SB 333 Modifies provisions relating to the Department of Health and Senior Services
Sponsor: Stouffer
LR Number: 1511L.07C Fiscal Note: 1511-07
Committee: Seniors, Families and Public Health
Last Action: 5/17/2007 - H Third Read and Passed Journal Page: H2178 / S1979-1984
Title: HCS#2 SCS SB 333 Calendar Position:
Effective Date: August 28, 2007
House Handler: Cooper

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HCS/SCS/SB 333 - This act modifies provisions relating to the department of health and senior services.

RENAMED BRAIN INJURY ADVISORY COUNCIL

This act changes the name of the Missouri Head Injury Advisory Council to the Missouri Brain Injury Advisory Council and codifies the executive order transferring the Missouri Brain Injury Advisory Council to the Department of Health and Senior Services. The act provides for the decrease of members of the council from the present twenty-five to eighteen. Meetings of the full council shall be held twice a year or at the call of the council chairperson.

This act modifies the definition of "brain injury" or "traumatic brain injury" to include a sudden insult or damage to the brain or its coverings, not of a degenerative nature. Cerebral vascular accidents, aneurisms and congenital deficits are specifically excluded from the definition of brain injury.

This act prescribes some additional duties for the department, including promulgating rules to prescribe polices or standards which affect charging and funding of adult brain injury rehabilitation services and reasonable rules relative to the implementation of participant rights undergoing rehabilitation services. The department shall also promulgate rules for those creating reasonable standard means test to be applied to all programs and services funded by the department. The department may also receive federal grants and aids for brain injury prevention, brain injury and brain injury rehabilitation. The administration of the Brain Injury Fund is also transferred to the department.

This act also provides that services provided by the department shall be directed toward preparation for education or vocational achievement, independent living, and community participation. (SECTIONS 192.745, 199.001 to 199.051, and SECTION 304.028)

These provisions are substantially similar to SCS/SB 333 (2007).

UNIFORM ANATOMICAL GIFT ACT

This act revises the Uniform Anatomical Gift Act beginning on July 1, 2008. This act facilitates donations by expanding the list of those who may make an anatomical gift for another individual during that individual's lifetime.

This act also facilitates donations from a deceased individual who made no lifetime choice by adding to the list of persons who can make a gift of the deceased individual's body or parts.

This act encourages and establishes standards for donor registries. This act provides that anatomical gifts made under the laws of other jurisdictions shall be recognized. Allowances are made for electronic records and signatures with respect to gift donations and consent.

This act provides for the donation of specific anatomical parts to named persons and more generally to eye banks, tissue banks, and organ procurement organizations. This act also outlines a priority for transplantation or therapy over research or education when an anatomical gift is made for all four purposes in a gift document that fails to establish a priority. Criminal sanctions are added for falsifying the making, amending, or revoking of an anatomical gift.

In addition, this act provides that a coroner or medical examiner shall cooperate with an organ procurement organization to maximize the opportunity to recover anatomical gifts for the purpose of transplantation, therapy, research, or education. A procurement organization includes eye banks and tissue banks.

A person who acts without negligence and in good faith under the terms of the act or anatomical gift laws of another state or foreign country is not liable for damages in any civil action or subject to prosecution in any criminal proceedings for his or her act. A party claiming another was negligent shall have the burden of proving the claimed negligence. (SECTIONS 58.720,58.775, 58.780, 58.785, SECTIONS 194.210 to 194.294, SECTION 194.304, and SECTION 302.171)

These provisions are substantially similar to HCS/HB 723 and SS/SCS/SB 496 (2007).

CHRONIC KIDNEY DISEASE TASK FORCE

This act creates the "Chronic Kidney Disease Task Force." The list of 17 members are specified in the act. The duties of the task force include developing a plan to educate the public and health care professionals about the advantages and methods of early screening, diagnosis, and treatment of chronic kidney disease. Also, the task force shall submit a report of its findings and recommendations to the General Assembly by August 30, 2008, at which time the task force shall expire.

This act is substantially similar to SB 677 and HB 1084 (2007).

PATIENT SAFETY

This act requires hospitals to report whenever they have a "serious reportable event in health care," as identified by the National Quality Forum. Such events include wrong-site surgery, retention of a foreign object in a patient after surgery, and death or serious disability associated with medication error.

The procedure for hospitals reporting such events to the Department of Health and Senior Services and to a patient safety organization are prescribed in the act. The requirements for a patient safety organization are also prescribed in the act. The patient-identifying data shall be redacted from information provided to the department or patient safety organization. The initial report of the event shall be reported to the patient safety organization and include a description of immediate actions taken by the hospital to minimize the risk of harm to patients and prevent reoccurrence. Within 20 days after the event occurred, the hospital shall submit to the patient safety organization a root cause analysis and a prevention plan, which shall be forwarded to the department.

The department shall investigate the reportable incident and based on its findings, determine whether the hospital's response and proposed prevention plan is sufficient to reduce the risk of future occurrences of that type. The department shall also periodically evaluate the performance of the patient safety organization regarding report submission processes and its reviews of prevention plans. The act also prescribes the procedure for the department when taking action on insufficient prevention plans.

If a reportable incident is disclosed to the department and patient safety organization and the prevention plan and root cause analysis is submitted and approved by the department, the incident shall not be deemed grounds for a finding of a licensure deficiency. The department shall promulgate rules establishing criteria for defining cases in which reportable incidents have occurred in a hospital with a frequency or possible pattern of adverse outcomes as to necessitate departmental intervention.

The patient safety organization shall in collaboration with the department publish an annual report to the public on reportable incidents. The report shall show the number and rate per patient encounter by region and by category of reportable incident and may identify reportable incidents by type of facility.

This act provides for certain legal protections of patient safety organization documents. The proceedings and records of the organization shall not be subject to discovery or introduction into evidence in any civil action against a provider. However, information otherwise available from original sources shall not be immune from discovery or use in any civil action if they were presented during a patient safety organization meeting. Patient safety work product shall be privileged and confidential and shall not be disclosed for any purpose. (SECTIONS 197.551 to 197.587)

These provisions are substantially similar to HB 1061 and SB 578 (2007).

VENTILATOR-ASSOCIATED PNEUMONIA

This act modifies the provision on hospitals, ambulatory surgical centers, and other facilities reporting the incidence rate of ventilator-associated pneumonia. Under current law, the Infection Control Advisory Panel and the Department of Health and Senior Services report quarterly on the incidence rates for various types of infections. This act provides that upon the recommendation of the panel, health care providers may use one or more other quality indicators designed to better measure the risk of transmission of ventilator-associated pneumonia from one patient to another. (SECTION 192.667)

This act is identical to HB 1099 (2006).

VULNERABLE PERSON PROTECTIONS

Under this act, the necessary statutory changes are made due to the transfer of the Division of Aging from the Department of Social Services to the Department of Health and Senior Services.

This act also modifies provisions relating to protections for elderly persons and the disabled receiving care for in-home services, adult day care, or personal care assistance.

This act modifies the provisions on the elder abuse and neglect awareness program to include information on financial exploitation of the elderly. SECTION 192.925

This act modifies the mandatory reporting and abuse and neglect provisions affecting elderly persons and the disabled receiving in-home care and adult-day care services to include personal care services. A new definition of "in-home services client" includes children in the Healthy Children and Youth (HCY) Program and "principal" of a facility to include a provider, officer, director, owner, partner or other person with primary management or supervisory responsibilities. SECTION 192.2150.1

Mandatory reporters must also now immediately report to the Department of Health and Senior Services if there is reasonable cause to believe that abuse or neglect occurred, that misappropriation of property or moneys of a patient, resident, in-home services client, or consumer or the falsification of any documents verifying service delivery of in-home services or consumer-directed services has occurred. SECTION 192.2150.2.

If a report is made by the patient's, in-home services client's or resident's physician, the department shall provide information regarding the progress of the investigation to the physician upon request. SECTION 192.2150.4

Upon receipt of a report that indicates an imminent danger to the health, safety, or welfare of a patient, resident, in-home services client or consumer or a substantial probability that death or serious physical injury will result, the department shall make a prompt and thorough investigation. The department shall initiate all other investigations as soon as practicable. Notification of an investigation and whether such report was substantiated shall also be made to the patient's, resident's, in-home services client's or consumer's legal representative as soon as possible. SECTION 192.2150.6

When information gained from an investigation indicates a crime has occurred, the department shall report such information to appropriate law enforcement authorities. SECTION 192.2150.7

This act requires the department to keep the names of individuals submitting abuse and falsification of document reports confidential unless the complainant agrees to the disclosure of his or her name, the Department of Health and Senior Services finds that disclosure is necessary to prevent further abuse, neglect or misappropriations of property or moneys, the name of the complainant is lawfully subpoenaed, the release of a name is required by the Administrative Hearing Commission, or the release of a name is requested by the Department of Social Services for the purpose of licensure under Chapter 210, RSMo. SECTION 192.2150.9

This act protects patients and patients' family members from eviction, harassment, or retaliation due to the filing of a report of a violation or suspected violation of the laws or regulations of this act. SECTION 192.2150.13

Any potential patient or new referral of the department shall be screened to ascertain if they are included on the Missouri sexual offender registry and the provider shall be notified if a sexual offender was identified. SECTION 192.2150.15

Any person who fails to make the required abuse, neglect, misappropriation, or falsification of documents report shall be guilty of a Class A misdemeanor. Any provider who knowingly conceals abuse or neglect that results in the death or serious injury of the patient shall be guilty of a Class D felony. In addition, any provider who willfully and knowingly fails to report known abuse by an employee may be subject to a one thousand dollar per abuse violation administrative penalty by the Department of Health and Senior Services. SECTION 192.2153

Any person who puts to his or her own use or the use of the provider or otherwise diverts from the in-home services client's use of any property or funds is guilty of a Class A misdemeanor. Any provider, principal in the operation of a provider or employee of a provider who knowingly conceals any act of abuse or neglect that results in death or serious physical injury is guilty of a Class D felony. SECTION 192.2153.2 and 3

This act provides that the department shall make available the employee disqualification list upon request to recognized schools of nursing or other health care professionals. Such information shall not be disclosed to unauthorized entities. SECTION 192.2175.11

This act extends the time a person can be listed on the employee disqualification list by one year if he or she is employed in a prohibited position while on the list. SECTION 192.2175.14

This act disqualifies individuals who are on the sexual offender registry from employment in long-term care facilities, hospitals, home health agencies, adult day care, in-home services providers, and consumer directed services. Also, this act modifies the provision on providers being guilty of a Class A misdemeanor for knowingly hiring or retaining employees who have been convicted of, found guilty of, or pled guilty to specified crimes to include violations of forgery and three or more instances of stealing. SECTIONS 192.2178.6

For any persons hired on or after August 28,2007, a provider shall not hire any person with a disqualifying criminal history unless such person has received a good cause waiver of the disqualifying criminal history. For any persons employed as of August 28, 2007, a provider shall not knowingly retain any person with a disqualifying criminal history unless such person has submitted a completed good cause waiver application prior to March 1, 2008. If the good cause waiver is denied, the provider shall not continue to retain such person after the provider is notified of the denial of the good cause waiver. This act adds licensed hospices to the list of employers who are required to obtain a background screening from the Family Care Safety Registry. SECTION 192.2178.6, 8, and 9

This act modifies the definition of "child care provider" to include in-home services providers currently under contract with the department of health and senior services. SECTION 210.900

Requires offenders who have pled guilty to or who are found guilty of a crime of violence against an elderly person to be sentenced to a term of imprisonment of at least 30 days with no eligibility for probation or parole during the first 30 days. SECTION 565.320

This act prohibits suspending imposition of or execution of sentence or imposing any fine in lieu of a term of imprisonment when a person pleads guilty to or is found guilty of elder abuse in the first or second degree; sexual offense in certain long-term care facilities; and financial exploitation of the elderly. SECTIONS 565.180 AND 182; 565.200; AND 570.145

MISAPPROPRIATION OF FUNDS OF ELDERLY OR DISABLED FACILITY CARE RESIDENT

This act also modifies the offense of misappropriation of funds of elderly or disabled facility care resident. This act provides that evidence of misappropriating funds and failing to pay for the facility care of an elderly or disabled person may include, but shall not be limited to proof that the facility has sent, by certified mail with confirmation receipt requested, notification of failure to pay nursing home expenses incurred by a resident to the person who has assumed responsibility of managing the financial affairs of the resident.

These provisions shall not be construed to limit the investigations or prosecutions of this crime or the crime of financial exploitation of an elderly or disabled person.

SECTION 198.097

These provisions are substantially similar to SB 675 (2007).

ADRIANE CROUSE