ to reasonable attorney's fees & co/s associat$ ) pursu+ ! case4 7#c7 ,relief = prevail+ pati5ts ,a pati5t :o has be5 discrim9at$ or retaliat$ aga9/ 9 violation ( ?is subsection may initiate judicial action 9 a ,unit$ ,/ates di/rict c\rt4 ,a prevail+ pati5t %all be entitl$ to liquidat$ damages ( #e1jjj = a violation ( ?is /atute 9 addition to any o!r damages "u o!r applicable /atutes1 regulations1 or common law4 ,prevail+ pati5ts are entitl$ to reasonable attorney's fees & co/s associat$ ) pursu+ ! case4 7#d7 ,limitation on actions ,no action may be br\ght "u p>agraph 7#b7 or 7#c7 m ?an #b ye>s aft] ! discrim9ation or retaliation ) respect to :i* ! action is br\ght4 7#e7 ,treatm5t ( adv]se employm5t actions ,= purposes ( ?is subsection-- 7,a7 an adv]se employm5t action %all be treat$ z discrim9ation or retaliation2 & 7,b7 ! t]m adv]se employm5t action includes-- 7i7 ! failure to promote an individual or provide any o!r employm5t-relat$ b5efit = :i* ! individual w\ld o!rwise be eligible2 7ii7 an adv]se evaluation or decision made 9 relation to accr$itation1 c]tification1 cr$5tial+1 or lic5s+ ( ! individual2 & 7iii7 a p]sonnel action t is adv]se to ! individual conc]n$4 7i7 ,relation%ip to /ate laws ,no?+ 9 ?is section %all be con/ru$ z exempt+ or reliev+ any p]son f any liability1 duty1 p5alty1 or puni%m5t provid$ by ! law ( any ,/ate or political subdivision ( a ,/ate1 o!r ?an any su* law :i* purports to require or p]mit any action prohibit$ "u ?is title4 7j7 ,relation%ip to conduct prohibit$ "u ! national labor relations act or o!r collective b>ga9+ laws ,no?+ 9 ?is section %all be con/ru$ z-- 7#a7 p]mitt+ conduct prohibit$ "u ! ,national ,labor ,relations ,act or "u any o!r ,f$]al1 ,/ate1 or local collective b>ga9+ law2 or 7#b7 preempt+1 limit+1 or modify+ a collective b>ga9+ agreem5t ent]$ into by a p>ticipat+ hospital4 7k7 ,regulations 7#a7 ,9 g5]al ,! ,secret>y %all promulgate su* regulations z are appropriate & necess>y to implem5t ?is section4 7#b7 ,implem5tation 7,a7 ,9 g5]al ,except z provid$ 9 subp>agraph 7,b71 z soon z practicable b n lat] ?an #b ye>s aft] ! date ( ! enactm5t ( ?is section1 a p>ticipat+ hospital %all h implem5t$ a hospital-wide /aff+ plan = nurs+ s]vices "u ?is section4 7,b7 ,special rule = rural hospitals ,9 ! case ( a p>ticipat+ hospital locat$ 9 a rural area 7z def9$ 9 section #ahhf7;d77#b77;,d771 su* p>ticipat+ hospital %all h implem5t$ a hospital-wide /aff+ plan = nurs+ s]vices "u ?is section z soon z practicable b n lat] ?an #d ye>s aft] ! date ( ! enactm5t ( ?is section4 7l7 ,def9itions ,9 ?is section3 7#a7 ,decl>$ /ate ( em]g5cy ,! t]m decl>$ /ate ( em]g5cy means an (ficially designat$ /ate ( em]g5cy t has be5 decl>$ by ! ,f$]al ,gov]nm5t or ! head ( ! appropriate ,/ate or local gov]nm5tal ag5cy hav+ au?ority to decl>e t ! ,/ate1 c\nty1 municipality1 or locality is 9 a /ate ( em]g5cy1 b does n include a /ate ( em]g5cy t results f a labor dispute 9 ! heal? c>e indu/ry or consi/5t und]/aff+4 7#b7 ,p>ticipat+ hospital ,! t]m p>ticipat+ hospital means a hospital 7z def9$ 9 section #ahfa7;e77 t has ent]$ into a provid] agreem5t "u section #ahff4 7#c7 ,p]son ,! t]m p]son means "o or m individuals1 associations1 corporations1 un9corporat$ organizations1 or labor unions4 7#d7 ,regi/]$ nurse ,! t]m regi/]$ nurse means an individual :o has be5 grant$ a lic5se to practice z a regi/]$ nurse 9 at lea/ #a ,/ate4 7#e7 ,%ift ,! t]m %ift means a s*$ul$ set ( h\rs or duty p]iod to be work$ at a p>ticipat+ hospital4 7#f7 ,unit ,! t]m unit means1 ) respect to a hospital1 an organizational dep>tm5t or sep>ate geographic area ( a hospital1 includ+ a burn unit1 a labor & deliv]y room1 a po/-ane/hesia s]vice area1 an em]g5cy dep>tm5t1 an op]at+ room1 a p$iatric unit1 a /epd[n or int]m$iate c>e unit1 a specialty c>e unit1 a telemetry unit1 a g5]al m$ical c>e unit1 a subacute c>e unit1 & a transitional inpati5t c>e unit4 4