The Commonwealth of Massachusetts

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IN THE YEAR TWO THOUSAND SIX

An Act RELATIVE TO PATIENT SAFETY

            Whereas, The deferred operation of this act would tend to defeat its purpose, which is to protect the patients in the commonwealth forthwith, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public health.

  Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1.  Chapter 6A of the General Laws is hereby amended by inserting after section 16G the following section:—

Section 16H.  A nursing advisory board is hereby established within, but not subject to the control of, the executive office of health and human services.  The advisory board shall consist of 8 members who shall have a demonstrated background in nursing or health services research and who shall represent the continuum of health care settings and services, including, but not limited to, long-term institutional care, acute care, community-based care, public health, school care, and higher education in nursing.  The members shall be appointed by the governor from a list of 10 individuals recommended by the board of registration in nursing and a list of 10 persons recommended by the Massachusetts Center for Nursing, Inc.  The advisory board shall elect a chair from among its members and adopt bylaws for its proceedings.  Members shall be appointed for staggered terms of 3 years, except for persons appointed to fill vacancies who shall serve for the unexpired term.  No member shall serve more than 2 consecutive full terms.

The advisory board shall:—

(a)  advise the governor and the general court on matters related to the practice of nursing, including the shortage of nurses across the commonwealth in all settings and services, including long-term institutional care, acute care, community-based care, public health, school care, and higher education in nursing;

(b)  subject to appropriation, develop a research agenda, apply for federal and private research grants, and commission and fund research projects to fulfill the agenda;

(c)  recommend policy initiatives to the governor and the general court;

(d)  prepare an annual report and disseminate the report to the governor, the general court, the secretary of health and human services, the director of labor and workforce development and the commissioner of public health; and

(e)  consider the use of current government resources, including, but not limited to the workforce training fund.

Any funds granted to the advisory board shall be deposited with the state treasurer and may be expended by the advisory board in accordance with the conditions of the grants, without specific appropriation.  The advisory board may expend for services and other expenses any amounts that the general court may appropriate therefore.  Said advisory board shall conduct at least 1 public hearing during each year.

Subject to appropriation, the executive office of health and human services shall establish, operate, and manage the advisory board.

SECTION 2.  Section 14 of chapter 13 of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by inserting after subsection (k) the following subsection:—

(l) establish an expert nursing corps, to be known as the Clara Barton expert nursing corps, which shall consist of recognized nurses of high achievement in the profession who shall mentor incoming or novice nurses and further the goals of the nursing profession.  The board shall adopt guidelines governing the implementation of the program.  Such guidelines shall include, but need not be limited to, the following provisions:  specialty, standing, experience, and successful efforts to enable the nursing profession.

SECTION 3. Chapter 15A of the General Laws, is hereby amended by inserting after section 15G the following section:---

Section 15H.  Notwithstanding the provisions of any general or special law to the contrary, any state or community college, or the university of Massachusetts may enter into employment contracts for a minimum period of 5 years with faculty members who teach nursing at such institutions, unless both parties agree to a shorter term of employment.  For the purpose of this section in order to preserve the public’s health and safety any nursing faculty positions made vacant by the retirement of any employee receiving benefits in accordance with this act shall be deemed a position of critical and essential nature and shall be included on the schedule provided by the board of higher education to the house and senate committee on ways and means as set forth in this section.

SECTION 4.  Chapter 15A of the General Laws is hereby amended by inserting after section 19E the following 6 sections:—

Section 19F.  Subject to appropriation, the board of higher education shall establish a student loan repayment program and a faculty position payment program, for the purpose of encouraging outstanding students to work in the profession of nursing or for existing nurses or nurse student graduates to teach nursing within the commonwealth by providing financial assistance for the repayment of qualified education loans or by providing compensation to health care facilities to cover nurse scheduled work time spent teaching.  The board of higher education shall adopt guidelines governing the implementation of the program, which shall include, but need not be limited to, eligibility, repayment schedules and fair practice measures.

Section 19G.  Subject to appropriation, the board of higher education shall provide grants to institutions of higher education and health care institutions in the commonwealth for the purpose of fostering partnerships between higher education institutions and clinical agencies that promote the recruitment and retention of nurses.  Such grants may also be made available to such institutions for the purpose of establishing and maintaining nurse mentoring or nursing internship programs.  The board shall adopt guidelines governing the awarding of these grants.

Section 19H.  Subject to appropriation, the board of higher education shall establish a scholarship program to provide students in approved Massachusetts colleges, universities and schools of nursing with scholarships for tuition and fees for the purpose of encouraging outstanding Massachusetts students to work as nurses in, but not limited to, acute care hospitals, psychiatric and mental health clinics or hospitals, community or neighborhood health centers, rehabilitation centers, nursing homes, or as a home health, school or public health nurses in the commonwealth, or to teach nursing in colleges, universities, or schools of nursing in the commonwealth.  The board of higher education shall adopt guidelines governing the implementation of the scholarship program.

Colleges, universities, and schools of nursing in the commonwealth may administer the Clara Barton scholarship program and select recipients in accordance with guidelines adopted by the board.  Scholarships may be made available to full or part time matriculating students in courses of study leading to a degree in nursing or the teaching of nursing.  The criteria of the recipients and the amount of the scholarships shall be determined by the board of higher education.

Section 19I.  Subject to appropriation, the board of higher education shall develop a program to provide matching grants to any hospital that commits resources or personnel to nurse education programs.  Such program shall provide a dollar-for-dollar match for any funds committed by a hospital to pay for nurse faculty positions in publicly funded schools of nursing, including the costs of providing hospital personnel loaned to said schools of nursing.

Section 19J.  Subject to appropriation, the board of higher education shall appropriate a portion of the Clara Barton Nursing Excellence Trust Fund, as established in section 2SSS of chapter 29, to be used for the provision of refresher courses and retraining for licensed registered nurses returning to bedside care.  Said funds shall be used for registered nurses attending refresher classes at accredited schools of nursing.

Section 19K.  Subject to appropriation, the board of higher education shall develop a program to increase the racial and ethnic diversity of the nursing workforce.  Such programs shall focus on the identification, recruitment and retention of nursing students from populations underrepresented in the health care professions.  Said programs shall pay special attention to economic, social, and educational barriers for the diversification of the nursing workforce.

SECTION 5.  Chapter 29 of the General Laws is hereby amended by inserting after section 2NNN the following section:—

Section 2OOO.  There is hereby established and set up on the books of the commonwealth a separate fund, to be known as the Clara Barton Nursing Excellence Trust Fund.  There shall be credited to the trust fund all revenues from public, subject to appropriation, and private sources as appropriations, gifts, grants, donations, and from the federal government as reimbursements, grants-in-aid or other receipts to further the purposes of the trust fund in accordance with sections 19F through 19K, inclusive, of chapter 15A, and any interest or investment earnings on such revenues.  All revenues credited to the trust fund under this section shall remain in the trust fund and shall be expended, without further appropriation, for applications pursuant to said sections 19F through 19K, inclusive.  The state treasurer shall deposit and invest monies in said fund in accordance with sections 34, 34A and 38 in such a manner as to secure the highest rate of return consistent with the safety of the trust fund.  The trust fund shall be expended only for the purposes stated in said sections 19F through 19K, inclusive, at the direction of the chancellor of the system of public higher education, as established in section 6 of chapter 15A.

On February 1 of each year, the state treasurer shall notify the advisory board of any projected interest and investment earnings available for expenditure from said fund for each fiscal year.

SECTION 6.  Chapter 111 of the General Laws is hereby amended by adding the following 7 sections:—

Section 220.  As used in sections 220 to 227, inclusive, the following words shall, unless the context clearly requires otherwise, have the following meanings:—

“Adjustment of standards”, the adjustment of nurse’s patient assignment standards in accordance with patient acuity according to, or in addition to, direct-care registered nurse staffing levels determined by the nurse manager, or designee, using the patient acuity system.

“Acuity”, the intensity of nursing care required to meet the needs of a patient; higher acuity usually requires longer and more frequent nurse visits and more supplies and equipment.

“Assignment”, the provision of care to a particular patient for which a direct-care registered nurse has responsibility within his scope of practice, not withstanding the provisions of any general or special law to the contrary.

“Assist”, patient care that a direct-care registered nurse may provide beyond his patient assignments if the tasks performed are specific and time-limited.

“Board”, the board of registration in nursing, as established in section 13 of chapter 13.

“Circulator”, a direct-care registered nurse devoted to tracking key activities in the operating room.

“Department”, the department of public health, as established in section 1 of chapter 17.

“Direct-care registered nurse”, a registered nurse who has accepted direct responsibility and accountability to carry out medical regimens, nursing or other bedside care for patients.

“Facility”, a hospital licensed under section 51 of chapter 111, the teaching hospital of the university of Massachusetts medical school, any licensed private or state-owned and state-operated general acute care hospital, an acute psychiatric hospital, an acute care specialty hospital, or any acute care unit within a state-operated facility as defined in 105 CMR 100.020.  As used in sections 220 to 227, inclusive, this definition is not intended to include non-acute rehabilitation facilities.

“Float nurse”, a direct-care registered nurse that has demonstrated competence in any clinical area that he may be requested to work and is not assigned to a particular unit in a facility.

“Nurse’s patient limit”, the maximum number of patients to be assigned to each direct-care registered nurse at one time on a particular unit.

“Mandatory overtime”, any employer request with respect to overtime, which, if refused or declined by the employee, may result in an adverse employment consequence to the employee.  The term overtime with respect to an employee, means any hours that exceed the predetermined number of hours that the employer and employee have agreed that the employee would work during the shift or week involved.

“Monitor in moderate sedation cases”, a direct-care registered nurse devoted to continuously monitoring his patient’s vital statistics and other critical symptoms.

“Non-assigned registered nurse”, includes but is not limited to any nurse administrator, nurse supervisor, nurse manager, or charge nurse that maintains his registered nurse licensing certification but is not assigned to a patient for direct care duties.

“Nurse manager”, the registered nurse, or his designee, whose tasks include but are not limited to assigning registered nurses to specific patients by evaluating the level of experience, training, education of the direct-care nurse and the specific acuity levels of the patient.

“Nurse’s patient assignment standard”, the optimal number of patients to be assigned to each direct-care registered nurse at one time on a particular unit.

 “Nursing care”, care which falls within the scope of practice as defined in section 80B of chapter 112 or otherwise encompassed within recognized professional standards of nursing practice, including assessment, nursing diagnosis, planning, intervention, evaluation and patient advocacy.

“Overwhelming patient influx”, an unpredictable or unavoidable occurrence at unscheduled or unpredictable intervals that causes a substantial increase in the number of patients requiring emergent and immediate medical interventions and care, such as a declared national or state emergency, or the activation of the health care facility disaster diversion plan to protect the public health or safety.

“Patient acuity system”, a measurement system that is based on scientific data and compares the registered nurse staffing level in each nursing department or unit against actual patient nursing care requirements of each patient in order to predict registered nursing direct-care requirements for individual patients based on severity of patient illness.

 “Teaching hospital”, a facility as defined in section 51 of chapter 111 that meets the teaching facility definition of the American Association of Medical Colleges.

“Temporary nursing service agencies”, as defined in section 72Y of chapter 111, as regulated by the department, also known as the nursing care pool.

Section 221.  The department shall:—

(a) develop, within 6 months of the passage of this section, regulations defining terms and prescribing the process for establishing a standardized patient acuity system

(b) develop, within 9 months of the passage of this section, a standardized patient acuity system, as defined in this section, to be utilized by all facilities to monitor the number of direct-care registered nurses needed to meet patient acuity level;

(c) establish within 12 months of the passage of this section, nurse’s patient assignment standards and nurse’s patient limits as defined in this section.;

(d) develop, within 12 months of the passage of this section, regulations providing for an accessible and confidential system to report any failure to comply with requirements of this section and public access to information regarding reports of inspections, results, deficiencies and corrections under this section.        

(e) reevaluate the numbers that comprise the nurse’s patient assignment standards and nurse’s patient limits in the evaluation period and then every 3 years thereafter taking into consideration evolving technology or changing treatment protocols and care practices.

Section 222.  (a) The department shall develop nurse’s patient assignment standards  which will be an ideal number of patients assigned to a direct-care registered nurse that will promote equal, high-quality, and safe patient care at all facilities.  The standards shall form the basis of nurse staffing plans as described in section 224.  The department shall use at least the following information to develop nurse’s patient assignment standards for all facilities:—

(1)  Massachusetts specific data, including, but not limited to, the role of registered nurses in the commonwealth, the current staffing plans of facilities, the relative experience and education of registered nurses, the variability of facilities, and the needs of the patient population;

(2)  fluctuating patient acuity levels;

(3)  scientific data related to patient outcomes, hospital medical error rates, and health care quality measures;

(4)  treatment modalities within behavioral health facilities; and

(5)  public testimony from the public and experts in the field.

(b) The nurse’s patient assignment standards may be adjustable and flexed, as determined by the department, to take into consideration adjustments in varying patient acuity, time of day, and registered nurse experience.  The number of patients assigned to each direct-care registered nurse shall not be averaged.  The nurse’s patient assignment standards shall not refer to a total number of patients and a total number of direct-care registered nurses on a unit and shall not be factored over a period of time.

(c) The department shall develop nurse’s patient limits which represent the maximum number of patients to be safely assigned to each direct-care registered nurse at one time on a particular unit.  The number of patients assigned to each direct-care registered nurse shall not be averaged and each limit shall pertain to only one direct-care registered nurse.  Nurse’s patient limits shall not refer to a total number of patients and a total number of direct-care registered nurses on a unit and shall not be factored over a period of time.  A facility’s failure to adhere to these nurse’s patient limits shall result in non-compliance with this section and be subject to the enforcement procedures outlined herein and section 227.

(d)  If the commissioner finds that, for any unit, it is not possible for the department to arrive at a rationally based limit utilizing available scientific data, he shall establish a temporary alternative quantifiable limit.  He shall furthermore report in writing to the speaker of the house, the senate president, the chairs of the joint committee on public health, the joint committee on state administration and regulatory oversight, the commissioner of the division of health care financing and policy, and the nursing advisory board as defined in this section, the reasons for the department‘s failure to arrive at a rationally based limit and the data necessary for the department to determine a limit by the next review period.

(e)  The setting of nurse’s patient assignment standards and nurse’s patient limits for registered nurses is not to be interpreted as justifying the understaffing of other critical health care workers, including licensed practical nurses and unlicensed assistive personnel.  The availability of these other health care workers enables registered nurses to focus on the nursing care functions that only registered nurses, by law, are permitted to perform and thereby helps to ensure adequate staffing levels.

(f) Nurse’s patient assignment standards and nurse’s patient limits shall be determined for the following departments, units or types of nursing care:— intensive care units; critical care units; neo-natal intensive care; burn units; step-down/intermediate care; operating rooms, (a) not to include a registered nurse working as a circulator (b) to be determined for registered nurse working as a monitor in moderate sedation cases; post-anesthesia care with the patient remaining under anesthesia; post-anesthesia care with the patient in a post-anesthesia state; emergency department overall; emergency critical care, provided that the triage, radiologist or other specialty registered nurse is not included; emergency trauma; labor and delivery with separate standards for (i) a patient in active labor, (ii) patients, or couplets, in immediate postpartum, and (iii) patients, or couplets, in postpartum; intermediate care nurseries; well-baby nurseries; pediatric units; psychiatric units; medical and surgical; telemetry; observational/out-patient treatment; transitional care; acute inpatient rehabilitation; specialty care unit; and any other units or types of care determined necessary by the department.

(g)  Nothing in this section shall exempt a facility that identifies a unit by a name or term other than those used in this section, from complying with the nurse’s patient assignment standards and nurse’s patient limits  and other provisions established in this section for care specific to the types of units listed.

            Section 223.  (a)  The department shall develop a patient acuity system that shall be used by facilities to:—

(1) assess the acuity of individual patients and assign a value, within a numerical scale, to each individual patient;

(2) establish a methodology for aggregating patient acuity;

(3) monitor and address the fluctuating level of acuity of each patient; and

(4) supplement the nurse’s patient assignments and indicate the need for adjustment of direct-care registered nurse staffing as patient acuity changes.

(b)  The patient acuity system shall allow for adjustments in the number of direct-care registered nurses due to the following factors:—

(1) the need for specialized equipment and technology;

(2) the intensity of nursing interventions required and the complexity of clinical nursing judgment needed to design, implement and evaluate the patient's nursing care plan consistent with professional standards of care;

(3)  the amount of nursing care needed, both in number of direct-care registered nurses and skill mix of nursing personnel required on a daily basis for each patient in a nursing department or unit;

(4)  appropriate terms and language that are readily used and understood by direct-care registered nurses; and

(5)  patient care services provided by registered nurses and licensed practical nurses and other health care personnel.

(c)  The patient acuity system shall include a method by which facilities may adjust a nurse’s patient assignments within the limits determined by the department as follows:—

(1)  A nurse manager or his designee shall adjust the patient assignments according to the patient acuity system whenever he determines the need.

(2)  A nurse manager or his designee shall adjust the patient assignments when the approved patient acuity system indicates a change in acuity of any particular patient to the extent that it triggers an alert mechanism tied to the aggregate patient acuity.

(3)  A nurse manager or his designee shall be responsible for reassigning patients to be in compliance with the patient acuity system.  The nurse manager may rearrange patient assignments within the direct-care registered nurses already under his management and may also utilize an available float nurse.

(4)  At any time, any registered nurse can assess the accuracy of the patient acuity system as applied to a patient in his care.

Nothing herein shall preclude any facility from adjusting the nurse safe staffing standard by increasing the number of direct-care registered nurses per patient above the established standard.  Nor shall the requirements set forth in this section supersede or replace any requirements otherwise mandated by law, regulation or collective bargaining contract so long as the facility meets the requirements determined by the department.

Section 224.  As a condition of licensing by the department each facility shall submit annually to the department a prospective staffing plan with a written certification that the staffing plan is sufficient to provide adequate and appropriate delivery of health care services to patients for the ensuing year.  A staffing plan shall:—

(1) detail the exact amount of physical beds and technical equipment associated with each bed in the entire facility;

(2) adhere to the nurse’s patient assignment standards;

(3) employ the patient acuity system for addressing fluctuations in patient acuity levels that may require adjustments in registered nurse staffing levels as determined by the department;

(4) provide for orientation of registered nursing staff to assigned clinical practice areas, including temporary assignments;

(5) include other unit or department activity such as discharges, transfers and admissions, and administrative and support tasks that are expected to be done by direct-care registered nurses in addition to direct nursing care;

(6) include written reports of the facility’s patient outcome data; and

(7) incorporate the assessment criteria used to validate the acuity system relied upon in the plan.

As a condition of licensing, each facility shall submit annually to the department an audit of the preceding year’s staffing plan.  The audit shall compare the staffing plan with measurements of actual staffing as well as measurements of actual acuity for all units within the facility assessed through the patient acuity system.

Section 225.  (a)  At the beginning of his shift, a direct-care registered nurse will be assigned to a certain patient or patients by his nurse manager, the number of which shall not exceed the nurse’s patient limit associated with his unit.

(b)  A non-assigned registered nurse may be included in the counting of the nurse to patient assignment standards only when that non-assigned registered nurse is providing direct care.  When a non-assigned registered nurse is engaged in activities other than direct patient care, that nurse shall not be included in the counting of the nurse to patient assignments.  Only a non-assigned registered nurse who has demonstrated current competence to the facility to provide the level of care specific to the unit to which the patient is admitted, may relieve a direct-care registered nurse from said unit during breaks, meals, and other routine and expected absences.

(c)  Nothing in this section shall prohibit a direct-care registered nurse from assisting with specific tasks within the scope of his practice for a patient assigned to another nurse.

(d)  Each facility shall plan for routine fluctuations in patient census. In the event of an overwhelming patient influx, said facility must demonstrate that prompt efforts were made to maintain required staffing levels during said influx and that mandated limits were reestablished as soon as possible and no longer than a total of 48 hours after termination of said event.

(e)  For the purposes of complying with the requirements set forth in this section, except in cases of federal or state government declared public emergencies or a facility-wide emergency, no facility may employ mandatory overtime.

Section 226.  (a)  No facility shall directly assign any unlicensed personnel to perform nondelegatable licensed nurse functions to replace care delivered by a licensed registered nurse.  Unlicensed personnel are prohibited from performing functions which require the clinical assessment, judgment and skill of a licensed registered nurse. Such functions shall include, but are not limited to:--

(1)  nursing activities which require nursing assessment and judgment during implementation;

(2)  physical, psychological, and social assessment which requires nursing judgment, intervention, referral or follow-up;

(3)  formulation of the plan of nursing care and evaluation of the patient’s response to the care provided;

(4)  administration of medications,

(5)  health teaching and health counseling.

(b)  For purposes of compliance with this section, no registered nurse shall be assigned to a unit or a clinical area within a facility unless said registered nurse has an appropriate orientation in said clinical area sufficient to provide competent nursing care and has demonstrated current competency levels through accredited institutions and other continuing education providers.

Section 227.  (a)  If a facility can illustrate to the department, with sufficient documentation as determined by the attorney general, in its role as the overseer of charities, extreme financial hardship as a consequence of meeting the requirements set forth in this section, then the facility may apply to the department for waivers.

(b)  As a condition of licensing, a facility required to have a staffing plan under this section shall make available daily on each unit the written nurse staffing plan to reflect the safe nurse staffing standard and the limit as a means of consumer information and protection.

(c)  The department shall enforce the following subsections 1 to 5, inclusive, as follows:--

(1)  Any facility that fails to maintain or adhere to limit staffing requirements in accordance with sections 220 to 226, inclusive, shall be subject to an investigation by the department to determine the causes of failure to comply with staffing requirements.  Upon a finding of non-compliance, the department shall give formal written notification to the facility as to the manner in which the facility failed to comply with limit staffing requirements.  Facilities shall be granted due process during the investigation which shall include the following:--

(a)  notice shall be granted to facilities that are noncompliant with staffing requirements pertaining to limits;

(b)  facilities shall be afforded the opportunity to submit to the department, through written clarification, justifications for failure to comply with limit staffing requirements;

(c)  based upon such justifications, the department may determine any corrective measures to be taken.  Such measures may include:--

(i)  an official notice of failure to comply;

(ii)  the imposition of additional reporting and monitoring requirements;

(iii)  revocation of said facility's license or registration; and

(iv)  the closing of the particular unit that is noncompliant.

(2)  Failure to comply with limit nurse staffing requirements shall be considered prima facie evidence of noncompliance with this section

(3)  Failure to comply with the provisions of this section is actionable.

(4)  Should the department issue a formal written notification to a facility found in noncompliance with limits, the facility must prominently post its notice within each noncompliant unit.  Copies of the notice shall be posted by the facility immediately upon receipt and maintained for 14 consecutive days in conspicuous places including all places where notices to employees are customarily posted.  The department will post said notices on its website immediately after a finding of noncompliance.  The notice shall remain on the department’s website for 14 consecutive days or until such noncompliance is rectified, whichever is greater.

(5)  If a facility is repeatedly found in noncompliance as determined by the department or receives 3 notices in a budget quarter, the commissioner may fine the facility an amount not more than $3,000 for each additional incident of noncompliance within that fiscal year.

(6)  The department is authorized to promulgate rules and regulations necessary to enforce this section.

SECTION 7.  The department of public health shall include in its regulations pertaining to temporary nursing service agencies, as defined in section 72Y of chapter 111, parameters in which the department shall deny registration and operation of said agencies only if the agency attempts to increase costs to facilities by at least 10 per cent.

SECTION 8.  The department of public health shall submit 2 written reports on its progress in carrying out this act to the senate president, the speaker of the house of representatives, the chairs of the joint committee on public health and the clerks of the house of representatives and the senate—one no later than March 1, 2007 and the other no later than December 1, 2008.

SECTION 9. The evaluation period to reevaluate the numbers that comprise the nurse’s patient assignment standards and nurse’s patient limits shall be January of 2012.

SECTION 10.  The executive office of economic development, in collaboration with the board of education, the board of higher education, the board of registration in nursing, the Massachusetts Nurses Association, the Massachusetts Hospital Association, Inc., the Massachusetts Organization of Nurse Executives Inc., and any other entity deemed relevant by the department, shall develop a comprehensive statewide plan to promote the nursing profession.  The plan shall include specific recommendations to increase interest in the nursing profession and increase the supply of registered nurses in the workforce, including recommendations that may be carried out by state agencies. The plan shall be filed with the speaker of the house, the senate president and the clerks of the house of representatives and the senate no later than April 15, 2008.

SECTION 11.  Teaching hospitals shall meet the applicable requirements in this act no later than October 1, 2008 and all other facilities shall meet the applicable requirements in this act no later than October 1, 2010.

SECTION 12.  Section 7 of this act shall no longer be effective on and after December 1, 2012.