House Bill72 (HB72) relates to health care by requiring the Health Care Authority to promulgate and enforce minimum nursing staff to patient ratios for licensed hospitals and create the staffing advisory committee. Also, to require licensed hospitals to develop and implement policies and procedures. HB72 also contains administrative penalties and declares an emergency. 

  House Bill72 (HB72) enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.

Analysis: HB72 enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.

Analysis: HB72 enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.
Analysis: HB72 enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.

Analysis: HB72 enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.

Summary: HB 72 relates to health care by requiring the Health Care Authority to promulgate and enforce minimum nursing staff to patient ratios for licensed hospitals and create the staffing advisory committee. Also, to require licensed hospitals to develop and implement policies and procedures. HB72 also contains administrative penalties and declares an emergency.
Analysis: HB72 enacts a new section of the Health Care Code that states: A "staffing advisory committee" is created for the purpose of advising the Authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of eleven members that reflect a geographic representation of the state, appointed by the Authority as follows: 
(1) two members shall be private hospital administrators or chief nursing officers. 
(2) two members shall be public hospital administrators or chief nursing officers; 
3) two members shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; 
(4) two members shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; 
(5) two members shall represent labor organizations representing employees in public or private hospitals; and 
(6) one nonvoting advisory member shall represent the Authority.
Terms are defined as for four years and not more than three terms are to be served. Language is provided for establishing the first terms of the advisory committee and for appointing a chairman. 
The frequency of meetings is contingent on the need to advise and provide data based on the committee’s ability to make rules as found in the legislation. A majority constitutes a quorum and the Authority may remove a member for neglect of duties.
The Authority, with the advice of the staffing advisory committee, may: (
1) ensure that staffing ratios promulgated by the Authority are maintained by a hospital. 
(2) waive staffing ratios for rural general acute care hospitals as needed to increase operational efficiency; provided that doing so would not jeopardize the health, safety and well-being of patients; and 
(3) seek injunctive relief for violations of this 2025 act.

By July 1, 2026, the Authority, with the advice of the staffing advisory committee, shall hold hearings and promulgate rules regarding: 
(1) minimum, specific and numerical staffing ratios for hospitals licensed by the Authority pursuant to the Health Care Code, which shall include: (a)  licensed nurse-to-patient ratios by licensed nurse classification and hospital unit; and (b)  unlicensed employee-to-patient ratios by unlicensed classification and hospital unit for unlicensed employees involved in direct patient care; 
(2) rural general acute care hospital staffing needs; provided that the ratios promulgated pursuant to Paragraph (1) of this subsection may be adjusted to accommodate these needs; 
(3)  emergency department staffing, which shall include the ratios provided pursuant to Paragraph (1) of this subsection but shall distinguish between regularly scheduled core staff licensed nurses and additional licensed nurses required to treat critical care patients; and,
(4) the documented patient classification systems to be used by hospitals in determining nursing care requirements, including the: (a)  severity of the illness to be treated; technology; (b)  need for specialized equipment and (c)  complexity of clinical judgment needed to design, implement and evaluate the patient care plan and the ability for self-care; and (d)  licensure of the personnel required for care. 
The rules promulgated by the Authority as represented above, shall not replace existing nurse-to-patient ratios and unlicensed employee-to-patient ratios that may exist as provided by rule or existing state or federal law as of the effective date of this 2025 act.
The Authority, in consultation with the staffing advisory committee, shall: (1)  review the rules adopted pursuant to the above language  of this section after five years following the adoption of the rules; and (2)  report proposed rules to the legislature prior to promulgation.
A hospital shall: 
(1)  employ staff to meet the staffing ratios established by the Authority, which shall be the minimum number of registered and licensed nurses and unlicensed employees involved in direct patient care; and 
(2)  adopt written policies and procedures for nursing staff and unlicensed employees involved in direct patient care and temporary personnel, which shall require: (a)  training and orientation for providing direct patient care; (b)  orientation for registered nurses and unlicensed employees sufficient to provide competent care to patients in a nursing unit or clinical area prior to assigning the registered nurse or unlicensed employees to those areas; provided that the registered nurse or unlicensed employee also demonstrates competency in providing care in the assigned area; and (c)  temporary personnel orientation and competency evaluation. 
 A hospital may employ additional staff in accordance with a documented patient classification system.
Certain prohibitions for hospitals are included in the legislation, to include ,in brief: assignment of unlicensed personnel in lieu of a registered nurse or allow unlicensed personnel under supervision of a registered nurse to perform functions that require technical skills, including administration of medication , venipuncture or parenteral or tub feedings. Also, invasive procedures, or assessment of the condition of a patient are prohibited. Also, educating patients or their families is not allowed. 
All hospitals shall adopt written policies and procedures for training and orientation of nursing staff and unlicensed employees involved in direct patient care.  No registered nurse or unlicensed employee involved in direct patient care shall be assigned to a nursing unit or clinical area unless that nurse or unlicensed employee involved in direct patient care has first received orientation in that clinical area sufficient to provide competent care to patients in that area and has demonstrated current competence in providing care in that area.  The written policies and procedures for orientation of nursing staff and unlicensed employees involved in direct patient care shall require that all temporary personnel receive orientation and be subject to competency validation.
A hospital shall not deviate from any staffing ratios established by the Authority pursuant to this 2025 act more than six times during a rolling thirty-day period.  The unit manager shall notify the staffing advisory committee and the Authority no later than ten days after each deviation. Each subsequent deviation during the thirty-day period constitutes a separate violation.  
The Authority shall, no later than July 1, 2026, adopt rules that establish a process for investigating and remedying any violation of hospital staffing requirements. The rules are to define deviations and allow for complaints from staff, exclusive representatives of the staff and the public. 
The Authority shall issure a warning for the first violation in four year period or imposes a fine of one thousand seven hundred dollars for the second violation, a fine of two thousand five hundred dollars for the third violation and impose a civil penalty of five thousand dollars for the fourth and subsequent violations, all in a four year period. 
The Authority may require a plan of correction for multiple violations. If a hospital does not follow the corrective action plan approved by the Authority, the hospital shall be fined fifty thousand dollars ($50,000) every thirty days until the hospital complies.
A civil action may be brought by any interested person or organization for injunctive relief to enforce the provisions or any rules adopted  by the advisory committee.
 In the event such a suit is at least partially successful, the court may award the interested person or organization litigation costs and reasonable attorney fees.  
Exceptions are provided in the legislation that allow for a national or state disaster, a sudden and unforeseen adverse weather condition or an infectious disease epidemic suffered by hospital staff.
Finally, the Authority may grant waivers to rural or critical access hospitals for portions of this 2025 act if the hospital is able to document reasonable efforts to obtain adequate staff.
HB 72 declares that It is necessary for the public peace, health and safety that this legislation take effect immediately.














 

 Committee Substitute March 1, 2025 in HJC
HJCcs/HB72: the House Judiciary Committee Substitute for HB72 adds a Statewide Advisory Committee. 
A new definition is added for "critical access hospital" means a hospital that: (1) provides twenty-four-hour emergency department services; (2)  has an average length of stay no longer than ninety-six hours; (3)  has fewer than twenty-five acute care inpatient beds; and (4)  is located at least thirty-five miles from the closest hospital.
The definition of “hospital “does not include clinics or outpatient departments that do not provide inpatient or emergency services.
A new definition of "hospital network committee" means a staffing committee established in a network of hospitals that are owned or operated by the same entity”
Further , new definitions for :
"Hospital unit" includes critical care units, burn units, labor and delivery rooms, post-anesthesia service areas, emergency departments, operating rooms, pediatric units, step-down or intermediate care units, specialty care units, telemetry units, general medical care units, subacute care units and transitional inpatient care units; 
“Rural" means a rural county or unincorporated area of a partially rural county, as designated by the health resources and services administration of the United States department of health and human services; and 
“Staffing committee" means nurse-led groups that create staffing plans for hospital units based upon patient population, acuity and needs and the skills and experience of the hospital's staff."
Under Section 2 of the CS a statewide staffing advisory committee is created under the Health Care Code. It reads:
“A.  The "statewide staffing advisory committee" is created for the purpose of advising the authority on matters related to nurse staffing as provided in this 2025 act.  The committee consists of fourteen members that reflect a geographic representation of the state, appointed by the authority as follows: (1)  two members shall be private hospital directors of nursing or chief nursing officers; (2)  two members shall be public hospital directors of nursing or chief nursing officers; (3)  two members shall be rural hospital directors of nursing or chief nursing officers; (4)  two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of private hospitals involved in direct patient care; (5)  two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of public hospitals involved in direct patient care; (6)  two members, at least one of whom shall be a nurse, shall be nonmanagerial and nonsupervisory employees of rural hospitals involved in direct patient care; (7)  one member shall represent nursing faculty from a public university or community college; and (8)  one member shall represent the authority and serve as chair. 
B.  Except as provided in Subsection C of this section, the members of the statewide staffing advisory committee shall serve for terms of two years and no more than three terms.  A member appointed by the committee to fill a vacancy shall serve the remainder of the term. 
C.  Term-length conditions for voting members appointed to the statewide staffing advisory committee are: (1)  for initial appointments, five members shall serve for three-year terms, four members shall serve for two-year terms and four members shall serve for one-year terms; (2)  for regular appointments after the initial appointments, two-year terms; (3)  for a vacancy appointment, the balance of the term; and (4)  a committee member shall continue to serve on the committee until a replacement is appointed. 
D.  The authority shall make all initial appointments to the statewide staffing advisory committee by September 1, 2025. 
E.  The statewide staffing advisory committee shall elect other officers as the committee determines to be necessary. 
F.  The statewide staffing advisory committee shall meet at a frequency necessary for the committee to advise and provide data for the authority to use in promulgating rules pursuant to Section 3 of this 2025 act.  The initial meeting of the statewide staffing advisory committee shall occur no later than October 1, 2025. 
G.  A majority of the statewide staffing advisory committee members currently serving constitutes a quorum. 
H.  The authority may remove from office a member of the statewide staffing advisory committee for neglect of duties.”
A new Section 3 will allow each hospital to establish a staffing committee or a network staffing committee and report to the statewide staffing committee its recommendations.
The Authority, with the advice of the statewide staffing advisory committee, may: (1)  ensure that licensed nurse-to-patient staffing ratios promulgated by the authority are maintained by a hospital; (2)  consider unlicensed personnel that provide direct patient care and 
Also, waive nurse to patient staffing ratios, coverage for rural general acute care hospitals and critical access hospitals to increase efficiency. 
The Authority may also seek injunctive relief for violations of the Act. 
By October 1, 2026, the authority, with the advice of the statewide staffing advisory committee, shall hold hearings to promulgate rules regarding: nursing staff to patient ratios, rural general acute care and critical access hospital staffing needs, emergency department staffing needs, documented patient classification systems, and circumstances in which it is permissible for a hospital to be outside of the established licensed nurse-to-patient staffing ratios.
A review of the rules shall be held after five years.
The initial licensed nurse-to-patient staffing ratios established by the authority shall become effective no later than one hundred eighty days after the ratios are adopted by rule, except for emergency departments which shall be eighteen months before rule applicability.
The Section 4 regarding training is modified to require semi annual reporting to the Authority and the statewide advisory staffing committee.
Under Section 5 reporting requirements will now mean: “A.  A hospital shall provide written notice to the authority and the statewide staffing advisory committee whenever there are seven deviations from any staffing ratios established by the authority pursuant to this 2025 act during a rolling ninety-day period.  The written notice shall: (1)  be provided within ten days of a seventh deviation from the staffing ratios established by the authority pursuant to this 2025 act; (2)  explain the cause of the deviations; and (3)  provide a plan to prevent future deviations.
An appeal process is provided for hospitals and penalties are provided for first time, (1)  issue a warning for the first violation in a one-year period; (2)  impose a civil penalty not to exceed one thousand seven hundred fifty dollars ($1,750) for the second violation of the same provision in a one-year period; (3)  impose a civil penalty not to exceed two thousand five hundred dollars ($2,500) for the third violation of the same provision in a one-year period; and (4)  impose a civil penalty not to exceed five thousand dollars ($5,000) for the fourth and subsequent violations of the same provision in a one-year period.
Violations may be enforced by a civil action brought by any interested person or organization for injunctive relief to enforce the provisions of the 2025 Act.
Hospitals may not abide by the Act under certain provisions of the Act such as national and regional emergencies.