- House Committee Substitute -

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

Current law outlines procedures for the issuance of a teaching certificate. After September 1, 2004, this act requires the successful completion of a certified CPR course (Section 168.021).

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 within a reasonable time 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 case manager must investigate and report to the nurse. The Department may authorize the nurse to participate. 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 $1,000 per violation. The Department must require providers to verify compliance with program standards. Reports are confidential, except in certain situations (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. Reports are confidential, except in certain situations(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).

Before allowing an employee to have contact with a resident, 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 or evidence of a pattern of violation by the provider 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 Department may require the production of information for investigations or inspections. Failure to comply with any request is ground for refusal, suspension, or revocation of a license or contract (Section 187.090). 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. The term "health care provider" is also clarified as one paid to provide services (Section 191.900).

Current law establishes the Missouri Health Facilities Review Committee to oversee the certificate of need process. This act requires the Department to supervise Committee staff (Section 197.310). The moratorium on beds is extended to January 1, 2007 (Section 197.317). The expiration on the zero expenditure minimum for certain facilities, beds, or services is extended to January 1, 2007 (Section 197.318).

The Attorney General may serve subpoenas or other process in order to enforce Sections 187.020 - 187.028 and 191.900 - 191.910 (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, intermediate care facility, or skilled nursing facility 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. The Department must obtain the name and address of the reporter before obtaining abuse and neglect information (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).

Penalty provisions are also clarified (Section 198.067).

A new section requires long term care facilities, adult day care facilities, and residential care facilities I and II to provide such immunizations annually or upon admission. Written consent must be obtained from the resident and his or her physician. Adult day care facilities must also inform clients regarding immunization. The Department must develop rules for documenting compliance, including the documentation of residents who refuse the immunization. The Department may not impose a violation on a facility for not making an immunization available if a shortage exists (Section 198.074).

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

Currently, Section 198.526 outlines 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 having 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).

The Department of Health and Senior Services is given

equal access to information provided by mental health facilities or the Department of Mental Health (Sections 630.140, 630.167).

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 prepare a notice of management change for a new owner or manager of a facility to distribute to the press and to a resident's legal guardian or family member. Such facility must also post a sign indicating new ownership or management (Section 660.610).

Portions of this act are substantially similar to HBs 1654 & 1156 (2002) and HB 349 (2001).

ERIN MOTLEY