A3670 —

2019, c.476 (A3670 3R) §2CHAPTER –476 C.26:2H-12.28a  §§3,4An -Act C.27:5F-27.1concerning &stroke 27:5F-27.2care, §5amending -and Repealersupplementing  P.L.2004, P.L.c.136, supplementing Title 27 of the Revised Statutes, and repealing sections 3 and 4 of P.L.2004, c.136.

2019, CHAPTER 476, approved January 21, 2020 Assembly, No.

3670 (Third Reprint)     An Act concerning stroke care, amending 2and supplementing2 P.L.2004, c.136, 2supplementing Title 27 of the Revised Statutes, and2 repealing sections 3 and 4 of P.L.2004, c.136 2[, and supplementing various parts of the statutory law]2.

      2.   C.26:2H-12.28  TheDesignation Commissioner of Health shall designate hospitals that meet the criteria set forth in this [act] section as primary 1, thrombectomy-capable,1 or comprehensive stroke centerscenters. or acute stroke ready hospitals.

     a.    2.    AThe hospitalCommissioner shallof applyHealth to the commissioner for designation and shall demonstratedesignate tohospitals the satisfaction of the commissioner that themeet hospital [meets the criteria set forth in section 3 or 4 of this actsection for] has been certified as aprimary, primarythrombectomy-capable, 1, thrombectomy-capable,1 or comprehensive stroke centercenters or as an acute stroke ready hospital,hospitals. respectively, by the Joint Commission, the American Heart Association, 3[the Healthcare Facilities Accreditation Program,]3 DNV GL, or another organization that provides such certifications as may be approved by the commissioner.  A facility designated as a primary or comprehensive stroke center prior to the effective date of P.L.    , c.     3(C.        )3 (pending before the Legislature as this bill) shall retain such designation by obtaining, and providing the commissioner with documentation of, the appropriate certification by the Joint Commission, the American Heart Association, 3[the Healthcare Facilities Accreditation Program,]3 DNV GL, or 3[another] other3 approved organization within three years of the effective date of P.L.    , c.     3(C.        )3 (pending before the Legislature as this bill), except that the commissioner may grant the facility up to two one-year extensions to obtain the appropriate certification, provided the facility certifies that the additional time is necessary to obtain the appropriate certification.  2Failure to meet the requirements of this subsection shall be deemed a voluntary surrender of the hospital’s prior designation as a primary or comprehensive stroke center.  A hospital that has its certification by the Joint Commission, the American Heart Association, 3[the Healthcare Facilities Accreditation Program,]3 DNV GL, or other certifying organization revoked shall report the revocation to the Department of Health no later than five days after the date the hospital receives notice of the revocation from the certifying entity.2      b.    The commissioner shall designate as many hospitals as primary stroke centers as apply for the designation, provided that the hospital meets the [criteria set forth in section 3 of this act.  In addition to the criteria set forth in section 3 of this act, the commissioner is encouraged to take into consideration whether the hospital contracts with carriers that provide coverage through the State Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.) and the NJ FamilyCare Program, established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.)] certification requirements set forth in subsection a.

     a.     A hospital shall apply to the commissioner for designation and shall demonstrate to the satisfaction of the commissioner that the hospital has been certified as a primary, thrombectomy-capable, or comprehensive stroke center or as an acute stroke ready hospital, respectively, by the Joint Commission, the American Heart Association, DNV GL, or another organization that provides such certifications as may be approved by the commissioner.  A facility designated as a primary or comprehensive stroke center prior to the effective date of P.L.2019, c.476 (C.26:2H-12.28a et al.) shall retain such designation by obtaining, and providing the commissioner with documentation of, the appropriate certification by the Joint Commission, the American Heart Association, DNV GL, or other approved organization within three years of the effective date of P.L.2019, c.476 (C.26:2H-12.28a et al.), except that the commissioner may grant the facility up to two one-year extensions to obtain the appropriate certification, provided the facility certifies that the additional time is necessary to obtain the appropriate certification.  Failure to meet the requirements of this subsection shall be deemed a voluntary surrender of the hospital’s prior designation as a primary or comprehensive stroke center.  A hospital that has its certification by the Joint Commission, the American Heart Association, DNV GL, or other certifying organization revoked shall report the revocation to the Department of Health no later than five days after the date the hospital receives notice of the revocation from the certifying entity.

     b.    The commissioner shall designate as many hospitals as primary stroke centers as apply for the designation, provided that the hospital meets the certification requirements set forth in subsection a.

     c.     1TheThe commissioner shall designate as many hospitals as thrombectomy-capable stroke centers as apply for the designation, provided that the hospital meets the certification requirements set forth in subsection a.

     d.1   d.      The commissioner shall designate as many hospitals as comprehensive stroke centers as apply for the designation, provided that the hospital meets the [criteria set forth in section 4 of this act] certification requirements set forth in subsection a.

     1[d.] e.     e.1  The commissioner shall designate as many hospitals as acute stroke ready hospitals as apply for the designation, provided that the hospital meets the certification requirements set forth in subsection a.

of this section. section.      1[e.]  f.1 The commissioner shall appropriately recognize stroke centers that have attained a level of stroke care distinction recognized by the Joint Commission, the American Heart Association, 3[the Healthcare Facilities Accreditation Program,]3 DNV GL, or another nationally-recognized, guidelines-based organization that provides such distinctions and is approved by the commissioner.  Stroke centers that have attained a distinction that shall be recognized pursuant to this subsection may include, but shall not be not limited to, centers that offer mechanical endovascular therapies.

     1[f.] f.     g.1  The commissioner mayshall suspendappropriately orrecognize revokestroke acenters hospital'sthat designationhave asattained a level of stroke centercare distinction recognized by the Joint Commission, the American Heart Association, DNV GL, or acuteanother strokenationally-recognized, readyguidelines-based hospital,organization afterthat noticeprovides such distinctions and hearing,is ifapproved by the commissionercommissioner.  determinesStroke centers that thehave hospitalattained isa notdistinction inthat complianceshall withbe therecognized requirementspursuant ofto this act.subsection may include, but shall not be not limited to, centers that offer mechanical endovascular therapies.

     1[g.]g.    h.1  The commissioner shallmay encouragesuspend primaryor 1,revoke thrombectomy-capable,1a andhospital's comprehensivedesignation strokeas centersa tostroke coordinate,center byor written agreement, with acute stroke ready hospitalshospital, throughoutafter thenotice Stateand tohearing, provideif appropriatethe accesscommissioner todetermines carethat forthe acutehospital strokeis patients. not Agreementsin madecompliance pursuantwith tothe thisrequirements subsectionof shallthis include:act.

     h.    The commissioner shall encourage primary, thrombectomy-capable, and comprehensive stroke centers to coordinate, by written agreement, with acute stroke ready hospitals throughout the State to provide appropriate access to care for acute stroke patients.  Agreements made pursuant to this subsection shall include:

     1[h.] i.     i.1 Each 2Each hospital that is not a designated comprehensive stroke center shall, no later than 180 days after the effective date of P.L.   P.L.2019, ,c.476 c.   (C.26:2H-12.28a (C.       et )al.), (pending before the Legislature as this bill), enter into an agreement with at least one State-designated comprehensive stroke center, which agreement shall, at a minimum:

     (2)   provide, where most clinically appropriate, consistent with patient safety and patient consent, for the 3[urgent] effective and efficient3efficient transfer of patients needing the services of the comprehensive stroke centercenter, 3, particularly in time-sensitive cases including, but not limited to, large vessel occlusion3occlusion; ;

     j.2   j.     The Commissioner of Health shall prepare, maintain, and make available on the Department of Health website a list of facilities designated as primary stroke centerscenters, 3[,]3 1, thrombectomy-capable stroke centers,1centers, comprehensive stroke centers, and acute stroke ready hospitals.  A current copy of the list shall be transmitted to each emergency medical services provider, as defined in subsection e.

of section 3 of P.L.   P.L.2019, ,c.476 c.   (C.27:5F-27.1), (C.        ) (pending before the Legislature as this bill), no later than June 1 of each year.

     1[i.]k. 2[j.1] k.2 (1) Primary 1, thrombectomy-capable,1 and comprehensive stroke centers and acute stroke ready hospitals shall, on a quarterly basis, submit to the department data concerning stroke care that are deemed appropriate by the Department of Health, and that, at a minimum, align with the stroke consensus measures jointly supported by the Joint Commission, the United States Centers for Disease Control and Prevention’s Paul Coverdell National Acute Stroke Registry, American Heart Association, and the American Stroke Association.       (2)   Data submitted pursuant to paragraph (1) of this subsection shall be compiled by the department into a Statewide stroke database, which shall be made available on the department website.

(1) Primary, thrombectomy-capable, and comprehensive stroke centers and acute stroke ready hospitals shall, on a quarterly basis, submit to the department data concerning stroke care that are deemed appropriate by the Department of Health, and that, at a minimum, align with the stroke consensus measures jointly supported by the Joint Commission, the United States Centers for Disease Control and Prevention’s Paul Coverdell National Acute Stroke Registry, American Heart Association, and the American Stroke Association.       (2)   Data submitted pursuant to paragraph (1) of this subsection shall be compiled by the department into a Statewide stroke database, which shall be made available on the department website.

(cf:  C.26:2H-12.28a  Stroke Care Advisory Panel.

P.L.2012, c.17, s.193)        2.   2. (New section)   a.  In order to ensure the implementation of a strong Statewide system of stroke care, there is established in the Department of Health the Stroke Care Advisory Panel, which, subject to subsection c.

ofa. this section, shall consist of 2[13] 182 members, as follows:

In order to ensure the implementation of a strong Statewide system of stroke care, there is established in the Department of Health the Stroke Care Advisory Panel, which, subject to subsection c.

of this section, shall consist of 18 members, as follows:

and 2[11]16 162 public members to be appointed by the Governor.  The public members shall include 2[atwo nursenurses who isprovide experiencedstroke incare at a comprehensive stroke care;center;

a hospital physician who has clinical experience] two nurses who provide stroke care at a comprehensive stroke center;

three hospital physicians who are 3[board-certified2] fellowship trained neuro-interventionalists3neuro-interventionalists in neurosurgical or neuroendovascular intervention for stroke and who 2[serves]serve serve2 as the director of a primaryprimary, 1,thrombectomy-capable, thrombectomy-capable,1 or comprehensive stroke center;

2[and representatives of the New Jersey First Aid Council, the American Stroke Association, primary 1thrombectomy-capable,1 and comprehensive stroke centers, acute stroke ready hospitals, hospitals located in urban and rural areas of the State, physicians, and volunteer and non-volunteer emergency medical services providers] two physicians who are board-certified in neurology or neurosurgery who provide stroke care, and who serve as the medical director of a primary 3oror comprehensive3comprehensive stroke center;

and a representative from the Medical Society of New Jersey2Jersey.  .  Public members shall serve for a term of two years and shall be eligible for reappointment.       b.    The Stroke Care Advisory Panel established under this section shall organize as soon as practicable but no later than 60 days after the effective date of 3[thisP.L.2019, act]c.476 P.L.   (C.26:2H-12.28a ,et c.   al.), (C.        )3 , and, except as provided in subsection c.

     c.     The chairperson, vice-chairperson, and any public members of the Stroke Advisory Panel constituted in the Department of Health as of the effective date of P.L.   P.L.2019, ,c.476 c.   (C.26:2H-12.28a (C.       et )al.) (pending before the Legislature as this bill) may choose to remain on the Stroke Care Advisory Panel for up to one year following the effective date of P.L.    , c.    (C.        ) (pendingP.L.2019, beforec.476 the(C.26:2H-12.28a Legislatureet asal.).  this bill).  Thereafter, the public members shall be eligible for reappointment pursuant to subsection a.

     d.    The Stroke Care Advisory Panel established pursuant to this section shall continue any duties and responsibilities vested in the Stroke Advisory Panel constituted in the Department of Health as of the effective date of P.L.   P.L.2019, ,c.476 c.   (C.26:2H-12.28a (C.       et )al.).  (pending before the Legislature as this bill).  In addition, the Stroke Care Advisory Panel shall be charged with assessing the stroke system of care in New Jersey and identifying and recommending means of improving the provision of stroke care.  In addition to any other actions or recommendations as it finds necessary and appropriate, the panel shall:

     (1)   analyze the Statewide stroke database maintained pursuant to paragraph (2) of subsection 3[i.]k. k.3 of section 2 of P.L.2004, c.136 (C.26:2H-12.28) to identify potential interventions to improve the provision of stroke care in the State, with a focus on identifying and improving care in underserved regions and populations of the State;

of section 2 of P.L.2004, c.136 (C.26:2H-12.28) to identify potential interventions to improve the provision of stroke care in the State, with a focus on identifying and improving care in underserved regions and populations of the State;

     (4)   enhance coordination and communication between hospitals, primaryprimary, 1,thrombectomy-capable, thrombectomy-capable,1 and comprehensive stroke centers, acute stroke ready hospitals, and other support services necessary to assure access to effective and efficient stroke carecare, 3, particularly in time-sensitive cases including, but not limited to, large vessel occlusion3occlusion; ;

     (5)   develop 3[evidence-based]3 treatment 3[guidelines]protocols protocols3 regarding the transitioning of patients to community-based follow-up care in hospital outpatient, physician office, and ambulatory clinic settings for ongoing care after hospital discharge following acute treatment for stroke;

     e.     2TheThe Department of Health shall assign a current employee to the Stroke Care Advisory Panel, which employee shall have primary responsibility for assisting the panel in carrying out its responsibilities with respect to data analysis, data sharing, data oversight, and data reporting.  If the department does not have a current employee available who has the requisite skills, training, and experience to fulfil this role, the department may contract with an appropriate third party patient safety organization to perform this function for the panel on an at cost or no cost basis.

     f.2 f.     No later than one year after the date of organization, and annually thereafter, the Stroke Care Advisory Panel shall submit a report to the Governor and, pursuant to section 2 of P.L.1991, c.164 (C.52:14-19.1), to the Legislature, detailing its activities, findings, and proposals for legislative, executive, or other action to improve and enhance the Statewide stroke system of care.

      C.27:5F-27.1  3.   Standardized (New section)  a.  2[The Office of Emergency Medical Services in the Department] No later than June 1 of each year, the Commissioner2 of Health shall adopt a nationally recognized standardized stroke triage assessment tooltool. 2[, which shall be made available on the Department of Health website and shall be transmitted to each emergency medical services provider in the State no later than June 1 of each year] to be used by emergency medical services providers and protocols for the treatment and timely transport of acute stroke patients to the hospital with the most appropriate level of stroke care capability for the 3effective and efficient treatment of the3 patient’s condition.  No later than May 1 of each year, the Office of Emergency Medical Services in the Department of Health, in consultation with the Stroke Advisory Panel established pursuant to section 2 of P.L.    , c.    (C.        ) (pending before the Legislature as this bill), shall provide the commissioner with a non-binding list of recommendations to assist the commissioner in adopting a stroke triage assessment tool and protocols pursuant to this subsection2.

     b.   3. Each emergency medical services provider in the State shall 2[develop and]2 implement 3[a stroke triage assessment tool that is substantially similar to]3 the 3nationally-recognized3 standardized stroke triage assessment tool adopted pursuant to subsection a.