HCS HB 1516 -- PROTECTIONS FOR VULNERABLE ADULTS AND CHILDREN
(Bruns)

COMMITTEE OF ORIGIN:  Committee on Crime Prevention and Public
Safety

This substitute changes the laws regarding protections for
vulnerable adults and children.  In its main provisions, the
substitute:

(1)  Changes the laws regarding infection control and specifies
when incidents of ventilator-associated pneumonia must be
included by the Department of Health and Senior Services in its
quarterly infection incidence rate reports (Section 192.667,
RSMo);

(2)  Adds reducing the incidents of financial exploitation of the
elderly to the public education and awareness program
administered by the Department of Health and Senior Services
(Section 192.925);

(3)  Establishes the Evan de Mello Reimbursement Program within
the departments of Health and Senior Services and Mental Health
to provide financial assistance for the cost of transportation
and ancillary services associated with the medical treatment of
an eligible child.  The program is the payer of last resort after
all other available sources have been exhausted, and
reimbursement is subject to appropriations.  To be eligible for
assistance under the program, a child must be suffering from a
condition or impairment that results in severe physical illness
or impairments, in need of transportation or ancillary services
due to his or her condition, certified by a physician of the
child's choice as a child who will likely benefit from medical
services, and required to travel at least 100 miles for medical
services and the child's parents or guardian are unable to pay
the travel expenses.  The departments must establish rules which
include an application and review process, a cap on benefits that
cannot be less than $5,000 per recipient, and household income
eligibility limits which cannot exceed 350% of the federal
poverty level (Section 192.975);

(4)  Transfers the Division of Aging from the Department of
Social Services to the Department of Health and Senior Services
(Section 192.2000);

(5)  Transfers the powers, duties, and functions of the Board of
Nursing Home Administrators from the Department of Social
Services to the Department of Health and Senior Services (Section
192.2000.9);

(6)  Revises the definition of "protective services" to mean a
service provided by the state or other governmental or private
organizations or individuals which are necessary for the eligible
adult to meet his or her essential human needs (Section
192.2003);

(7)  Grants immunity from civil and criminal liability for any
person making a report of abuse or neglect to the Department of
Health and Senior Services unless the person acts negligently,
recklessly, in bad faith, or with malicious purpose (Sections
192.2103.5 and 192.2150.11);

(8)  Defines "consumer," "in-home services," "misappropriation,"
"personal care attendant," "principal," "patient," "provider,"
and "resident" as they relate to abuse and neglect of the
elderly, the disabled, and children (Section 192.2150);

(9)  Requires any health service provider, health service vendor
employee, personal care attendant, or any person having
reasonable cause to believe that a patient or consumer has been a
victim of misappropriation of a patient's money or property or
has falsified documents verifying delivery of health care
services to report the information to the Department of Health
and Senior Services within 24 hours of discovering the act
(Sections 192.2150.2 and 192.2150.3);

(10)  Requires the Department of Health and Senior Services, upon
receipt of an imminent danger report, to initiate a thorough
investigation promptly, but removes the 24-hour time requirement.
If an investigation indicates a crime has occurred, the
appropriate law enforcement agency and the prosecutor must be
notified.  The department must notify the resident's legal
representative of the report and investigation status when it
involves a resident who has been appointed a guardian and/or
conservator or who is incapacitated and resides at a
state-licensed facility.  The department may also notify the
resident's family members or guardians (Sections 192.2150.6 and
192.2150.7);

(11)  Requires the Department of Health and Senior Services to
keep confidential the names of individuals submitting abuse and
misappropriation reports unless the complainant agrees to the
disclosure of his or her name; it is necessary to prevent further
abuse and neglect, misappropriation of funds, or document
falsification; the name of the complainant is lawfully
subpoenaed; the release of a name is required by the
Administrative Hearing Commission; or the release of a name is
requested by the Department of Social Services for the purpose of
licensure under Chapter 210 (Section 192.2150.9);

(12)  Requires the Department of Health and Senior Services to
add persons who have falsified documents verifying service
delivery to consumers or have misappropriated property or moneys
belonging to consumers to the employee disqualification list
(Section 192.2150.12);

(13)  Protects a patient and the patient's family members or an
employee from eviction, harassment, or retaliation due to the
filing of a report of a violation or suspected violation of the
provisions of the substitute (Section 192.2150.13);

(14)  Requires potential patients and consumers whose services
are funded by the MO HealthNet Program to be checked against the
sexual offender registry and requires the Department of Health
and Senior Services to notify providers at the time of referral
if a patient or consumer is on the registry (Section
192.2150.15);

(15)  Specifies that any person failing to file a required report
within the time guidelines and any person or provider who misuses
or diverts the consumer's use of any personal property or money
or falsifies service delivery documents will be guilty of a class
A misdemeanor.  Any provider or employee who knowingly conceals
abuse or neglect that results in the death or serious injury of a
patient will be guilty of a class D felony (Sections 192.2153.1 -
192.2153.3);

(16)  Authorizes the Department of Health and Senior Services to
assess a $1,000 fine on any provider who willfully and knowingly
fails to report known abuse by an employee (Section 192.2153.4);

(17)  Specifies that any person or entity who unlawfully
discloses information from the employee disqualification list
will be guilty of an infraction; and upon request from the
Division of Employment Security within the Department of Labor
and Industrial Relations, the Department of Social Services must
provide copies of employee investigation reports of those on the
list.  Individuals on the list cannot be paid from public moneys
for personal care assistant services (Sections 192.2153.11 -
192.2153.13);

(18)  Requires health care providers or employment agencies to
check with the Department of Health and Senior Services to see if
a full- or part-time applicant for employment which involves
consumer contact is on the employee disqualification list prior
to hiring the applicant (Section 192.2178.3);

(19)  Prohibits, as of August 28, 2008, a provider from hiring
any person with a disqualifying history unless the person has
submitted an approved good cause waiver.  Providers cannot
continue to employ people who were employed prior to August 28,
2008, with disqualifying backgrounds after March 1, 2009, unless
the person submits an approved good cause waiver prior to January
1, 2009.  An employer who knowingly hires a person who is a
registered sexual offender on or after August 28, 2008, will be
guilty of a class A misdemeanor (Sections 192.2178.7 and
192.2178.8);

(20)  Specifies that a consumer-directed service consumer or
hospice will be guilty of a class A misdemeanor if it does not
request a background screening check from the family care safety
registry prior to allowing an employee to have contact with an
in-home patient (Section 192.2178.9);

(21)  Requires, beginning January 1, 2009, every hospital
licensed in the state to develop a methicillin-resistant
staphylococcus aureus (MRSA) control program to isolate infected
patients; reduce the risk of MRSA transmission; establish
procedures, protocols, and education for staff known to be
MRSA-colonized or MRSA-infected; and establish an
infection-control intervention protocol (Section 197.150);

(22)  Clarifies existing language regarding the installation of
sprinkler systems in long-term care facilities (Section 198.074);

(23)  Allows facilities that have submitted a plan for compliance
for the installation of a commercial sprinkler system to be
eligible for a loan from the Department of Health and Senior
Services (Section 198.074.4);

(24)  Allows local fire protection districts or fire departments
that are deemed qualified by the State Fire Marshal to conduct
fire safety inspections of long-term care facilities for
compliance with state statutes regarding the installation of
sprinkler systems (Section 198.074.9);

(25)  Adds, subject to appropriations, home nursing visits and
follow-up care as needed until an infant's second birthday for
certain at-risk newborns to the list of covered services under
the MO HealthNet Program.  The MO HealthNet Division within the
Department of Social Services is required to request the
appropriate waivers or state plan amendments from the federal
Department of Health and Human Services to provide these services
as a three-year pilot project in the counties of Buchanan,
Greene, and Jackson (Section 208.152);

(26)  Changes the laws regarding the assistance provided to
nursing home residents who are transitioning back into their
communities.  Subject to appropriations, MO HealthNet-eligible
nursing home residents will receive a one-time transition grant
of up to $2,400, administered by the Division of Senior and
Disability Services within the Department of Health and Senior
Services, to spend on housing costs associated with moving a
senior citizen or disabled person from a nursing home back to a
residence within their community.  The division will work with
the Department of Social Services to generate additional funding
for the transition grants (Section 208.819);

(27)  Prohibits any state or federal funding for personal care
assistance services if the attendant is on the employee
disqualification list; is a registered sexual offender; or has a
disqualifying criminal history, unless a good cause waiver is
obtained (Section 208.909.4);

(28)  Requires the Children's Division within the Department of
Social Services to make a good faith attempt to contact and place
a child with a grandparent if the division deems the placement is
in the best interest of the child when a child must be removed
from his or her primary caretaker's home in the case of an
emergency placement.  Prior to contacting the grandparent, the
division must care for any physical health needs of the child.
The grandparent must comply with the emergency background check
requirements.  If contact with a grandparent cannot be made
within three hours of the division determining an emergency
placement is necessary, the child may be placed in a foster home.
If placed in a foster home, the division must continue to attempt
to contact the child's grandparents during the initial 24-hour
period after an emergency placement was deemed necessary.  When a
court determines that a child must be placed in a foster home,
the division must make a good faith attempt to contact the
grandparents of the child to determine if they wish to be
considered and given first consideration for foster home
placement of the child (Sections 210.305 and 210.565);

(29)  Defines "related personal care" as care provided for a
person with a physical or medical disability by an adult relative
as it relates to the Family Care Safety Act (Section 210.900.2);
and

(30)  Requires any person responsible for the care of a person 60
years of age or older who has cause to suspect that the person
has been abused, neglected, or financially exploited by a person,
firm, or corporation to make a report to the Department of Health
and Senior Services (Section 565.188.1).

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
but Greater than $850,548 in FY 2009, Unknown but Greater than
$863,640 in FY 2010, and Unknown but Greater than $881,936 in
FY 2011.  Estimated Income on Other State Funds of $3,234,000 in
FY 2009, $501,600 in FY 2010, and $501,600 in FY 2011.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:10 pm