2005 -- H 6549

=======

LC03357

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2005

____________

A N A C T

RELATING TO HEALTH AND SAFETY -- THE LONG-TERM CARE REFORM ACT OF

2005 -- NURSING FACILITY QUALITY MONITORING AND EARLY INTERVENTION

FOR RESIDENT SAFETY

     Introduced By: Representatives Naughton, Costantino, McNamara, Corvese, and Kennedy

     Date Introduced: May 26, 2005

     Referred To: House Finance

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. The general assembly finds that safeguarding the quality of care provided to

1-2

vulnerable and frail nursing home residents is an essential role of state government. Given the

1-3

significance of this responsibility, the "Long-Term Care Reform Act of 2005" is enacted with the

1-4

following purposes:

1-5

     To clarify the roles and responsibilities, and to enhance the coordination of

1-6

efforts, of various state entities in monitoring of nursing home quality and service

1-7

provision.

1-8

     To adopt federal definitions to determine severity of threat or harm to a resident,

1-9

and to exceed federal guidelines in more promptly responding to reported

1-10

incidences or complaints of potential harm.

1-11

     To institute a system of nursing home financial and quality reporting to provide

1-12

early detection of deteriorating quality of care or supervision.

1-13

     To give the department of health the ability to focus a more intensive level of

1-14

nursing home monitoring on those homes for which there are early indicators of

1-15

quality of financial management concerns.

1-16

     To provide the responsible agencies of state government with a range of potential

1-17

interventions to be utilized in response to deteriorating nursing home care.

2-1

     SECTION 2. Sections 23-17-12 and 23-17-12.1 of the General Laws in Chapter 23-17

2-2

entitled "Licensing of Health Care Facilities" are hereby amended to read as follows:

2-3

     23-17-12. Inspections -- Nursing and personal care homes. -- (a) The licensing agency

2-4

shall make or cause to be made unannounced inspections and investigations of nursing facilities

2-5

and residential care/assisted living facilities. The director shall establish by regulation criteria to

2-6

determine the frequency for unannounced inspections and investigation that shall include specific

2-7

criteria to determine the appropriate frequency of those surveys including, but not limited to,

2-8

patient acuity, quality indicators, staff turnover, financial condition, and a facility's past

2-9

compliance with the regulations. In no instance shall any facility with a pattern of noncompliance

2-10

with regulations or orders, indications of marginal financial status, repeated levels of nursing

2-11

hours per resident below the state average, or other risk factors determined to influence quality,

2-12

receive less than two (2) surveys in addition to the annual licensing survey required by this

2-13

chapter. Any nursing care facility which is cited for substandard care by the licensing agency

2-14

shall be inspected on a bimonthly basis for the twelve (12) month period immediately following

2-15

any citation. The licensing agency shall, on an annual basis, cause no less than ten percent (10%)

2-16

of all nursing care facility surveys to be conducted, in whole or in part, on nights and/or on

2-17

weekends. The inspections shall be conducted both as to profit and nonprofit facilities and the

2-18

results shall be open to public inspection; however, requirements as to the fire safety code will be

2-19

deferred in accordance with section 23-28.1-7.

2-20

      (b) The department shall adopt regulations to assure that no employee or agent of the

2-21

department shall be participating in or supervising an inspection of any facility to which that

2-22

employee has any ownership, employment, or consultant arrangement. The restrictions imposed

2-23

by the department under this subsection shall be in addition to, and not in place of, the

2-24

requirements of chapter 36-14 of the general laws.

2-25

      (b)(c) The licensing agency shall make or cause to be made unannounced inspections

2-26

and/or investigations of any establishment, facility, boarding house, dormitory, however named,

2-27

to determine whether the lodging facility should be licensed and regulated under the provisions of

2-28

this chapter.

2-29

      (c)(d) All members of the general assembly and any general officer of this state may

2-30

make announced and unannounced inspections of extended care facilities, skilled nursing homes,

2-31

intermediate care facilities, personal care homes, nursing homes, and state institutions.

2-32

     23-17-12.1. Scope of inspections. -- Inspections and investigations shall include health,

2-33

sanitation, nursing care, and dietary and other conditions immediately affecting the patients. The

2-34

department shall assign responsibility for verifying compliance with licensing requirements and

3-1

issuing renewal licenses to an individual or office independent of the inspection process. The

3-2

department shall establish written procedures to: (a) track all deficiencies identified during and

3-3

after the inspection and investigation processes; and (b) clearly define the internal process for

3-4

appealing deficiency citations.

3-5

     SECTION 3. Chapter 23-17 of the General Laws entitled "Licensing of Health Care

3-6

Facilities" is hereby amended by adding thereto the following sections:

3-7

     23-17-12.5. Complaints -- Nursing homes. – (a) Complaints regarding a nursing facility

3-8

that do not constitute patient abuse, neglect or mistreatment, as regulated under chapter 23-17.8,

3-9

shall be investigated and evaluated by the department as follows:

3-10

     (1) The investigation and evaluation shall be made within twenty-four (24) hours if the

3-11

department has reasonable cause to believe the patient's or resident's health or safety is in

3-12

"immediate jeopardy"; within seven (7) days for reports – deemed by the department to be of

3-13

"non-immediate jeopardy – high potential for harm"; within twenty-one (21) days for reports

3-14

deemed by the department to be of "non-immediate jeopardy – medium potential for harm"; and

3-15

within sixty (60) days for reports deemed by the department to be of "non-immediate jeopardy –

3-16

low potential for harm."

3-17

     (2) The investigation shall include a visit to the facility.

3-18

     (3) Reports of complaint investigations shall be governed in accordance with chapter 23-

3-19

17.8.

3-20

     (b) Definitions. For purposes of this section, the following definitions shall apply:

3-21

     (1) "Immediate jeopardy" means a situation in which the nursing facility's alleged

3-22

noncompliance with one or more state or federal requirements or conditions has caused, or is

3-23

likely to cause serious injury, harm, impairment or death to a resident; or shall be defined in

3-24

accordance with 42 CFR 489 or any subsequent applicable federal regulations.

3-25

     (2) "Non-immediate jeopardy – high potential for harm" means a situation in which a

3-26

nursing facility's alleged noncompliance with one or more state or federal requirements or

3-27

conditions may have caused harm that negatively impacts the individual's mental, physical and/or

3-28

psychosocial status; or shall be defined in accordance with 42 CFR 489 or any subsequent

3-29

applicable federal regulations.

3-30

     (3) "Non-immediate jeopardy – medium potential for harm" means a situation in which a

3-31

nursing facility's alleged noncompliance with one or more state or federal requirements or

3-32

conditions has caused or may have caused harm that is of limited consequence and does not

3-33

significantly impair the individual's mental, physical and/or psychosocial status to function; or

3-34

shall be defined in accordance with 42 CFR 489 or any subsequent applicable federal regulations.

4-1

     (4) "Non-immediate jeopardy – low potential for harm" means a situation in which a

4-2

nursing facility's alleged noncompliance with one or more state or federal requirements or

4-3

conditions may have caused mental, physical and/or psychosocial discomfort that does not

4-4

constitute injury or damage; or shall be defined in accordance with 42 CFR 489 or any

4-5

subsequent applicable federal regulations.

4-6

     (c) Avoidance of conflict. The department shall establish procedures to insure that the

4-7

prioritization and classification of complaints received in accordance with section (a) above, and

4-8

chapter 23-17.8, shall be independent of other nursing facility regulatory functions. The

4-9

department shall include procedures to assure that no employee or agent of the department shall

4-10

be participating in or supervising a complaint investigation concerning any facility to which that

4-11

employee has any ownership, employment, or consultant arrangement. The restrictions imposed

4-12

by the department under this subsection shall be in addition to, and not in place of, the

4-13

requirements of chapter 36-14 of the general laws.

4-14

     (d) Interagency agreements. The department shall enter into interagency agreements with

4-15

any other departments or agents of state government clarifying roles and responsibilities for the

4-16

receipt and investigation of complaints regarding nursing facility care, including guidelines to

4-17

allow an exchange of data unless such exchange is explicitly prohibited by law.

4-18

     23-17-12.6. Independent quality monitor, quality consultant and temporary

4-19

manager. – (a) Under the authority granted to the director in section 23-1-21 and in addition to

4-20

the authority established in section 23-17-12.7, whenever the director determines that there is a

4-21

deficiency in a nursing facility that constitutes immediate jeopardy to health and safety of a

4-22

resident or residents, the director may take the following actions:

4-23

     (1) appoint an independent quality monitor, at the facility's expense, to conduct periodic

4-24

inspections to assess the efforts made by the nursing facility to achieve compliance with state and

4-25

federal regulations governing nursing facilities that participate in the Medicare and medical

4-26

assistance programs and to report its findings to the director;

4-27

     (2) require the nursing facility to engage, at the facility's expense, an independent quality

4-28

consultant to advise and assist the nursing facility's management to achieve and maintain

4-29

compliance with state and federal regulations governing nursing facilities that participate in the

4-30

Medicare and medical assistance programs and to develop and implement the nursing facility's

4-31

quality improvement program; and/or

4-32

     (3) require the nursing facility to engage, at the facility's expense, a temporary manager to

4-33

achieve and maintain compliance with state and federal regulations governing nursing facilities

4-34

that participate in the Medicare and medical assistance programs and to implement the nursing

5-1

facility's quality improvement program.

5-2

     (b) The appointment of a state quality monitor, and ordering the facility to hire an

5-3

independent quality consultant or temporary manager are sanctions that may be in addition to or

5-4

in lieu of other sanctions imposed by the state.

5-5

     (c) Any state appointed quality monitor, or quality consultant or temporary manager hired

5-6

by the nursing facility may not be employees of the department.

5-7

     (d) For purposes of this section, temporary manager means any person, corporation, or

5-8

other entity, as required to be hired by the department to manage the facility to correct

5-9

deficiencies and address financial difficulties identified in the facility's operation.

5-10

     (e) The director may require the hiring of a temporary manager to operate a nursing

5-11

facility when the director determines that a nursing facility is:

5-12

     (1) experiencing severe financial difficulties which if continued, present a substantial

5-13

probability of financial insolvency; or

5-14

     (2) a facility is operating in such a manner or condition that continued operation by the

5-15

licensee, or his or her representative, presents a substantial probability of immediate jeopardy to

5-16

the health or safety of the residents.

5-17

     (f) The qualifications of any quality consultant or temporary manager as required under

5-18

this section shall be approved by the department. Any quality consultant or temporary manager

5-19

hired by the nursing facility under this section shall report on progress toward quality

5-20

improvement to the department in a manner and format determined by the director.

5-21

     23-17-12.7. Adverse change in financial condition. – (a) Whenever the department, or

5-22

the department in consultation with the department of human services, determines that a nursing

5-23

facility's financial status is of concern and determines, through inspection of the facility or

5-24

investigation of a complaint, that incident(s), event(s) or patterns of care exist that harm or have

5-25

the potential to result in harm or danger to the residents of a facility, the departments, acting

5-26

jointly, may convene a meeting, as soon as possible but in no event later than ten (10) days after

5-27

the finding(s) cited above, with the license holder and its controlling persons to communicate the

5-28

state's concerns with respect to the operation of the facility. The license holder shall be given the

5-29

opportunity to respond to the state's concerns and to offer explanation as to why the concerns are

5-30

not valid or accurate.

5-31

     (b) In the event that the explanation provided by the license holder is not found by the

5-32

department to be adequate or otherwise satisfactory, the department shall direct the license holder

5-33

to prepare and submit a plan of correction and remediation for the department's review and

5-34

approval, including, but not limited to, the following elements:

6-1

     (1) Specific targeted improvements;

6-2

     (2) Definite deadlines for accomplishing those targeted improvements;

6-3

     (3) Measurable standards that will be used to judge whether the targeted improvements

6-4

have been accomplished;

6-5

     (4) A spending plan that supports all costs associated with accomplishment of the

6-6

targeted improvements;

6-7

     (5) Monthly reporting of cash availability, the status of vendor payments and employee

6-8

payrolls, and staffing levels, as metrics concerning financial status and quality of care; and

6-9

     (6) With regard to concerns regarding resident care, and if directed by the department, a

6-10

proposal to engage an independent quality monitor or independent quality consultant, to oversee,

6-11

in consultation with the facility administrator and medical director, the implementation of the

6-12

plan of correction and remediation, and to provide progress updates to the department of health.

6-13

     (c) The department, in consultation with the department of human services, shall adopt

6-14

regulations to implement this section. The regulations shall incorporate the criteria to measure

6-15

financial status promulgated by the department of human services pursuant to section 40-8-19.1

6-16

of the general laws.

6-17

     (d) Whenever a facility's financial status is determined to be marginal, the department

6-18

shall cause such a facility to be inspected in order to determine if financial problems are causing

6-19

the facility to be out of compliance with nursing facility regulatory standards.

6-20

     (e) Whenever a facility is determined to be having severe financial difficulties, the

6-21

department shall cause the facility to have more frequent inspections and the director may, at the

6-22

facility's expense:

6-23

     (1) appoint an independent consultant to review the facility's management and financial

6-24

status and make recommendations to improve the facility's financial status; or

6-25

     (2) require the hiring of a temporary manager to take over the facility's operations.

6-26

     (f) With the exception of the plan of correction and remediation, as allowed in subsection

6-27

(g) below, the information obtained by the department under this section is confidential and is not

6-28

subject to disclosure under section 38-2-2, Access to Public Records. However, upon request, the

6-29

department shall release the information to the following who shall treat the information as

6-30

confidential:

6-31

     (1) the facility;

6-32

     (2) a person other than the facility if the facility consents in writing to the disclosure;

6-33

     (3) the state Medicaid agency responsible for rate setting of nursing facilities;

6-34

     (4) the state long-term care ombudsman; or

7-1

     (5) the department of attorney general.

7-2

     (g) At the time the plan of correction and remediation is accepted by the department of

7-3

health, it shall be considered to be a public record, and the facility shall make it, and all reports

7-4

that follow and are related to it, available for public inspection, and shall provide a written

7-5

summary of the plan to the residents of the facility and their families.

7-6

     (h) The provisions in subsection (e) herein relating to the confidentiality of records do not

7-7

apply:

7-8

     (1) to a facility whose license has been revoked or suspended;

7-9

     (2) to the use of the information in an administrative proceeding initiated by the

7-10

department, including implementing enforcement actions, and in judicial proceedings relating

7-11

thereto.

7-12

     SECTION 4. Sections 23-17.8-1 and 23-17.8-9 of the General Laws in Chapter 23-17.8

7-13

entitled "Abuse in Health Care Facilities" are hereby amended to read as follows:

7-14

     23-17.8-1. Definitions. -- (a) (1) "Abuse" means:

7-15

      (i) Any assault as defined in chapter 5 of title 11, including, but not limited to, hitting,

7-16

kicking, pinching, slapping, or the pulling of hair; provided, however, unless it is required as an

7-17

element of the offense charged, it shall not be necessary to prove that the patient or resident was

7-18

injured by the assault;

7-19

      (ii) Any assault as defined in chapter 37 of title 11;

7-20

      (iii) Any offense under chapter 10 of title 11;

7-21

      (iv) Any conduct which harms or is likely to physically harm the patient or resident

7-22

except where the conduct is a part of the care and treatment, and in furtherance of the health and

7-23

safety of the patient or resident; or

7-24

      (v) Intentionally engaging in a pattern of harassing conduct which causes or is likely to

7-25

cause emotional or psychological harm to the patient or resident, including but not limited to,

7-26

ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident

7-27

or cursing directed towards a patient or resident, or threatening to inflict physical or emotional

7-28

harm on a patient or resident.

7-29

      (2) Nothing in this section shall be construed to prohibit the prosecution of any violator

7-30

of this section under any other chapter.

7-31

      (b) "Department" means the department of health when the incident occurs in a health

7-32

care facility, and the department of mental health, retardation, and hospitals when the incident

7-33

occurs in a community residence for people who are mentally retarded or persons with

7-34

developmental disabilities.

8-1

      (c) "Facility" means any health care facility or community residence for persons who are

8-2

mentally retarded, or persons with developmental disabilities as those terms are defined in this

8-3

section. "Health care facility" means any hospital or nursing facility required to be licensed under

8-4

chapter 17 of this title, and any assisted living residence required to be licensed under chapter

8-5

17.4 of this title, and any community residence whether privately or publicly owned.

8-6

"Community residence" for persons who are mentally retarded or persons with developmental

8-7

disabilities means any residential program licensed by the department of mental health,

8-8

retardation, and hospitals which meets the definition of a community residence as defined in

8-9

section 40.1-24-1(2) and provides services to people who are mentally retarded or persons with

8-10

developmental disabilities.

8-11

      (d) "High Managerial Agent" means an officer of a facility, the administrator and

8-12

assistant administrator of the facility, the director and assistant director of nursing services, or any

8-13

other agent in a position of comparable authority with respect to the formulation of the policies of

8-14

the facility or the supervision in a managerial capacity of subordinate employees.

8-15

      (e) "Mistreatment" means the inappropriate use of medications, isolation, or use of

8-16

physical or chemical restraints:

8-17

      (1) As punishment;

8-18

      (2) For staff convenience;

8-19

      (3) As a substitute for treatment or care;

8-20

      (4) In conflict with a physician's order; or

8-21

      (5) In quantities which inhibit effective care or treatment, or which harms or is likely to

8-22

harm the patient or resident.

8-23

      (f) "Neglect" means the intentional failure to provide treatment, care, goods, and services

8-24

necessary to maintain the health and safety of the patient or resident, or the intentional failure to

8-25

carry out a plan of treatment or care prescribed by the physician of the patient or resident, or the

8-26

intentional failure to report patient or resident health problems or changes in health problems or

8-27

changes in health conditions to an immediate supervisor or nurse, or the intentional lack of

8-28

attention to the physical needs of a patient or resident including, but not limited to toileting,

8-29

bathing, meals, and safety. No person shall be considered to be neglected for the sole reason that

8-30

he or she relies on or is being furnished treatment in accordance with the tenets and teachings of a

8-31

well-recognized church or denomination by a duly-accredited practitioner of a well-recognized

8-32

church or denomination.

8-33

      (g) "Patient" means any person who is admitted to a facility for treatment or care, while

8-34

"resident" means any person who maintains their residence or domicile, on either a temporary or

9-1

permanent basis, in a facility.

9-2

      (h) "Person" means any natural person, corporation, partnership, unincorporated

9-3

association, or other business entity.

9-4

     (i) "Immediate jeopardy" means a situation in which the nursing facility's alleged

9-5

noncompliance with one or more state or federal requirements or conditions has caused, or is

9-6

likely to cause serious injury, harm, impairment or death to a resident; or shall be defined in

9-7

accordance with 42 CFR 489 or any subsequent applicable federal regulations.

9-8

     (j) "Non-immediate jeopardy – high potential for harm" means a situation in which a

9-9

nursing facility's alleged noncompliance with one or more state or federal requirements or

9-10

conditions may have caused harm that negatively impacts the individual's mental, physical and/or

9-11

psychosocial status; or shall be defined in accordance with 42 CFR 489 or any subsequent

9-12

applicable federal regulations.

9-13

     (k) "Non-immediate jeopardy – medium potential for harm" means a situation in which a

9-14

nursing facility's alleged noncompliance with one or more state or federal requirements or

9-15

conditions has caused or may have caused harm that is of limited consequence and does not

9-16

significantly impair the individual's mental, physical and/or psychosocial status to function; or

9-17

shall be defined in accordance with 42 CFR 489 or any subsequent applicable federal regulations.

9-18

     (l) "Non-immediate jeopardy – low potential for harm" means a situation in which a

9-19

nursing facility's alleged noncompliance with one or more state or federal requirements or

9-20

conditions may have caused mental, physical and/or psychosocial discomfort that does not

9-21

constitute injury or damage; or shall be defined in accordance with 42 CFR 489 or any

9-22

subsequent applicable federal regulations.

9-23

     23-17.8-9. Duties of the directors of the department of health and the department of

9-24

mental health, retardation, and hospitals. -- The directors of the department of health and the

9-25

department of mental health, retardation and hospitals or their designee shall:

9-26

      (1) Immediately notify the attorney general or his or her designee upon receipt of an oral

9-27

or written report made pursuant to section 23-17.8-2;

9-28

      (2) Investigate and evaluate the information reported in the reports. The investigation

9-29

and evaluation shall be made within twenty-four (24) hours if the department has reasonable

9-30

cause to believe the patient's or resident's health or safety is in "immediate danger from further

9-31

abuse and neglect and jeopardy"; within seven (7) days for all other reports. deemed by the

9-32

department to be of "non-immediate jeopardy – high potential for harm"; within twenty-one (21)

9-33

days for reports deemed by the department to be of "non-immediate jeopardy – medium potential

9-34

for harm"; and within sixty (60) days for reports deemed by the department to be of "non-

10-1

immediate jeopardy – low potential for harm." The investigation shall include a visit to the

10-2

facility, an interview with the patient or resident allegedly abused, mistreated, or neglected, a

10-3

determination of the nature, extent, and cause or causes of the injuries, the identity of the person

10-4

or persons responsible for the injuries, and all other pertinent facts. The determination shall be in

10-5

writing;

10-6

      (3) Evaluate the environment at the facility named in the report and make a written

10-7

determination of the risk of physical or emotional injury to any other patients or residents in the

10-8

same facility;

10-9

      (4) Forward to the attorney general within a reasonable time after a case is initially

10-10

reported pursuant to section 23-17.8-2, subject to subdivision (1), a summary of the findings and

10-11

recommendations on each case;

10-12

      (5) If the director or the director's designee has reasonable cause to believe that a patient

10-13

or resident has died as a result of abuse, mistreatment, or neglect, immediately report the death to

10-14

the attorney general and the office of the medical examiner. The office of the medical examiner

10-15

shall investigate the report and communicate its preliminary findings, orally within seventy-two

10-16

(72) hours, and in writing within seven (7) working days, to the attorney general. The office of

10-17

the medical examiner shall also communicate its final findings and conclusions, with the basis for

10-18

its final findings and conclusions, to the same parties within sixty (60) days;

10-19

      (6) Promulgate any regulations that may be necessary to implement the provisions of this

10-20

chapter;

10-21

      (7) Maintain a file of the written reports prepared pursuant to this chapter. The written

10-22

reports shall be confidential, but shall be released to the attorney general or to a court of

10-23

competent jurisdiction, and may be released, upon written request and with the approval of the

10-24

director or his or her designee, to the patient or resident, counsel, the reporting person or agency,

10-25

the appropriate review board, or a social worker assigned to the case.

10-26

     SECTION 5. Chapter 40-8 of the General Laws entitled "Medical Assistance" is hereby

10-27

amended by adding thereto the following section:

10-28

     40-8-19.1. Nursing facility financial oversight. – (a) On an annual basis, every licensed

10-29

nursing facility participating in the medical assistance program shall file a financial statement or

10-30

other financial information acceptable to the department with its annul cost report (BM-64) for

10-31

the time period covered by the cost report that would provide sufficient information for the

10-32

department to assess the facility's financial status.

10-33

     (b) The department shall, by regulation:

10-34

     (1) Develop, in consultation with the department of health, criteria for the financial

11-1

statements or financial information to be submitted in lieu of the financial statement as required

11-2

in subsection 40-8-19.1(a);

11-3

     (2) Develop criteria for reviewing the financial statement or financial information

11-4

submitted and assessing the financial status of facilities to determine if they have sufficient

11-5

resources to meet operational and financial expenses and to comply with resident care and facility

11-6

standards; and

11-7

     (3) Establish a set of indicators or criteria that would indicate if a facility's financial status

11-8

is marginal of if a facility is having severe financial difficulties. These criteria shall include, but

11-9

not be limited to:

11-10

     (i) significant operating losses for two (2) successive years;

11-11

     (ii) frequent requests for advance on Medicaid reimbursements;

11-12

     (iii) unfavorable working capital ratios of assets to liabilities;

11-13

     (iv) high proportion of accounts receivable more than ninety (90) days old;

11-14

     (v) increasing accounts payable, unpaid taxes and/or payroll related costs;

11-15

     (vi) minimal or decreasing equity and/or reserves;

11-16

     (vii) high levels of debt and high borrowing costs;

11-17

     (c) Whenever a facility's financial status is determined to be marginal or to have severe

11-18

financial difficulties, the department shall notify the director of the department of health.

11-19

     (d) Special rate appeal pursuant to section 23-17-12.7. – The department shall file a state

11-20

plan amendment with the U.S. Department of Health and Human Services to modify the

11-21

principles of reimbursement for nursing facilities, to be effective on October 1, 2005, or as soon

11-22

thereafter as is authorized by an approved state plan amendment, to assign a special prospective

11-23

appeal rate for any facility for which, pursuant to section 23-17-12.6, the department of health has

11-24

appointed an independent quality monitor; the department of health has required to engage an

11-25

independent quality consultant or temporary manager; and/or the department of health pursuant to

11-26

section 23-17-12.7 has been required to develop and implement a plan of correction and

11-27

remediation to address concerns regarding resident care and coincident financial solvency. The

11-28

special prospective appeal rate shall be assigned for a duration of not less than six (6) months,

11-29

shall be based upon the additional cost of the independent quality monitor, independent quality

11-30

consultant or temporary manager, as the case may be, or the approved spending plan set forth in

11-31

the plan of correction and remediation, and subject to review of cost report, and subsequent

11-32

extension at the discretion of the department, at six (6) month intervals thereafter. In calculating

11-33

the prospective per diem, the department shall disregard the cost center ceilings for the direct

11-34

labor and other operating expense cost centers. The department shall recoup any funds specified

12-1

in the spending plan that have not been expended.

12-2

     SECTION 6. Severability. If any provision of this act or the application thereof to any

12-3

person or circumstance is held invalid, such invalidity shall not affect other provisions or

12-4

applications of the act, which can be given effect with out the invalid provision or application,

12-5

and to this end the provision of this act are declared to be severable.

12-6

     SECTION 7. Reporting. On or before January 15, 2006, the director of health and the

12-7

director of human services shall submit a report to the joint legislative committee on health care

12-8

oversight on the implementation and effectiveness of the "Long-Term Care Reform Act of 2005."

12-9

     SECTION 8. This act shall take effect upon passage.

=======

LC03357

========

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY -- THE LONG-TERM CARE REFORM ACT OF

2005 -- NURSING FACILITY QUALITY MONITORING AND EARLY INTERVENTION

FOR RESIDENT SAFETY

***

13-1

     This act would clarify the roles and responsibilities of various state entities in monitoring

13-2

of nursing home quality by providing a system of reporting to provide early detection of

13-3

deteriorating quality.

13-4

     This act would take effect upon passage.

=======

LC03357

=======