HS HCS HB 1654 & 1156 -- PROTECTION OF THE ELDERLY (Hosmer)

This substitute modifies the law relating to protection of the
elderly.  In its major provisions, the substitute:

(1)  Creates a new chapter on protection of the elderly and
transfers several existing statutory sections to this chapter;

(2)  Expands the list of persons required to report suspected
elder abuse to the Department of Health and Senior Services and
mandates that suspected abuse be reported within 24 hours;

(3)  Requires reports of suspected elder abuse to be referred to
the appropriate law enforcement agency.  Current law requires
only substantiated reports to be referred.  The department is
also required to investigate immediately any report of elder
abuse or neglect that involves a threat of imminent harm;

(4)  Requires the department and law enforcement agencies to
cross-train personnel in investigating cases of suspected elder
abuse;

(5)  Requires emergency medical services (EMS) and hospital
employees who abuse, neglect, or financially exploit the elderly
to be placed on the employee disqualification list;

(6)  Requires the department to establish a telephone check-in
pilot project for in-home services employees by July 1, 2003;

(7)  Requires the Department of Health and Senior Services and
the Department of Mental Health to cooperate in abuse and neglect
investigations;

(8)  Allows the Attorney General to handle Medicare fraud
investigations.  The substitute also allows the Attorney General
to obtain investigative subpoenas and search warrants in
connection with investigations of abuse cases;

(9)  Requires disclosure of financial interests of nursing home
owners and operators applying for licensure and renewal of
licensure.  The substitute also allows the department to deny
licensure or renewal based on a review of the facility's
compliance history and the owner or operator's compliance
history;

(10)  Authorizes the department, when confronted with violations
or deficiencies related to staffing, to implement corrective
actions such as staffing ratios, training plans, or plans related
to staff supervision;

(11)  Requires notice of noncompliance of a licensed facility to
be given to the Attorney General;

(12)  Requires facilities to meet or exceed federal requirements
concerning the posting of deficiencies;

(13)  Allows for revocation of a facility's license when the
operator has been cited for failure to comply with a class I
standard two times in 24 months or for failure to comply with a
class II or III standard two times in 12 months;

(14)  Allows the Attorney General to bring an action to recover
civil penalties from licensed facilities for violations;

(15)  Requires nursing assistants employed by a skilled nursing
facility or intermediate care facility to complete training
within 120 days of being hired;

(16)  Adds freedom from neglect to the list of rights of
long-term care facility residents and extends the time for filing
a complaint for violations of a resident's right from 180 days to
two years from the date of the alleged deprivation or injury;

(17)  Allows the department to reduce the frequency of
inspections of licensed facilities from twice a year to once a
year based on the facility's compliance record;

(18)  Makes it a class A misdemeanor for a department employee to
knowingly disclose the time of an unannounced inspection of a
facility licensed by the department and requires the department
to terminate his or her employment;

(19)  Creates a hearsay exception for elderly and disabled
persons in certain cases;

(20)  Makes it a class B misdemeanor for an owner or employee of
a skilled nursing facility or an Alzheimer's special unit to have
sexual contact with a resident of the facility or with a client
in his or her care.  Second or subsequent violations are class A
misdemeanors.  In addition, sexual intercourse or deviant sexual
intercourse in these cases is a class D felony.  Second or
subsequent violations are class C felonies.  An employee who is
married to a resident or client and engages in this activity with
his or her spouse is exempt from prosecution.  Consent of the
victim is no defense to prosecution;

(21)  Prohibits persons from claiming any legal privilege as a
defense for failing to report suspected elder abuse, except that
the attorney-client privilege and communications made to a
minister or clergy person may still be claimed;

(22)  Requires the department to provide certain information and
certain links regarding long-term care facilities and facility
surveys on its web site;

(23)  Mandates the inclusion of certain access and training
requirements in all Medicaid participation agreements with
in-home services providers and long-term care facilities;

(24)  Allows investigation reports to be made available without a
court order to certain persons;

(25)  Clarifies when the department can seek an injunction in
connection with an investigation;

(26)  Requires all payments by long-term care facilities to
vendors of essential services to be made within 120 days;

(27)  Requires the Division of Medical Services to promulgate
rules that include specific provisions relating to an adjustment
in the Medicaid reimbursement rate for certain long-term care
facilities that change ownership;

(28)  Prohibits persons from claiming any legal privilege as a
defense for failing to report suspected elder abuse, except that
the attorney-client privilege and communications made to a
minister or clergy person may still be claimed;

(29)  Requires the Department of Health and Senior Services to
hire and administratively supervise clerical and administrative
support staff for the Missouri Health Facilities Review
Committee;

(30)  Extends from January 1, 2003, to January 1, 2007, the
moratorium on issuing a certificate of need for additional
long-care beds (Section 197.317, RSMo);

(31)  Extends until January 1, 2007, a minimum expenditure of
zero under Section 197.318;

(32)  Requires health facilities to notify the Health Facilities
Review Committee of the number of licensed beds in the facility
that are unavailable on an annual basis and requires the
committee to collect a surcharge of $1,000 for each licensed and
unavailable bed beginning January 1, 2003;

(33)  Revises the conditions under which an individual can be
accepted to live in a residential care facility I or residential
care facility II;

(34)  Allows a residential care facility II to admit or continue
to care for patients with dementia who require assistance in
order to evacuate in the case of an emergency under specified
conditions;

(35)  Requires facilities to comply with certain training
requirements;

(36)  Requires the departments of Health and Senior Services,
Social Services, Mental Health, and Elementary and Secondary
Education to compare their assessment procedures for individuals
who receive long-term care services and work together to make
changes in these procedures;

(37)  Divides the existing class I standards for nursing homes
into three separate classes for death violations, harm
violations, and risk violations;

(38)  Requires licensed nursing homes that receive Medicaid
funding to submit an annual financial statement by October 15 of
each year to the department for the purpose of developing an
annual report for the General Assembly and specifies the
information to be included in the financial statement;

(39)  Allows facilities to receive Medicaid reimbursement for
private-pay residents who are in the facility for more than one
year before becoming eligible for Medicaid without going through
the certificate of need process;

(40)  Allows specified health maintenance organizations acting as
programs for all-inclusive care for the elderly (PACE) projects
to be exempt from the certificate of authority requirement.  This
exemption applies only to the approved PACE contract;

(41)  Requires long-term care facilities to offer residents the
opportunity to receive influenza and pneumonia vaccinations at
the facility on an annual basis or upon admission.  The
facilities are not required to administer the vaccines, but they
are required to make them available or contract with individuals
who will administer the vaccine.  The Department of Health and
Senior Services is required to determine how facilities will
document compliance;

(42)  Requires the Division of Family Services to do a division
of assets for married couples when determining eligibility for
supplemental nursing care payments when one spouse is living in a
residential care facility;

(43)  Prohibits skilled nursing facilities that receive payments
of over $100,000 for services from the State of Missouri from
using the funds for purposes not related to the provision of
health care services.  It also specifies recordkeeping and
reporting requirements for these facilities; and

(44)  Establishes a Joint Committee on Nursing Home Medicaid
Reimbursement.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
Unknown Exceeding $3,757,381 in FY 2003, Unknown Exceeding
$6,994,366 in FY 2004, and Unknown Exceeding $8,395,041 in FY
2005.  Revenues and savings exceed $100,000 annually and netted
against costs.  Estimated Net Cost to Intergovernmental Transfer
Fund of Unknown up to $4,286,915 in FY 2003, Unknown up to
$4,331,302 in FY 2004, and Unknown up to $4,341,285 in FY 2005.
Subject to appropriations.

Missouri House of Representatives
Last Updated October 11, 2002 at 9:02 am