Bill Text: MO HB781 | 2013 | Regular Session | Engrossed
Bill Title: Changes the laws regarding MO HealthNet-funded home- and community-based care
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2013-05-13 - Public Hearing Held (S) [HB781 Detail]
Download: Missouri-2013-HB781-Engrossed.html
FIRST REGULAR SESSION
[PERFECTED]
HOUSE COMMITTEE SUBSTITUTE FOR
97TH GENERAL ASSEMBLY
1934H.03P D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 208.895 and 660.315, RSMo, and to enact in lieu thereof three new sections relating to MO HealthNet-funded home- and community-based care.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 208.895 and 660.315, RSMo, are repealed and three new sections enacted in lieu thereof, to be known as sections 208.895, 208.960, and 660.315, to read as follows:
208.895. 1. Upon the receipt of a [properly completed] referral for service for MO HealthNet-funded home- and community-based care [containing a nurse assessment] or a physician's order, the department of health and senior services [may] shall:
(1) [Review the recommendations regarding services and] Process the referral within fifteen business days;
(2) [Issue a prior-authorization for home and community-based services when information contained in the referral is sufficient to establish eligibility for MO HealthNet-funded long-term care and determine the level of service need as required under state and federal regulations;
(3)] Arrange for the provision of services by [an in-home] a home- and community-based provider;
[(4) Reimburse the in-home provider for one nurse visit to conduct an assessment and recommendation for a care plan and, where necessary based on case circumstances, a second nurse visit may be authorized to gather additional information or documentation necessary to constitute a completed referral;
(5) Notify the referring entity upon the authorization of MO HealthNet eligibility and provide MO HealthNet reimbursement for personal care benefits effective the date of the assessment or physician's order, and MO HealthNet reimbursement for waiver services effective the date the state reviews and approves the care plan;
(6)] (3) Notify the referring entity within five business days of receiving the referral if additional information is required to process the referral; [and
(7) Inform the provider and contact the individual when information is insufficient or the proposed care plan requires additional evaluation by state staff that is not obtained from the referring entity to schedule an in-home assessment to be conducted by the state staff within thirty days]
(4) Inform the applicant of:
(a) The full range of available MO HealthNet home- and community-based services, including, but not limited to, adult day care services, home-delivered meals, and the benefits of self-direction and agency model services;
(b) The choice of home- and community-based service providers in the applicant’s area, and that some providers conduct their own assessments, but that choosing a provider who does not conduct assessments will not delay delivery of services; and
(c) The option to choose more than one home- and community-based service provider to deliver or facilitate the services the applicant is qualified to receive;
(5) Prioritize the referrals received, giving the highest priority to referrals for high-risk individuals, followed by individuals who are alleged to be victims of abuse or neglect as a result of an investigation initiated from the elder abuse and neglect hotline, and then followed by individuals who have not selected a provider or who have selected a provider that does not conduct assessments; and
(6) Notify the referring entity and the applicant within ten business days of receiving the referral if it has not scheduled the assessment.
2. If the department of health and senior services [may contract for initial home- and community-based assessments, including a care plan, through an independent third-party assessor. The contract] has not complied with subsection 1 of this section, a provider has the option of completing an assessment and care plan recommendation. At such time that the department approves or modifies the assessment and care plan, the care plan shall become effective; such approval or modification shall occur within five business days after receipt of the assessment and care plan from the provider. If such approval, modification, or denial by the department does not occur within five business days, the provider’s care plan shall be approved and payment shall begin no later than five business days after receipt of the assessment and care plan from the provider. The department shall [include a requirement that:
(1) Within fifteen days of receipt of a referral for service, the contractor shall have made a face-to-face assessment of care need and developed a plan of care; and
(2) The contractor] notify the referring entity [within five days] or individual of receipt of referral if additional information is needed to process the referral. [The contract shall also include the same requirements for such assessments as of January 1, 2010, related to timeliness of assessments and the beginning of service. The contract shall be bid under chapter 34 and shall not be a risk-based contract.]
3. The two nurse visits authorized by subsection 16 of section 660.300 shall continue to be performed by home- and community-based service providers for including, but not limited to, reassessment and level of care recommendations. [These reassessments and care plan changes shall be reviewed and approved by the independent third-party assessor. In the event of dispute over the level of care required, the third-party assessor shall conduct a face-to-face review with the client in question.]
4. [The provisions of this section shall expire August 28, 2013] At such time that the department approves or modifies the assessment and care plan, the latest approved care plan shall become effective.
5. The department’s auditing of home- and community-based service providers shall include a review of the client plan of care and provider assessments, and choice and communication of home- and community-based service provider service options to individuals seeking MO HealthNet services. Such auditing shall be conducted utilizing a statistically valid sample. The department shall also make publicly available a review of its process for informing participants of service options within MO HealthNet home- and community-based service provider services and information on referrals.
6. For purposes of this section:
(1) “Assessment” means a face-to-face determination that a MO HealthNet participant is eligible for home- and community-based services and:
(a) Is conducted by an assessor trained to perform home- and community-based care assessments;
(b) Uses forms provided by the department;
(c) Includes unbiased descriptions of each available service within home- and community-based services with a clear person-centered explanation of the benefits of each home- and community-based service, whether the applicant qualifies for more than one service and ability to choose more than one provider to deliver or facilitate services; and
(d) Informs the applicant, either by the department or the provider conducting the assessment, that choosing a provider or multiple providers that do not conduct their own assessments will in no way affect the quality of service or the timeliness of the applicant’s assessment and authorization process;
(2) A “referral” shall contain basic information adequate for the department to contact the client or person needing service. At a minimum, the referral shall contain:
(a) The stated need for MO HealthNet home- and community-based services;
(b) The name, date of birth, and Social Security number of the client or person needing service, or the client’s or person’s MO HealthNet number; and
(c) The physical address and phone number of the client or person needing services.
Additional information which may assist the department may also be submitted.
7. The department shall:
(1) Develop an automated electronic assessment care plan tool to be used by providers; and
(2) Make recommendations to the general assembly by January 1, 2014, for the implementation of the automated electronic assessment care plan tool.
8. At the end of the first year of this plan being in effect, the department of health and senior services shall prepare a report for the appropriation committee for health, mental health and social services or a committee appointed by the speaker to review the following:
(1) How well the department is doing on meeting the fifteen-day requirement;
(2) The process the department used to approve the assessors;
(3) Financial data on the cost of the program prior to and after enactment of this section;
(4) Any audit information available on assessments performed outside the department; and
(5) The department’s staffing policies implemented to meet the fifteen-day assessment requirement.
208.960. Health care professionals licensed under chapter 331 shall be reimbursed under the MO HealthNet program for providing services currently covered under section 208.152 and within the scope of practice under section 331.010.
660.315. 1. After an investigation and a determination has been made to place a person's name on the employee disqualification list, that person shall be notified in writing mailed to his or her last known address that:
(1) An allegation has been made against the person, the substance of the allegation and that an investigation has been conducted which tends to substantiate the allegation;
(2) The person's name will be included in the employee disqualification list of the department;
(3) The consequences of being so listed including the length of time to be listed; and
(4) The person's rights and the procedure to challenge the allegation.
2. If no reply has been received within thirty days of mailing the notice, the department may include the name of such person on its list. The length of time the person's name shall appear on the employee disqualification list shall be determined by the director or the director's designee, based upon the criteria contained in subsection 9 of this section.
3. If the person so notified wishes to challenge the allegation, such person may file an application for a hearing with the department. The department shall grant the application within thirty days after receipt by the department and set the matter for hearing, or the department shall notify the applicant that, after review, the allegation has been held to be unfounded and the applicant's name will not be listed.
4. If a person's name is included on the employee disqualification list without the department providing notice as required under subsection 1 of this section, such person may file a request with the department for removal of the name or for a hearing. Within thirty days after receipt of the request, the department shall either remove the name from the list or grant a hearing and set a date therefor.
5. Any hearing shall be conducted in the county of the person's residence by the director of the department or the director's designee. The provisions of chapter 536 for a contested case except those provisions or amendments which are in conflict with this section shall apply to and govern the proceedings contained in this section and the rights and duties of the parties involved. The person appealing such an action shall be entitled to present evidence, pursuant to the provisions of chapter 536, relevant to the allegations.
6. Upon the record made at the hearing, the director of the department or the director's designee shall determine all questions presented and shall determine whether the person shall be listed on the employee disqualification list. The director of the department or the director's designee shall clearly state the reasons for his or her decision and shall include a statement of findings of fact and conclusions of law pertinent to the questions in issue.
7. A person aggrieved by the decision following the hearing shall be informed of his or her right to seek judicial review as provided under chapter 536. If the person fails to appeal the director's findings, those findings shall constitute a final determination that the person shall be placed on the employee disqualification list.
8. A decision by the director shall be inadmissible in any civil action brought against a facility or the in-home services provider agency and arising out of the facts and circumstances which brought about the employment disqualification proceeding, unless the civil action is brought against the facility or the in-home services provider agency by the department of health and senior services or one of its divisions.
9. The length of time the person's name shall appear on the employee disqualification list shall be determined by the director of the department of health and senior services or the director's designee, based upon the following:
(1) Whether the person acted recklessly or knowingly, as defined in chapter 562;
(2) The degree of the physical, sexual, or emotional injury or harm; or the degree of the imminent danger to the health, safety or welfare of a resident or in-home services client;
(3) The degree of misappropriation of the property or funds, or falsification of any documents for service delivery of an in-home services client;
(4) Whether the person has previously been listed on the employee disqualification list;
(5) Any mitigating circumstances;
(6) Any aggravating circumstances; and
(7) Whether alternative sanctions resulting in conditions of continued employment are appropriate in lieu of placing a person's name on the employee disqualification list. Such conditions of employment may include, but are not limited to, additional training and employee counseling. Conditional employment shall terminate upon the expiration of the designated length of time and the person's submitting documentation which fulfills the department of health and senior services' requirements.
10. The removal of any person's name from the list under this section shall not prevent the director from keeping records of all acts finally determined to have occurred under this section.
11. The department shall provide the list maintained pursuant to this section to other state departments upon request and to any person, corporation, organization, or association who:
(1) Is licensed as an operator under chapter 198;
(2) Provides in-home services under contract with the department;
(3) Employs nurses and nursing assistants for temporary or intermittent placement in health care facilities;
(4) Is approved by the department to issue certificates for nursing assistants training;
(5) Is an entity licensed under chapter 197;
(6) Is a recognized school of nursing, medicine, or other health profession for the purpose of determining whether students scheduled to participate in clinical rotations with entities described in subdivision (1), (2), or (5) of this subsection are included in the employee disqualification list; or
(7) Is a consumer reporting agency regulated by the federal Fair Credit Reporting Act that conducts employee background checks on behalf of entities listed in subdivisions (1), (2), (5), or (6) of this subsection. Such a consumer reporting agency shall conduct the employee disqualification list check only upon the initiative or request of an entity described in subdivisions (1), (2), (5), or (6) of this subsection when the entity is fulfilling its duties required under this section. The information shall be disclosed only to the requesting entity.
The department shall inform any person listed above who inquires of the department whether or not a particular name is on the list. The department may require that the request be made in writing. No person, corporation, organization, or association who is entitled to access the employee disqualification list may disclose the information to any person, corporation, organization, or association who is not entitled to access the list. Any person, corporation, organization, or association who is entitled to access the employee disqualification list who discloses the information to any person, corporation, organization, or association who is not entitled to access the list shall be guilty of an infraction.
12. No person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) to (7) of subsection 11 of this section shall knowingly employ any person who is on the employee disqualification list. Any person, corporation, organization, or association who received the employee disqualification list under subdivisions (1) to (7) of subsection 11 of this section, or any person responsible for providing health care service, who declines to employ or terminates a person whose name is listed in this section shall be immune from suit by that person or anyone else acting for or in behalf of that person for the failure to employ or for the termination of the person whose name is listed on the employee disqualification list.
13. Any employer [who is] or vendor as defined in sections 197.250, 197.400, 198.006, 208.900, or 660.250 required to [discharge an employee because the employee was placed on a disqualification list maintained by the department of health and senior services after the date of hire] deny employment to an applicant or to discharge an employee, provisional or otherwise, as a result of information obtained through any portion of the background screening and employment eligibility determination process under section 210.903, or subsequent, periodic screenings, shall not be liable in any action brought by the applicant or employee relating to discharge where the employer is required by law to terminate the employee, provisional or otherwise, and shall not be charged for unemployment insurance benefits based on wages paid to the employee for work prior to the date of discharge, pursuant to section 288.100[.] , if the employer terminated the employee because the employee: (1) Has been found guilty, pled guilty or nolo contendere in this state or any other state of a crime as listed in subsection 6 of section 660.317;
(2) Was placed on the employee disqualification list under this section after the date of hire;
(3) Was placed on the employee disqualification registry maintained by the department of mental health after the date of hire;
(4) Has a disqualifying finding under this section, section 660.317, or is on any of the background check lists in the family care safety registry under sections 210.900 to 210.936; or
(5) Was denied a good cause waiver as provided for in subsection 10 of section 660.317.
The benefits paid to the employee shall not be attributable to service in the employ of the employer required to discharge an employee under the provisions of this subdivision and shall be deemed as such under the unemployment compensation laws of this state.
14. Any person who has been listed on the employee disqualification list may request that the director remove his or her name from the employee disqualification list. The request shall be written and may not be made more than once every twelve months. The request will be granted by the director upon a clear showing, by written submission only, that the person will not commit additional acts of abuse, neglect, misappropriation of the property or funds, or the falsification of any documents of service delivery to an in-home services client. The director may make conditional the removal of a person's name from the list on any terms that the director deems appropriate, and failure to comply with such terms may result in the person's name being relisted. The director's determination of whether to remove the person's name from the list is not subject to appeal.
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