Bill Text: PA HB2159 | 2009-2010 | Regular Session | Introduced

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Bill Title: Establishing an informal dispute resolution process for long-term care nursing facilities and an informal dispute resolution panel within the Department of Health; and providing for membership of the panel, for the scope of informal resolution review and for data collection.

Spectrum: Slight Partisan Bill (Republican 14-5)

Status: (Introduced - Dead) 2009-12-09 - Referred to AGING AND OLDER ADULT SERVICES [HB2159 Detail]

Download: Pennsylvania-2009-HB2159-Introduced.html

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PRINTER'S NO. 2994
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 2159 Session of2009
INTRODUCED BY STERN, MUNDY, FLECK, GEIST, GINGRICH, HESS, HORNAMAN, KAUFFMAN, MAJOR, MOUL, MURT, O'NEILL, PHILLIPS, READSHAW, SIPTROTH, SWANGER, VULAKOVICH, WATSON AND YOUNGBLOOD, DECEMBER 9, 2009
REFERRED TO COMMITTEE ON AGING AND OLDER ADULT SERVICES, DECEMBER 9, 2009
AN ACT
Establishing an informal dispute resolution process for long-
term care nursing facilities and an informal dispute
resolution panel within the Department of Health; and
providing for membership of the panel, for the scope of
informal resolution review and for data collection.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Long-Term
Care Nursing Facility Informal Dispute Resolution Act.
Section 2. Purpose.
The purpose of this act is to give long-term care nursing
facilities the opportunity to refute deficiencies cited in a
department survey.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Deficiency." A long-term care nursing facility's failure to
meet a requirement of the Social Security Act (49 Stat. 620, 42
U.S.C. § 301 et seq.), 42 CFR Pt. 483 Subpt. B (relating to
requirements for states and long term care facilities), the act
of July 19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act, or 28 Pa. Code Pt. IV Subpt. C (relating to
long-term care facilities).
"Department." The Department of Health of the Commonwealth.
"Facility." A long-term care nursing facility.
"Findings." Examples of noncompliance noted on a statement
of deficiencies.
"IDR." Informal dispute resolution as provided for in this
act.
"Immediate jeopardy." A situation in which a deficiency has
caused or is likely to cause serious injury to, harm to,
impairment of or death of a resident.
"Long-term care nursing facility." A facility that provides
either skilled or intermediate nursing care or both levels of
care to more than one patient unrelated to the licensee for a
period exceeding 24 hours. The term does not include an
intermediate care facility exclusively for the mentally
retarded, commonly called ICF/MR.
"Panel." The informal dispute resolution panel established
in section 4(a).
"Plan of correction." A facility's response to deficiencies
which explains how corrective action will be accomplished, how
the facility will identify other residents who might be affected
by the deficient practice, what measures will be used or
systemic changes made to ensure that the deficient practice will
not recur and how the facility will monitor to ensure that
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solutions are sustained.
"Qualified geriatrician." A physician who meets the
requirements of the American Medical Directors Certification
Program and:
(1) is a certified medical director; or
(2) has successfully completed a geriatric fellowship
approved by the American Geriatrics Society.
"Remedies." Enforcement actions, including termination of a
provider agreement with Medicare, Medicaid, or both; denial of
payment for new admissions; denial of payment for all residents;
imposition of a temporary manager; civil money penalties;
monitoring; directed plan of correction; directed in-service
training or other alternative enforcement actions.
"Scope." The degree to which a pattern or widespread
deficiencies throughout a facility are isolated.
"Severity." Whether deficiencies constitute:
(1) no actual harm with potential for minimal harm;
(2) no actual harm with a potential for more than
minimal harm, but not immediate jeopardy;
(3) actual harm which is not immediate jeopardy; or
(4) immediate jeopardy to resident health or safety.
"Statement of deficiencies." Written notice by the
department to a facility specifying the deficiencies found upon
inspection.
"Substandard quality of care." A deficiency relating to
requirements for resident behavior and facility practice,
quality of life or quality of care which constitutes:
(1) immediate jeopardy to resident health or safety;
(2) a pattern of or widespread actual harm which is not
immediate jeopardy; or
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(3) a widespread potential for more than minimal harm,
but less than immediate jeopardy, with no actual harm.
"Survey." An inspection of a facility conducted by
representatives of the department in accordance with procedures
outlined in Chapter 7 of the Federal State Operations Manual,
relating to survey and enforcement process for skilled nursing
facilities and nursing facilities.
Section 4. Informal dispute resolution process.
(a) Establishment of panel.--The department shall establish
an informal dispute resolution panel to determine whether a
cited deficiency as evidenced by a statement of deficiencies
against a facility should be upheld.
(b) Minimum requirements of process.--The department shall
promulgate regulations which shall incorporate by reference the
provisions of 42 CFR § 488.331 (relating to informal dispute
resolution) and shall contain the following minimum requirements
of the IDR process:
(1) Within ten business days of the end of the survey,
the department shall transmit to the facility a statement of
deficiencies committed by the facility, by certified mail or
the department intranet, if the facility is connected to the
intranet.
(2) Within ten days of receipt of the statement of
deficiencies, the facility shall return a plan of correction
to the department. The facility may request an IDR conference
to refute the deficiencies cited in the statement of
deficiencies. The request must be submitted in writing within
the same ten-day period that the facility has for submission
of the plan of correction.
(3) Within 14 days of receipt of the request for an IDR
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conference made by a facility, the panel shall hold the IDR
conference. The IDR conference shall afford the facility the
opportunity to provide additional information or
clarification in support of the facility's contention that
the deficiencies were erroneously cited. This opportunity
shall be at the option of the facility:
(i) a review of written information submitted by the
facility; or
(ii) either a conference call or a face-to-face
meeting at the headquarters office of the Division of
Nursing Care Facilities.
(4) Within five calendar days of the IDR conference, the
panel shall make a determination, based upon the facts and
findings presented, and shall transmit the decision to the
facility.
(5) If the panel rules that the original statement of
deficiencies should be changed as a result of the conference,
the department shall transmit a revised statement of
deficiencies to the facility with the notification of the
determination.
(6) Within ten calendar days of receipt of the
determination made by the department and the revised
statement of deficiencies, the facility shall submit a plan
of correction to the department.
(7) The department may not post on its Internet website
or enter into the Centers for Medicare and Medicaid Services
Online Survey, Certification and Reporting System any
information about deficiencies which are in dispute unless
the dispute determination is made and the facility has
responded with a revised plan of correction, if needed.
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Section 5. Informal dispute resolution panel.
(a) Membership.--The panel shall consist of three members
who shall be separate from the Informal Dispute Resolution Unit
within the Division of Nursing Care Facilities of the
department. Panel members must meet the minimum surveyor
qualifications, and at least one of the members must be a
registered nurse. A member of the State Board of Examiners of
Nursing Home Administrators shall be an ex-officio member of the
panel.
(b) Qualified geriatrician.--If a deficiency under dispute
involves physician decision making, the panel shall consult with
a qualified geriatrician to provide information and
recommendations regarding physician practice.
(c) Additional consultants.--Additional consultants,
requested by the panel or the facility, may be consulted if
specific expertise is needed to address deficiencies under
dispute.
(d) Panel decisions.--A decision of the panel shall be
forwarded to the director of the Bureau of Facility Licensure
and Certification who shall notify the facility of the decision.
Section 6. Scope of informal dispute resolution review.
(a) Matters not subject to challenge.--A facility may not
challenge:
(1) the scope and severity assessments of deficiencies,
except for the scope and severity assessments which
constitute substandard quality of care or immediate jeopardy;
(2) remedies imposed;
(3) alleged failure of a survey team to comply with a
requirement of the survey process;
(4) alleged inconsistency of the survey team in citing
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deficiencies among facilities; or
(5) alleged inadequacy or inaccuracy of the IDR process.
(b) Matters subject to challenge.--A facility may challenge
individual findings which lead to the assessment of scope and
severity.
Section 7. Data collection.
The department shall collect and maintain data regarding:
(1) The number of IDR requests made on an annual basis.
(2) The number of written reviews.
(3) The number of conference calls and face-to-face
meetings under section 4(b)(3)(ii).
(4) The number of requests in which no change was made.
(5) The number of requests in which a deficiency was
removed.
(6) The number of requests in which a deficiency was
downgraded.
This information shall also be maintained per deficiency.
Section 20. Effective date.
This act shall take effect in 60 days.
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