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.