SCS/HS/HCS/HBs 1654 & 1156 - This act modifies provisions related to protection of the elderly.

Definitions related to elder abuse are modified and rule authority is given to the Department (Sections 187.010 and 187.015).

Certain persons are required to report suspected abuse or neglect of facility residents. Anyone failing to make a report within a reasonable time or filing a false report is guilty of a Class A misdemeanor. Immunity is given to reporters, unless they act negligently, recklessly, or in bad faith. The Department must maintain statistics on all deaths and must report to the Division of Health Standards and Licensure (Section 187.020).

If a report is made about a long-term care resident, certain information must be included in the report. Within 24 hours, the Department of Health and Senior Services must initiate an investigation and notify the resident's family. If a report involves imminent harm, the Department must start an on-site investigation within 24 hours. If an investigation indicates possible abuse or neglect, the resident may be removed from the facility. Reports are confidential, with exceptions. Within five working days, the person making the report must be notified of its progress. Harassment of reporters is prohibited. Any person who knowingly abuses or neglects a resident of a facility is guilty of a Class D felony and will be placed on the employee disqualification list (Section 187.024).

Section 187.028 contains provisions similar to Section 187.024, but for eligible adults not residing in a facility and in-home services clients. If a report is made by the client's physician, then the Department must maintain contact with the physician regarding the investigation. When a report is received by the Department, the client's case manager must involve a nurse or other professional, as appropriate. Reports are confidential, with exceptions (Section 187.028). The Department must investigate reports by using the procedures established in Sections 660.250 to 660.295 and must refer all suspected cases to law enforcement (Section 187.030).

The Department and law enforcement must require elder abuse training and must develop an investigation checklist. Immunity from liability is provided to reporters, unless they act in bad faith (Section 187.034).

Emergency services and medical facility employees must be placed on the employee disqualification list (EDL) if found guilty of abuse or neglect (Section 187.040).

Section 187.050 contains provisions similar to 187.024, but for the misappropriation of property or falsification of documents of an in-home services client. Any in-home services provider or employee who performs such acts will be guilty of a Class A misdemeanor. Reports are confidential, with exceptions (Section 187.050).

Any person placed on the EDL must be notified in writing with thirty days to respond or appeal. Certain persons will be automatically listed on the EDL, such as those who intentionally or negligently inflict serious physical injury or death to another. No person on the EDL may be employed by anyone receiving the list. Language is removed regarding the eligibility of a person on the EDL for unemployment benefits. Employers may not be charged for unemployment benefits if a person is removed because of placement on the EDL. Upon a finding by the Department of Labor and Industrial Relations that a person belongs on the EDL, such person will be deemed to have committed misconduct under chapter 288. Persons listed on the EDL may request removal once every twelve months. The EDL must be distributed to area agencies on aging, emergency services, and adult day care programs (Section 187.080).

Before allowing an employee to have contact with a resident, providers must request a criminal background check and must check the EDL. Failure to disclose will result in a Class A misdemeanor. Failure by a provider to investigate or evidence of a pattern of violation by the provider will result in civil penalties. Providers may use private investigators. Providers may use private investigators to do background checks (Section 187.084). All reports of abuse or neglect will be kept confidential, with specific exceptions. Report copies may not disclose the reporter or the victim (Section 187.087).

Allows the Department to require the production of information for investigations or inspections. Failure to comply with any request is ground for refusal, suspension, or revocation of a license or contract (Section 187.090).

The Departments of Health and Senior Services and Mental Health must work cooperatively in the investigation of abuse and neglect, when appropriate (Section 187.102).

The term "financial" is included in the definition of abuse and "medical assistance" is redefined as any federal health care program. The term "health care provider" is also clarified as one who is paid to deliver or purports to deliver services (Section 191.900). Certain powers of the Attorney General are modified regarding the prosecution of abuse and neglect cases (Section 191.910). Terms related to long term care are modified (Section 198.006). The provisions of Section 187.020 are included as non-applicable to certain entities, such as hospitals (Section 198.012).

Upon licensure or renewal of a facility's license, the Department must require a listing of the facility operator or owner's properties. The Department must determine the facility's compliance history and include facility responses to survey findings in the official departmental review (Section 198.019).

Unless the Department determines otherwise, facilities must be subject to at least two inspections per year (Section 198.022). Written notice of facility noncompliance must be copied to the Attorney General (Section 198.029). Every residential care facility I or II, intermediate care facility, or skilled nursing facility must post a current inspection report (Section 198.030).

Sections 187.020 - 187.050 are included in the requirement for confidentiality of resident records. Insurance carriers may not use unsubstantiated inspection or written investigation reports for insurance underwriting. The Department must obtain the name and address of the reporter after obtaining abuse and neglect information (Section 198.032).

The Department may revoke a license if a facility fails to comply with class I, II, or III standards on two occasions within 12 months, refuses inspection, knowingly adversely affects health, safety, or welfare of a resident, or demonstrates financial incapacity (Section 198.036). Facilities shall have administrative appeal rights (Section 198.039).

Penalty provisions for facilities are clarified and the Department or the AG may bring an action in circuit court. At the Department's discretion, state civil penalties may be reduced based on previous federal penalties for the same violation (Section 198.067). The pathway to safety law for Alzheimer's residents in RCFs is modified (Section 198.073).

A new section requires long term care facilities and residential care facilities I and II to provide influenza and pneumonia immunizations annually or upon admission. Written consent must be obtained from the resident and his or her physician. The Department must develop rules for documenting compliance, including the documentation of residents who refuse the immunization. The Department may not impose a violation on a facility for not making an immunization available if a shortage exists (Section 198.074).

The Departments of Health and Senior Services, Mental Health, and Elementary and Secondary Education must collaborate on assessment procedures for long term care services (Section 198.080).

A requirement is added that skilled or intermediate care nursing assistants must complete training within 6 months of employment. The Department must approve all training (Section 198.082). The Department must establish three classification standards, including three violation categories (Section 198.085).

The Department must establish and implement a demonstration project to establish a licensure category for health care facilities treating Alzheimer's residents (Section 198.086). Facilities must establish appropriate policies and must notify staff, residents, and families of residents (Section 198.088). Residents may file written complaints regarding the deprivation of rights or estates within two years of the alleged violation (Section 198.093).

Nursing home districts shall not be prohibited from establishing and maintaining senior housing within their corporate limits (Section 198.345).

Facility inspections are required twice per year, unless otherwise provided pursuant to 198.526 (Section 198.525). Currently, Section 198.526 outlines facility inspection procedures. The Department may reduce the frequency of inspections to one per year if the facility has no class I deficiencies or class II violations during an inspection, related to the direct care of residents, and if there is no change in ownership or operation. This act provides for immediate termination and a Class A misdemeanor for any Division employee who discloses an inspection time to a facility (Section 198.526).

Current law allows the Department to establish aging-in- place pilot programs throughout the state. This act requires the Department to base licensure procedures on the highest level of service provided at the site (Section 198.531).

Current law allows individuals to appeal medical assistance denials. This act requires the administrative hearing commission to consider a provider's continued participation in the program (Section 208.156). This act also exempts 501(c)(3) programs for all-inclusive care for the elderly (PACE) projects from HMO law (Section 354.407). This act provides a hearsay exception for statements made by elderly or disabled individuals (Section 491.076).

Providers or employees of SNFs or Alzheimer's units are prohibited from having sexual contact with residents. Anyone having sexual contact is guilty of a Class B misdemeanor, with subsequent violations being a Class A misdemeanor. Anyone having sexual intercourse is guilty of a Class D felony, with subsequent violations being a Class C felony. This section does not apply to persons married to a resident. Consent of the victim is not a defense (Section 565.200).

The Department of Health and Senior Services is given equal access to information provided by mental health facilities or the Department of Mental Health (Sections 630.140, 630.167).

With the exception of an attorney or member of the clergy, no legal privilege will exempt a person from the disclosure of records related to abuse and neglect. The Department shall have access to financial, medical, and mental health records (Section 660.030).

This act requires all Medicaid participation agreements to include a requirement for abuse and neglect training. Agreements must allow ombudsman access to the facility (Section 660.252). This act clarifies that abuse and neglect reports are not public records (Section 660.263).

The Department may enjoin interference with an investigation or inspection (Section 660.270). The Department must refer all suspected cases of elder abuse to the appropriate law enforcement agency (Section 660.302).

The Division of Family Services must comply with Medicaid law on institutionalized and impoverished spouses when determining Medicaid eligibility (Section 1). This act prohibits employee discrimination by skilled nursing facilities (Section 2). Finally, this act establishes the Joint Committee on Nursing Home Medicaid Reimbursement, consisting of ten members of the General Assembly (Section 3).

Portions of this act are substantially similar to SB 670 (2002).
ERIN MOTLEY