SCS/SB 60 - This act modifies the law regarding certain health care services.

The first Tuesday in March will be known as "Alzheimer's Awareness Day" to increase the awareness of Alzheimer's disease and related dementias. This portion is substantially similar to SB 449 and contained in HB 603 (TAT). (Section 9.160).

This act provides for Medicaid coverage for certain breast and cervical cancer patients. A new subdivision 13 is added to Section 208.151, RSMo, to provide that persons who have been diagnosed with breast or cervical cancer will be eligible for Medicaid coverage if other eligibility requirements are met. To be eligible, the person must:

Be under 65; - Have been screened for breast or cervical cancer under the federal Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection Program; Need treatment for breast or cervical cancer; and Be uninsured.

During the eligibility determinately, the person will be considered presumptively eligible. If all eligibility requirements are met, then the person will receive Medicaid coverage. This portion is substantially similar to SB 448 and contained in CCS/SS/SCS/HS/HCS/HB 762 (TAT). (Section 208.151)

Currently, insurance companies must cover mastectomies and prosthetic devices or reconstructive surgery after a mastectomy. New language adds that no time limit shall be imposed on an individual for the receipt of a prosthetic or reconstructive surgery and it provides that if an individual changes his or her insurance, then coverage for such procedures must transfer to the new policy. This portion is substantially similar to SB 349 and contained in CCS/SS/SCS/HS/HCS/HB 762 (TAT). (Section 376.1209).

This act modifies the duties of the Division of Aging by requiring the Division to provide technical assistance to the elderly and to persons with Alzheimer's or related dementia. Information should include dementia-specific training materials and trainers. By January 1, 2002, the Division must establish minimum requirements for dementia-specific employee training. The training will be incorporated into new employee orientation and in-services. The term "employee" includes independent contractors. (Section 660.150). Definitions are added to Section 660.250 for "home health agency," "home health agency employee," and "home health patient."

A new section provides that all Medicaid agreements between providers and the Department of Social Services must include a requirement for each direct care worker to be trained in abuse and neglect identification, prevention, and reporting. This will be included in the workers' current initial training requirement. (Section 660.252). Currently, the Department must perform certain duties upon receipt of an abuse report. New language requires prompt investigation of reports and investigation within twenty-four hours of reports that indicate clear danger to the client. (Section 660.260).

Currently, certain persons are required to report any elder abuse or neglect of in-home services clients. New language in subsection 1 adds in-home services providers, employees of area agencies on aging (AAA) or organized AAA programs, funeral directors, and embalmers. If a physician makes an initial report, then the Department of Social Services must maintain contact with the physician regarding the investigation. When a report of abuse or neglect of an in-home services client is received, the client's case manager and the Department nurse must investigate and immediately report the results to the Department nurse. The Department may allow the provider's nurse to assist the case manager. Subsection 3 requires local area agencies on aging to provide volunteer training to all required reporters regarding the detection and report of elder abuse. (Section 660.300.1 - .11).

Currently, any person who knowingly abuses or neglects a client is guilty of a Class D felony. New language allows administrative penalties of up to $1000 per violation for the in- home services provider if an employee is found guilty of a violation and if the provider willfully and knowingly failed to report the abuse to the Department. Providers may seek administrative review of the decision. Violation is defined as a determination of guilt. The Department must establish a quality assurance and supervision process. The process must require random visits or other approved methods to verify provider compliance and the accuracy of records.

The Department is currently required to maintain an employee disqualification list of persons who have abused or neglected in- home services clients. New language provides that an in-home services provider will be guilty of a Class A misdemeanor for knowingly employing a person who is on the disqualification list, who refuses to register with the Family Care Safety Registry, or who is listed on any of the background check lists in the Registry. (Section 660.300.12 - .13).

Once a client is assessed for level of care, the Department must conduct a "Safe At Home" evaluation. The plan of service for each client should be authorized by a nurse and the in-home services provider nurse may conduct the assessment. Other departments may be consulted on a case-by-case basis. The Department may also refer any client to a mental health professional, if necessary. All clients will be advised of their rights at the initial evaluation, including the right to call the Department for any reason. All nurse visits authorized by this act must be reimbursed to the in-home services provider agency, subject to appropriations. (Section 660.300.14 - .17).

The Department must refer all suspected cases of elder abuse to law enforcement to jointly determine when protective services are needed. Both groups must require training regarding the handling of elder abuse cases and must develop a checklist. (Section 660.302).

Section 1 exempts current aging-in-place pilot projects from certificate of need law.

Section 660.058, RSMo, is repealed due to unnecessary enactment in 1999. Portions of this act are substantially similar to SBs 959 & 598 (2000).
ERIN MOTLEY