CCS SS SCS HB 395 -- LONG-TERM CARE FACILITIES

This bill changes the laws regarding long-term care facilities
and residents and home and community-based care assessments.

FIRE SAFETY STANDARDS IN NURSING HOMES (Sections 198.074 and
198.075, RSMo)

Any section of a licensed nursing home facility in which a major
renovation has been completed on or after August 28, 2007, must
install and maintain an approved sprinkler system in accordance
with National Fire Protection Association (NFPA) 13.  The fire
sprinkler exemption for certain skilled nursing and intermediate
care facilities of existing residential board and care
occupancies of NFPA life safety code is removed.

If a facility submits a plan of compliance for the installation
of a sprinkler system required under state law, the facility must
install a complete fire alarm system that complies with NFPA 72
upon installation of the sprinkler system.  Until the sprinkler
system is installed in the facility which has submitted a plan,
each resident room or any room designated for sleeping in the
facility must be equipped with at least one battery-powered smoke
alarm and be installed, tested, and maintained in accordance with
the federal standard.  The facility must also be equipped with
heat detectors interconnected to the fire alarm system which are
installed, tested, and maintained in accordance with the federal
standard in certain specified areas of the facility.  The current
requirement that interconnected smoke detectors be in place
throughout the facility is removed.  All department inspectors
who inspect facilities for compliance of these provisions must
complete a fire inspector course, as developed by the Division of
Fire Safety within the Department of Public Safety, by
December 31, 2012.

The bill specifies that the Fire Safety Standards Loan Fund can
be used to implement the sprinkler requirements for certain
qualifying residential care and assisted-living facilities and
all types of qualifying skilled nursing and intermediate care
facilities.  The administration of the fund is transferred from
the Department of Health and Senior Services to the State
Treasurer's Office.

The State Fire Marshal must annually conduct a fire safety
inspection of all licensed residential care and assisted-living
facilities instead of the local fire protection district or fire
department which is currently allowed.

BONDS FOR LONG-TERM CARE RESIDENTS' PROPERTY IN TRUST (Section
198.096)

Currently, a bond must be obtained and filed with the Department
of Health and Senior Services for a long-term care facility that
holds a resident's property in trust in an amount equal to one
and one-half times the amount of the average monthly balance or
average total of the monthly balances, rounded to the nearest
$1,000, for the preceding calendar year.  The bill changes the
amount to the average balance for the preceding 12 months.

CRIMINAL BACKGROUND CHECKS (Section 198.187)

Any licensed long-term care facility may request a criminal
background check of any resident in its facility.

INSPECTORS AND SURVEYORS (Sections 198.525 and 198.527)

The Department of Health and Senior Services is prohibited from
assigning an individual to inspect or survey a licensed long-term
care facility in which the inspector or surveyor was an employee
of the facility within the preceding two years.

The department must require disclosure statements from newly
hired and currently employed inspectors and surveyors of
long-term care facilities regarding their past employment in
long-term care facilities and the current or past employment of
any immediate family members in long-term care facilities.

Any person may notify the department if facts exist that would
lead a reasonable person to conclude that an inspector or
surveyor has a personal or business affiliation that would result
in a conflict of interest in conducting an inspection or survey
of a facility.  Upon receiving the notice, the department must
take steps to verify the information.  If the department has
probable cause to believe that it is correct, it must not assign
the inspector or surveyor to the facility or any facility within
its organization in order to avoid an appearance of prejudice or
favor to the facility or bias on the part of the inspector or
surveyor.

The responsibility of ensuring the uniform application of
regulation standards in long-term care facilities is transferred
from the Department of Social Services to the Department of
Health and Senior Services.

MISSOURI INFORMAL DISPUTE RESOLUTION ACT (Section 198.545)

The Missouri Informal Dispute Resolution Act is established which
requires the Department of Health and Senior Services to contract
with the federally designated Medicare Quality Improvement
Organization in the state to conduct informal dispute resolutions
(IDRs) for licensed long-term care facilities.  The IDR process
will constitute an informal administrative process but cannot be
construed to be a formal evidentiary hearing and must be used to
determine if a cited deficiency of a facility should be upheld.
The department must incorporate by reference the provisions of
federal rules regarding the IDR process and include the following
minimum requirements:

(1)  Notification by the department to the facility by certified
mail and the availability of an IDR and the IDR process within 10
working days of any deficiency found during an inspection survey.
The facility has 10 days after the receipt of the statement of
deficiencies to return a plan of correction to the department or
request in writing an IDR conference to refute the cited
deficiencies; and

(2)  Conducting an IDR conference by the quality improvement
organization (QIO) within 10 days of a requested IDR by a
facility.  The QIO must make a determination regarding the
resolution of the IDR within 10 days of the conference and
transmit the decision and rationale for the outcome in writing to
the facility and the department.  If the department disagrees
with the determination, it must transmit the department's
decision and rationale for the reversal of the decision to the
facility within 10 days.  If the QIO determines that the original
statement of deficiencies should be changed, the department must
transmit a revised statement to the facility within 10 days of
the decision.  The facility must submit a plan of correction to
the department within 10 days of receipt of the QIO determination
and the revised statement of deficiencies.

PERSONAL NEEDS ALLOWANCE (Section 208.016)

The bill codifies into statute the current practice as permitted
under federal law of granting a monthly personal needs allowance
for MO HealthNet Program participants in long-term care
facilities.  Currently, the allowance is set annually by
appropriation at $30 a month.  The bill specifies that, beginning
January 1, 2010, the allowance must be increased by an amount
equal to the product of the percentage of the Social Security
benefit cost-of-living adjustment and the average amount that MO
HealthNet participants are required to contribute to the cost of
institutionalized care but must not exceed $5 in any year.  Once
the allowance reaches $50 a month, there will be no further
increases unless authorized by annual appropriation.

HEALTH CARE PROVIDER ALLOWANCE TAXES (Sections 208.437, 208.480,
338.535, 338.550, and 633.401)

The bill extends the expiration date from June 30, 2009, to
September 30, 2011, for the Missouri Medicaid Program's managed
care organization reimbursement allowance in Sections 208.431 -
208.437 and the pharmacy reimbursement allowance tax in Sections
338.500 - 338.550.

The expiration date of the federal reimbursement allowance
assessment for hospitals in Sections 208.453 - 208.480 is
extended from September 30, 2009, to September 30, 2011, and the
assessment for intermediate care facilities for the mentally
retarded is extended from June 30, 2009, to September 30, 2011.

NURSING HOME TRANSITION GRANTS (Section 208.819)

Currently, MO HealthNet participants with disabilities
transitioning from nursing homes back into the community are
eligible for a one-time grant of up to $1,500 to offset costs
associated with housing a person with disabilities.  Subject to
appropriations, the bill increases the grant amount to $2,400,
allows senior citizens to be eligible for the grant, and moves
grant administration from the Division of Vocational
Rehabilitation within the Department of Elementary and Secondary
Education to the Division of Senior and Disability Services
within the Department of Health and Senior Services in
consultation with the Department of Social Services.

The bill also changes the responsibility for developing
information and training on community-based service options for
residents transitioning into the community from the Division of
Medical Services within the Department of Social Services, the
Division of Vocational Rehabilitation within the Department of
Elementary and Secondary Education, and the Department of Health
and Senior Services to the departments of Health and Senior
Services and Mental Health.

HOME AND COMMUNITY-BASED CARE ASSESSMENTS (Section 1)

Procedures are established for reimbursements for home and
community-based services by the Department of Health and Senior
Services to in-home providers who complete assessments for
prospective recipients of MO HealthNet-funded home and
community-based care.

The bill contains an emergency clause for the provisions
regarding the health care provider allowance taxes.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:24 am