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| 4 | 4 | | |
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| 5 | 5 | | 2025 -- H 5170 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC000587 |
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| 8 | 8 | | ======== |
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| 9 | 9 | | S T A T E O F R H O D E I S L A N D |
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| 10 | 10 | | IN GENERAL ASSEMBLY |
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| 11 | 11 | | JANUARY SESSION, A.D. 2025 |
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| 12 | 12 | | ____________ |
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| 13 | 13 | | |
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| 14 | 14 | | A N A C T |
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| 15 | 15 | | RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS |
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| 16 | 16 | | Introduced By: Representatives Donovan, McNamara, Carson, Speakman, Fogarty, |
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| 17 | 17 | | Spears, Boylan, Potter, Cruz, and Morales |
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| 18 | 18 | | Date Introduced: January 24, 2025 |
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| 19 | 19 | | Referred To: House Health & Human Services |
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| 20 | 20 | | |
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| 21 | 21 | | |
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| 22 | 22 | | It is enacted by the General Assembly as follows: |
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| 23 | 23 | | SECTION 1. Section 23-17.5-30 of the General Laws in Chapter 23-17.5 entitled "Rights 1 |
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| 24 | 24 | | of Nursing Home Patients" is hereby amended to read as follows: 2 |
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| 25 | 25 | | 23-17.5-30. Family councils. 3 |
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| 26 | 26 | | (a) For the purposes of this section “family council” means an organized group of the 4 |
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| 27 | 27 | | family members, friends or representatives of facility residents who may meet in private without 5 |
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| 28 | 28 | | the presence of facility staff. 6 |
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| 29 | 29 | | (b) The role of the family council shall be to address issues affecting residents generally at 7 |
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| 30 | 30 | | the facility, not to pursue individual grievances. The family council shall not be entitled to obtain 8 |
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| 31 | 31 | | information about individual residents or staff members, or any other information deemed 9 |
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| 32 | 32 | | confidential under state or federal law. Notwithstanding the foregoing: 10 |
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| 33 | 33 | | (1) A facility shall provide the family council with the names, email addresses, and other 11 |
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| 34 | 34 | | contact information for each resident’s representatives, family members, or other individuals 12 |
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| 35 | 35 | | designated by the resident if the person has provided written consent specifying the contact 13 |
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| 36 | 36 | | information that may be shared with the family council. 14 |
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| 37 | 37 | | (2) The facility shall inform the identified family members, friends, and representatives of 15 |
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| 38 | 38 | | their right to have their contact information shared with the family council and their right to consent 16 |
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| 39 | 39 | | or withhold consent to have their contact information shared with the family council pursuant to 17 |
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| 40 | 40 | | subsection (b)(1) of this section. 18 |
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| 41 | 41 | | (c) No licensed nursing facility may prohibit the formation of a family council. When 19 |
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| 42 | 42 | | |
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| 43 | 43 | | |
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| 44 | 44 | | LC000587 - Page 2 of 6 |
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| 45 | 45 | | requested by a member of a resident’s family or a resident’s representative, a family council shall 1 |
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| 46 | 46 | | be allowed to meet in a common meeting room of the nursing facility at least once a month during 2 |
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| 47 | 47 | | mutually agreed upon hours. 3 |
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| 48 | 48 | | (d) Upon the admission of a resident, the nursing facility shall inform the resident and the 4 |
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| 49 | 49 | | resident’s family members, in writing, of their right to form a family council, or if a family council 5 |
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| 50 | 50 | | already exists, of the date, time and location of scheduled meetings. 6 |
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| 51 | 51 | | (1) If a facility has a family council, the facility shall inform the resident and the resident’s 7 |
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| 52 | 52 | | representatives, family members, or other individuals designated by the resident or identified 8 |
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| 53 | 53 | | during the admission process of the existence of the family council. The facility shall provide the 9 |
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| 54 | 54 | | resident and those family members, friends, and resident representatives with the name and contact 10 |
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| 55 | 55 | | information of the family council representative, as designated by the family council, in writing, 11 |
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| 56 | 56 | | prior to or within five (5) business days after the resident’s admission or the resident’s 12 |
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| 57 | 57 | | representative, family member, or other individual is designated or identified. When family council 13 |
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| 58 | 58 | | meeting information is provided by the family council, the facility shall include notice of family 14 |
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| 59 | 59 | | council meetings in routine communications to those family members, friends, and resident 15 |
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| 60 | 60 | | representatives. The notice shall include the time, place, and date of meetings, and the name and 16 |
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| 61 | 61 | | contact information of the family council representative, as designated by the family council. 17 |
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| 62 | 62 | | (2) If a facility does not have a family council, the facility shall provide, upon admission 18 |
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| 63 | 63 | | of a new resident, written information to the resident’s family members, friends, or resident 19 |
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| 64 | 64 | | representatives identified during the admission process of their right to form a family council. 20 |
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| 65 | 65 | | (3) The family council shall not allow a family member or friend of a resident to participate 21 |
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| 66 | 66 | | in the family council against the objection of the resident. 22 |
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| 67 | 67 | | (e) The nursing facility administration shall notify the state long-term care ombudsman of 23 |
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| 68 | 68 | | the existence or planned formation of a family council at that facility. With the consent of the 24 |
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| 69 | 69 | | designated representative(s) of the family council, the facility shall share the name and contact 25 |
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| 70 | 70 | | information of the designated representative(s) of the family council with the long-term care 26 |
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| 71 | 71 | | ombudsman program. 27 |
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| 72 | 72 | | (f) The family council may exclude members only for good cause, subject to appeal by the 28 |
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| 73 | 73 | | excluded party to the state long-term care ombudsman. No member shall be excluded on the basis 29 |
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| 74 | 74 | | of race or color, religion, gender, sexual orientation, disability, age or country of ancestral origin. 30 |
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| 75 | 75 | | (g) A facility shall provide its family council with adequate space in a prominent posting 31 |
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| 76 | 76 | | area for the display of information pertaining to the family council. 32 |
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| 77 | 77 | | (h) Staff or visitors may attend family council meetings at the council’s invitation. 33 |
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| 78 | 78 | | (i) The nursing facility shall provide a designated staff person who, at the request of the 34 |
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| 79 | 79 | | |
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| 80 | 80 | | |
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| 81 | 81 | | LC000587 - Page 3 of 6 |
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| 82 | 82 | | council, shall be responsible for providing assistance to the family council and for responding to 1 |
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| 83 | 83 | | recommendations and requests made by the family council. 2 |
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| 84 | 84 | | (j) The nursing facility shall consider the recommendations of the family council 3 |
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| 85 | 85 | | concerning issues and policies affecting resident care and life at the nursing facility. If a family 4 |
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| 86 | 86 | | council submits written requests, concerns or recommendations, the facility shall consider those 5 |
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| 87 | 87 | | requests, concerns or recommendations, and respond, in writing, regarding any action or inaction 6 |
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| 88 | 88 | | taken in response within five (5) business days, and shall detail its rationale for that response. 7 |
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| 89 | 89 | | (k) A violation of the provisions of this section will constitute a violation of the rights of 8 |
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| 90 | 90 | | nursing home residents. 9 |
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| 91 | 91 | | SECTION 2. Chapter 23-17.5 of the General Laws entitled "Rights of Nursing Home 10 |
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| 92 | 92 | | Patients" is hereby amended by adding thereto the following section: 11 |
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| 93 | 93 | | 23-17.5-38. Facility admission waiting lists. 12 |
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| 94 | 94 | | (a) A nursing home which receives payment from the state for rendering care to indigent 13 |
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| 95 | 95 | | persons shall: 14 |
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| 96 | 96 | | (1) Be prohibited from discriminating against indigent persons who apply for admission to 15 |
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| 97 | 97 | | such facility on the basis of source of payment. Except as otherwise provided by law, all applicants 16 |
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| 98 | 98 | | for admission to such facility shall be admitted in the order in which such applicants apply for 17 |
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| 99 | 99 | | admission. Each nursing home shall: 18 |
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| 100 | 100 | | (i) Provide a receipt to each applicant for admission to its facility who requests placement 19 |
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| 101 | 101 | | on a waiting list stating the date and time of such request; and 20 |
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| 102 | 102 | | (ii) Maintain a dated list of such applications which shall be available at all times to any 21 |
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| 103 | 103 | | applicant, their bona fide representative, authorized personnel from the department of health and 22 |
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| 104 | 104 | | human services, the long-term care ombudsman, and such other state agencies or other bodies 23 |
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| 105 | 105 | | established by state statute whose statutory duties necessitate access to such lists. 24 |
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| 106 | 106 | | (2)(i) If a nursing home desires to remove the name of an applicant who is unresponsive to 25 |
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| 107 | 107 | | facility telephone calls and letters from its waiting list, no sooner than ninety (90) days after initial 26 |
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| 108 | 108 | | placement of the person's name on the waiting list, inquire by letter to such applicant and any one 27 |
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| 109 | 109 | | person if designated by such applicant whether the applicant desires continuation of their name on 28 |
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| 110 | 110 | | the waiting list. If the applicant does not respond and an additional thirty (30) days pass, the facility 29 |
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| 111 | 111 | | may remove such applicant's name from its waiting list; 30 |
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| 112 | 112 | | (ii) A nursing home may annually send a waiting list placement continuation letter to all 31 |
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| 113 | 113 | | persons on the waiting list for at least ninety (90) days to inquire as to whether such person desires 32 |
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| 114 | 114 | | continuation of their name on the waiting list; provided that, such letter shall also be sent to any 33 |
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| 115 | 115 | | one person if designated by such applicant. If such person does not respond and at least thirty (30) 34 |
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| 116 | 116 | | |
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| 117 | 117 | | |
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| 118 | 118 | | LC000587 - Page 4 of 6 |
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| 119 | 119 | | days pass, the facility may remove the person's name from its waiting list. Indigent persons shall 1 |
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| 120 | 120 | | be placed on any waiting list for admission to a facility and shall be admitted to the facility as 2 |
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| 121 | 121 | | vacancies become available, in the same manner as self-pay applicants, except as provided in 3 |
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| 122 | 122 | | subsections (e) and (f) of this section; 4 |
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| 123 | 123 | | (3) Post in a conspicuous place a notice informing applicants for admission that the facility 5 |
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| 124 | 124 | | is prohibited by statute from discriminating against indigent applicants for admission on the basis 6 |
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| 125 | 125 | | of source of payment. Such notice shall advise applicants for admission of the remedies available 7 |
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| 126 | 126 | | under this section and shall list the name, address and telephone number of the state long-term care 8 |
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| 127 | 127 | | ombudsman; 9 |
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| 128 | 128 | | (4) Be prohibited from requiring that an indigent person pay any sum of money or furnish 10 |
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| 129 | 129 | | any other consideration including, but not limited to, the furnishing of an agreement by the relative, 11 |
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| 130 | 130 | | conservator or other responsible party of an indigent person which obligates such party to pay for 12 |
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| 131 | 131 | | care rendered to an indigent person as a condition for admission of such indigent person; and 13 |
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| 132 | 132 | | (5) Record in the patient roster, or in a separate roster maintained for this purpose, the 14 |
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| 133 | 133 | | number of patients who are Medicare, Medicaid and private pay patients on each day. Such 15 |
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| 134 | 134 | | numbers shall be recorded daily and made available, upon request, to the state long-term care 16 |
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| 135 | 135 | | ombudsman. 17 |
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| 136 | 136 | | (b) Upon the receipt of a complaint concerning a violation of this section, the department 18 |
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| 137 | 137 | | of health shall conduct an investigation into such complaint. 19 |
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| 138 | 138 | | (c) The department of health is authorized to decrease the daily reimbursement rate to a 20 |
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| 139 | 139 | | nursing home for one year for a violation of this section which occurred during the twelve (12) 21 |
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| 140 | 140 | | month period covered by the cost report upon which the per diem rate is calculated. The per diem 22 |
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| 141 | 141 | | rate shall be reduced by one-quarter (1/4) of one percent for an initial violation of this section and 23 |
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| 142 | 142 | | one percent for each additional violation. 24 |
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| 143 | 143 | | (d) Prior to imposing any sanction, the department of health shall notify the nursing home 25 |
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| 144 | 144 | | of the alleged violation and the accompanying sanction, and shall permit such facility to request an 26 |
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| 145 | 145 | | administrative hearing. A facility shall request such hearing within fifteen (15) days of receipt of 27 |
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| 146 | 146 | | the notice of violation from the department of health. The department shall stay the imposition of 28 |
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| 147 | 147 | | any sanction pending the outcome of the administrative hearing. 29 |
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| 148 | 148 | | (e) A nursing home with a number of self-pay residents equal to or less than thirty percent 30 |
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| 149 | 149 | | (30%) of its total number of residents shall not be required to admit an indigent person on a waiting 31 |
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| 150 | 150 | | list for admission when a vacancy becomes available during the subsequent six (6) months, 32 |
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| 151 | 151 | | provided: 33 |
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| 152 | 152 | | (1) No bed may be held open for more than thirty (30) days; and 34 |
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| 153 | 153 | | |
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| 154 | 154 | | |
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| 155 | 155 | | LC000587 - Page 5 of 6 |
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| 156 | 156 | | (2) The nursing home notifies the department of health and the state long-term care 1 |
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| 157 | 157 | | ombudsman on the date on which such six (6) month period of waiting list exemption began and 2 |
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| 158 | 158 | | thereafter on a quarterly basis if the conditions for exemption still apply. 3 |
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| 159 | 159 | | (f) A nursing home shall not be required to admit an indigent person on a waiting list for 4 |
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| 160 | 160 | | admission when a vacancy becomes available if the vacancy is in a private room. 5 |
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| 161 | 161 | | (g) Notwithstanding the provisions of this section, a nursing home shall, without regard to 6 |
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| 162 | 162 | | the order of its waiting list, admit an applicant who: 7 |
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| 163 | 163 | | (1) Seeks to transfer from a nursing home that is closing; or 8 |
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| 164 | 164 | | (2)(i) Seeks to transfer from a nursing home in which the applicant was placed following 9 |
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| 165 | 165 | | the closure of the nursing home where such applicant previously resided or, in the case of a nursing 10 |
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| 166 | 166 | | home placed in receivership, the anticipated closure of the nursing home where such applicant 11 |
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| 167 | 167 | | previously resided; provided that, the transfer occurs not later than sixty (60) days following the 12 |
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| 168 | 168 | | date that such applicant was transferred from the nursing home where they previously resided and 13 |
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| 169 | 169 | | except when the nursing home that is closing transferred the resident due to an emergency, the 14 |
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| 170 | 170 | | applicant submitted an application to the nursing home to which they seek admission at the time of 15 |
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| 171 | 171 | | the applicant's transfer from the nursing home where they previously resided; 16 |
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| 172 | 172 | | (ii) A nursing home that qualifies for a waiting list exemption pursuant to subsections (e) 17 |
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| 173 | 173 | | or (f) of this section shall not be required to admit an indigent person under this subsection except 18 |
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| 174 | 174 | | when the resident is being transferred from a nursing home that is closing due to an emergency. 19 |
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| 175 | 175 | | (h) No nursing home shall be required to admit an applicant pursuant to the provisions of 20 |
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| 176 | 176 | | this section if the nursing home has determined that: 21 |
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| 177 | 177 | | (1) The applicant does not have a payor source because the applicant has been denied 22 |
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| 178 | 178 | | Medicaid eligibility or the applicant has failed to pay a nursing home that is closing for the three 23 |
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| 179 | 179 | | (3) months preceding the date of the application for admittance and has no pending application for 24 |
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| 180 | 180 | | Medicaid; 25 |
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| 181 | 181 | | (2) The applicant is subject to a Medicaid penalty period; or 26 |
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| 182 | 182 | | (3) The applicant does not require nursing home level of care as determined in accordance 27 |
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| 183 | 183 | | with applicable state and federal requirements. 28 |
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| 184 | 184 | | SECTION 3. This act shall take effect upon passage. 29 |
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| 185 | 185 | | ======== |
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| 186 | 186 | | LC000587 |
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| 187 | 187 | | ======== |
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| 188 | 188 | | |
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| 189 | 189 | | |
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| 190 | 190 | | LC000587 - Page 6 of 6 |
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| 191 | 191 | | EXPLANATION |
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| 192 | 192 | | BY THE LEGISLATIVE COUNCIL |
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| 193 | 193 | | OF |
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| 194 | 194 | | A N A C T |
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| 195 | 195 | | RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS |
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| 196 | 196 | | *** |
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| 197 | 197 | | This act would support the establishment and role of independent family councils in 1 |
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| 198 | 198 | | nursing facilities. This act would further prevent discrimination against nursing home residents, 2 |
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| 199 | 199 | | where the method of payment is Medicaid, by making the waiting list process transparent, and 3 |
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| 200 | 200 | | requiring facilities with more than thirty percent (30%) self-pay residents to admit applicants on a 4 |
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| 201 | 201 | | first-come-first-served basis for non-private rooms. 5 |
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| 202 | 202 | | This act would take effect upon passage. 6 |
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| 203 | 203 | | ======== |
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| 204 | 204 | | LC000587 |
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| 205 | 205 | | ======== |
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