SENATE BILL NO. 476
INTRODUCED BY B. KEENAN, BISHOP, CHRISTIAENS, E. CLARK, GLASER, GRIMES, LAWSON, NELSON, SCHRUMPF, B. THOMAS
AN ACT CLARIFYING THE REQUIREMENTS FOR CERTIFICATION OF LONG-TERM CARE FACILITIES THAT PROVIDE INTERMEDIATE AND SKILLED NURSING CARE; REQUIRING THE DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES TO ADOPT RULES TO DEFINE TERMS, AN INFORMAL DISPUTE RESOLUTION PROCESS, AND STANDARDS FOR QUESTIONING A PHYSICIAN'S ORDERS FOR DRUGS OR TREATMENTS; AND AMENDING SECTIONS 53-6-107 AND 53-6-108, MCA.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
Section 1. Section 53-6-107, MCA, is amended to read:
"53-6-107. Sanctions -- penalties. (1) The department of public health and human services may suspend, terminate, or
refuse to renew an agreement with a health care facility that has failed to meet the requirements for certification for or
participation in the Montana medicaid program under 53-6-106 through 53-6-108 or other applicable law. The department
may also impose sanctions in the form of denial of medicaid payments for new admissions or other penalties or sanctions,
as described in 53-6-111 or Title XIX of the Social Security Act, 42 U.S.C. 1396, et seq., as may be amended, and any
implementing federal regulations and policies.
(2) The department may impose a civil monetary penalty, with interest not to exceed 12% a year, for each day that a
facility is substantially out of compliance with standards or participation requirements provided by applicable state or
federal laws, regulations, or rules, or policies, including but not limited to standards adopted by the department under the
authority of Title 50, chapter 5, or 53-6-106 through 53-6-108. Penalties must be collected by the department and may be
applied to the protection of the health and property of residents of health care facilities that the department finds deficient,
including but not limited to payment for the costs of relocation of residents to other facilities, operation of a facility
pending correction of deficiencies or closure, and reimbursement of residents for personal funds lost.
(3) The department may appoint temporary management personnel to oversee the operation of the facility and to ensure the health and safety of the facility's residents if there is a need for temporary management because:
(a) an orderly closure of the facility is necessary; or
(b) improvements are being made to bring the facility into compliance with applicable standards.
(4) The department shall, in the case of an emergency, close the facility or transfer residents in the facility to other facilities, or both."
Section 2. Section 53-6-108, MCA, is amended to read:
"53-6-108. Rules governing sanctions or remedies. The department of public health and human services shall adopt
rules governing the application of sanctions or remedies imposed under 53-6-107, the amounts of any fines, and the
severity of each of these sanctions or remedies. The rules must be designed for the imposition of incrementally more severe
fines for repeated or uncorrected deficiencies. The civil penalty for violation of the applicable standards imposed by state or
federal laws, regulations, or rules, or policies may not exceed $10,000 for each day that the deficiency remains uncorrected.
A health care facility aggrieved by an action of the department may request a hearing pursuant to Title 2, chapter 4, part 6."
Section 3. Consistent regulation of long-term care facilities -- rulemaking authority. In order to provide more consistent regulation of long-term care facilities that provide intermediate and skilled nursing care statewide, the department shall adopt rules in consultation with long-term care provider groups, the long-term care ombudsman, as described in 52-3-603, and appropriate consumer groups by July 1, 2003, that:
(1) define the following terms used in the survey and certification process for long-term care facilities that provide intermediate and skilled nursing care:
(a) actual harm;
(b) potential for more than minimal harm;
(c) avoidable;
(d) unavoidable; and
(e) immediate jeopardy;
(2) define an informal dispute resolution process to provide nursing homes with an opportunity to respond to survey findings and deficiency citations that are believed to be made in error. The rules must be consistent with the purpose of informal dispute resolution that is intended to give the provider an opportunity to demonstrate that a deficiency has been applied in error or is a misjudgment of true facts. The objective of the process is to avoid the imposition of unnecessary sanctions and to diminish the need for formal administrative hearings with the state, as provided for in 53-6-108, or the federal government agencies that are responsible for the enforcement of remedies. The process must provide for an objective review of the raised issues by an individual who is independent of the survey process and who can evaluate the legal sufficiency of the findings of the surveyors.
(3) define standards for survey determinations in which the surveyors question the efficacy of orders for drugs and treatments made by a resident's attending physician. The standards must recognize that a written physician's order provides evidence of medical necessity and the appropriateness of the drugs and treatments ordered, unless the survey agency alleges substandard practice by the physician. The standards must provide for the reporting of any substandard practice of a physician to the board of medical examiners by the surveyors. The standards must outline a facility's responsibilities in monitoring drugs and treatments ordered for residents and for consulting with the attending physician as appropriate.
Section 4. Codification instruction. [Section 3] is intended to be codified as an integral part of Title 53, chapter 6, part 1, and the provisions of Title 53, chapter 6, part 1, apply to [section 3].
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