- House Substitute -
HS/HCS/SS/SCS/SBs 670 & 684 - This act makes a number of changes designed to protect the elderly.
The term "medical assistance" is redefined as any federal health care program. The term "health care provider" is also clarified as one paid to provide services (Section 191.900).
With approval of the court, the Attorney General has authority to investigate violations of Sections 191.900 and 191.910 and Section 198.070 (Section 191.910).
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. Minority legislative members must be appointed by the minority floor leaders (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. The effort to purchase provision required before the purchase of additional beds is reduced to twelve months, rather than eighteen. A facility may expand its capacity if it has an average occupancy of ninety percent over the previous four quarters. Facility may relocate up to twenty-five beds to a facility of the same licensure and may relocate up to fifteen beds to a facility of different licensure (Section 197.318). Current law requires a facility to notify the Committee of the discontinuance of a service. This act requires the facility to notify the Committee annually of the number of unavailable licensed beds and must pay a $1,000 surcharge for each bed that exceeds ten percent of the total beds owned (Section 197.340). A new section exempts continuing care retirement communities from the moratorium (Section 197.370). The Department or Attorney General may file for an injunction against violation of Sections 197.400 through 197.477 (Section 197.455).
Currently, licensure provisions do not apply to certain entities, such as hospitals. This act adds entities which have presented a model to the Department, received approval, followed the model, and received zoning or governmental approval before April 20, 2001. (Section 198.012).
A new section requires the Department to review the compliance history of a facility before issuing or renewing a license (Section 198.019). This act provides for the issuance of a license if an applicant has previously operated facilities and has had a satisfactory compliance history, and if the applicant has not had a licensed denied or revoked based on lack of financial capacity (Section 198.022). Written notice of facility noncompliance must be copied to the Attorney General (Section 198.029). The Department may direct a noncompliant facility to take corrective actions related to staffing (Section 198.026). This act provides for copies of noncompliance notices to be sent to the Attorney General and to members of the General Assembly (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). The Department is currently prohibited from disclosing confidential resident records. This act prohibits the use of unsubstantiated inspection reports by insurance carriers for the purpose of underwriting (Section 198.032).
The Department may revoke a license if a facility fails to comply with class I standards on two occasions within a 24-month period, refuses inspection, knowingly adversely affects health, safety, or welfare of a resident, or demonstrates financial incapacity (Section 198.036). Current law allows an aggrieved facility to pursue an administrative hearing. This act requires the Commission to consider conditions as they existed at the time of violation when issuing a decision (Section 198.039).
A new section allows a skilled nursing facility with private pay residents to receive Medicaid reimbursement if a private pay resident becomes Medicaid eligible without satisfying CON requirements (Section 198.046). Penalty provisions are also clarified (Section 198.067). A new section clarifies the General Assembly's intention that civil penalties be imposed in cases with more than one violation (Section 198.068).
Certain persons are required to report suspected abuse or neglect of facility residents. This act adds nurse practitioners, physician's assistants, and facility owners to the list (Section 198.070). This act modifies the pathway to safety law for Alzheimer's residents in residential care facilities (Section 198.073). 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).
The Departments of Health and Senior Services, Mental Health, and Elementary and Secondary Education must collaborate on assessment procedures for long term care services (Section 198.080). 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). The Department must establish three classification standards, including three violation categories (Section 198.085). Facilities must establish appropriate policies and must notify staff, residents, and families of residents of such policies (Section 198.088).
Residents may file written complaints regarding the deprivation of rights or estates within two years of the alleged violation (Section 198.093). All Medicaid facilities must submit annual financial statements to the Department (Section 198.094).
The Department may use the revenues of facilities in receivership in any way approved by the circuit court (Section 198.115). Nursing home districts shall not be prohibited from establishing and maintaining senior housing within their corporate limits (Section 198.345).
Facilities inspections are required twice per year, unless otherwise provided pursuant to 198.526 (Section 198.525). Currently, Section 198.526 outlines facility inspection procedures. This act provides for immediate termination and a Class A misdemeanor for any Division employee who discloses an inspection time to a facility (Section 198.526).
Current law allows the Department to establish aging-in-place pilot programs throughout the state. This act requires the Department to base licensure procedures on the highest level of service provided at the site (Section 198.531). This act also exempts 501(c)(3) programs for all-inclusive care for the elderly (PACE) projects from HMO law (Section 354.407).
Certain persons are required to report suspected abuse and neglect of any person sixty years or older. This act expands the list of mandatory reporters. Older individual is clarified to indicate one who is unable to protect his or her interests or unable to meet essential human needs (Section 565.188).
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 (Section 660.071). The term "eligible adult" is modified (Section 660.250).
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 provide a referral to the Department of Mental Health during an investigation, if necessary (Section 660.260). This act allows certain reports to be available without a court order (Section 660.263). This act allows the Department to enjoin interference with an investigation (Section 660.270).
Certain persons are required to report suspected abuse and neglect of in-home services clients. This act expands the list of mandatory reporters (Section 660.300). The Department must promptly refer all cases of suspected abuse to the appropriate law enforcement agency (Section 660.302). The Department and law enforcement must share resources for training (Section 660.322).
Medicaid eligible individuals must be reimbursed in accordance with Department of Social Services policy on January 1, 2002. The personal independence commission must study the issue of spenddown (Section 660.630).
No long term care facility may be over 120 days delinquent in its payment to essential vendors (Section 1). The Division of Medical Services must permit Medicaid reimbursement rate adjustments for facilities which change ownership (Section 2). The Department must create a telephone check-in pilot project by July 1, 2003 (Section 3). In-home provider agencies must be given administrative appeal rights (Section 4). Section 197.367 is repealed.
Portions of this act are substantially similar to HBs 1654 & 1156 (2002) and HB 349 (2001).
ERIN MOTLEY
HA 1 - EXTENDS THE CON EXPENDITURE MINIMUM AND MORATORIUM TO 2008.
HA 2 - REQUIRES CERTAIN STATE DEPTS. TO IMPLEMENT A STATE SUICIDE PREVENTION PLAN.
HA 3 - ADDS CON HOSPITAL PROVISIONS.
HA 4 - REMOVES TELEPHONE CHECK-IN PILOT PROJECT (SECTION 3).
HA 5 - TREATS INDIAN TRIBES LIKE ANY OTHER EMPLOYER FOR THE PURPOSES OF UNEMPLOYMENT REIMBURSEMENT.
HA 6 - PROHIBITS LONG TERM CARE FACILITIES FROM USING STATE FUNDS FOR PURPOSES OTHER THAN HEALTH CARE.
HA 7 - ALLOWS A NURSING HOME DISTRICT TO ESTABLISH SENIOR HOUSING WITHIN ITS CORPORATE LIMITS.
HA 8 - ADJUSTS CALCULATION METHOD FOR MEDICAL RECORD COPYING FEES
HA 9 - PROHIBITS MEDICAID FUNDING OF PROVIDERS WHO HAVE BEEN CONVICTED OF MEDICAID FRAUD.
HA 10 - DEFINES THE TERM "NEXT OF KIN"
HA 11 - ALLOWS CERTAIN FACILITIES TO RELOCATE BEDS