March 29, 2006, Introduced by Reps. Stahl, Shaffer, Green, Ward, Wojno, Sheltrown, Vander Veen, Zelenko, Vagnozzi, Polidori, Clack, Gonzales, Condino, Cushingberry, Gaffney, Pearce and Van Regenmorter and referred to the Committee on Senior Health, Security, and Retirement.
A bill to amend 1978 PA 368, entitled
"Public health code,"
by amending sections 12615, 17307, 20106, 20109, 20127, 20142,
20155, 20156, 20162, 20168, 20176, 20194, 20198, 20201, 22205,
22210, and 22239 (MCL 333.12615, 333.17307, 333.20106, 333.20109,
333.20127, 333.20142, 333.20155, 333.20156, 333.20162, 333.20168,
333.20176, 333.20194, 333.20198, 333.20201, 333.22205, 333.22210,
and 333.22239), section 12615 as amended by 1988 PA 315, section
17307 as added by 2001 PA 139, section 20106 as amended by 2000 PA
253, section 20109 as amended by 1996 PA 224, section 20155 as
amended by 2001 PA 218, section 20156 as amended by 1990 PA 179,
section 20162 as amended by 2004 PA 284, section 20176 as amended
by 1994 PA 52, section 20194 as amended by 2003 PA 3, section 20198
as added by 1998 PA 270, section 20201 as amended by 2006 PA 38,
sections 22205 and 22239 as amended by 2002 PA 619, and section
22210 as amended by 1993 PA 88; and to repeal acts and parts of
acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 12615. This part is in addition to, and does not
supersede the requirements for a policy regulating the smoking of
tobacco
on the premises of a nursing home set forth in section
21733
3233 of the long-term care
continuum act, or the
requirements for a food service establishment set forth in section
12905.
Sec.
17307. (1) In addition to the requirements of section
21720
3220 of the long-term care continuum
act, a nursing home
shall not operate except under the direction of a nursing home
administrator.
(2) A person shall not engage in the practice of nursing home
administration unless the person is the holder of a valid nursing
home administrator's license issued under this part.
Sec. 20106. (1) "Health facility or agency", except as
provided in section 20115, means:
(a) An ambulance operation, aircraft transport operation,
nontransport prehospital life support operation, or medical first
response service.
(b) A clinical laboratory.
(c) A county medical care facility.
(d) A freestanding surgical outpatient facility.
(e) A health maintenance organization.
(f) A home for the aged.
(g) A hospital.
(h) A nursing home.
(i) A hospice.
(j) A hospice residence.
(k) A facility or agency listed in subdivisions (a) to (h)
located in a university, college, or other educational institution.
(2) "Health maintenance organization" means that term as
defined in section 3501 of the insurance code of 1956, 1956 PA 218,
MCL 500.3501.
(3)
"Home for the aged" means
a supervised personal care
facility,
other than a hotel, adult foster care facility, hospital,
nursing
home, or county medical care facility that provides room,
board,
and supervised personal care to 21 or more unrelated,
nontransient,
individuals 60 years of age or older. Home for the
aged
includes a supervised personal care facility for 20 or fewer
individuals
60 years of age or older if the facility is operated in
conjunction
with and as a distinct part of a licensed nursing home
that term as defined in section 4301 of the long-term care
continuum act.
(4)
"Hospice" means a health care program that provides a
coordinated
set of services rendered at home or in outpatient or
institutional
settings for individuals suffering from a disease or
condition
with a terminal prognosis that
term as defined in
section 3101 of the long-term care continuum act.
(5) "Hospital" means a facility offering inpatient, overnight
care, and services for observation, diagnosis, and active treatment
of an individual with a medical, surgical, obstetric, chronic, or
rehabilitative condition requiring the daily direction or
supervision of a physician. Hospital does not include a mental
health hospital licensed or operated by the department of community
health or a hospital operated by the department of corrections.
(6) "Hospital long-term care unit" means a nursing care
facility, owned and operated by and as part of a hospital,
providing organized nursing care and medical treatment to 7 or more
unrelated individuals suffering or recovering from illness, injury,
or infirmity.
Sec. 20109. (1) "Nursing home" means that term as defined in
section
3101 of the long-term care continuum act. a nursing care
facility,
including a county medical care facility, that provides
organized
nursing care and medical treatment to 7 or more unrelated
individuals
suffering or recovering from illness, injury, or
infirmity.
Nursing home does not include a unit in a state
correctional
facility. Nursing home does not include 1 or more of
the
following:
(a)
A hospital.
(b)
A veterans facility created under Act No. 152 of the
Public
Acts of 1885, being sections 36.1 to 36.12 of the Michigan
Compiled
Laws.
(c)
A hospice residence that is licensed under this article.
(d)
A hospice that is certified under 42 C.F.R. 418.100.
(2) "Person" means a person as defined in section 1106 or a
governmental entity.
(3) "Public member" means a member of the general public who
is not a provider; who does not have an ownership interest in or
contractual relationship with a nursing home other than a patient
contract; who does not have a contractual relationship with a
person who does substantial business with a nursing home; and who
is not the spouse, parent, sibling, or child of an individual who
has an ownership interest in or contractual relationship with a
nursing home, other than a patient contract.
(4) "Skilled nursing facility" means a hospital long-term care
unit, nursing home, county medical care facility, or other nursing
care facility, or a distinct part thereof, certified by the
department to provide skilled nursing care.
Sec. 20127. (1) Task force 4 shall be composed of 15 state
residents
to review the operation of part 217 32
of the long-term
care
continuum act and rules promulgated
under part 217 32
of the
long-term care continuum act, to hear and evaluate complaints in
implementation
of part 217 32
of the long-term care continuum
act, and to recommend to the legislature and the department changes
in
part 217 32
of the long-term care continuum act and
the rules.
(2) The director shall appoint the task force members, 1 of
whom shall be a nurse having a background in gerontology, 1 a
social worker having a background in gerontology, 5 representatives
of nursing homes, 3 representatives of public interest health
consumer groups, and 5 public members, 3 of whom have or have had
relatives in a nursing home. In addition, there shall be 2 ex
officio
members without vote, 1 representing the department, of
public
health, and 1 representing the department of social
human
services.
(3) A majority of the voting members of the task force shall
be consumers.
(4) The task force annually shall elect a chairperson and a
vice-chairperson.
(5) The task force shall determine what constitutes a quorum
and may establish procedures for the conduct of its business.
(6) The task force shall be charged with the following tasks:
(a) Meeting at least 6 times a year, at the call of the
chairperson, the director, or any 3 members of the committee.
(b) Receiving and commenting on drafts of proposed rules.
(c) Receiving and making recommendations regarding complaint
investigation reports, decisions, and procedures.
(d) Making reports and recommendations on needed changes in
statutes and rules.
(e)
Reviewing decisions as provided in section 21764 3264 of
the long-term care continuum act.
(f)
Reviewing complaints received under section 21763 3263
of the long-term care continuum act.
Sec. 20142. (1) A health facility or agency shall apply for
licensure or certification on a form authorized and provided by the
department. The application shall include attachments, additional
data, and information required by the department.
(2) An applicant shall certify the accuracy of information
supplied in the application and supplemental statements.
(3)
An applicant or a licensee under part 213 or 217 shall
disclose
the names, addresses, principal occupations, and official
positions
of all persons who have an ownership interest in the
health
facility or agency. If the health facility or agency is
located
on or in leased real estate, the applicant or licensee
shall
disclose the name of the lessor and any direct or indirect
interest
the applicant or licensee has in the lease other than as
lessee.
A change in ownership shall be reported to the director not
less
than 15 days before the change occurs, except that a person
purchasing
stock of a company registered pursuant to the securities
exchange
act of 1934, 15 U.S.C. 78a to 78kk, is exempt from
disclosing
ownership in the facility. A person required to file a
beneficial
ownership report pursuant to section 16(a) of the
securities
exchange act of 1934, 15 U.S.C. 78p shall file with the
department
information relating to securities ownership required by
the
department rule or order. An applicant or licensee proposing a
sale
of a nursing home to another person shall provide the
department
with written, advance notice of the proposed sale. The
applicant
or licensee and the other parties to the sale shall
arrange
to meet with specified department representatives and shall
obtain
before the sale a determination of the items of
noncompliance
with applicable law and rules which shall be
corrected.
The department shall notify the respective parties of
the
items of noncompliance prior to the change of ownership and
shall
indicate that the items of noncompliance must be corrected as
a
condition of issuance of a license to the new owner. The
department
may accept reports filed with the securities and
exchange
commission relating to the filings. A person who violates
this
subsection is guilty of a misdemeanor, punishable by a fine of
not
more than $1,000.00 for each violation.
(4)
An applicant or licensee under part 217 shall disclose the
names
and business addresses of suppliers who furnish goods or
services
to an individual nursing home or a group of nursing homes
under
common ownership, the aggregate charges for which exceed
$5,000.00
in a 12-month period which includes a month in a nursing
home's
current fiscal year. An applicant or licensee shall disclose
the
names, addresses, principal occupations, and official positions
of
all persons who have an ownership interest in a business which
furnishes
goods or services to an individual nursing home or to a
group
of nursing homes under common ownership, if both of the
following
apply:
(a)
The person, or the person's spouse, parent, sibling, or
child
has an ownership interest in the nursing home purchasing the
goods
or services.
(b)
The aggregate charges for the goods or services purchased
exceeds
$5,000.00 in a 12-month period which includes a month in
the
nursing home's current fiscal year.
(3) (5)
An applicant or licensee who makes a false statement
in an application or statement required by the department pursuant
to this article is guilty of a felony, punishable by imprisonment
for not more than 4 years, or a fine of not more than $30,000.00,
or both.
Sec. 20155. (1) Except as otherwise provided in this section,
the
department of consumer and industry services shall
make
annual and other visits to each health facility or agency licensed
under this article for the purposes of survey, evaluation, and
consultation. A visit made pursuant to a complaint shall be
unannounced.
Except for a county medical care facility, a home for
the
aged, a nursing home, or a hospice residence, the
department
shall determine whether the visits that are not made pursuant to a
complaint
are announced or unannounced. Beginning June 20, 2001,
the
department shall assure that each newly hired nursing home
surveyor,
as part of his or her basic training, is assigned full-
time
to a licensed nursing home for at least 10 days within a 14-
day
period to observe actual operations outside of the survey
process
before the trainee begins oversight responsibilities. A
member
of a survey team shall not be employed by a licensed nursing
home
or a nursing home management company doing business in this
state
at the time of conducting a survey under this section. The
department
shall not assign an individual to be a member of a
survey
team for purposes of a survey, evaluation, or consultation
visit
at a nursing home in which he or she was an employee within
the
preceding 5 years.
(2)
The department of consumer and industry services shall
make
at least a biennial visit to each licensed clinical laboratory
,
each nursing home, and each hospice residence for
the purposes
of
survey, evaluation, and consultation.
The department of
consumer
and industry services shall semiannually provide for joint
training
with nursing home surveyors and providers on at least 1 of
the
10 most frequently issued federal citations in this state
during
the past calendar year. The department of consumer and
industry
services shall develop a protocol for the review of
citation
patterns compared to regional outcomes and standards and
complaints
regarding the nursing home survey process. The review
will
result in a report provided to the legislature. Except as
otherwise
provided in this subsection, beginning with his or her
first
full relicensure period after June 20, 2000, each member of a
department
of consumer and industry services nursing home survey
team
who is a health professional licensee under article 15 shall
earn
not less than 50% of his or her required continuing education
credits,
if any, in geriatric care. If a member of a nursing home
survey
team is a pharmacist licensed under article 15, he or she
shall
earn not less than 30% of his or her required continuing
education
credits in geriatric care.
(3)
The department of consumer and industry services shall
make a biennial visit to each hospital for survey and evaluation
for the purpose of licensure. Subject to subsection (6), the
department may waive the biennial visit required by this subsection
if a hospital, as part of a timely application for license renewal,
requests a waiver and submits both of the following and if all of
the requirements of subsection (5) are met:
(a) Evidence that it is currently fully accredited by a body
with expertise in hospital accreditation whose hospital
accreditations are accepted by the United States department of
health and human services for purposes of section 1865 of part C of
title
XVIII of the social security act, 42
U.S.C. USC 1395bb.
(b) A copy of the most recent accreditation report for the
hospital issued by a body described in subdivision (a), and the
hospital's responses to the accreditation report.
(4) Except as provided in subsection (8), accreditation
information
provided to the department of consumer and industry
services
under subsection (3) is confidential, is not a
public
record, and is not subject to court subpoena. The department shall
use the accreditation information only as provided in this section
and shall return the accreditation information to the hospital
within a reasonable time after a decision on the waiver request is
made.
(5)
The department of consumer and industry services shall
grant a waiver under subsection (3) if the accreditation report
submitted under subsection (3)(b) is less than 2 years old and
there is no indication of substantial noncompliance with licensure
standards or of deficiencies that represent a threat to public
safety or patient care in the report, in complaints involving the
hospital, or in any other information available to the department.
If the accreditation report is 2 or more years old, the department
may do 1 of the following:
(a) Grant an extension of the hospital's current license until
the next accreditation survey is completed by the body described in
subsection (3)(a).
(b) Grant a waiver under subsection (3) based on the
accreditation report that is 2 or more years old, on condition that
the hospital promptly submit the next accreditation report to the
department.
(c) Deny the waiver request and conduct the visits required
under subsection (3).
(6) This section does not prohibit the department from citing
a violation of this part during a survey, conducting investigations
or inspections pursuant to section 20156, or conducting surveys of
health facilities or agencies for the purpose of complaint
investigations or federal certification. This section does not
prohibit
the state fire marshal bureau of fire services from
conducting
annual surveys of hospitals , nursing homes, and
county medical care facilities.
(7) At the request of a health facility or agency, the
department of
consumer and industry services may conduct a
consultation engineering survey of a health facility and provide
professional advice and consultation regarding health facility
construction and design. A health facility or agency may request a
voluntary consultation survey under this subsection at any time
between licensure surveys. The fees for a consultation engineering
survey are the same as the fees established for waivers under
section 20161(10).
(8)
If the department of consumer and industry services
determines that substantial noncompliance with licensure standards
exists or that deficiencies that represent a threat to public
safety or patient care exist based on a review of an accreditation
report submitted pursuant to subsection (3)(b), the department
shall prepare a written summary of the substantial noncompliance or
deficiencies and the hospital's response to the department's
determination. The department's written summary and the hospital's
response are public documents.
(9) The
department of consumer and industry services or a
local
health department shall conduct investigations or
inspections,
other than inspections of financial records, of a
county
medical care facility, home for the aged, nursing home, or
hospice
residence without prior notice to the health facility or
agency.
An employee of a state agency charged with
investigating
or inspecting the health facility or agency or an employee of a
local health department who directly or indirectly gives prior
notice regarding an investigation or an inspection, other than an
inspection of the financial records, to the health facility or
agency or to an employee of the health facility or agency, is
guilty of a misdemeanor. Consultation visits that are not for the
purpose of annual or follow-up inspection or survey may be
announced.
(10)
The department of consumer and industry services shall
maintain a record indicating whether a visit and inspection is
announced or unannounced. Information gathered at each visit and
inspection, whether announced or unannounced, shall be taken into
account in licensure decisions.
(11)
The department of consumer and industry services shall
require periodic reports and a health facility or agency shall give
the department access to books, records, and other documents
maintained by a health facility or agency to the extent necessary
to carry out the purpose of this article and the rules promulgated
under this article. The department shall respect the
confidentiality of a patient's clinical record and shall not
divulge or disclose the contents of the records in a manner that
identifies an individual except under court order. The department
may copy health facility or agency records as required to document
findings.
(12)
The department of consumer and industry services may
delegate survey, evaluation, or consultation functions to another
state agency or to a local health department qualified to perform
those functions. However, the department shall not delegate survey,
evaluation, or consultation functions to a local health department
that
owns or operates a hospice or hospice residence licensed under
this
article part 34 of the
long-term care continuum act. The
delegation shall be by cost reimbursement contract between the
department and the state agency or local health department. Survey,
evaluation, or consultation functions shall not be delegated to
nongovernmental agencies, except as provided in this section. The
department may accept voluntary inspections performed by an
accrediting body with expertise in clinical laboratory
accreditation under part 205 if the accrediting body utilizes forms
acceptable to the department, applies the same licensing standards
as applied to other clinical laboratories and provides the same
information and data usually filed by the department's own
employees when engaged in similar inspections or surveys. The
voluntary inspection described in this subsection shall be agreed
upon by both the licensee and the department.
(13)
If, upon investigation, the department
of consumer and
industry
services or a state agency determines that an individual
licensed to practice a profession in this state has violated the
applicable licensure statute or the rules promulgated under that
statute, the department, state agency, or local health department
shall forward the evidence it has to the appropriate licensing
agency.
(14)
The department of consumer and industry services shall
report
to the appropriations subcommittees, the senate and house of
representatives
standing committees having jurisdiction over issues
involving
senior citizens, and the fiscal agencies on March 1 of
each
year on the initial and follow-up surveys conducted on all
nursing
homes in this state. The report shall include all of the
following
information:
(a)
The number of surveys conducted.
(b)
The number requiring follow-up surveys.
(c)
The number referred to the Michigan public health
institute
for remediation.
(d)
The number of citations per nursing home.
(e)
The number of night and weekend complaints filed.
(f)
The number of night and weekend responses to complaints
conducted
by the department.
(g)
The average length of time for the department to respond
to
a complaint filed against a nursing home.
(h)
The number and percentage of citations appealed.
(i)
The number and percentage of citations overturned or
modified,
or both.
(15)
The department of consumer and industry services shall
report
annually to the standing committees on appropriations and
the
standing committees having jurisdiction over issues involving
senior
citizens in the senate and the house of representatives on
the
percentage of nursing home citations that are appealed and the
percentage
of nursing home citations that are appealed and amended
through
the informal deficiency dispute resolution process.
(14) (16)
Subject to subsection (17) (15),
a clarification
work
group comprised of the department
of consumer and industry
services
in consultation with a nursing home resident or a
member
of a nursing home resident's family, nursing home provider groups,
the
American medical directors association,
the department of
community
health, the state long-term care ombudsman, and the
federal centers for medicare and medicaid services shall clarify
the following terms as those terms are used in title XVIII and
title XIX and applied by the department to provide more consistent
regulation of nursing homes in Michigan:
(a) Immediate jeopardy.
(b) Harm.
(c) Potential harm.
(d) Avoidable.
(e) Unavoidable.
(15) (17)
All of the following clarifications developed
under
subsection (16) (14)
apply for purposes of subsection (16)
(14):
(a) Specifically, the term "immediate jeopardy" means "a
situation in which immediate corrective action is necessary because
the nursing home's noncompliance with 1 or more requirements of
participation has caused or is likely to cause serious injury,
harm, impairment, or death to a resident receiving care in a
nursing home".
(b) The likelihood of immediate jeopardy is reasonably higher
if there is evidence of a flagrant failure by the nursing home to
comply
with a clinical process guideline adopted under subsection
(18)
(16) than if the nursing home has substantially and
continuously complied with those guidelines. If federal regulations
and guidelines are not clear, and if the clinical process
guidelines have been recognized, a process failure giving rise to
an immediate jeopardy may involve an egregious widespread or
repeated process failure and the absence of reasonable efforts to
detect and prevent the process failure.
(c) In determining whether or not there is immediate jeopardy,
the survey agency should consider at least all of the following:
(i) Whether the nursing home could reasonably have been
expected to know about the deficient practice and to stop it, but
did not stop the deficient practice.
(ii) Whether the nursing home could reasonably have been
expected to identify the deficient practice and to correct it, but
did not correct the deficient practice.
(iii) Whether the nursing home could reasonably have been
expected to anticipate that serious injury, serious harm,
impairment, or death might result from continuing the deficient
practice, but did not so anticipate.
(iv) Whether the nursing home could reasonably have been
expected to know that a widely accepted high-risk practice is or
could be problematic, but did not know.
(v) Whether the nursing home could reasonably have been
expected to detect the process problem in a more timely fashion,
but did not so detect.
(d) The existence of 1 or more of the factors described in
subdivision (c), and especially the existence of 3 or more of those
factors simultaneously, may lead to a conclusion that the situation
is one in which the nursing home's practice makes adverse events
likely to occur if immediate intervention is not undertaken, and
therefore constitutes immediate jeopardy. If none of the factors
described in subdivision (c) is present, the situation may involve
harm or potential harm that is not immediate jeopardy.
(e) Specifically, "actual harm" means "a negative outcome to a
resident that has compromised the resident's ability to maintain or
reach, or both, his or her highest practicable physical, mental,
and psychosocial well-being as defined by an accurate and
comprehensive resident assessment, plan of care, and provision of
services". Harm does not include a deficient practice that only may
cause or has caused limited consequences to the resident.
(f) For purposes of subdivision (e), in determining whether a
negative outcome is of limited consequence, if the "state
operations manual" or "the guidance to surveyors" published by the
federal centers for medicare and medicaid services does not provide
specific guidance, the department may consider whether most people
in similar circumstances would feel that the damage was of such
short duration or impact as to be inconsequential or trivial. In
such a case, the consequence of a negative outcome may be
considered more limited if it occurs in the context of overall
procedural consistency with an accepted clinical process guideline
adopted
pursuant to subsection (18) (16), as compared to a
substantial inconsistency with or variance from the guideline.
(g) For purposes of subdivision (e), if the publications
described in subdivision (f) do not provide specific guidance, the
department may consider the degree of a nursing home's adherence to
a
clinical process guideline adopted pursuant to subsection (18)
(16) in considering whether the degree of compromise and future
risk to the resident constitutes actual harm. The risk of
significant compromise to the resident may be considered greater in
the context of substantial deviation from the guidelines than in
the case of overall adherence.
(h) To improve consistency and to avoid disputes over
"avoidable" and "unavoidable" negative outcomes, nursing homes and
survey agencies must have a common understanding of accepted
process guidelines and of the circumstances under which it can
reasonably be said that certain actions or inactions will lead to
avoidable negative outcomes. If the "state operations manual" or
"the guidance to surveyors" published by the federal centers for
medicare and medicaid services is not specific, a nursing home's
overall documentation of adherence to a clinical process guideline
with
a process indicator adopted pursuant to subsection (18)
(16)
is relevant information in considering whether a negative outcome
was "avoidable" or "unavoidable" and may be considered in the
application of that term.
(16) (18)
Subject to subsection (19) (17),
the department,
in consultation with the clarification work group appointed under
subsection (16)
(14), shall develop and adopt clinical process
guidelines that shall be used in applying the terms set forth in
subsection (16)
(14). The department shall establish and adopt
clinical process guidelines and compliance protocols with outcome
measures for all of the following areas and for other topics where
the department determines that clarification will benefit providers
and consumers of long-term care:
(a) Bed rails.
(b) Adverse drug effects.
(c) Falls.
(d) Pressure sores.
(e) Nutrition and hydration including, but not limited to,
heat-related stress.
(f) Pain management.
(g) Depression and depression pharmacotherapy.
(h) Heart failure.
(i) Urinary incontinence.
(j) Dementia.
(k) Osteoporosis.
(l) Altered mental states.
(m) Physical and chemical restraints.
(17) (19)
The department shall create a clinical advisory
committee to review and make recommendations regarding the clinical
process
guidelines with outcome measures adopted under subsection
(18)
(16). The department shall appoint physicians,
registered
professional nurses, and licensed practical nurses to the clinical
advisory committee, along with professionals who have expertise in
long-term care services, some of whom may be employed by long-term
care facilities. The clarification work group created under
subsection (16)
(14) shall review the clinical process guidelines
and outcome measures after the clinical advisory committee and
shall make the final recommendations to the department before the
clinical process guidelines are adopted.
(18) (20)
The department shall create a process by which the
director of the division of nursing home monitoring or his or her
designee or the director of the division of operations or his or
her designee reviews and authorizes the issuance of a citation for
immediate jeopardy or substandard quality of care before the
statement of deficiencies is made final. The review shall be to
assure that the applicable concepts, clinical process guidelines,
and
other tools contained in subsections
(17) (15) to (19)
(17)
are being used consistently, accurately, and effectively. As used
in this subsection, "immediate jeopardy" and "substandard quality
of care" mean those terms as defined by the federal centers for
medicare and medicaid services.
(19) (21)
The department may give grants, awards, or other
recognition to nursing homes to encourage the rapid implementation
of
the clinical process guidelines adopted under subsection (18)
(16).
(20) (22)
The department shall assess the effectiveness of
the amendatory act that added this subsection. The department shall
file an annual report on the implementation of the clinical process
guidelines and the impact of the guidelines on resident care with
the standing committee in the legislature with jurisdiction over
matters pertaining to nursing homes. The first report shall be
filed
on July 1, of the year following the year in which the
amendatory
act that added this subsection takes effect 2002.
(21) (23)
The department of consumer and
industry services
shall instruct and train the surveyors in the use of the
clarifications
described in subsection (17) (15)
and the clinical
process
guidelines adopted under subsection
(18) (16) in
citing
deficiencies.
(24)
A nursing home shall post the nursing home's survey
report
in a conspicuous place within the nursing home for public
review.
(22) (25)
Nothing in this amendatory act shall be construed
to limit the requirements of related state and federal law.
(23) (26)
As used in this section:
(a) "Title XVIII" means title XVIII of the social security
act, chapter
531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2,
1395b-6
to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5, 1395j to
1395t,
1395u to 1395w, 1395w-2 to 1395w-4, 1395w-21 to 1395w-28,
1395x
to 1395yy, and 1395bbb to 1395ggg 42
USC 1395 to 1395hhh.
(b)
"Title XIX" means title XIX of the social security act,
chapter
531, 49 Stat. 620, 42 U.S.C. 1396 to 1396f, 1396g-1 to
1396r-6,
and 1396r-8 to 1396v 42 USC
1396 to 1396v.
Sec.
20156. (1) A representative of the department of public
health
or the
state fire marshal division of the
department of
state
police bureau of fire
services, upon presentation of proper
identification, may enter the premises of an applicant or licensee
at any reasonable time to determine whether the applicant or
licensee meets the requirements of this article and the rules
promulgated
under this article. The director; the director of
social
services; the state fire marshal; the director of the office
of
services to the aging; or the director of a local health
department;
or an authorized representative of the director, the
director
of social services, the state fire marshal, the director
of
the office of services to the aging, or the director of a local
health
department may enter on the premises of an applicant or
licensee
under part 217 at any time in the course of carrying out
program
responsibilities.
(2)
The state fire marshal division of the department of
state
police bureau of fire
services shall enforce rules
promulgated by the state fire safety board for health facilities
and agencies to assure that physical facilities owned, maintained,
or operated by a health facility or agency are planned,
constructed, and maintained in a manner to protect the health,
safety, and welfare of patients.
(3)
The department of public health shall not issue a
license or certificate to a health facility or agency until it
receives
an appropriate certificate of approval from the state
fire
marshal division of the department of state police bureau of
fire
services. For purposes of this section,
a decision of the
state
fire marshal division of the department of state police
bureau of fire services to issue a certificate controls over that
of a local fire department.
(4) Subsections (2) and (3) do not apply to a health facility
or an agency licensed under part 205, 209, or 210.
Sec.
20162. (1) Beginning on the effective date of the
amendatory
act that added section 20935 July
23, 2004, upon a
determination that a health facility or agency is in compliance
with this article and the rules promulgated under this article, the
department shall issue an initial license within 6 months after the
applicant files a completed application. Receipt of the application
is considered the date the application is received by any agency or
department of this state. If the application is considered
incomplete by the department, the department shall notify the
applicant in writing or make the notice electronically available
within 30 days after receipt of the incomplete application,
describing the deficiency and requesting additional information. If
the department identifies a deficiency or requires the fulfillment
of a corrective action plan, the 6-month period is tolled until
either of the following occurs:
(a) Upon notification by the department of a deficiency, until
the date the requested information is received by the department.
(b) Upon notification by the department that a corrective
action plan is required, until the date the department determines
the requirements of the corrective action plan have been met.
(2) The determination of the completeness of an application
does not operate as an approval of the application for the license
and does not confer eligibility of an applicant determined
otherwise ineligible for issuance of a license.
(3) Except as otherwise provided in this subsection, if the
department fails to issue or deny a license within the time period
required by this section, the department shall return the license
fee and shall reduce the license fee for the applicant's next
licensure application, if any, by 15%. Failure to issue or deny a
license within the time period required under this section does not
allow the department to otherwise delay processing an application.
The completed application shall be placed in sequence with other
completed applications received at that same time. The department
shall not discriminate against an applicant in the processing of
the application based upon the fact that the application fee was
refunded or discounted under this subsection. The department may
issue a nonrenewable temporary permit for not more than 6 months if
additional time is needed to make a proper investigation or to
permit the applicant to undertake remedial action related to
operational or procedural deficiencies or items of noncompliance. A
temporary permit shall not be issued to cover deficiencies in
physical plant requirements.
(4) Except
as provided in part 217, the The
department may
issue a provisional license for not more than 3 consecutive years
to an applicant who temporarily is unable to comply with the rules
as to the physical plant owned, maintained, or operated by a health
facility or agency except as otherwise provided in this article. A
provisional license shall not be issued to a new health facility or
agency or a facility or agency whose ownership is transferred after
September 30, 1978, unless the facility or agency was licensed and
operating under this article or a prior law for not less than 5
years. Provisional licensure under acts repealed by this code shall
be counted against the 3-year maximum for licensure.
(5) The department, in order to protect the people of this
state, shall provide a procedure for the orderly closing of a
facility if it is unable to maintain its license under this
section.
(6) Except
as provided in part 217, the The
department, upon
finding that a health facility or agency is not operating in accord
with the requirements of its license, may:
(a) Issue an order directing the licensee to:
(i) Discontinue admissions.
(ii) Transfer selected patients out of the facility.
(iii) Reduce its licensed capacity.
(iv) Comply with specific requirements for licensure or
certification as appropriate.
(b) Through the office of the attorney general, initiate
misdemeanor proceedings against the licensee as provided in section
20199(1).
(7) An order issued under subsection (6) shall be governed by
the notice and hearing requirements of section 20168(1) and the
status requirements of section 20168(2).
(8) Beginning October 1, 2005, the director of the department
shall submit a report by December 1 of each year to the standing
committees and appropriations subcommittees of the senate and house
of representatives concerned with public health issues. The
director shall include all of the following information in the
report concerning the preceding fiscal year:
(a) The number of initial applications the department received
and completed within the 6-month time period required under
subsection (1).
(b) The number of applications requiring a request for
additional information.
(c) The number of applications denied.
(d) The average processing time for initial licenses granted
after the 6-month period.
(e) The number of temporary permits issued under subsection
(3).
(f) The number of initial license applications not issued
within the 6-month period and the amount of money returned to
applicants under subsection (3).
(9) As used in this section, "completed application" means an
application complete on its face and submitted with any applicable
licensing fees as well as any other information, records, approval,
security, or similar item required by law or rule from a local unit
of government, a federal agency, or a private entity but not from
another department or agency of this state.
Sec. 20168. (1) Upon a finding that a deficiency or violation
of this article or the rules promulgated under this article
seriously affects the health, safety, and welfare of individuals
receiving care or services in or from a licensed health facility or
agency, the department may issue an emergency order limiting,
suspending, or revoking the license of the health facility or
agency. If
the department of public health issues an emergency
order
affecting the license of a nursing home, the department of
public
health may request the department of social services to
limit
reimbursements or payments authorized under section 21718.
The department shall provide an opportunity for a hearing within 5
working days after issuance of the order.
(2) An order shall incorporate the department's findings. The
conduct of a hearing under this section shall not suspend the
department's order.
Sec. 20176. (1) A person may notify the department of a
violation of this article or of a rule promulgated under this
article that the person believes exists. The department shall
investigate each written complaint received and shall notify the
complainant in writing of the results of a review or investigation
of the complaint and any action proposed to be taken. Except as
otherwise
provided in sections section 20180, 21743(1)(d),
and
21799a,
the name of the complainant and the charges
contained in
the complaint are a matter of public record.
(2) Except
as otherwise provided in section 21799a, a A
complainant who is aggrieved by the decision of the department
under this section may appeal to the director. After review of an
appeal under this subsection, the director may order the department
to reinvestigate the complaint.
Sec. 20194. (1) Subject to subsections (2), (3), and (4), a
health facility or agency, except a health facility or agency
licensed under part 209, and including a health facility that is
not licensed under this article but holds itself out as providing
medical services, shall conspicuously display in the patient
waiting areas or other common areas of the health facility or
agency
copies of a pamphlet developed by the department of
consumer
and industry services outlining the procedure for filing
a complaint against a health facility or agency with the department
and the procedure for filing a complaint against an individual who
is licensed or registered under article 15 and employed by, under
contract to, or granted privileges by the health facility or
agency. The pamphlet shall be developed and distributed by the
department of
consumer and industry services after consultation
with appropriate professional associations.
(2)
The department of consumer and industry services shall
develop the pamphlets required under subsection (1) in languages
that are appropriate to the ethnic composition of the patient
population where the pamphlet will be displayed. The department
shall use large, easily readable type and nontechnical, easily
understood language in the pamphlet. The department shall
periodically distribute copies of the pamphlet to each health
facility or agency and to each unlicensed health facility described
in subsection (1).
(3)
The department of consumer and industry services shall
include a model standardized complaint form in the pamphlet
described in subsection (1). The department may develop a separate
model standardized complaint form that is specific to a particular
health facility or agency or category of health facilities and
agencies. The department shall develop a model standardized
complaint form that is specific to nursing homes. The department
shall include on the model standardized complaint form, at a
minimum, simple instructions on how to file a complaint, including
with
the nursing home as required under section 21723 3223 of the
long-term care continuum act, the department, the state long-term
care ombudsman, the Michigan protection and advocacy service, inc.,
and the health care fraud unit of the department of attorney
general. The department shall distribute copies of the model
standardized complaint form simultaneously with copies of the
pamphlet
as required under subsection (2).
The nursing home shall
conspicuously
display and make available multiple copies of the
pamphlet
and model standardized complaint form with the complaint
information
required to be posted under section 21723 in the
patient
waiting areas or other common areas of the nursing home
that
are easily accessible to nursing home patients and their
visitors,
as described in subsection (1), and shall provide a copy
of
the pamphlet and complaint form to each nursing home resident or
the
resident's surrogate decision maker upon admission to the
nursing
home. The department shall include on the model
standardized complaint form a telephone number for the receipt of
oral complaints.
(4) The
department may continue to distribute the complaint
pamphlets
within its possession on the effective date of the
amendatory
act that added this subsection until the department's
stock
is exhausted or until October 1, 2003, whichever is sooner.
Beginning
October 1, 2003, the The department shall only
distribute the complaint pamphlets and model standardized complaint
forms that are in compliance with subsections (2) and (3).
(5) The department shall make the complaint pamphlet and the
model standardized complaint form available to the public on the
department's internet website. The department shall take
affirmative action toward the development and implementation of an
electronic filing system that would allow an individual to file a
complaint through the website.
Sec. 20198. (1) Subject to subsection (3), an individual shall
not enter upon the premises of a health facility or agency that is
an inpatient facility, an outpatient facility, or a residential
facility for the purpose of engaging in an activity that would
cause a reasonable person to feel terrorized, frightened,
intimidated, threatened, harassed, or molested and that actually
causes a health facility or agency employee, patient, resident, or
visitor to feel terrorized, frightened, intimidated, threatened,
harassed, or molested. This subsection does not prohibit
constitutionally protected activity or conduct that serves a
legitimate purpose.
(2) An individual who violates subsection (1) is guilty of a
misdemeanor, punishable by imprisonment for not more than 1 year or
a fine of not less than $1,000.00 or more than $10,000.00, or both.
(3)
Subsections (1) and (2) do not apply to a nursing home
covered
under sections 21763(5) and 21799c(1)(c).
Sec. 20201. (1) A health facility or agency that provides
services directly to patients or residents and is licensed under
this article shall adopt a policy describing the rights and
responsibilities of patients or residents admitted to the health
facility or agency. Except for a licensed health maintenance
organization which shall comply with chapter 35 of the insurance
code of 1956, 1956 PA 218, MCL 500.3501 to 500.3580, or a nursing
home, hospice, or home for the aged which shall comply with the
long-term care continuum act, the policy shall be posted at a
public place in the health facility or agency and shall be provided
to each member of the health facility or agency staff. Patients or
residents shall be treated in accordance with the policy.
(2) The policy describing the rights and responsibilities of
patients or residents required under subsection (1) shall include,
as a minimum, all of the following:
(a) A patient or resident shall not be denied appropriate care
on the basis of race, religion, color, national origin, sex, age,
disability, marital status, sexual preference, or source of
payment.
(b) An individual who is or has been a patient or resident is
entitled to inspect, or receive for a reasonable fee, a copy of his
or her medical record upon request in accordance with the medical
records access act, 2004 PA 47, MCL 333.26261 to 333.26271. Except
as otherwise permitted or required under the health insurance
portability and accountability act of 1996, Public Law 104-191, or
regulations promulgated under that act, 45 CFR parts 160 and 164, a
third party shall not be given a copy of the patient's or
resident's medical record without prior authorization of the
patient or resident.
(c) A patient or resident is entitled to confidential
treatment of personal and medical records, and may refuse their
release to a person outside the health facility or agency except as
required because of a transfer to another health care facility, as
required by law or third party payment contract, or as permitted or
required under the health insurance portability and accountability
act of 1996, Public Law 104-191, or regulations promulgated under
that act, 45 CFR parts 160 and 164.
(d) A patient or resident is entitled to privacy, to the
extent feasible, in treatment and in caring for personal needs with
consideration, respect, and full recognition of his or her dignity
and individuality.
(e) A patient or resident is entitled to receive adequate and
appropriate care, and to receive, from the appropriate individual
within the health facility or agency, information about his or her
medical condition, proposed course of treatment, and prospects for
recovery, in terms that the patient or resident can understand,
unless medically contraindicated as documented by the attending
physician in the medical record.
(f) A patient or resident is entitled to refuse treatment to
the extent provided by law and to be informed of the consequences
of that refusal. If a refusal of treatment prevents a health
facility or agency or its staff from providing appropriate care
according to ethical and professional standards, the relationship
with the patient or resident may be terminated upon reasonable
notice.
(g) A patient or resident is entitled to exercise his or her
rights as a patient or resident and as a citizen, and to this end
may present grievances or recommend changes in policies and
services on behalf of himself or herself or others to the health
facility or agency staff, to governmental officials, or to another
person of his or her choice within or outside the health facility
or agency, free from restraint, interference, coercion,
discrimination, or reprisal. A patient or resident is entitled to
information about the health facility's or agency's policies and
procedures for initiation, review, and resolution of patient or
resident complaints.
(h) A patient or resident is entitled to information
concerning an experimental procedure proposed as a part of his or
her care and has the right to refuse to participate in the
experimental procedure without jeopardizing his or her continuing
care.
(i) A patient or resident is entitled to receive and examine
an explanation of his or her bill regardless of the source of
payment and to receive, upon request, information relating to
financial assistance available through the health facility or
agency.
(j) A patient or resident is entitled to know who is
responsible for and who is providing his or her direct care, is
entitled to receive information concerning his or her continuing
health needs and alternatives for meeting those needs, and to be
involved in his or her discharge planning, if appropriate.
(k) A patient or resident is entitled to associate and have
private communications and consultations with his or her physician,
attorney, or any other person of his or her choice and to send and
receive personal mail unopened on the same day it is received at
the health facility or agency, unless medically contraindicated as
documented by the attending physician in the medical record. A
patient's or resident's civil and religious liberties, including
the right to independent personal decisions and the right to
knowledge of available choices, shall not be infringed and the
health facility or agency shall encourage and assist in the fullest
possible exercise of these rights. A patient or resident may meet
with, and participate in, the activities of social, religious, and
community groups at his or her discretion, unless medically
contraindicated as documented by the attending physician in the
medical record.
(l) A patient or resident is entitled to be free from mental
and physical abuse and from physical and chemical restraints,
except those restraints authorized in writing by the attending
physician for a specified and limited time or as are necessitated
by an emergency to protect the patient or resident from injury to
self or others, in which case the restraint may only be applied by
a qualified professional who shall set forth in writing the
circumstances requiring the use of restraints and who shall
promptly report the action to the attending physician. In case of a
chemical restraint, a physician shall be consulted within 24 hours
after the commencement of the chemical restraint.
(m) A patient or resident is entitled to be free from
performing services for the health facility or agency that are not
included for therapeutic purposes in the plan of care.
(n) A patient or resident is entitled to information about the
health facility or agency rules and regulations affecting patient
or resident care and conduct.
(o) A patient or resident is entitled to adequate and
appropriate pain and symptom management as a basic and essential
element of his or her medical treatment.
(3)
The following additional requirements for the policy
described
in subsection (2) apply to licensees under parts 213 and
217:
(a)
The policy shall be provided to each nursing home patient
or
home for the aged resident upon admission, and the staff of the
facility
shall be trained and involved in the implementation of the
policy.
(b)
Each nursing home patient may associate and communicate
privately
with persons of his or her choice. Reasonable, regular
visiting
hours, which shall be not less than 8 hours per day, and
which
shall take into consideration the special circumstances of
each
visitor, shall be established for patients to receive
visitors.
A patient may be visited by the patient's attorney or by
representatives
of the departments named in section 20156, during
other
than established visiting hours. Reasonable privacy shall be
afforded
for visitation of a patient who shares a room with another
patient.
Each patient shall have reasonable access to a telephone.
A
married nursing home patient or home for the aged resident is
entitled
to meet privately with his or her spouse in a room that
assures
privacy. If both spouses are residents in the same
facility,
they are entitled to share a room unless medically
contraindicated
and documented by the attending physician in the
medical
record.
(c)
A nursing home patient or home for the aged resident is
entitled
to retain and use personal clothing and possessions as
space
permits, unless to do so would infringe upon the rights of
other
patients or residents, or unless medically contraindicated as
documented
by the attending physician in the medical record. Each
nursing
home patient or home for the aged resident shall be
provided
with reasonable space. At the request of a patient, a
nursing
home shall provide for the safekeeping of personal effects,
funds,
and other property of a patient in accordance with section
21767,
except that a nursing home is not required to provide for
the
safekeeping of a property that would impose an unreasonable
burden
on the nursing home.
(d)
A nursing home patient or home for the aged resident is
entitled
to the opportunity to participate in the planning of his
or
her medical treatment. A nursing home patient shall be fully
informed
by the attending physician of the patient's medical
condition
unless medically contraindicated as documented by a
physician
in the medical record. Each nursing home patient shall be
afforded
the opportunity to discharge himself or herself from the
nursing
home.
(e)
A home for the aged resident may be transferred or
discharged
only for medical reasons, for his or her welfare or that
of
other residents, or for nonpayment of his or her stay, except as
provided
by title XVIII or title XIX. A nursing home patient may be
transferred
or discharged only as provided in sections 21773 to
21777.
A nursing home patient or home for the aged resident is
entitled
to be given reasonable advance notice to ensure orderly
transfer
or discharge. Those actions shall be documented in the
medical
record.
(f)
A nursing home patient or home for the aged resident is
entitled
to be fully informed before or at the time of admission
and
during stay of services available in the facility, and of the
related
charges including any charges for services not covered
under
title XVIII, or not covered by the facility's basic per diem
rate.
The statement of services provided by the facility shall be
in
writing and shall include those required to be offered on an as-
needed
basis.
(g)
A nursing home patient or home for the aged resident is
entitled
to manage his or her own financial affairs, or to have at
least
a quarterly accounting of personal financial transactions
undertaken
in his or her behalf by the facility during a period of
time
the patient or resident has delegated those responsibilities
to
the facility. In addition, a patient or resident is entitled to
receive
each month from the facility an itemized statement setting
forth
the services paid for by or on behalf of the patient and the
services
rendered by the facility. The admission of a patient to a
nursing
home does not confer on the nursing home or its owner,
administrator,
employees, or representatives the authority to
manage,
use, or dispose of a patient's property.
(h)
A nursing home patient or a person authorized by the
patient
in writing may inspect and copy the patient's personal and
medical
records. The records shall be made available for inspection
and
copying by the nursing home within a reasonable time, not
exceeding
1 week, after the receipt of a written request.
(i)
If a nursing home patient desires treatment by a licensed
member
of the healing arts, the treatment shall be made available
unless
it is medically contraindicated, and the medical
contraindication
is justified in the patient's medical record by
the
attending physician.
(j)
A nursing home patient has the right to have his or her
parents,
if a minor, or his or her spouse, next of kin, or
patient's
representative, if an adult, stay at the facility 24
hours
a day if the patient is considered terminally ill by the
physician
responsible for the patient's care.
(k)
Each nursing home patient shall be provided with meals
that
meet the recommended dietary allowances for that patient's age
and
sex and that may be modified according to special dietary needs
or
ability to chew.
(l) Each nursing home patient has the right to receive
representatives
of approved organizations as provided in section
21763.
(4)
A nursing home, its owner, administrator, employee, or
representative
shall not discharge, harass, or retaliate or
discriminate
against a patient because the patient has exercised a
right
protected under this section.
(5)
In the case of a nursing home patient, the rights
enumerated
in subsection (2)(c), (g), and (k) and subsection
(3)(d),
(g), and (h) may be exercised by the patient's
representative.
(6)
A nursing home patient or home for the aged resident is
entitled
to be fully informed, as evidenced by the patient's or
resident's
written acknowledgment, before or at the time of
admission
and during stay, of the policy required by this section.
The
policy shall provide that if a patient or resident is
adjudicated
incompetent and not restored to legal capacity, the
rights
and responsibilities set forth in this section shall be
exercised
by a person designated by the patient or resident. The
health
facility or agency shall provide proper forms for the
patient
or resident to provide for the designation of this person
at
the time of admission.
(3) (7)
This section does not prohibit a health facility or
agency from establishing and recognizing additional patients'
rights.
(8)
As used in this section:
(a)
"Patient's representative" means that term as defined in
section
21703.
(b)
"Title XVIII" means title XVIII of the social security
act,
42 USC 1395 to 1395hhh.
(c)
"Title XIX" means title XIX of the social security act, 42
USC
1396 to 1396v.
Sec. 22205. (1) "Health facility", except as otherwise
provided in subsection (2), means:
(a) A hospital licensed under part 215.
(b) A psychiatric hospital or psychiatric unit licensed under
the mental health code, 1974 PA 258, MCL 330.1001 to 330.2106.
(c)
A nursing home licensed under part
217 32 of the long-
term care continuum act or a hospital long-term care unit as
defined in section 20106(6).
(d) A freestanding surgical outpatient facility licensed under
part 208.
(e) A health maintenance organization issued a license or
certificate of authority in this state.
(2) "Health facility" does not include the following:
(a) An institution conducted by and for the adherents of a
church or religious denomination for the purpose of providing
facilities for the care and treatment of the sick who depend solely
upon spiritual means through prayer for healing.
(b) A health facility or agency located in a correctional
institution.
(c) A veterans facility operated by the state or federal
government.
(d) A facility owned and operated by the department of
community health.
(3) "Initiate" means the offering of a covered clinical
service that has not been offered in compliance with this part or
former part 221 on a regular basis at that location within the 12-
month period immediately preceding the date the covered clinical
service will be offered.
(4) "Medical equipment" means a single equipment component or
a related system of components that is used for clinical purposes.
Sec. 22210. (1) A hospital that applies to the department for
a certificate of need and meets all of the following criteria shall
be granted a certificate of need for a short-term nursing care
program with up to 10 licensed hospital beds:
(a) Is eligible to apply for certification as a provider of
swing-bed
services under section 1883 of title XVIII, 42 U.S.C.
USC 1395tt.
(b) Subject to subsection (2), has fewer than 100 licensed
beds not counting beds excluded under section 1883 of title XVIII
of the social security act.
(c) Does not have uncorrected licensing, certification, or
safety deficiencies for which the department or the state fire
marshal, or both, has not accepted a plan of correction.
(d) Provides evidence satisfactory to the department that the
hospital has had difficulty in placing patients in skilled nursing
home beds during the 12 months immediately preceding the date of
the application.
(2) After October 1, 1990, the criteria set forth in
subsection (1)(b) may be modified by the commission, using the
procedure set forth in section 22215(3). The department shall not
charge a fee for processing a certificate of need application to
initiate a short-term nursing care program.
(3) A hospital that is granted a certificate of need for a
short-term nursing care program under subsection (1) shall comply
with all of the following:
(a) Not charge for or otherwise attempt to recover the cost of
a length of stay for a patient in the short-term nursing care
program that exceeds the length of time allowed for post-hospital
extended care under title XVIII.
(b) Admit patients to the short-term nursing care program only
pursuant to an admissions contract approved by the department.
(c) Not discharge or transfer a patient from a licensed
hospital bed other than a hospital long-term care unit bed and
admit that patient to the short-term nursing care program unless
the discharge or transfer and admission is determined medically
appropriate by the attending physician.
(d) Permit access to a representative of an organization
approved
under section 21764 3264
of the long-term care continuum
act to patients admitted to the short-term nursing care program,
for
all of the purposes described in section 21763 3263 of the
long-term care continuum act.
(e) Subject to subsection (8), not allow the number of patient
days for the short-term nursing care program to exceed the
equivalent of 1,825 patient days for a single state fiscal year.
(f) Transfer a patient in the short-term nursing care program
to an appropriately certified nursing home bed, county medical care
facility bed, or hospital long-term care unit bed located within a
50-mile radius of the patient's residence within 5 business days
after the hospital has been notified, either orally or in writing,
that a bed has become available.
(g) Not charge or collect from a patient admitted to the
short-term nursing care program, for services rendered as part of
the short-term nursing care program, an amount in excess of the
reasonable charge for the services as determined by the United
States secretary of health and human services under title XVIII.
(h) Assist a patient who has been denied coverage for services
received in a short-term nursing care program under title XVIII to
file an appeal with the medicare recovery project operated by the
office of services to the aging.
(i) Operate the short-term nursing care program in accordance
with this section and the requirements of the swing bed provisions
of
section 1883 of title XVIII, 42 U.S.C. USC
1395tt.
(j) Provide data to the department considered necessary by the
department to evaluate the short-term nursing care program. The
data shall include, but is not limited to, all of the following:
(i) The total number of patients admitted to the hospital's
short-term nursing care program during the period specified by the
department.
(ii) The total number of short-term nursing care patient days
for the period specified by the department.
(iii) Information identifying the type of care to which patients
in the short-term care nursing program are released.
(k) As part of the hospital's policy describing the rights and
responsibilities of patients admitted to the hospital, as required
under section 20201, incorporate all of the following additional
rights and responsibilities for patients in the short-term nursing
care program:
(i) A copy of the hospital's policy shall be provided to each
short-term nursing care patient upon admission, and the staff of
the hospital shall be trained and involved in the implementation of
the policy.
(ii) Each short-term nursing care patient may associate and
communicate privately with persons of his or her choice.
Reasonable, regular visiting hours, which shall take into
consideration the special circumstances of each visitor, shall be
established for short-term nursing care patients to receive
visitors. A short-term nursing care patient may be visited by the
patient's attorney or by representatives of the departments named
in section 20156 during other than established visiting hours.
Reasonable privacy shall be afforded for visitation of a short-term
nursing care patient who shares a room with another short-term
nursing care patient. Each short-term nursing care patient shall
have reasonable access to a telephone.
(iii) A short-term nursing care patient is entitled to retain
and use personal clothing and possessions as space permits, unless
medically contraindicated, as documented by the attending physician
in the medical record.
(iv) A short-term nursing care patient is entitled to the
opportunity to participate in the planning of his or her medical
treatment. A short-term nursing care patient shall be fully
informed by the attending physician of the short-term nursing care
patient's medical condition, unless medically contraindicated, as
documented by a physician in the medical record. Each short-term
nursing care patient shall be afforded the opportunity to discharge
himself or herself from the short-term nursing care program.
(v) A short-term nursing care patient is entitled to be fully
informed either before or at the time of admission, and during his
or her stay, of services available in the hospital and of the
related charges for those services. The statement of services
provided by the hospital shall be in writing and shall include
those services required to be offered on an as needed basis.
(vi) A patient in a short-term nursing care program or a person
authorized in writing by the patient may, upon submission to the
hospital of a written request, inspect and copy the patient's
personal or medical records. The hospital shall make the records
available for inspection and copying within a reasonable time, not
exceeding 7 days, after the receipt of the written request.
(vii) A short-term nursing care patient has the right to have
his or her parents, if the short-term nursing care patient is a
minor, or his or her spouse, next of kin, or patient's
representative, if the short-term nursing care patient is an adult,
stay at the facility 24 hours a day if the short-term nursing care
patient is considered terminally ill by the physician responsible
for the short-term nursing care patient's care.
(viii) Each short-term nursing care patient shall be provided
with meals that meet the recommended dietary allowances for that
patient's age and sex and that may be modified according to special
dietary needs or ability to chew.
(ix) Each short-term nursing care patient has the right to
receive a representative of an organization approved under section
21764, for all of the purposes described in section 21763.
(l) Achieve and maintain medicare certification under title
XVIII.
(4) A hospital or the owner, administrator, an employee, or a
representative of the hospital shall not discharge, harass, or
retaliate or discriminate against a short-term nursing care patient
because the short-term nursing care patient has exercised a right
described in subsection (3)(k).
(5) In the case of a short-term nursing care patient, the
rights described in subsection (3)(k)(iv) may be exercised by the
patient's representative, as defined in section 21703(2).
(6) A short-term nursing care patient shall be fully informed,
as evidenced by the short-term nursing care patient's written
acknowledgment, before or at the time of admission and during stay,
of the rights described in subsection (3)(k). The written
acknowledgment shall provide that if a short-term nursing care
patient is adjudicated incompetent and not restored to legal
capacity, the rights and responsibilities set forth in subsection
(3)(k) shall be exercised by a person designated by the short-term
nursing care patient. The hospital shall provide proper forms for
the short-term nursing care patient to provide for the designation
of this person at the time of admission.
(7) Subsection (3)(k) does not prohibit a hospital from
establishing and recognizing additional rights for short-term
nursing care patients.
(8) Upon application, the department may grant a variation
from the maximum number of patient days established under
subsection (3)(e), to an applicant hospital that demonstrates to
the satisfaction of the department that there is an immediate need
for skilled nursing beds within a 100-mile radius of the hospital.
A variation granted under this subsection shall be valid for not
more than 1 year after the date the variation is granted. The
department shall promulgate rules to implement this subsection
including, at a minimum, a definition of immediate need and the
procedure for applying for a variation.
(9) A hospital that violates subsection (3) is subject to the
penalty provisions of section 20165.
(10) A person shall not initiate a short-term nursing care
program without first obtaining a certificate of need under this
section.
Sec. 22239. (1) If the certificate of need approval was based
on a stipulation that the project would participate in title XIX
and the project has not participated in title XIX for at least 12
consecutive months within the first 2 years of operation or
continued to participate annually thereafter, the department shall
revoke the certificate of need. A stipulation described in this
section is germane to all health facility projects.
(2) The department shall monitor the participation in title
XIX of each certificate of need applicant approved under this part.
Except as otherwise provided in subsection (3), the department
shall require each applicant to provide verification of
participation in title XIX with its application and annually
thereafter.
(3) The department shall not revoke or deny a certificate of
need
for a nursing home licensed under part
217 32 of the long-
term care continuum act if that nursing home does not participate
in
title XIX on the effective date of the amendatory act that
added
this subsection March 31,
2003 but agrees to participate in
title XIX if beds become available. This section does not prohibit
a person from applying for and obtaining a certificate of need to
acquire or begin operation of a nursing home that does not
participate in title XIX.
Enacting section 1. Sections 20173, 20173a, 20173b, and 20178
and parts 213, 214, and 217 of the public health code, 1978 PA 368,
MCL 333.20173, 333.20173a, 333.20173b, 333.20178, 333.21301 to
333.21335, 333.21401 to 333.21420, and 333.21701 to 333.21799e, are
repealed.
Enacting section 2. This amendatory act does not take effect
unless House Bill No. 5762 of the 93rd Legislature is enacted into
law.