HB 628 -- Protection of the Elderly

Co-Sponsors:  Sutherland, Willoughby, Jolly, Ransdall, Wright,
Jetton, Hanaway, Goodman, Portwood

This bill:

(1)  Extends the certificate of need moratorium on new or
additional beds in long-term care facilities from January 1,
2003, to January 1, 2007;

(2)  Extends the expiration date contained in subsection 3 of
Section 197.318, RSMo, pertaining to an expenditure minimum
amount applied to Section 197.317 from January 1, 2003, to
January 1, 2007;

(3)  Requires the Department of Health and Senior Services to
provide the most recent home health agency survey information on
its web site;

(4)  Requires the department to 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;

(5)  Changes the definition of "department" from the Department
of Social Services to the Department of Health and Senior
Services for purposes of the sections dealing with licensure of
long-term care facilities;

(6)  Requires copies of records requested by the department from
a facility to be made by facility staff on the day the request is
made, prohibits the department from removing or disassembling
medical records during an inspection of the facility, and allows
the department to request the past five years compliance history
from licensure applicants located outside the state;

(7)  Allows satisfactory documentation of a correction of a
deficiency contained in a written report in lieu of an on-site
revisit of the deficiency;

(8)  Requires residential care facilities, intermediate care
facilities, and skilled nursing facilities to post a copy of the
most recent inspection report for the facility;

(9)  Requires the department to maintain a hotline log for
reports of abuse in long-term care facilities and to attempt to
obtain the name of the person making the report;

(10)  Makes additions to the grounds upon which the department
can revoke a license; allows for revocation of a license when an
operator refuses to allow department representatives to inspect a
facility for compliance or unreasonably refuses access to
employees necessary to carry out the department's duties pursuant
to Chapter 198; and allows for revocation of a license if an
operator or a principal in the operation of a facility has been
convicted of a felony offense concerning the operation of a
long-term care facility or health care facility, the management
of a long-term care facility, or the provision or receipt of
health care;

(11)  Lists 12 sanctions, from "plan of correction" through
"license revocation," which the department may impose
commensurate with the seriousness of the violation;

(12)  Increases civil monetary penalties for class I violations
to $1,000-$10,000; for class II violations to $250-$1,000; and
for class III violations to $50-$250;

(13)  Makes the liability incur immediately for a civil monetary
penalty for a class I violation, regardless of subsequent
correction of the violation.  Civil monetary penalties for class
II and III violations will be imposed if the violation is not
corrected at the time of reinspection;

(14)  Redistributes penalties collected as follows:  25% to the
Elderly Home-Delivered Meals Trust Fund; 25% to the Nursing
Facility Quality Care Fund for care improvement projects within
the Office of the State Ombudsman for long-term care residents;
and 50% to the Nursing Facility Quality Care Fund for developing
a program to assist qualified nursing facilities to improve the
quality of service to their residents;

(15)  Prohibits the department from imposing a fine for a class
II or III violation if it is self-reported and there is no
reoccurrence of the violations for 12 months;

(16)  Prohibits the transfer of a civil penalty to a new owner;

(17)  Expands the list of persons required to report suspected
abuse of an individual over the age of 60 or an eligible adult to
the department;

(18)  Makes the concealment of abuse or neglect resulting in
death or serious physical injury by an administrator a class D
felony;

(19)  Makes a person who abuses or neglects a resident of a
nursing facility subject to prosecution for elder abuse;

(20)  Defines the requirements for a person to be placed on the
employee disqualification list;

(21)  Requires facility staff to notify the attending physician,
the resident's immediate family, and the local coroner or medical
examiner upon the death of any resident prior to transfer to a
funeral home;

(22)  Requires nursing assistant training to be completed within
four months of employment, including 100 hours of supervised,
on-the-job training;

(23)  Requires the department to establish procedures for the
determination and selection of qualified receivers;

(24)  Prohibits retaliation against residents or employees for
reporting suspected violations;

(25)  Adds residential care facilities I and all skilled nursing
facilities to those that are to be inspected at least twice a
year;

(26)  Allows the department to decrease the frequency of
inspections to once a year if a facility is found to be in
substantial compliance;

(27)  Prohibits employees of the department from disclosing the
time of an unannounced inspection.  Violation is subject to
immediate dismissal and is a class A misdemeanor;

(28)  Requires patients to be considered Medicaid-eligible until
an application is approved or declined if the Division of Family
Services is unable to make a determination within 60 days of the
submission of a completed application;

(29)  Requires salaries for physical, occupational, speech, and
inhalation therapy to be included in the patient care expenditure
component of the nursing facility Medicaid per diem rate;

(30)  Allows the department to reduce a facility's rate if its
cost report is found to be fraudulent;

(31)  Requires the department to report incidents of alleged
elder abuse to the appropriate law enforcement agency in the
event that the department is unable to substantiate whether abuse
occurred due to a failure of the owner or employees to cooperate
with the investigation;

(32)  Increases the penalty for financial exploitation of an
elderly or disabled person.  Currently, financial exploitation of
the elderly is a class A misdemeanor if the value of the property
is less than $250 and a class C felony if the value of the
property is $250 or more.  Financial exploitation of the elderly
is a class A misdemeanor if the value of the property is less
than $50; a class D felony if the value of the property is
between $50 and $500; a class C felony if the value of the
property is between $500 and $1,000; and a class B felony if the
value of the property is $1,000 or more;

(33)  Makes the filing of a false report of abuse or neglect a
class A misdemeanor and subsequent false reports class D
felonies;

(34)  Expands the list of persons required to report suspected
abuse of in-home services clients to the department;

(35)  Allows the department to impose a fine on in-home services
providers if they fail to report a known incident of abuse or
neglect by an employee to the department;

(36)  Makes a person who abuses or neglects an in-home services
client subject to prosecution for elder abuse;

(37)  Defines the requirements for an in-home services employee
to be placed on the employee disqualification list;

(38)  Requires the department to provide specific written notice
to in-home services provider agencies in cases where contracts
are denied, placed on probation, or terminated.  The provider
will have 30 days to file a complaint requesting a hearing before
the Administrative Hearing Commission, where the burden of proof
will be on the provider;

(39)  Allows the department to issue letters of censure or
warning without notice;

(40)  Allows the commission to stay the suspension or termination
of an in-home services provider's contract.  The commission's
final decision must be based on the conditions that existed at
the time of the action of the department.  Any person may seek
judicial review of the commission's final decision;

(41)  Exempts employers who are required to discharge an employee
because that employee was placed on the disqualification list
from unemployment insurance benefit charges based on wages paid
to that employee;

(42)  Requires providers to 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, a nationwide check must be
conducted at the applicant's expense;

(43)  Requires the department to provide the Division of
Employment Security with copies of investigative reports that led
to an employee being placed on the disqualification list, upon
request; and

(44)  Permits the disclosure of confidential personal records
without a court order only to specific state agencies in order to
perform their constitutional and statutory duties or to the
resident or the resident's legal guardian.

Missouri House of Representatives
Last Updated July 25, 2003 at 10:12 am