HCS SCS SB 538 -- LONG-TERM CARE FACILITIES

SPONSOR:  Champion (Wasson)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Senior
Citizen Advocacy by a vote of 11 to 0.

This substitute changes the laws regarding long-term care
facilities and residents, blaster licenses, 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 to be
installed, tested, and maintained in accordance with the federal
standard in certain 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 substitute 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 and assisted living
facilities instead of the local fire protection district or fire
department which is currently allowed to conduct inspections.

SUPPORT FOR RESIDENTS OF LONG-TERM CARE FACILITIES (Section
198.089)

The Department of Health and Senior Services must strongly
encourage all licensed long-term care facilities to institute
policies that will encourage familial involvement in the
well-being and support of residents in the facilities including
family conferences and meetings.

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 substitute 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 housed in its facility.

INSPECTORS AND SURVEYORS (Sections 195.525 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
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 any inspector or
surveyor has any 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 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 process must include:

(1)  The incorporation by reference the provisions of federal
rules regarding the IDR process;

(2)  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

(3)  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 reversal of the decision to the facility within 10
days.  If the deficiency is upheld, the facility must submit a
plan of correction to the department within 10 days after the QIO
determination is delivered.

PERSONAL NEEDS ALLOWANCE (Section 208.016)

The substitute codifies into Missouri law the current practice of
granting a monthly personal needs allowance for residents in
long-term care facilities as permitted under federal law.
Currently, the allowance is set annually by appropriation at $30
a year.  The substitute specifies that, beginning January 1,
2010, the yearly allowance will increase by no more than $5 a
year.  The allowance must be increased by an amount equal to the
product 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.

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

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

The expiration date of the federal reimbursement allowance
assessment in Sections 208.453 - 208.480 is extended from
September 30, 2009, to September 30, 2011, and the intermediate
care facility for the mentally retarded provider assessment 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 substitute 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 substitute also changes the responsibility for developing
information and training on community-based service options for
residents transitioning into the community to the departments of
Health and Senior Services and Mental Health.

BLASTER LICENSES (Sections 319.306 and 319.321)

Individuals using explosive materials along with a well screen
cleaning device for the purpose of unblocking clogged agriculture
irrigation well screens are added to the list of individuals who
are exempt from obtaining a blaster's license and from complying
with state and federal laws regarding persons using explosives.

HOME AND COMMUNITY-BASED CARE ASSESSMENTS (Section 1)

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

The substitute contains an emergency clause for the provisions
regarding the healthcare provider tax.

FISCAL NOTE:  Estimated Cost on General Revenue Fund of Unknown
but Greater than $549,334 in FY 2010, Unknown but Greater than
$1,585,708 in FY 2011, and Unknown but Greater than $2,391,295 in
FY 2012.  No impact on Other State Funds in FY 2010, FY 2011, and
FY 2012.

PROPONENTS:  Supporters say that the personal care allowance for
long-term care facility residents needs to be increased so
residents can purchase much-needed personal items.

Testifying for the bill were Senator Champion; Bill Trimm,
Silver-haired Legislature; Missouri Association of Homes for the
Aging; Missouri Health Care Association; Missouri Coalition for
Quality Care; Department of Health and Senior Services; and
Department of Social Services.

OPPONENTS:  There was no opposition voiced to the committee.

Missouri House of Representatives
95th General Assembly, 1st Regular Session
Last Updated November 17, 2009 at 9:26 am