SB670 - Makes a number of changes designed to protect the elderly
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||Makes a number of changes designed to protect the elderly
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
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
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
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
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
Portions of this act are substantially similar to HBs 1654 &
1156 (2002) and HB 349 (2001).
HA 1 - EXTENDS THE CON EXPENDITURE MINIMUM AND MORATORIUM TO
HA 2 - REQUIRES CERTAIN STATE DEPTS. TO IMPLEMENT A STATE SUICIDE
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