HCS SS SCS SB 670 & 684 -- PROTECTION OF THE ELDERLY

SPONSOR:  Sims (Harlan)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Social
Services, Medicaid and the Elderly by a vote of 11 to 1.

This substitute makes a number of changes in laws regarding
protection of the elderly.  In its major provisions, the
substitute:

(1)  Requires the successful completion of a certified CPR course
for the issuance of a teaching certificate after September 1,
2004;

(2)  Modifies definitions for elder care terms;

(3)  Requires certain persons to report suspected abuse or
neglect of facility residents.  Anyone failing to make a report
within a reasonable time or filing a false report is guilty of a
class A misdemeanor.  Immunity is given to reporters, unless they
act negligently, recklessly, or in bad faith.  The Department of
Health and Senior Services must maintain statistics on all deaths
over age 65;

(4)  Requires certain information to be included in a report made
about a long-term care resident.  Within 24 hours, the department
must initiate an investigation and notify the resident's family.
If a report involves imminent harm, the department must start an
on-site investigation within 24 hours.  If an investigation
indicates possible abuse or neglect, the resident may be removed
from the facility.  Reports are confidential, but information may
be released to certain persons.  Within five working days, the
person making the report must be notified of its progress.
Harassment of reporters is prohibited.  Any person who knowingly
abuses or neglects a resident of a facility is guilty of a class
D felony and will be placed on the employee disqualification
list;

(5)  Requires certain information to be included in reports for
eligible adults not residing in a facility and in-home services
clients.  If a report is made by a client's physician, then the
department must maintain contact with the physician regarding the
investigation.  When a report is received, the client's case
manager and the department nurse must be notified, and the case
manager must investigate.  The nurse may participate in the
investigation as well.  If an in-home services employee is found
guilty and the provider fails to report it, then the provider may
be subject to penalties of $1,000 per violation.  The department
must require providers to verify compliance with program
standards.  Reports are confidential, except in certain
situations;

(6)  Requires the department to investigate reports using the
procedures established in Sections 660.250 to 660.295, RSMo, and
to refer all suspected cases to law enforcement.  The department
and law enforcement must require elder abuse training and must
develop an investigation checklist.  Immunity from liability is
provided to reporters, unless they act in bad faith;

(7)  Requires certain information to be included in reports about
the misappropriation of property or falsification of documents of
an in-home services client.  Any in-home services provider or
employee who performs these acts will be guilty of a class A
misdemeanor.  Reports are confidential, except in certain
situations;

(8)  Requires any person placed on the employee disqualification
list (EDL) to be notified in writing with 30 days to respond or
appeal.  Certain persons will be automatically listed on the EDL,
such as those who intentionally or negligently inflict serious
physical injury or death to another.  No person on the EDL may be
employed by anyone receiving the list.  Persons listed on the EDL
may request removal once every 12 months;

(9)  Requires providers to request a criminal background check
and to check the EDL before allowing an employee to have contact
with a resident.  Failure to disclose will result in a class A
misdemeanor.  Failure by a provider to investigate or evidence of
a pattern of violation by the provider will result in civil
penalties.  Providers may use private investigators to do
background checks.  All reports of abuse or neglect will be kept
confidential, with specific exceptions;

(10)  Allows the department to require the production of
information for investigations or inspections.  Failure to comply
with any request is grounds for refusal, suspension, or
revocation of a license or contract.  The Departments of Health
and Senior Services, Social Services, and Mental Health must work
cooperatively in the investigation of abuse and neglect, when
appropriate;

(11)  Includes the term "financial" in the definition of abuse
and redefines "medical assistance" as any federal health care
program.  The term "health care provider" is also clarified as
one paid to provide services;

(12)  Allows the Attorney General to serve subpoenas or other
process in order to enforce Sections 187.020 to 187.028 and
191.900 to 191.910.  The provisions of Section 187.020 are
included as non-applicable to certain entities, such as
hospitals;

(13)  Requires written notice of noncompliance to be sent to the
Attorney General.  Every residential care facility I or II,
intermediate care facility, or skilled nursing facility must meet
or exceed federal requirements for posting deficiencies.
Sections 187.020 to 187.050 are included in the requirement for
confidentiality of resident records.  The department must obtain
the name and address of the reporter before obtaining abuse and
neglect information;

(14)  Requires one state licensure inspection of every facility
every 15 months.  One or more additional inspections will be
required if a facility receives or fails to correct certain
deficiencies.  A second inspection may be done if a facility
changes ownership.  This does not prohibit the department from
making other inspections, as necessary.  Penalty provisions are
also clarified;

(15)  Requires long-term care facilities and residential care
facilities I and II to provide immunizations for influenza and
pneumonia 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 such
immunizations.  The department must develop rules for documenting
compliance, including the documentation of residents who refuse
the immunizations.  The department may not impose a violation on
a facility for not making immunizations available if a shortage
exists;

(16)  Requires skilled or intermediate care nursing assistants to
complete training within six months of employment.  The
department must approve all training;

(17)  Allows for immediate termination and a class A misdemeanor
for any division employee who discloses an inspection time to a
facility;

(18)  Prohibits providers or employees of skilled nursing
facilities or Alzheimer's units 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 with a resident 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;

(19)  Allows the department to have equal access to information
provided by mental health facilities or the Department of Mental
Health;

(20)  Requires all Medicaid participation agreements to include a
requirement for abuse and neglect training.  If Alzheimer's
patients are served, then training on the care of these patients
will be required;

(21)  Requires the department to prepare a notice of management
change for a new owner or manager of a facility for distribution
to the press and the residents' legal guardians or family
members.  The facility must also post a sign indicating new
ownership or management;

(22)   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; and

(23)  Extends from January 1, 2003, to January 1, 2007, the
moratorium on issuing a certificate of need for additional
long-care beds.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
Unknown exceeding $440,592 in FY 2003, Unknown exceeding $479,756
in FY 2004, and Unknown exceeding $485,829 in FY 2005.

PROPONENTS:  Supporters say that the substitute is a rational
solution to protect the elderly and includes reasonable measures.
They support the elimination of the moratorium on certificate of
need for nursing facilities.  Supporters voiced resignation about
provisions that create concurrent jurisdiction in certain abuse
cases for local prosecuting attorneys and the Attorney General's
office, the provision that requires mandated reporters to make
their report within 24 hours, and provisions dealing with the
definition of "eligible adult" for purposes of the mandated
reporter requirements.

Testifying for the bill were Senator Sims; St. Louis County
Prosecuting Attorney; Missouri Association of Homes for the
Aging; Association for the Protection of the Elderly; Bethesda
Health Corporation; Attorney General's Office; Missouri Coalition
Against Domestic Violence; and Lutheran Senior Services.

OPPONENTS:  There was no opposition voiced to the committee.

Amy Woods, Legislative Analyst

Missouri House of Representatives
Last Updated October 11, 2002 at 9:04 am