HCS SCS SB 959 & 598 -- IN-HOME CARE

SPONSOR: Howard (Harlan)

COMMITTEE ACTION: Voted "do pass" by the Committee on Critical Issues by a vote of 16 to 6.

This substitute modifies the law relating to elder abuse and the provision of in-home services. In its major provisions, the substitute:

(1) Creates three classifications of home health care and provides for various licensure requirements for each category (Sections 197.400 - .477, RSMo);

(2) Defines "noncompliant client" (Section 660.250);

(3) Requires the Department of Social Services to incorporate an abuse and neglect curriculum into its Medicaid agreements with in-home services providers (Section 660.252);

(4) Requires the department to investigate within 24 hours any report that indicates a clear danger to the client (Section 660.260);

(5) Adds in-home services providers and employees, volunteers of area agencies on aging (AAA), or organized AAA programs to the list of persons who are required to report any elder abuse or neglect of clients. If a physician makes an initial report of abuse, then the department must maintain contact with the physician regarding the progress of the investigation (Section 660.300);

(6) Requires in-home services providers to report any noncompliant client who is at risk of serious physical harm. Upon that notification, a department nurse must investigate the case and attempt to resolve the situation (Section 660.300);

(7) Creates within the department the Interdisciplinary Case Management Team (ICMT) to assist with all reports of noncompliant clients. The ICMT must, at a minimum, include the client's case manager, a department nurse, a provider nurse, a long-term care specialist, and a mental health professional (Section 660.300);

(8) Requires area agencies on aging to provide to all mandated reporters volunteer training on the detection and reporting of elder abuse (Section 660.300);

(9) Requires the department to establish for all in-home clients a classification procedure based on the assessed needs of clients. The department is also required to provide 2 nursing visits to each client with a non-nursing plan of service (Section 660.300);

(10) Requires the department to advise clients of their rights at the initial evaluation (Section 660.300);

(11) Requires the department to refer all suspected cases of elder abuse to law enforcement officials. The department, in cooperation with law enforcement agencies, must develop a checklist for investigating suspected elder abuse (Section 660.302); and

(12) Requires the Division of Aging to establish a telephone check-in pilot project by July 1, 2001, in a first classification county with a charter form of government. The pilot project must allow in-home services employees to document the actual time they spend with clients by checking in and out by telephone (Section 660.303).

FISCAL NOTE: Estimated Cost to General Revenue Fund of $1,468,746 in FY 2001, $2,916,363 in FY 2002, and $3,009,575 in FY 2003.

PROPONENTS: Supporters say that this bill establishes procedures to assist in situations when in-home services providers encounter noncompliant clients. Allowing nursing visits for Medicaid clients who have non-nursing plans will help provide clients with better care. Extending the categories of in-home services that require licensure will help detect and prevent elder abuse.

Testifying for the bill were Senator Howard; Missouri Alliance for Home Care; Missouri Hospital Association; Oxford Health Care; Department of Health; and Missouri Council for In-Home Services (except that this organization opposes extending the categories of in-home services that require licensure because those provisions create additional requirements that will be very costly for in-home services providers.)

OPPONENTS: There was no opposition voiced to the committee.

Katharine Barondeau, Legislative Analyst