SS#2/SCS/HS/HCS/HB 618 - This act requires managed care organizations to provide enrollees with the option of receiving a covered service in a long-term care facility or a continuing care retirement community. All organizations providing coverage must abide by the health carrier's contracts with similar providers. The managed care organization shall reimburse the resident's facility at a rate not less than the Medicare allowable rate. In addition, a resident facility may not prohibit a health carrier's participating providers from providing services to residents instead of the residents' own insurance providers. The Department of Insurance will be responsible for certifying health plans under this act.

The managed care organization must allow an enrollee to select a religiously appropriate provider, even if that provider is not within that particular managed care network. Any out of network provider that accepts an enrollee will be subject to the same terms, standards, and laws as network providers. Finally, no out of network provider may be forced to admit an enrollee if it cannot provide the necessary services.

Currently, section 198.070 requires the report of any abuse or neglect of long term care facility residents. This act provides that if a facility self-reports abuse or neglect, it will not be recorded as a hotline call, but rather as a "self-reported incident". If the incident results in a violation, then it will be reported as a "substantiated report".

The Department of Social Services must ensure uniformity of regulation standards for long term care facilities. It must do so by evaluating inspection procedures and developing a uniform course of instruction for it. The course will be mandatory and will be evaluated with the assistance of the Department of Health. The Department of Social Services must also work with the Department of Health to evaluate the implementation of and compliance with section 198.012.1(3) and report on the evaluation by January 1, 2000.

The Division of Aging must establish up to twenty Alzheimer's pilot projects throughout the state. Such Alzheimer's projects will be exempted from the certificate of need law. The Division is also required to establish up to six Aging in Place pilot projects.

The Department of Social Services must maintain records of compliance if the Department also maintains records of inspections and violations for long term care facilities. The Department should specify if a facility exceeds minimum requirements.

Portions of this substitute are substantially similar to SB 339, HB 826, SB 215, HBs 490 and 308, and HBs 316, 660, and 203 (1999).
ERIN MOTLEY