HCS SS SS SCS SB 556 & 311 -- PROTECTION OF THE ELDERLY

SPONSOR:  Kinder (Sutherland)

COMMITTEE ACTION:  Voted "do pass" by the Special Committee on
General Laws by a vote of 10 to 0.

This substitute revises many statutes relating to protection of
the elderly, primarily through the regulation of long-term care
and other service providers.  The substitute also contains many
technical changes.

HOME HEALTH AGENCIES

The Department of Health and Senior Services may request
out-of-state home health agency applicant data for the last five
years.  The department must provide the most recent home health
agency survey information on its web site and must maintain an
employee disqualification list for individuals who knowingly and
recklessly abuse eligible adults in hospitals, ambulatory
surgical centers, and hospices and eligible adults who receive
home health care services.

NECESSARY PROVIDER HOSPITALS

"Necessary provider hospitals" licensure is repealed.

LONG-TERM CARE

Several sections reflect changes of responsibility from the
Department of Social Services to the Department of Health and
Senior Services for licensure of long-term care facilities.

The substitute adds procedures and requires the Department of
Health and Senior Services to develop rules for identification
and on-site review of unlicensed facilities and handling of
complaints about unlicensed facilities.  The department may
request the past five years' compliance history from licensure
applicants located outside the state.  With satisfactory
documentation of correction of a deficiency, an on-site revisit
may be waived.  Residential care facilities, intermediate care
facilities, and skilled nursing facilities must post a copy of
the most recent inspection report for the facility.  The
department must maintain a hotline log for reports of abuse in
long-term care facilities and must attempt to obtain the name of
the person making the report.  Identity of the caller would
remain confidential.  The substitute makes additions to the
grounds upon which the department can revoke a license and allows
for revocation of a license when an operator refuses to allow
department representatives access to employees or residents under
certain circumstances.  If an operator or a principal has been
convicted of a felony concerning the operation of a long-term
care facility or health care facility or knowingly acted in a way
that caused material harm, the license may be revoked.  The
substitute lists 10 sanctions, from "plan of correction" through
"license revocation," which the department may impose
commensurate with the seriousness of the violation.  The
substitute increases the ranges of civil monetary penalties for
class I violations to $1,000 to $10,000; for class II violations
to $250 to $1,000; and for class III violations to $50 to $250
and increases the cap on civil penalties from $10,000 to $25,000.
The liability for a civil monetary penalty for a class I
violation incurs immediately upon imposition of the penalty for
violation, regardless of subsequent correction of the violation.
Civil monetary penalties for class II or III violations will be
imposed if the violation is not corrected at the time of
reinspection.  No fine will be imposed for a class II or III
violation if it is self-reported and does not recur for 12
months.  Civil penalties do not transfer to a new owner.  The
list of persons required to report suspected abuse of an
individual over the age of 60 or an eligible adult to the
department is expanded and made consistent with those in the
elder abuse statutes and the chapter on health and senior
services.  Concealment by an administrator of abuse or neglect
resulting in death or serious physical injury is a class D
felony; a person who abuses or neglects a resident of a facility
is subject to criminal prosecution under the elder abuse
statutes.  Facility staff must attempt to notify the resident's
immediate family and contact the attending physician and the
local coroner or medical examiner upon the death of any resident
prior to transfer to a funeral home.  Nursing assistant training
must be completed within four months of employment.  Standards
for a class I violation must be reasonably foreseeable to result
in serious harm.  Alzheimer's demonstration projects must permit
a family member or other caregiver to reside in the facility,
within certain safety standards.  Grounds for punitive damages
should be based on clear and convincing evidence that the health
care provider was willful, wanton, or malicious.  Procedures for
the determination and selection of qualified receivers are
established.

NURSING HOME DISTRICTS

The substitute prohibits retaliation by a nursing home district
against residents or employees for reporting suspected
violations.

MEDICAID

Medicaid eligibility will be assumed for long-term care until an
application is approved or denied.  Medicaid reimbursement for
long-term care facilities will be recalculated over a three-year
period.  This section has an emergency clause.

LONG-TERM CARE INSPECTION REQUIREMENTS

Residential care facilities I and all skilled nursing facilities
must be inspected at least twice a year.  The department may
decrease the frequency of inspections to once a year if a
facility is found to be in substantial compliance.  Department
employees are prohibited from disclosing an unannounced
inspection.  The department must post on its web site the most
recent survey of every long-term care facility licensed in the
state.

UNIFORM DATA PROJECT

A uniform data management pilot program with at least 50
facilities will be implemented, and its results reported to the
General Assembly.

ELDER ABUSE AND EXPLOITATION

The department must report incidents of alleged elder abuse to
the appropriate law enforcement agency when the department is
unable to substantiate whether abuse occurred due to a failure of
the owner or employees to cooperate with the investigation.  The
use of force is added to financial exploitation of an elderly or
disabled person and the penalty increased.

MENTAL HEALTH PATIENT'S RIGHTS

The filing of a false report of abuse or neglect is a class A
misdemeanor.  Subsequent false reports are class D felonies.  The
agency responsible for protective services for adults is changed
from the Department of Social Services to the Department of
Health and Senior Services.  Definitions of "home health agency,"
"home health agency employee," and "home health patient" are
added.

PROTECTIVE SERVICES FOR ADULTS

Definitions are added for "home health agency," "employee," and
"patient"; the definition of "eligible adult" is changed, using
disability rather than handicap.  Reporting is changed to add
abuse and neglect; authority is added for the Department of
Health and Senior Services to obtain an order to produce
information.  Reports received by the department of deteriorating
physical conditions will be given to the case manager and
department nurse for immediate investigation.  Home health
patients are added to certain subsections about abuse and
investigations of abuse and neglect reports.  The department may
impose a fine on in-home services providers if they fail to
report a known incident of abuse or neglect.  The substitute
redefines certain requirements for an in-home services employee
to be placed on the employee disqualification list.  The
department must report information from misappropriation
investigations to law enforcement.  The department must provide
written notice to in-home services provider agencies when
contracts are denied, placed on probation, or terminated.  The
substitute also sets up appeal procedures through the
Administrative Hearing Commission, where the burden of proof will
be on the provider.  Any person may seek judicial review of the
commission's final decision.  Aggravating circumstances are added
to the list of considerations for determining the length of time
a person's name appears on the employee disqualification list.
Employers are freed from unemployment insurance benefit charges
when required to discharge an employee who was placed on the
disqualification list.  Licensed adult day care providers are
required to get background checks. Providers must conduct
criminal background checks on new employees prior to allowing
them to have contact with residents or patients.  If the
applicant has resided less than five consecutive years in this
state and has no employment history with a licensed facility in
that period, the provider must request a nationwide check.  The
background check cannot cost the provider more than $5.  The
disclosure of confidential personal records without court order
may only occur to specific state agencies in order to perform
their constitutional and statutory duties or to the eligible
adult, the legal guardian, or person designated by the eligible
adult.

STATE OMBUDSMAN FOR LONG-TERM CARE FACILITY RESIDENTS

Ombudsman coordinators and volunteers are given the authority to
report abuse.  The regional ombudsman may report uncooperative
nursing home administrators to the state ombudsman.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
Greater than $19,218,285 in FY 2004, Greater than $43,469,009 in
FY 2005, and Greater than $73,803,332 in FY 2006.  Estimated Net
Income to Elderly Home-Delivered Meals Trust Fund of Unknown in
FY 2004, FY 2005, and FY 2006.  Estimated Net Income to Nursing
Facility Quality of Care Fund of Unknown in FY 2004, FY 2005, and
FY 2006.

PROPONENTS:  Supporters say that the substitute is the
culmination of several years of hard effort and compromise.  It
should give state agencies flexibility to go after bad facilities
in ways appropriate to the seriousness of the problem, without
putting too much burden on the operations that are already well
run.

Testifying for the bill were Senators Kinder and Dougherty;
Lieutenant Governor Maxwell; Department of Health and Senior
Services; AARP; Silver-Haired Legislature; Richard Russell; Edna
Chavis; Missouri Coalition of Alzheimer's Association Chapters;
Office of the Governor; Missouri Association of Homes for the
Aging; Sunrise Assisted Living Facility; Lutheran Senior
Services; and Missouri Health Care Association.

OPPONENTS:  There was no opposition voiced to the committee.

Becky DeNeve, Senior Legislative Analyst

Missouri House of Representatives
Last Updated July 25, 2003 at 10:13 am