- Committee -

SCS/SBs 670 & 684 - This act makes a number of changes designed to protect the elderly.

Definitions for elder care terms are modified (Section 187.010). Certain persons are required to report suspected abuse or neglect of facility residents. Anyone failing to make a report or filing a false report is guilty of a Class A misdemeanor. Immunity is given to reporters, unless they act negligently, recklessly, or in bad faith. The Department of Health and Senior Services must maintain statistics on all deaths over age sixty-five (Section 187.020).

If a report is made about a long-term care resident, certain information must be included in the report. Within 24 hours, the Department of Health and Senior Services must initiate an investigation and notify the resident's family. If a report involves imminent harm, the Department must start an on-site investigation within 24 hours. If an investigation indicates possible abuse or neglect, the resident may be removed from the facility. Reports are confidential, but information may be released to certain persons. Within five working days, the person making the report must be notified of its progress. Harassment of reporters is prohibited. Any person who knowingly abuses or neglects a resident of a facility is guilty of a Class D felony and will be placed on the employee disqualification list (Section 187.024).

Section 187.028 contains provisions similar to Section 187.024, but for eligible adults not residing in a facility and in-home services clients. If a report is made by a client's physician, then the Department must maintain contact with the physician regarding the investigation. When a report is received, the client's case manager and the department nurse must be notified and the case manager must investigate. The nurse may participate in the investigation as well. If an in-home services employee is found guilty and the provider fails to report it, then the provider may be subject to penalties of $1000 per violation. The Department must require providers to verify compliance with program standards (Section 187.028). This portion of the act is substantially similar to SB 684.

The Department must investigate reports by using the procedures established in Sections 660.250 to 660.295 and must refer all suspected cases to law enforcement. The Department and law enforcement must require elder abuse training and must develop an investigation checklist (Section 187.030). Immunity from liability is provided to reporters, unless they act in bad faith (Section 187.034).

Section 187.050 contains provisions similar to 187.024, but for the misappropriation of property or falsification of documents of an in-home services client. Any in-home services provider or employee who performs such acts will be guilty of a Class A misdemeanor (Section 187.050).

Any person placed on the employee disqualification list (EDL) must be notified in writing with thirty days to respond or appeal. Certain persons will be automatically listed on the EDL, such as those who intentionally or negligently inflict serious physical injury or death to another. No person on the EDL may be employed by anyone receiving the list. Persons listed on the EDL may request removal once every twelve months (Section 187.080).

Prior to hiring an employee, providers must request a criminal background check and must check the EDL. Failure to disclose will result in a Class A misdemeanor. Failure by a provider to investigate will result in civil penalties. Providers may use private investigators to do background checks (Section 187.084). All reports of abuse or neglect will be kept confidential, with specific exceptions (Section 187.087).

The Departments of Health and Senior Services, Social Services, and Mental Health must work cooperatively in the investigation of abuse and neglect, when appropriate (Section 187.102).

The term "financial" is included in the definition of abuse and redefines "medical assistance" as any federal health care program (Section 191.900).

The Attorney General, with approval of the court, is allowed to investigate violations of Sections 191.900 - 191.910 or Sections 187.020 - 187.028 (Section 191.910). The provisions of Section 187.020 are included as non-applicable to certain entities, such as hospitals (Section 198.012).

Written notice of facility noncompliance must be copied to the Attorney General (Section 198.029). Every residential care facility I or II must meet or exceed federal requirements for posting deficiencies (Section 198.030). Sections 187.020 - 187.050 are included in the requirement for confidentiality of resident records (Section 198.032).

One state licensure inspection is required of every facility every fifteen months. One or more additional inspections will be required if a facility receives or fails to correct certain deficiencies. A second inspection may be done if a facility changes ownership. This does not prohibit the Department from making other inspections, as necessary (Section 198.033).

The Attorney General is included in provisions allowing a civil action against a noncomplying facility (Section 198.067).

A requirement is added that skilled or intermediate care nursing assistants must complete training within 120 days of employment. The Department must approve all training (Section 198.082).

Currently, Section 198.526 deals with facility inspection procedures. New language provides for immediate termination and a Class A misdemeanor for any Division employee who discloses an inspection time to a facility (Section 198.526).

Providers or employees of SNFs or Alzheimer's units are prohibited from sexual contact with residents. Anyone having sexual contact is guilty of a Class B misdemeanor, with subsequent violations being a Class A misdemeanor. Anyone having sexual intercourse is guilty of a Class D felony, with subsequent violations being a Class C felony. This section does not apply to persons married to a resident (Section 565.200).

A new section provides that no legal privilege, with the exception of attorney/client, will excuse a person's failure to report or cooperate with the investigation of abuse or neglect. All Department personnel shall have access to victim's records, unless otherwise prohibited by federal law (Section 660.030).

The Department must provide certain long term care information over its website, including facility survey results (Section 660.051). The Department must consider a facility's compliance history when issuing or renewing a license (Section 660.083).

All Medicaid participation agreements must include a requirement for abuse and neglect training. If Alzheimer's patients are served, then training on the care of such patients shall be required (Section 660.252).

The Department must restructure the adult day care program to allow for a basic level of care without rehabilitative services. The Department should authorize additional reimbursement for transportation, as well (Section 660.401).

This act exempts all existing aging-in-place pilot programs from the certificate of need process (Section 1).

Portions of this act are substantially similar to HB 349 (2001).

ERIN MOTLEY