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

This bill revises many statutes relating to protection of the
elderly, primarily through the regulation of long-term care and
other service providers.  The bill 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 patients in hospitals, ambulatory surgical
centers, and hospices and persons 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"Necessary provider hospitals" licensure is repealed.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 bill requires the Department of Health and Senior Services to
investigate complaints about unlicensed facilities and refer
violations to the local prosecuting attorney or the Attorney
General's office.  Abuse or neglect is a class D felony.  The
department may request the past five years' compliance history
from licensure applicants located outside the state.  With
satisfactory documentation of the 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 bill makes additions to the
grounds upon which the department can revoke a license.  The bill
lists 10 sanctions, from a plan of correction through license
revocation, which the department may impose commensurate with the
seriousness of the violation.  The bill 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 contact the attending physician
and the local coroner or medical examiner and attempt to notify
the resident's immediate family upon the death of any resident
prior to transfer to a funeral home.  Nursing assistant training
must be completed within four months of employment.  Alzheimer's
demonstration projects must permit a family member or other
caregiver to reside in the facility, within certain safety
standards.  Procedures for the determination and selection of
qualified receivers are established.

NURSING HOME DISTRICTS

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

NURSING FACILITY REIMBURSEMENT ALLOWANCE

Medicaid eligibility will be assumed for long-term care until an
application is approved or denied, if a determination cannot be
made within 60 days of application.

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 MANAGEMENT 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.

PROTECTIVE SERVICES FOR ADULTS

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 are added for "home
health agency," "employee," and "patient"; and the definition of
"eligible adult" is changed, using disability rather than
handicap.  Reporting is changed to add abuse and neglect; and
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 department nurse and case manager 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.  The bill redefines certain requirements for an in-home
services employee to be placed on the employee disqualification
list.  The bill provides for a "Safe at Home Evaluation" for
clients, requires two authorized nurse visits per year for
assessment, and outlines reimbursement procedures for nurse
visits.  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, suspended, placed on
probation, or terminated.  The bill 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
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 the
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.

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