HS HCS HB 826 -- LONG-TERM CARE FACILITIES (Harlan)

This substitute modifies the law relating to long-term care
facilities.  In its major provisions, the substitute:

(1)  Allows a facility to increase its licensed bed capacity if
it submits a letter of intent to expand to the Division of
Aging, has no patient care class I deficiencies within the last
18 months, has an average occupancy rate of 90% or greater for
the previous 6 quarters, and makes a good faith effort to
purchase beds for one year following the date of the letter of
intent, but was unable to reach an agreement with another
facility.  A facility with more than 50 beds may expand within
the same licensure category by 25% or 30 beds, whichever is
greater, if that licensure category has experienced an average
occupancy rate of at least 93% for the previous 6 quarters.  A
facility with fewer than 50 beds may expand within the same
licensure category by 25% or 30 beds, whichever is greater, if
that licensure category has experienced an average occupancy
rate of at least 90% for the previous 6 quarters (Section
197.315.19);

(2)  Allows facilities to transfer or sell long-term care beds
to other facilities if the facility receiving the beds has
submitted a letter of intent to expand to the Division of Aging,
has no patient care class I deficiencies within the last 18
months, and has maintained an average occupancy rate of 90% or
greater for the previous 6 quarters.  A facility that transfers
or sells its licensed beds may not expand its capacity in that
licensure category for 5 years (Section 197.315.19(3));

(3)  Allows residential care facilities to relocate a portion of
the facility's licensed beds to another facility under the same
ownership if the facility is within the same licensure category
and located within 6 miles (Section 197.315.19(2));

(4)  Extends from July 1, 1999, to July 1, 2002, the moratorium
on issuing a certificate of need for additional long-term care
beds (Section 197.317).  This provision has an emergency clause;

(5)  Prohibits penalties assessed against long-term care
operators under Section 198.067 from being considered charitable
contributions for tax purposes.  In addition, the Department of
Social Services must promptly report substantiated reports of
elder abuse to the prosecutor and an appropriate law enforcement
agency;

(6)  Allows a residential care facility II to admit or continue
to care for persons who are incapable of negotiating a path to
safety if, among other requirements, a physician determines that
the facility meets the person's needs, the facility is equipped
with an automatic sprinkler system, the facility specially
assesses each resident incapable of negotiating a path to
safety, the facility meets special staffing requirements, and
the facility uses personal electronic monitoring devices when a
resident's physician recommends such a device (Section
198.073.3);

(7)  Requires the Division of Medical Services to recalculate a
nursing facility's Medicaid per diem reimbursement rate when the
facility incurs a capital expenditure greater than $2,000 per
bed.  In recalculating the rate, the Division of Medical
Services is prohibited from applying any minimum occupancy or
utilization criteria.  The division is also prohibited from
reducing the facility's rate after performing a recalculation
under this provision (Section 198.427.2);

(8)  Requires the Division of Aging to investigate all
complaints against long-term care facilities within 30 days
(except for abuse and neglect complaints which must be
investigated more quickly) and to select independent monitors of
facilities when monitoring is required.  Complaints and written
results will be readily available to the public at the long-term
care facility (Sections 1 and 2);

(9)  Requires the Division of Aging to develop flexible
assessment procedures for assessing an individual's long-term
care needs (Section 3);

(10)  Requires the Division of Aging to inspect each facility
licensed by the division twice a year (Section 4);

(11)  Requires the Division of Aging to implement a
demonstration project to develop a licensure category for free--
standing facilities to treat persons with Alzheimer's disease or
Alzheimer's related dementia.  The division may select 20
provider organizations to participate in the project.  The
facilities must be specifically designed and operated to provide
elderly individuals who have dementia with a safe environment
that promotes the highest practicable functioning of each
resident (Section 5);

(12)  Requires the Division of Aging to establish an informal
dispute resolution project in one area of the state.  The
project must provide at least one face-to-face conference with a
representative of the division and a facility resident or the
resident's representative when that resident is the subject of a
complaint investigation (Section 7);

(13)  Prohibits renewing a residential care facility's license
for more than 50 beds when the facility has been licensed for
more than 5 years, is licensed for more than 50 beds, and fails
to maintain an occupancy level greater than 30% for any calendar
year (Section 8);

(14)  Requires the Division of Aging to establish an aging-in--
place pilot program to provide a continuum of care for elders
who need long-term care.  A maximum of 4 sites may be selected
(Section 9);

(15)  Requires the Division of Aging to provide budget allotment
tables to each Area Agency on Aging (AAA) by January 1 of each
year.  By March 1 of each year, each AAA must submit its area
plan, budget, and service contracts to the Division of Aging.
Each April, each AAA is required to present its plan to the
Division of Aging, in a public hearing to be held in the area
served by the AAA.  The Division of Aging must conduct on-site
monitoring of each AAA at least once a year, and send its
monitoring reports to the AAA Advisory Council and the board of
directors for the area agency which is the subject of the report
(Section 10);

(16)  Establishes requirements for the Division of Aging to
better facilitate the uniform application of regulations in
long-term care facilities throughout the state (Section 11);

(17)  Prohibits applying the certificate of need law to a
facility with 60 beds operated exclusively for the care of
residents with Alzheimer's disease or dementia located within a
tax increment financing district which also includes a skilled
nursing facility;

(18)  Allows persons entitled to a hearing because of denial or
revocation of a residential care facility license and persons
entitled to a hearing because of denial of a claim for medical
assistance or reimbursement pursuant to chapter 208, RSMo., to
bring the action in the circuit court of the county where they
reside, where the facility is located, or Cole County.  Under
current law, the hearing must be before the Administrative
Hearing Commission; and

(19)  Requires the Department of Social Services to maintain
records of compliance with statutes, rules, or the conditions of
licensure, for any residential care facility I or II,
intermediate care facility, or skilled nursing facility, for
which the department maintains records of site inspections and
violations of statutes, rules, or the conditions of licensure.
In addition, the department is required to record any action
taken by such a facility that exceeds the minimal requirements
for compliance.

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$686,530 in FY 2000, $37,569,070 to $46,454,320 in FY 2001, and
$73,182,859 to $90,953,359 in FY 2002.  Estimated Income to
Nursing Facility Quality Care Fund of $3,000 in FY 2000, $10,700
in FY 2001, and $13,700 in FY 2002.

HCS HB 826 -- LONG-TERM CARE FACILITIES

SPONSOR:  Harlan

COMMITTEE ACTION:  Voted "do pass" by the Committee on Critical
Issues by a vote of 19 to 2.

This substitute modifies the law relating to long-term care
facilities.  In its major provisions, the substitute:

(1)  Allows long-term care facilities to increase their beds by
up to 25% of their licensed capacity, or 30 new beds, not to
exceed 100% of the facility's licensed capacity if the facility
has an average occupancy rate of 90% or greater for the last 4
consecutive calendar quarters (Section 197.315.19);

(2)  Allows long-term care facilities to transfer beds to other
facilities if the facility receiving the beds has an average
occupancy rate of 90% for the last 4 consecutive calendar
quarters (Section 197.315.19).  These provisions do not affect
the July 1, 1999, expiration date of the moratorium on issuing a
certificate of need for additional or new long-term care beds;

(3)  Allows residential care facilities to relocate a portion of
the facility's licensed beds to another facility under the same
ownership if the facility is within the same licensure category
and located within 6 miles (Section 197.315.19);

(4)  Allows a residential care facility II to admit or continue
to care for persons who are incapable of negotiating a path to
safety if, among other requirements, a physician determines that
the facility meets the person's needs, the facility is equipped
with an automatic sprinkler system, the facility specially
assesses each resident incapable of negotiating a path to
safety, the facility meets special staffing requirements, and
the facility uses personal electronic monitoring devices when a
resident's physician recommends such a device (Section
198.073.3);

(5)  Requires the Division of Aging to investigate all
complaints against long-term care facilities within 30 days
(except for abuse and neglect complaints which must be
investigated more quickly) and to select independent monitors of
facilities when monitoring is required.  Complaints and written
results will be readily available to the public at the long-term
care facility (Sections 1 and 2);

(6)  Requires the Division of Aging to inspect each facility
licensed by the Division twice a year (Section 4);

(7)  Requires the Division of Aging to inspect a long-term care
facility before a change of operators occurs and before granting
a temporary operating permit.  Inspection results must be
disclosed to the current and succeeding operators (Section
198.015.8);

(8)  Authorizes the division to license free-standing facilities
for persons with Alzheimer's disease or dementia and establishes
requirements for those facilities.  The facilities must be
specifically designed and operated to provide elderly
individuals who have dementia with a safe environment that
promotes the highest practicable functioning of each resident
(Section 5); and

(9)  Requires the Division of Aging to develop flexible
assessment procedures for assessing an individual's long-term
care needs (Section 3).

FISCAL NOTE:  Estimated Net Cost to General Revenue Fund of
$328,908 in FY 2000, $846,707 in FY 2001, and $865,316 in FY
2002.

PROPONENTS:  Supporters say that it is unfair to prevent
desirable long-term care facilities from expanding because a
neighboring less desirable facility is not fully occupied.
Currently, many people must admit their loved ones to a facility
that is their third or fourth choice.  Competition in the free
market without certificate of need review would promote quality
long-term care.  The "pathway to safety" requirement must be
modified because it forces many residents to enter skilled
nursing facilities before they need skilled care.  Many
residents experience deteriorating conditions after a move.
Consequently, moving a resident should be avoided unless it is
necessary.  Allowing free-standing Alzheimer's facilities is
important because of the increasing number of individuals with
Alzheimer's disease.

Testifying for the bill were Representative Harlan; Kingswood
Retirement Community; New Florence Nursing and Care Center;
Heisinger Lutheran Home; Lenoir Retirement Community; Americare
Systems, Inc.; Missouri Association of Homes for the Aging;
Missouri Coalition for Quality Care; American Association of
Retired Persons;  Missouri Coalition of Alzheimer's
Associations; Lutheran Senior Services; and the Division of
Aging (providing testimony for technical assistance only).

OPPONENTS:  Those who oppose the bill say that this bill will
only contribute to the problem of too many unoccupied long-term
care beds.  Also, it is currently very difficult for many long--
term care facilities to hire and retain enough staff to
operate.  Adding additional beds and facilities will exacerbate
the staffing problem.

Testifying against the bill were Missouri Health Care
Association; Citizens Memorial Health System; Reliant Care
Group; Warsaw Health and Rehabilitation Center; David Duncan;
Charles Riley; Warren Schmittgens; and Melissa Watkins.

Katharine Hickel Barondeau, Legislative Analyst

HB 826 -- Long-Term Care Facilities

Co-Sponsors:  Harlan, Cooper, Troupe, Ladd Stokan, Griesheimer

This bill modifies the law relating to long-term care
facilities.  In its major provisions, the bill:

(1)  Allows long-term care facilities to increase their beds by
up to 25% of their licensed capacity, or 30 new beds, not to
exceed 100% of the facility's licensed capacity if the facility
has an average occupancy rate of 90% or greater for the last 4
consecutive calendar quarters (Section 197.315.19);

(2)  Allows long-term care facilities to transfer beds to other
facilities if the facility receiving the beds has an average
occupancy rate of 90% for the last 4 consecutive calendar
quarters (Section 197.315.19).  These provisions do not affect
the July 1, 1999, expiration date of the moratorium on issuing a
certificate of need for additional or new long-term care beds;

(3)  Allows residential care facilities to relocate a portion of
the facility's licensed beds to another facility under the same
ownership if the facility is within the same licensure category
and located within 6 miles (Section 197.315.19);

(4)  Allows a residential care facility II to admit or continue
to care for persons who are incapable of negotiating a path to
safety if, among other requirements, a physician determines that
the facility meets the person's needs, the facility is equipped
with an automatic sprinkler system, the facility specially
assesses each resident incapable of negotiating a path to
safety, the facility meets special staffing requirements, and
the facility uses personal electronic monitoring devices when a
resident's physician recommends such a device (Section
198.073.3);

(5)  Requires the Division of Aging to investigate all
complaints against long-term care facilities within 30 days
(except for abuse and neglect complaints which must be
investigated more quickly) and to select independent monitors of
facilities when monitoring is required (Sections 1 and 2);

(6)  Establishes requirements of the Division of Aging which
relate to strategic planning for the needs of the elderly
(Section 5).  The Division is also required to inspect each
facility licensed by the Division twice a year (Section 7);

(7)  Requires the Division of Aging to recommend whether
certificate of need review should be discontinued (Section 4);

(8)  Authorizes the Division to license free-standing facilities
for persons with Alzheimer's disease or dementia and establishes
requirements for those facilities.  The facilities must be
specifically designed and operated to provide elderly
individuals who have dementia with a safe environment that
promotes the highest practicable functioning of each resident
(Section 8); and

(9)  Requires the Division of Aging to develop flexible
assessment procedures for assessing an individual's long-term
care needs (Section 6).