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| 5 | 5 | | 2025 -- S 0265 |
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| 6 | 6 | | ======== |
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| 7 | 7 | | LC000334 |
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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: Senators de la Cruz, and Rogers |
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| 17 | 17 | | Date Introduced: February 13, 2025 |
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| 18 | 18 | | Referred To: Senate Health & Human Services |
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| 19 | 19 | | |
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| 20 | 20 | | |
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| 21 | 21 | | It is enacted by the General Assembly as follows: |
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| 22 | 22 | | SECTION 1. Section 23-17.5-33 of the General Laws in Chapter 23-17.5 entitled "Rights 1 |
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| 23 | 23 | | of Nursing Home Patients" is hereby amended to read as follows: 2 |
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| 24 | 24 | | 23-17.5-33. Minimum staffing level compliance and enforcement program. 3 |
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| 25 | 25 | | (a) Compliance determination. 4 |
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| 26 | 26 | | (1) The department shall submit proposed rules and regulations for adoption by October 5 |
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| 27 | 27 | | 15, 2021, establishing a system for determining compliance with minimum staffing requirements 6 |
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| 28 | 28 | | set forth in § 23-17.5-32. 7 |
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| 29 | 29 | | (2) Compliance shall be determined quarterly by comparing the number of hours provided 8 |
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| 30 | 30 | | per resident, per day using the Centers for Medicare and Medicaid Services’ payroll-based journal 9 |
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| 31 | 31 | | and the facility’s daily census, as self-reported by the facility to the department on a quarterly basis. 10 |
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| 32 | 32 | | (3) The department shall use the quarterly payroll-based journal and the self-reported 11 |
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| 33 | 33 | | census to calculate the number of hours provided per resident, per day and compare this ratio to the 12 |
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| 34 | 34 | | minimum staffing standards required under § 23-17.5-32. Discrepancies between job titles 13 |
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| 35 | 35 | | contained in § 23-17.5-32 and the payroll-based journal shall be addressed by rules and regulations. 14 |
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| 36 | 36 | | (b) Monetary penalties. 15 |
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| 37 | 37 | | (1) The department shall submit proposed rules and regulations for adoption on or before 16 |
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| 38 | 38 | | October 15, 2021, implementing monetary penalty provisions for facilities not in compliance with 17 |
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| 39 | 39 | | minimum staffing requirements set forth in § 23-17.5-32. 18 |
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| 40 | 40 | | (2) Monetary penalties shall be imposed quarterly and shall be based on the latest quarter 19 |
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| 41 | 41 | | |
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| 42 | 42 | | |
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| 43 | 43 | | LC000334 - Page 2 of 4 |
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| 44 | 44 | | for which the department has data. 1 |
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| 45 | 45 | | (3) No monetary penalty may be issued for noncompliance with the increase in the standard 2 |
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| 46 | 46 | | set forth in § 23-17.5-32(c)(ii) from January 1, 2023, to March 31, 2023. If a facility is found to be 3 |
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| 47 | 47 | | noncompliant with the increase in the standard during the period that extends from January 1, 2023, 4 |
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| 48 | 48 | | to March 31, 2023, the department shall provide a written notice identifying the staffing 5 |
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| 49 | 49 | | deficiencies and require the facility to provide a sufficiently detailed correction plan to meet the 6 |
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| 50 | 50 | | statutory minimum staffing levels. 7 |
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| 51 | 51 | | (4) Monetary penalties shall be established based on a formula that calculates on a daily 8 |
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| 52 | 52 | | basis the cost of wages and benefits for the missing staffing hours. 9 |
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| 53 | 53 | | (5) All notices of noncompliance shall include the computations used to determine 10 |
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| 54 | 54 | | noncompliance and establishing the variance between minimum staffing ratios and the 11 |
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| 55 | 55 | | department’s computations. 12 |
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| 56 | 56 | | (6) The penalty for the first offense shall be two hundred percent (200%) of the cost of 13 |
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| 57 | 57 | | wages and benefits for the missing staffing hours. The penalty shall increase to two hundred fifty 14 |
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| 58 | 58 | | percent (250%) of the cost of wages and benefits for the missing staffing hours for the second 15 |
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| 59 | 59 | | offense and three hundred percent (300%) of the cost of wages and benefits for the missing staffing 16 |
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| 60 | 60 | | hours for the third and all subsequent offenses. 17 |
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| 61 | 61 | | (7) For facilities that have an offense in three (3) consecutive quarters, EOHHS shall deny 18 |
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| 62 | 62 | | any further Medicaid Assistance payments with respect to all individuals entitled to benefits who 19 |
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| 63 | 63 | | are admitted to the facility on or after January 1, 2022, or shall freeze admissions of new residents. 20 |
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| 64 | 64 | | (c)(1) The penalty shall be imposed regardless of whether the facility has committed other 21 |
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| 65 | 65 | | violations of this chapter during the same period that the staffing offense occurred. 22 |
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| 66 | 66 | | (2) The penalty may not be waived except as provided in subsection (c)(3) of this section, 23 |
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| 67 | 67 | | but the department shall have the discretion to determine the gravity of the violation in situations 24 |
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| 68 | 68 | | where there is no more than a ten percent (10%) deviation from the staffing requirements and make 25 |
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| 69 | 69 | | appropriate adjustments to the penalty. 26 |
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| 70 | 70 | | (3) The department is granted discretion to waive the penalty when unforeseen 27 |
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| 71 | 71 | | circumstances have occurred that resulted in call-offs of scheduled staff. This provision shall be 28 |
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| 72 | 72 | | applied no more than two (2) times per calendar year. 29 |
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| 73 | 73 | | (4) Nothing in this section diminishes a facility’s right to appeal pursuant to the provisions 30 |
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| 74 | 74 | | of chapter 35 of title 42 (“administrative procedures”). 31 |
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| 75 | 75 | | (d)(1) Pursuant to rules and regulations established by the department, funds that are 32 |
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| 76 | 76 | | received from financial penalties shall be used for technical assistance or specialized direct care 33 |
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| 77 | 77 | | staff training. 34 |
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| 78 | 78 | | |
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| 79 | 79 | | |
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| 80 | 80 | | LC000334 - Page 3 of 4 |
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| 81 | 81 | | (2) The assessment of a penalty does not supplant the state’s investigation process or 1 |
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| 82 | 82 | | issuance of deficiencies or citations under this title. 2 |
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| 83 | 83 | | (3) A notice of noncompliance, whether or not the penalty is waived, and the penalty 3 |
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| 84 | 84 | | assessment shall be prominently posted in the nursing facility and included on the department’s 4 |
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| 85 | 85 | | website. 5 |
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| 86 | 86 | | (e) Any penalty incurred for any offense committed during calendar years 2022, 2023, and 6 |
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| 87 | 87 | | 2024 pursuant to §§ 23-17.5-32, and 23-17.5-33, shall be abated. 7 |
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| 88 | 88 | | SECTION 2. This act shall take effect upon passage. 8 |
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| 89 | 89 | | ======== |
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| 90 | 90 | | LC000334 |
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| 91 | 91 | | ======== |
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| 92 | 92 | | |
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| 93 | 93 | | |
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| 94 | 94 | | LC000334 - Page 4 of 4 |
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| 95 | 95 | | EXPLANATION |
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| 96 | 96 | | BY THE LEGISLATIVE COUNCIL |
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| 97 | 97 | | OF |
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| 98 | 98 | | A N A C T |
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| 99 | 99 | | RELATING TO HEALTH AND SAFETY -- RIGHTS OF NURSING HOME PATIENTS |
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| 100 | 100 | | *** |
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| 101 | 101 | | This act would amend the law on nursing home minimum staffing requirements in order 1 |
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| 102 | 102 | | that any penalty incurred during calendar years 2022, 2023, and 2024 would be abated. 2 |
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| 103 | 103 | | This act would take effect upon passage. 3 |
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| 104 | 104 | | ======== |
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| 105 | 105 | | LC000334 |
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| 106 | 106 | | ======== |
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| 107 | 107 | | |
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