SCS/SB 24 - This act modifies the investigation and reporting of abuse and neglect for in-home services to the elderly.

New language adds definitions for "home health agency," "home health agency employee," and "home health patient." The definition of "eligible adult" is broadened to include any person sixty years of age or older who is unable to protect his or her own interests or is unable to meet his or her essential human needs (Section 660.250).

Section 660.252 provides that all Medicaid agreements between in-home service providers and the Department must include training in abuse and neglect identification, prevention, and reporting. This will be included in the initial training requirement.

Section 660.260 requires the Department to initiate a prompt investigation of reports received. Within 24 hours, the Department must investigate reports that indicate a clear danger to the client.

When the Department of Social Services is investigating whether an eligible adult is in serious physical danger and in need of protective services, referrals for protective intervention and oversight will be provided to clients served by the Department of Mental Health (Section 660.260).

Section 660.300 lists the mandatory reporters of abuse or neglect of in-home services clients. New language includes nurse practitioners, physician's assistant, 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 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 must investigate and immediately report the results to the Department nurse. The Department may allow the provider's nurse to assist the case manager (Section 660.300).

Section 660.300 requires local area agencies on aging to provide volunteer training to all mandated reporters regarding the detection and report of abuse and neglect.

Section 660.300 allows administrative penalties of up to $1,000 per violation for the in-home services provider if an employee is found guilty of a violation and the provider did not report the abuse to the Department. Providers may seek administrative review of the decision and may appeal to the circuit court. Violation is defined as a determination of guilt by a court. The Department must establish a quality assurance and supervision process. The process must require random visits to verify compliance and the accuracy of records.

An in-home services provider will be guilty of a class A misdemeanor for knowingly employing a person 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).

Once a client is assessed for level of care, the Department must conduct a "Safe At Home" evaluation. The evaluation tool should be developed by rule. The plan of service for each client should be authorized by a nurse and the in-home services provider nurse may conduct the assessment, if authorized by the Department. Other departments may be consulted on a case-by-case basis. Nurse visits shall be at least twice a year. 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 (Section 660.300).

Section 660.302 requires the Department to 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 for investigations.

The Department shall establish a telephone check-in pilot project that requires a check-in system for in-home employees to document the time spent in the clients' homes. Workers will "clock in" when they arrive and "clock out" when they leave. The state will track the results of the project. The Department shall also follow a "true-up" procedure to accurately and appropriately remedy any over-billings or under-billings. The Department is given rule-making authority to implement this program (Section 1).

This act repeals Section 660.058, RSMo, pertaining to budget allotments, service contracts, and performance measures for the area agencies on aging.

This act is similar to SB 684 (2002).
LORIE TOWE