Chapter
249
2005 -- H 6550 SUBSTITUTE A
Enacted 07/08/05
A N A C T
RELATING TO HEALTH
AND SAFETY -- THE LONG-TERM CARE REFORM ACT OF
2005 -- NURSING
FACILITY QUALITY IMPROVEMENT
Introduced By: Representatives McNamara, Kennedy, Faria, Church, and Rice
Date Introduced: May 26,
2005
It is
enacted by the General Assembly as follows:
SECTION 1. Legislative purpose and intent. The legislature is committed to ensuring the
highest
quality of long-term care for the state's most vulnerable and frail
populations: or elderly
and
persons with disabilities. The recent closure of Hillside Health Center, a
nursing facility
located
in Providence, was precipitated not only by a history of problems in meeting
federal and
state
nursing facility licensing standards but also financial instability which led
to eventual
insolvency.
Two recently released reports, one by the state Long-Term Care Coordinating
Council's
Task Force on Nursing Facility Closures, entitled "Hillside Health Center:
Doors
Closed,
Lessons Learned" and one prepared for the Governor by the state Office of
Health and
Human
Services, entitled "Review of Department of Health's Response to the
Quality of Care at
Hillside
Health Center," showed critical deficiencies in the care provided to a
number of residents
at
Hillside Health Center, specifically including resident Germaine Morsilli
(referred to as
resident
number "1" in certain state department of health survey reports). These
reports also
pointed
to serious gaps and weaknesses in state oversight of nursing facilities and the
state's
ability
to safeguard the health and well-being of nursing facility residents. The
purpose of this act
is to
adopt further requirements to strengthen state oversight of nursing facilities,
to improve
quality
of care of nursing facility residents, to prevent future residents from
suffering serious
harm
such as that experienced by Germaine Morsilli, and prevent the trauma faced by
other
residents
and families when Hillside Health Center was forced to close.
SECTION
2. This act shall be known as the "Germaine Morsilli Nursing Facility
Quality
Improvement
and Reform Act."
SECTION
3. Sections 5-45-3 and 5-45-12 of the General Laws in Chapter 5-45 entitled
"Nursing
Home Administrators" are hereby amended to read as follows:
5-45-3.
Board of examiners -- Functions. -- (a) It is the function of the board
to:
(1) Conduct examinations as required by the department and to act in an
advisory
capacity
to the department in all matters pertaining to the licensing of nursing home
administrators;
(2) Develop and apply appropriate techniques, including examinations and
investigations,
for determining whether an individual meets those standards, subject to the
approval
of the director;
(3) Recommend to the department the issuance of licenses and registrations to
individuals
determined, after application of those techniques, to meet those standards; and
to
recommend
to the director the revocation or suspension of licenses or registrations
previously
issued;
and to recommend disciplinary action to be taken against a nursing home
administrator,
including
placing a licensee on probation, and ordering continuing education or
professional
mentoring
by nursing facility professionals in
any case where the individual holding that license
or
registration is determined substantially to have failed to conform to the
requirements of those
standards
or when a nursing facility under the administrator's control has been found
on its
survey
to have continued poor performance or is repeatedly unable to remain in
compliance with
standards; and
(4) Adopt, on or before January 1, 1995, with the approval of the director of
the
department
of health, rules and regulations governing a mandatory program of continuing
education
for nursing home administrators.
(b) Programs for continuing education for nursing facility administrators may
be
presented
by:
(1) The Rhode Island Health Care Association;
(2) The Rhode Island Association of Facilities for the Aging;
(3) The American College of Health Care Administrators;
(4) The Alliance for Better Nursing Home Care;
(5) Nationally recognized associations of the groups listed in subdivisions (1)
-- (4) of
this
subsection;
(6) Any accredited college or university; or
(7) Any organizations authorized and approved by the department.
5-45-12.
Disciplinary proceedings -- Grounds for discipline. – (a) The
department may
suspend,
or revoke or refuse to renew any license issued under this
chapter, or may reprimand,
censure,
or discipline a licensee or may require participation in continuing
education, or
professional
mentoring or may place an administrator on probation in accordance with the
provisions
of this section, upon decision and after a hearing as provided by chapter 35 of
title 42,
upon
proof that the licensee engaged in unprofessional conduct. Unprofessional
conduct includes,
but is
not limited to, any of the following:
(1) Being unfit or incompetent by reason of negligence, habits, or other
causes;
(2) Violating any of the provisions of this chapter or the rules enacted in
accordance with
it; or
acting in a manner inconsistent with the health and safety of the patients of
the home
nursing
facility in which he or she is the
administrator;
(3) Engaging in fraud or deceit in the practice of nursing home administration,
or in his
or her admission
to this practice;
(4) Being convicted in a court of competent jurisdiction, either within or
without this
state,
of a felony.
(5) Failing to conform to minimal standards of acceptable and prevailing
practice of
nursing
home administration.
(b)
If a nursing home administrator is placed on probation, the department may
require
the
licensee to:
(1)
Report regularly to the department on matters that are the basis of the
probation;
(2)
Limit practice to the areas prescribed by the department; or
(3)
Complete a prescribed program of continuing professional education until the
licensee
attains
a degree of skill satisfactory to the department in those areas that are the
basis of the
probation.
SECTION
4. Section 23-17-10.5 of the General Laws in Chapter 23-17 entitled
"Licensing
of Health Care Facilities" is hereby amended to read as follows:
23-17-10.5.
Medical director and attending physician file. -- Each nursing facility
licensed
under this chapter shall designate a physician to serve as medical director.
The medical
director
shall be responsible for implementation of resident care policies and for the
coordination
of
medical care in the facility. Such responsibilities shall include, but not
be limited to: the
implementation
of facility policies and procedures related to the medical care delivered in
the
facility;
physician and advanced practice practitioner credentialing; practitioner
performance
reviews;
employee health including infection control measures; evaluation of health care
delivery,
including
oversight of medical records and participation in quality improvement;
provision of
staff
education on medical issues; participation in state survey process, including
the resolution of
deficiencies
as needed; and such other duties and responsibilities as may be stipulated in
regulations
promulgated by the department of health.
The
medical director, charged with the aforementioned duties and responsibilities
for the
delivery
of medical care in the nursing facility, shall be immune from civil or criminal
prosecution
for reporting to the board of medical licensure and discipline the
unprofessional
conduct,
incompetence or negligence of a nursing facility physician or limited registrant;
provided,
that the report, testimony or other communication was made in good faith and
while
acting
within the scope of authority conferred by this section. Each nursing facility shall maintain
an
active file of all current attending physicians including their phone number
and address, an
emergency
phone number, their current medical license number, and their preferred
hospital
admitting
privileges. The director of the department of health is hereby authorized to
promulgate
rules
and regulations to implement the provisions of this section.
SECTION
5. Chapter 23-17 of the General Laws entitled "Licensing of Health Care
Facilities"
is hereby amended by adding thereto the following sections:
23-17-12.8.
Posting of nursing staff levels in nursing facilities. – The
department is
authorized
to adopt federal Medicare nurse staff posting requirements by regulation. In
addition
to
any federal requirements for posting of nursing staff levels, the nursing
facility shall post the
nurse
staff levels for the facility in a public place within the facility. The
posting information
shall
be maintained on file by the nursing facility and shall be made available to
the public upon
request.
The nursing facility shall prepare an annual report showing the average daily
direct care
nurse
staffing level for the facility by shift and by category of nurse to include
registered nurses,
licensed
practical nurses, nursing assistants and medication technicians; the use of
nurse and
nursing
assistant staff from temporary placement agencies; and the nurse and nurse
assistant
turnover
rates. The information on nurse staffing shall be reviewed as part of the
nursing
facility's
annual licensing survey and shall be available to the public, both in printed
form and on
the
department’s
website, by facility.
23-17-12.9.
Resident and family notification. – The director shall establish
regulations
which:
(1) notify the resident, or his or her legal representative, the resident's
family
representative,
the resident's attending physicians of record and the nursing facility's
medical
director,
if that resident has been found to be in immediate jeopardy to health and
safety; (2)
notify
all facility residents, or their legal representatives, their family representatives,
their
attending
physicians and the nursing facility's medical director, whenever a nursing
facility is
cited
for substandard quality of care as defined in 42 CFR 488.301 or successor
regulation; and
(3)
provide for notification of changes regarding resident condition as provided in
federal
regulation
42 CFR 483.10 or successor regulation. A facility citation for substandard
quality of
care
shall be considered to be a public record ten (10) days following the citation,
or upon
departmental
approval of the corresponding plan of correction, whichever is sooner.
For
purposes of this section, "immediate jeopardy to health and safety"
means a situation
which
the institution's noncompliance with one or more state or federal requirements or
conditions
has caused, or is likely to cause, serious injury, harm, impairment or death to
a resident
receiving
care in the institution.
23-17-12.10.
Quality predictive modeling -- Established. – The department of
health
shall
develop a data modeling or other capacity to use quality data already collected
from nursing
facilities
to detect patterns of high performance and/or potential deficiency(ies)
affecting resident
care.
23-17-12.11.
Nursing facility quality improvement program. – (a) Established. –
Each
licensed
nursing facility shall develop and implement a quality improvement program and
establish
a quality improvement committee.
(b)
Each licensed nursing facility shall designate a qualified individual, who
shall be
determined
by the facility's administrator, to coordinate and manage the nursing
facility's quality
improvement
program.
(1)
The nursing facility's quality improvement committee shall include at least the
following
members:
(i)
The nursing facility administrator;
(ii)
The director of nursing;
(iii)
The medical director;
(iv)
A social worker; and
(v)
A representative of dietary services.
(2)
The quality improvement committee shall:
(i)
Meet at least quarterly;
(ii)
Maintain records of all quality improvement activities; and
(iii)
Keep records of committee meetings that shall be available to the department
during
any
on-site visit.
(3)
The quality improvement committee for a nursing facility shall annually review
and
approve
the quality improvement plan for the nursing facility. Said plan shall be
available to the
public
upon request.
(c)
Each nursing facility shall establish a written quality improvement plan that shall
be
reviewed
by the department during the facility's annual survey and that:
(1)
Provides criteria to monitor nursing care, including medication administration,
prevention
and treatment of decubitus ulcers, dehydration and nutritional status and
weight loss or
gain,
accidents and injuries, unexpected deaths, changes in mental or psychological
status, and
any
other data necessary to monitor quality of care; and
(2)
Includes methods to identify, evaluate and correct problems.
(d)
The nursing facility administrator shall take appropriate remedial actions
based on the
recommendations
of the nursing facility's quality improvement committee.
(e)
The director may not require the quality improvement committee to disclose the
records
and the reports prepared by the committee except as necessary to assure
compliance with
the
requirements of this section.
(f)
Good faith attempts by the quality improvement committee to identify and
correct
quality
deficiencies will not be used as a basis for sanctions.
(g)
If the department determines that a nursing facility is not implementing its
quality
improvement
program effectively and that quality improvement activities are inadequate, the
department
may impose sanctions on the nursing facility to improve quality of resident
care
including
mandated hiring of, directly or by contract, an independent quality consultant.
SECTION
6. Chapter 23-17.5 of the General Laws entitled "Rights of Nursing Home
Patients"
is hereby amended by adding thereto the following section:
23-17.5-30.
Family councils. – (a) For the purposes of this section "family
council"
means
an organized group of the family members, friends or representatives of
facility residents
who
may meet in private without the presence of facility staff.
(b)
The role of the family council shall be to address issues affecting residents
generally
at
the facility, not to pursue individual grievances. The family council shall not
be entitled to
obtain
information about individual residents or staff members, or any other
information deemed
confidential
under state or federal law.
(c)
No licensed nursing facility may prohibit the formation of a family council.
When
requested
by a member of a resident's family or a resident's representative, a family
council shall
be
allowed to meet in a common meeting room of the nursing facility at least once
a month
during
mutually agreed upon hours.
(d)
Upon the admission of a resident, the nursing facility shall inform the
resident and the
resident's
family members, in writing, of their right to form a family council, or if a
family
council
already exists, of the date, time and location of scheduled meetings.
(e)
The nursing facility administration shall notify the state long-term care
ombudsman of
the
existence or planned formation of a family council at that facility.
(f)
The family council may exclude members only for good cause, subject to appeal
by
the
excluded party to the state long-term care ombudsman. No member shall be
excluded on the
basis
of race or color, religion, gender, sexual orientation, disability, age or
country of ancestral
origin.
(g)
A facility shall provide its family council with adequate space in a prominent
posting
area
for the display of information pertaining to the family council.
(h)
Staff or visitors may attend family council meetings at the council's
invitation.
(i)
The nursing facility shall provide a designated staff person who, at the
request of the
council,
shall be responsible for providing assistance to the family council and for
responding to
recommendations
and requests made by the family council.
(j)
The nursing facility shall consider the recommendations of the family council
concerning
issues and policies affecting resident care and life at the nursing facility.
(k)
A violation of the provisions of this section will constitute a violation of the
rights of
nursing
home residents.
SECTION 7. This act
shall take effect upon passage.
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LC03356/SUB A
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