Bill Text: MI SB0071 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Health; home health care; in-home services agencies; require to be licensed. Amends secs. 20106, 20108, 20115 & 20142 of 1978 PA 368 (MCL 333.20106 et seq.) & adds pt. 218.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2013-01-24 - Referred To Committee On Health Policy [SB0071 Detail]

Download: Michigan-2013-SB0071-Introduced.html

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SENATE BILL No. 71

 

 

January 24, 2013, Introduced by Senator JANSEN and referred to the Committee on Health Policy.

 

 

 

     A bill to amend 1978 PA 368, entitled

 

"Public health code,"

 

by amending sections 20106, 20108, 20115, and 20142 (MCL 333.20106,

 

333.20108, 333.20115, and 333.20142), section 20106 as amended by

 

2000 PA 253, section 20108 as amended by 1990 PA 179, and section

 

20115 as amended by 2012 PA 499, and by adding part 218.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 20106. (1) "Health facility or agency", except as

 

provided in section 20115, means:

 

     (a) An ambulance operation, aircraft transport operation,

 

nontransport prehospital life support operation, or medical first

 

response service.

 

     (b) A clinical laboratory.

 

     (c) A county medical care facility.

 

     (d) A freestanding surgical outpatient facility.

 

     (e) A health maintenance organization.

 

     (f) A home for the aged.

 

     (g) A hospital.

 

     (h) A nursing home.

 

     (i) A hospice.

 

     (j) A hospice residence.

 

     (k) A facility or agency listed in subdivisions (a) to (h)

 

located in a university, college, or other educational institution.

 

     (l) An in-home care services agency.

 

     (2) "Health maintenance organization" means that term as

 

defined in section 3501 of the insurance code of 1956, 1956 PA 218,

 

MCL 500.3501.

 

     (3) "Home for the aged" means a supervised personal care

 

facility, other than a hotel, adult foster care facility, hospital,

 

nursing home, or county medical care facility that provides room,

 

board, and supervised personal care to 21 or more unrelated,

 

nontransient, individuals 60 years of age or older. Home for the

 

aged includes a supervised personal care facility for 20 or fewer

 

individuals 60 years of age or older if the facility is operated in

 

conjunction with and as a distinct part of a licensed nursing home.

 

     (4) "Hospice" means a health care program that provides a

 

coordinated set of services rendered at home or in outpatient or

 

institutional settings for individuals suffering from a disease or

 

condition with a terminal prognosis.

 

     (5) "Hospital" means a facility offering inpatient, overnight

 

care, and services for observation, diagnosis, and active treatment

 

of an individual with a medical, surgical, obstetric, chronic, or

 

rehabilitative condition requiring the daily direction or

 

supervision of a physician. Hospital does not include a mental

 

health hospital licensed or operated by the department of community

 

health or a hospital operated by the department of corrections.

 

     (6) "Hospital long-term care unit" means a nursing care

 

facility, owned and operated by and as part of a hospital,

 

providing organized nursing care and medical treatment to 7 or more

 

unrelated individuals suffering or recovering from illness, injury,

 

or infirmity.

 

     Sec. 20108. (1) "In-home care services agency" means that term

 

as defined in section 21807.

 

     (2) (1) "Intermediate care facility" means a hospital long-

 

term care unit, nursing home, county medical care facility, or

 

other nursing care facility, or distinct part thereof, certified by

 

the department to provide intermediate care or basic care that is

 

less than skilled nursing care but more than room and board.

 

     (3) (2) "License" means an authorization, annual or as

 

otherwise specified, granted by the department and evidenced by a

 

certificate of licensure or permit granting permission to a person

 

to establish or maintain and operate, or both, a health facility or

 

agency. For purposes of part 209, "license" includes a license

 

issued to an individual under that part.

 

     (4) (3) "Licensee" means the holder of a license or permit to

 

establish or maintain and operate, or both, a health facility or

 

agency. For purposes of part 209, "licensee" includes an individual

 

licensed under that part.

 

     (5) (4) "Limited license" means a provisional license or

 

temporary permit or a license otherwise limited as prescribed by

 

the department.

 

     (6) (5) "Medically contraindicated" means, with reference to

 

nursing homes only, having a substantial adverse effect on the

 

patient's physical health, as determined by the attending

 

physician, which effect is explicitly stated in writing with the

 

reasons therefor for that effect in the patient's medical record.

 

     (7) (6) "Medical first response service" means that term as

 

defined in section 20906.

 

     (8) (7) "Nontransport prehospital life support operation"

 

means that term as defined in section 20908.

 

     Sec. 20115. (1) The department may promulgate rules to further

 

define the term "health facility or agency" and the definition of a

 

health facility or agency listed in section 20106 as required to

 

implement this article. The department may define a specific

 

organization as a health facility or agency for the sole purpose of

 

certification authorized under this article. For purpose of

 

certification only, an organization defined as a hospital in

 

section 20106(5), 20108(1), or 20109(4) 20106, as an in-home care

 

services agency or intermediate care facility in section 20108, or

 

as a skilled nursing facility in section 20109 is considered a

 

health facility or agency. The term "health facility or agency"

 

does not mean a visiting nurse service or home aide service

 

conducted by and for the adherents of a church or religious

 

denomination for the purpose of providing service for those who

 

depend upon spiritual means through prayer alone for healing.

 

     (2) The department shall promulgate rules to differentiate a

 

freestanding surgical outpatient facility from a private office of

 

a physician, dentist, podiatrist, or other health professional. The

 

department shall specify in the rules that a facility including,

 

but not limited to, a private practice office described in this

 

subsection must be licensed under this article as a freestanding

 

surgical outpatient facility if that facility performs 120 or more

 

surgical abortions per year and publicly advertises outpatient

 

abortion services.

 

     (3) The department shall promulgate rules that in effect

 

republish R 325.3826, R 325.3832, R 325.3835, R 325.3857, R

 

325.3866, R 325.3867, and R 325.3868 of the Michigan administrative

 

code, but shall include in the rules standards for a freestanding

 

surgical outpatient facility or private practice office that

 

performs 120 or more surgical abortions per year and that publicly

 

advertises outpatient abortion services. The department shall

 

assure that the standards are consistent with the most recent

 

United States supreme court decisions regarding state regulation of

 

abortions.

 

     (4) Subject to section 20145 and part 222, the department may

 

modify or waive 1 or more of the rules contained in R 325.3801 to R

 

325.3877 of the Michigan administrative code regarding construction

 

or equipment standards, or both, for a freestanding surgical

 

outpatient facility that performs 120 or more surgical abortions

 

per year and that publicly advertises outpatient abortion services,

 

if both of the following conditions are met:

 

     (a) The freestanding surgical outpatient facility was in

 

existence and operating on December 31, 2012.

 

     (b) The department makes a determination that the existing

 

construction or equipment conditions, or both, within the

 

freestanding surgical outpatient facility are adequate to preserve

 

the health and safety of the patients and employees of the

 

freestanding surgical outpatient facility or that the construction

 

or equipment conditions, or both, can be modified to adequately

 

preserve the health and safety of the patients and employees of the

 

freestanding surgical outpatient facility without meeting the

 

specific requirements of the rules.

 

     (5) By January 15 each year, the department of community

 

health shall provide the following information to the department of

 

licensing and regulatory affairs:

 

     (a) From data received by the department of community health

 

through the abortion reporting requirements of section 2835, all of

 

the following:

 

     (i) The name and location of each facility at which abortions

 

were performed during the immediately preceding calendar year.

 

     (ii) The total number of abortions performed at that facility

 

location during the immediately preceding calendar year.

 

     (iii) The total number of surgical abortions performed at that

 

facility location during the immediately preceding calendar year.

 

     (b) Whether a facility at which surgical abortions were

 

performed in the immediately preceding calendar year publicly

 

advertises abortion services.

 

     (6) As used in this section:

 

     (a) "Abortion" means that term as defined in section 17015.

 

     (b) "Publicly advertises" means to advertise using directory

 

or internet advertising including yellow pages, white pages, banner

 

advertising, or electronic publishing.

 

     (c) "Surgical abortion" means an abortion that is not a

 

medical abortion as that term is defined in section 17017.

 

     Sec. 20142. (1) A health facility or agency shall apply for

 

licensure or certification on a form authorized and provided by the

 

department. The application shall include attachments, additional

 

data, and information required under this article and by the

 

department.

 

     (2) An applicant shall certify the accuracy of information

 

supplied in the application and supplemental statements.

 

     (3) An applicant or a licensee under part 213, or 217, or 218

 

shall disclose the names, addresses, principal occupations, and

 

official positions of all persons individuals who have an ownership

 

interest in the health facility or agency. If the health facility

 

or agency is located on or in leased real estate, the applicant or

 

licensee shall disclose the name of the lessor and any direct or

 

indirect interest the applicant or licensee has in the lease other

 

than as lessee. A change in ownership shall be reported to the

 

director not less than 15 days before the change occurs, except

 

that a person purchasing stock of a company registered pursuant to

 

the securities exchange act of 1934, 15 U.S.C. 78a to 78kk 15 USC

 

78a to 78pp, is exempt from disclosing ownership in the facility. A

 

person required to file a beneficial ownership report pursuant to

 

section 16(a) of the securities exchange act of 1934, 15 U.S.C. USC

 

78p shall file with the department information relating to

 

securities ownership required by the department rule or order. An

 

applicant or licensee proposing a sale of a nursing home to another

 

person shall provide the department with written, advance notice of

 

the proposed sale. The applicant or licensee and the other parties

 

to the sale shall arrange to meet with specified department

 

representatives and shall obtain before the sale a determination of

 

the items of noncompliance with applicable law and rules which

 

shall be corrected. The department shall notify the respective

 

parties of the items of noncompliance prior to the change of

 

ownership and shall indicate that the items of noncompliance must

 

be corrected as a condition of issuance of a license to the new

 

owner. The department may accept reports filed with the securities

 

and exchange commission relating to the filings. A person who

 

violates this subsection is guilty of a misdemeanor, punishable by

 

a fine of not more than $1,000.00 for each violation.

 

     (4) An applicant or licensee under part 217 shall disclose the

 

names and business addresses of suppliers who furnish goods or

 

services to an individual nursing home or a group of nursing homes

 

under common ownership, the aggregate charges for which exceed

 

$5,000.00 in a 12-month period which includes a month in a nursing

 

home's current fiscal year. An applicant or licensee shall disclose

 

the names, addresses, principal occupations, and official positions

 

of all persons individuals who have an ownership interest in a

 

business which that furnishes goods or services to an individual

 

nursing home or to a group of nursing homes under common ownership,

 

if both of the following apply:

 

     (a) The person individual, or the person's individual's

 

spouse, parent, sibling, or child has an ownership interest in the

 

nursing home purchasing the goods or services.

 

     (b) The aggregate charges for the goods or services purchased

 

exceeds $5,000.00 in a 12-month period which includes a month in

 

the nursing home's current fiscal year.

 

     (5) An applicant or licensee who makes a false statement in an

 

application or statement required by the department pursuant to

 

this article is guilty of a felony, punishable by imprisonment for

 

not more than 4 years, or a fine of not more than $30,000.00, or

 

both.

 

PART 218.

 

IN-HOME CARE SERVICES AGENCIES

 

     Sec. 21801. (1) For purposes of this part, the words and

 

phrases defined in sections 21803 to 21811 have the meanings

 

ascribed to them in those sections.

 

     (2) In addition, article 1 contains general definitions and

 

principles of construction applicable to all articles in this code

 

and part 201 contains definitions applicable to this part.

 

     Sec. 21803. (1) "Administrator" means an individual

 

responsible for managing the operation of an in-home care services

 

agency.

 

     (2) "Director of clinical services" means an individual

 

responsible for nursing, therapy, nutritional, social, and related

 

services that support the plan of care provided by an in-home care

 

services agency.

 

     (3) "Family" means individuals who are important to, and

 

designated by, the patient or client and who need not be relatives.

 

     Sec. 21805. (1) "Home health agency-certified" means an agency

 

that is certified by the federal government under title XVIII of

 

the social security act, 42 USC 1395 to 1395kkk-1, to provide home

 

health services.

 

     (2) "Home health aide services" means services provided by a

 

home health agency-certified or an in-home care services agency

 

and, if required by a rule or under a contract, provided under the

 

supervision of a registered nurse, physical therapist, occupational

 

therapist, speech therapist, or respiratory therapist who is

 

employed by or under contract to the home health agency-certified

 

or in-home care services agency. Home health aide services include

 

ambulation and exercise, assistance with self-administered

 

medications, reporting changes in a patient's or client's condition

 

and needs, completing appropriate records, and personal care or

 

homemaker services.

 

     (3) "Home health services" means services that include, but

 

are not limited to, nursing services, home health aide services,

 

physical therapy services, occupational therapy services, speech

 

therapy services, respiratory therapy services, nutritional

 

services, medical social services, and home medical supplies or

 

equipment services.

 

     Sec. 21807. (1) "Home medical equipment supplier" means an

 

organization that furnishes durable medical equipment, prosthetics,

 

and orthotics supplies and services, either directly or through a

 

contractual arrangement, to a patient or client in his or her

 

residence. To be eligible for licensure under this part, a home

 

medical equipment supplier shall comply with standards specified in

 

the general licensure regulations, including, but not limited to,

 

compliance with centers for medicare and medicaid supplier quality

 

standards governing the safety of home medical equipment services

 

supplier facilities, the safety and quality of home medical

 

equipment, and the safety, quality, and effectiveness of home

 

medical equipment service procedures; and shall maintain a physical

 

facility and medical equipment inventory.

 

     (2) "Home medical supplies or equipment services" means

 

diagnostic, treatment, and monitoring equipment and supplies

 

provided for the direct care of a patient or client in his or her

 

residence. Home medical supplies or equipment services include, but

 

are not limited to, the delivery, installation, maintenance,

 

replacement of, or instruction in the use of medical equipment and

 

related supplies used by a patient or client in his or her

 

residence.

 

     (3) "In-home care services" means skilled home health

 

services, personal care services, and other assistance provided to

 

a patient or client in his or her residence.

 

     (4) "In-home care services agency" means an organization that

 

does any of the following:

 

     (a) Administers or provides skilled home health services or

 

personal care services directly or through a contractual

 

arrangement to a patient or client in his or her residence.

 

     (b) For a fee provides only referrals of individuals to a

 

patient or client seeking skilled home health services or personal

 

care services in his or her residence.

 

     (c) Manages or schedules the delivery of skilled home health

 

services or personal care services to a patient or client in his or

 

her residence.

 

     Sec. 21809. (1) "Organization" means any individual, business,

 

firm, partnership, corporation, company, association, joint stock

 

association, or a public or private agency or entity, or the legal

 

successor of any of these, that employs or contracts with 2 or more

 

individuals to provide home health services.

 

     (2) "Personal care services" means assistance with activities

 

of daily living or activities of institutional daily living,

 

including, but not limited to, bathing, dressing, eating,

 

transferring, walking or mobility, toileting, and incontinence

 

care. Personal care services include housekeeping, personal

 

laundry, medication reminders, and companionship services furnished

 

to a patient or client in his or her residence and those normal

 

daily routines that the patient or client could perform for himself

 

or herself were he or she physically capable and that are intended

 

to enable the patient or client to remain safely and comfortably in

 

his or her residence. Personal care services are not services that

 

require the supervision of a licensed or certified health care

 

professional acting within the scope of his or her license or

 

certificate.

 

     (3) "Plan of care" means a written document based on an

 

assessment of a patient's or client's needs and preferences that

 

identifies home health services necessary to meet those needs and

 

preferences.

 

     Sec. 21811. (1) "Quality improvement" means reviewing and

 

evaluating appropriateness and effectiveness of home health

 

services provided under this part.

 

     (2) "Residence" means a place of permanent or temporary

 

residence or other residential environment.

 

     (3) "Skilled home health services" means health and medical

 

services furnished to a patient or client in his or her residence

 

that include wound care services, use of medical supplies including

 

drugs and biologicals prescribed by a physician, in-home infusion

 

services, nursing services, home health aide or certified nurse

 

aide services that require the supervision of a licensed or

 

certified health care professional acting within the scope of his

 

or her license or certificate, occupational therapy, physical

 

therapy, respiratory care services, dietetics and nutrition

 

counseling services, medical administration, medical social

 

services, and speech-language pathology services. Skilled home

 

health services do not include delivery of home medical supplies or

 

equipment services.

 

     (4) "Survey" means a visit for the purposes of survey,

 

evaluation, and consultation conducted by the department or other

 

person under section 20155 to evaluate and monitor an in-home care

 

services agency's compliance with this article.

 

     Sec. 21821. (1) Except as otherwise provided in this part, a

 

person shall not advertise, operate, manage, conduct, open, or

 

maintain an in-home care services agency without a license under

 

this part. This part applies to a nursing home, hospital, or other

 

organization that functions as a home health agency-certified, in-

 

home care services agency, or home medical equipment supplier. This

 

part applies to a health facility or agency otherwise licensed

 

under this article to the extent the facility or agency provides

 

home health services outside of its licensed premises.

 

     (2) Except as otherwise provided in this subsection, a person

 

shall not use any of the following titles, words, or phrases:

 

     (a) "Home health agency-certified", "visiting nurse", or "home

 

health services", in its corporate or business name, or advertise

 

using those titles, words, or phrases unless licensed to provide

 

those services under this part.

 

     (b) "Home medical equipment supplier", "home medical supplies

 

or equipment services", or "durable medical equipment, prosthetics,

 

orthotics, and supplies" in its corporate or business name, or

 

advertise using those titles, words, or phrases unless licensed to

 

provide those services under this part.

 

     (c) "In-home care services agency", in-home care agency, "in-

 

home services agency", or any similar titles, words, or phrases to

 

indicate that a person is a home health agency-certified, in-home

 

care services agency, or home medical equipment supplier in its

 

corporate or business name, or advertise using those titles, words,

 

or phrases unless licensed to provide those services under this

 

part.

 

     (3) An in-home care services agency shall not employ, contract

 

with, or grant clinical privileges to an individual who regularly

 

has direct access to or provides direct services to patients or

 

clients unless a criminal history check of that individual has been

 

conducted in compliance with section 20173a. An individual

 

disqualified or denied employment by an in-home care services

 

agency based on a criminal history check conducted under this

 

section may appeal in the manner provided in section 20173b.

 

     (4) An organization is not subject to the licensing

 

requirements of this part if all of the following requirements are

 

met:

 

     (a) The organization has and continuously maintains

 

accreditation from the commission on accreditation of

 

rehabilitation facilities. The organization shall immediately

 

notify the department if it fails to maintain its accreditation as

 

required under this subdivision.

 

     (b) The organization has performed a criminal history check of

 

individuals as described in subsection (3).

 

     (c) On a form and in the manner prescribed by the department,

 

the organization submits both of the following:

 

     (i) Documentation that it meets the requirements of

 

subdivisions (a) and (b).

 

     (ii) Payment of an amount equal to 1/4 of the licensing fee

 

established under section 21829 that would otherwise be required by

 

that organization to be licensed under this part.

 

     Sec. 21823. The following are not subject to licensure under

 

this part:

 

     (a) Family providing home health services or hospice care.

 

     (b) An organization that provides only meal services to a

 

patient or client in his or her residence.

 

     (c) An individual providing in-home care services through a

 

direct agreement with not more than 2 patients or clients in their

 

residences. The exception provided by this subdivision does not

 

apply to an individual who is employed by or under contract with an

 

in-home care services agency, who is referred to the patient or

 

client by an in-home care services agency, or whose schedule and

 

delivery of home health services to a patient or client are managed

 

by an in-home care services agency.

 

     (d) An organization that provides services through a contract

 

with a licensed agency as long as the contract establishes that it

 

is the licensed agency that holds overall responsibility for

 

services to a patient or client in his or her residence.

 

     (e) An employee or volunteer of a licensed agency who provides

 

home health services only as an employee or volunteer.

 

     (f) Except as otherwise provided in this part, facilities and

 

institutions that are licensed under this or any other state law,

 

including, but not limited to, nursing homes, hospitals, adult

 

foster care facilities, psychiatric facilities or intermediate care

 

facilities for people with mental retardation, or other licensed

 

facilities and institutions.

 

     (g) An individual providing care to patients or clients in

 

their residences through a contract with the department of human

 

services.

 

     (h) Nursing homes, hospitals, or other institutions, agencies,

 

organizations, or persons that contract with licensed home health

 

agency-certified, in-home care services agency, or home medical

 

equipment supplier for the delivery of all home health services.

 

     (i) In-home assessments of patients or clients that do not

 

result in regular ongoing care of that patient or client in his or

 

her residence.

 

     (j) Services conducted by and for the adherents of a church or

 

religious denomination that rely upon spiritual means alone through

 

prayer for healing in accordance with the tenets and practices of

 

that church or religious denomination and the bona fide religious

 

beliefs genuinely held by its adherents.

 

     (k) A medicare-approved dialysis center operating a medicare-

 

approved home dialysis program.

 

     (l) A person providing case management services. For the

 

purposes of this subdivision, "case management services" means the

 

assessment, coordination, authorization, planning, training, and

 

monitoring of home health and home care and does not include the

 

direct provision of health services to a patient or client.

 

     (m) A person who provides home health services without

 

compensation.

 

     Sec. 21825. (1) In addition to any other requirement for

 

application for licensure under part 201, an applicant for an in-

 

home care services agency license shall do all of the following:

 

     (a) Demonstrate ability to comply with this part and the rules

 

promulgated under this part.

 

     (b) Cooperate with any on-site survey.

 

     (c) Provide evidence of and maintain professional liability,

 

public liability, worker's disability compensation, and property

 

damage insurance in an amount established by the department, based

 

on industry standards.

 

     (d) File with the department a list of the home health

 

services, in-home care services, and home medical supplies or

 

equipment services provided directly and under contract.

 

     (e) Pay to the department the license fee required under

 

section 21829.

 

     (f) Demonstrate to the department's satisfaction that the

 

owners, operators, and members of the governing body, if any, of

 

the in-home care services agency are of good moral character.

 

     (2) Notwithstanding sections 20142 and 20164, a license under

 

this part is transferable due to change in ownership if approved by

 

the department. A licensee shall submit an application for a

 

transfer due to change in ownership not less than 30 days before

 

the transfer is scheduled to occur. Subject to section 21829, the

 

department shall charge a reasonable fee for processing an

 

application for a transfer due to change in ownership. The

 

department shall establish a transfer approval process to ensure

 

that applicants for transfer due to change in ownership of an

 

existing licensed in-home care services agency satisfy the intent

 

and requirements of this article.

 

     Sec. 21827. (1) Notwithstanding any other provision of this

 

act to the contrary, an in-home care services agency that is

 

certified by the federal medicare program, or accredited by an

 

accreditation organization recognized and utilized by the federal

 

medicare program for purpose of granting eligibility for enrolled

 

medicare providers, including, but not limited to, the community

 

health accreditation program, the joint commission, or the

 

accreditation commission for health care, is not subject to a

 

licensure survey under this part if all of the following

 

requirements are met:

 

     (a) The department determines that the applicable standards of

 

the certification or accreditation program are substantially

 

equivalent to those required by this article for a survey.

 

     (b) An on-site survey has been conducted for the purposes of

 

certification or accreditation during the previous 36 months or as

 

extended by the certifying or accrediting entity.

 

     (c) The department receives directly from the certifying or

 

accrediting entity or from the applicant copies of the initial and

 

subsequent survey reports and other relevant reports or findings

 

that indicate compliance with the requirements of this part.

 

     (2) Notwithstanding subsection (1), the department retains

 

authority to conduct a survey of service areas not addressed by the

 

national certifying or accrediting entity.

 

     (3) The department shall review the survey standards of the

 

entities identified in this section for substantial equivalency to

 

those set forth in this article. In the event that the department

 

determines at any time that the survey standards are not

 

substantially equivalent to those required by this article, the

 

department shall notify the affected licensees that they are

 

subject to a survey under this part. The notification shall contain

 

a detailed description of the deficiencies in the alternative

 

survey process, as well as an explanation of the risk to patients

 

or clients.

 

     (4) The department may perform a validation survey on in-home

 

care services agencies that previously received a survey through

 

certification or accreditation under this section. The department

 

may perform a validation survey on no greater than 10% of each type

 

of certification or accreditation survey.

 

     (5) This section does not affect the department's enforcement

 

authority for in-home care services agencies under this part.

 

     Sec. 21829. (1) An application for a license or license

 

renewal shall be accompanied by a fee, not to exceed $500.00 per

 

year, as established by the department. The department shall

 

promulgate rules to adopt a schedule of fees required under this

 

part. The department shall establish various fees based on a

 

sliding scale using such factors as the number of agency full-time

 

equivalents, geographic area served, number of locations, or type

 

and volume of home health services provided. For agencies receiving

 

a licensure survey that requires more than 2 on-site surveys by the

 

department per licensure period, an additional fee as determined by

 

the department under this subsection shall be charged for each

 

additional on-site survey. The department may set different fees

 

for each licensure category. Agencies receiving a license without

 

an on-site survey by the department under this part shall pay the

 

same license fee as other in-home care services agencies in their

 

licensure category. A fee for a transfer due to a change in

 

ownership shall not exceed 50% of the base licensure fee.

 

     (2) Subject to subsection (1), the department may establish a

 

late fee for failure to apply for licensure, transfer, or renewal

 

as required by this part.

 

     (3) The department shall forward fees collected under this

 

section to the state treasurer for deposit in the in-home care fund

 

created in section 21853.

 

     Sec. 21831. (1) Upon receipt of an application for a license

 

and the license fee, the department shall issue a license if the

 

applicant meets the requirements established under this part. A

 

license, unless suspended or revoked, is effective for a period of

 

3 years.

 

     (2) The department shall conduct a survey within each

 

licensure period and may conduct a licensure survey before or after

 

a transfer due to change in ownership as provided in section 21825.

 

     Sec. 21833. The Michigan board of skilled home health services

 

is created within the department. The Michigan board of personal

 

care services is created within the department. Each board created

 

in this section shall advise the department regarding the

 

promulgation of rules under section 21835 and the licensing of in-

 

home care services agencies. The director of the department shall

 

appoint members to each board created in this section. A member of

 

a board created in this section shall serve at the pleasure of the

 

director on a voluntary basis and shall serve without compensation.

 

At a minimum, each board created in this section shall consist of

 

representatives of all of the following:

 

     (a) In-home care services agencies.

 

     (b) Consumers of home health services.

 

     (c) Seniors who are consumers of home health services.

 

     (d) Medicaid services providers.

 

     (e) Skilled home health services providers.

 

     (f) Personal care services providers.

 

     (g) Representatives of the department and of the department of

 

human services.

 

     Sec. 21835. The department, in consultation with the boards

 

created in section 21833, shall promulgate rules necessary to

 

implement, administer, and enforce this part on or before July 1,

 

2014. In order to ensure safe and adequate care, the rules shall

 

address, at a minimum, all of the following:

 

     (a) Maintenance and preservation of all records relating

 

directly to the care and treatment of patients and clients by

 

licensees. However, a licensee shall not be required to do either

 

of the following:

 

     (i) Track or report disease outcomes or demographics of the

 

patients or clients served by the licensee.

 

     (ii) Purchase medical records software.

 

     (b) Establishment and implementation of a procedure for the

 

receipt, investigation, and disposition of complaints regarding

 

home health services provided.

 

     (c) Establishment and implementation of a plan for ongoing

 

care of patients and clients and preservation of records if the

 

licensee ceases operations.

 

     (d) Supervision of home health services. A licensee shall not

 

be required to employ or contract the services of a licensed health

 

care professional unless the licensee is providing skilled home

 

health services that require the supervision of a licensed health

 

care professional.

 

     (e) Establishment and implementation of written policies

 

regarding response to referrals and access to home health services.

 

     (f) Establishment and implementation of written personnel

 

policies, procedures, and personnel records for paid staff that

 

provide for prehire screening, including criminal history check and

 

testing for communicable diseases, minimum qualifications, regular

 

performance evaluations that include observation in the patient's

 

or client's residence, participation in orientation and in-service

 

training, and involvement in quality improvement activities. The

 

department shall not establish experience, certification,

 

licensure, or other qualifications for in-home services agency

 

personnel or contractors beyond that required by federal or state

 

law.

 

     (g) Establishment and implementation of written policies and

 

procedures for volunteers who have direct access to or provide

 

direct services to patients or clients and that provide for

 

criminal history and health screening, orientation, and

 

supervision.

 

     (h) Establishment and implementation of written policies for

 

obtaining regular reports on patient or client satisfaction.

 

     (i) Establishment and implementation of a quality improvement

 

process.

 

     (j) Establishment and implementation, if appropriate, of

 

policies related to the delivery of skilled home health services

 

and personal care services, including all of the following:

 

     (i) Plan of care for each patient or client served.

 

     (ii) Periodic review of the plan of care.

 

     (iii) Supervision of care and clinical consultation as

 

necessary.

 

     (iv) Care consistent with the plan of care.

 

     (v) Admission, transfer, and discharge from care.

 

     (k) Establishment and implementation of policies related to

 

in-home services agency implementation and oversight of delegation

 

of licensed health professionals.

 

     (l) Compliance with all other applicable state and federal

 

laws.

 

     (m) Establishment of policies to ensure that the in-home care

 

services agency's caregivers are bonded or insured, or both as

 

applicable, and that the agency is responsible for payment of all

 

required employment taxes and liability and worker's disability

 

compensation insurance.

 

     (n) Establishment and implementation of training requirements

 

for in-home caregivers.

 

     Sec. 21837. The department shall continue to develop, with

 

cooperation and input from the state trade associations

 

representing the home health services industry, interpretive

 

guidelines that are specific to each type of home health service

 

and consistent with this part. The process for such continuing

 

developments shall provide opportunity for comment from licensees.

 

     Sec. 21839. (1) An in-home care services agency shall provide

 

each patient or client or the patient's or client's designated

 

representative with a copy of the policy established under section

 

20201 and this section describing the rights and responsibilities

 

of patients and clients served by the in-home care services agency.

 

If a conflict exists between a requirement of this section and

 

section 20201, the requirement of this section prevails. The policy

 

shall include, at a minimum, all of the following:

 

     (a) A listing of the home health services offered by the in-

 

home care services agency and those being provided.

 

     (b) The names of the administrator and the director of

 

clinical services and the manner in which those individuals may be

 

contacted.

 

     (c) The job title of the individual supervising the patients'

 

or clients' care and the manner in which that individual may be

 

contacted.

 

     (d) The state complaint hotline number and the appropriate

 

certifying or accrediting entity's hotline number.

 

     (e) That the patient or client or the patient's or client's

 

designated representative may participate on an ongoing basis in

 

the development of the plan of care.

 

     (f) That the patient or client or the patient's or client's

 

designated representative may select any licensee to provide home

 

health services, subject to the patient's or client's reimbursement

 

mechanism or other relevant contractual obligations.

 

     (g) That the patient or client will be treated with courtesy,

 

respect, privacy, and freedom from abuse and discrimination.

 

     (h) That the patient or client will have his or her property

 

treated with respect.

 

     (i) That the patient or client may request and be provided a

 

fully itemized billing statement, including the date of each

 

service and the charge. Licensees providing services through a

 

managed care plan, medicare, medicaid, or other third-party payer

 

are not required to provide itemized billing statements unless

 

there are applicable copayments, coinsurances, or deductibles.

 

     (j) That the patient or client, in compliance with 42 USC

 

1395cc, will receive information about his or her right to execute

 

an advance health care directive or durable power of attorney and

 

designation of patient advocate and the in-home care services

 

agency's responsibility to implement those documents.

 

     (k) That the patient or client will be informed that the in-

 

home care services agency's caregivers have extensive training,

 

that the agency's caregivers are supervised, that the agency's

 

caregivers have undergone a criminal history check, and that the

 

agency's caregivers are tested for tuberculosis and other

 

communicable diseases.

 

     (l) That the agency ensures that all employment laws are

 

followed, that the agency's caregivers are bonded or insured, or

 

both as applicable, and that the agency is responsible for payment

 

of all required federal and state employment taxes and liability

 

and worker's disability compensation insurance.

 

     (2) An in-home care services agency shall treat patients and

 

clients in accordance with the policy established under section

 

20201 and this section. An in-home care services agency shall

 

implement and update its policy as appropriate.

 

     Sec. 21841. In addition to the authority under section 20165

 

to deny, limit, suspend, or revoke a license under this part or

 

impose an administrative fine, the department may require a refund

 

of any amounts billed to, and collected from, the patient or client

 

or third-party payer in any case in which the department determines

 

that any of the violations described in section 20165(1) or (2)

 

have occurred.

 

     Sec. 21843. (1) Notwithstanding section 20155, the department

 

may at any time conduct a survey of all records and operations of a

 

licensee in order to determine compliance with this part.

 

Additionally, the department may conduct visits to observe care and

 

services to a patient or client in his or her residence. The right

 

to conduct a survey shall extend to any premises and records of

 

persons who the department has reason to believe are providing home

 

health services without a license in violation of this part.

 

     (2) Following a survey under this section, the department

 

shall proceed in the manner prescribed in part 201 with regard to

 

notice, right to hearing, and final determination of the matter. If

 

requested, the licensee shall submit to the department a written

 

plan of correction within the time frame designated on the notice.

 

The department shall provide the licensee with written notice of

 

the acceptance of the written plan of correction, or any changes

 

necessary in order for the written plan of correction to be

 

acceptable to the department.

 

     Sec. 21845. Any penalties or remedies provided in this part or

 

part 201 are independent and cumulative and not exclusive. Neither

 

the department nor any other person is limited to the penalties and

 

remedies in this part or part 201. The use of a penalty or remedy

 

by a person shall not be considered a bar to the use of other

 

penalties or remedies by that person or to the use of any penalty

 

or remedy by another person.

 

     Sec. 21847. (1) A person who violates this part by operating

 

an in-home care services agency without a license is guilty of a

 

misdemeanor. Each day of the violation is considered a separate

 

violation.

 

     (2) If the person who violates this part by operating an in-

 

home care services agency without a license is a corporation, it

 

may be punished by forfeiture of its corporate charter and all

 

rights and franchises under that charter.

 

     (3) A person who violates this part by operating an in-home

 

care services agency without a license is subject to an

 

administrative fine of up to the amount of the applicable license

 

fee for each violation or each day that a violation continues. If

 

the department has reasonable cause to believe that a person has

 

violated this part, the department may issue a citation after

 

discovery of the alleged violation. The citation shall be written

 

and shall state with particularity the nature of the violation as

 

required by the administrative procedures act of 1969. An alleged

 

violator may request an administrative hearing pursuant to the

 

administrative procedures act of 1969. The department shall forward

 

administrative fines collected under this section to the state

 

treasurer for deposit in the in-home care fund created in section

 

21853.

 

     Sec. 21849. (1) The department may order a person to cease and

 

desist from engaging in the unlicensed operation of an in-home care

 

services agency. The person ordered to cease and desist is entitled

 

to a hearing before a hearings examiner if the person files a

 

written request for a hearing within 20 days after the effective

 

date of the cease and desist order. The failure to request a

 

hearing constitutes a default, whereupon the department may enter a

 

permanent cease and desist order and proceed in the manner

 

prescribed in section 20165.

 

     (2) Upon a violation of a cease and desist order issued under

 

subsection (1), the department of attorney general may apply in

 

circuit court to restrain and enjoin, temporarily or permanently,

 

an individual from further violating the cease and desist order.

 

     Sec. 21851. A person who violates this part by operating an

 

in-home care services agency without a license is also subject to

 

the Michigan consumer protection act, 1976 PA 331, MCL 445.901 to

 

445.922, because the operation of an in-home care services agency

 

without a license in violation of this part is not reasonable in

 

relation to the development and preservation of business and is an

 

unfair, unconscionable, or deceptive method, act, or practice in

 

the conduct of trade or commerce.

 

     Sec. 21853. (1) The in-home care fund is created within the

 

state treasury.

 

     (2) The state treasurer may receive money or other assets from

 

any source for deposit into the in-home care fund. The state

 

treasurer shall direct the investment of the in-home care fund. The

 

state treasurer shall credit to the in-home care fund interest and

 

earnings from fund investments. Money in the in-home care fund at

 

the close of the fiscal year shall remain in the in-home care fund

 

and shall not lapse to the general fund.

 

     (3) The department is the administrator of the in-home care

 

fund for auditing purposes. The department shall expend money from

 

the in-home care fund, upon appropriation, only for the direct and

 

indirect costs of the department in administering this part. The

 

department shall ensure that expenditures under this subsection are

 

related to in-home care needs.

 

     Enacting section 1. This amendatory act takes effect January

 

1, 2014.