HOUSE BILL No. 4625 April 15, 1997, Introduced by Reps. Freeman, Leland, Bogardus, Hale, Schermesser, Wojno, Brown, Cherry, Gubow, Goschka and Schauer and referred to the Committee on Consumer Protection. A bill to amend 1978 PA 368, entitled "Public health code," (MCL 333.1101 to 333.25211) by adding section 21714a. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 SEC. 21714A. THE NURSING HOME DISCLOSURE FORM REQUIRED BY 2 SECTION 21714 SHALL BE SUBSTANTIALLY IN THE FOLLOWING FORM: 3 "STATE OF MICHIGAN 4 NURSING HOME DISCLOSURE FORM 5 FILED PURSUANT TO THE NURSING HOME CONSUMERS RIGHT-TO-KNOW ACT 6 NAME OF NURSING HOME:____________________________________________ 7 PROVIDER ID NO.:_________________________________________________ 8 NURSING HOME ADDRESS:____________________________________________ 9 NURSING HOME PHONE:______________________________________________ 10 REPORTING PERIOD:________________________________________________ 00795'97 a CPD 2 1 NURSING HOME SPONSORSHIP (CHECK ONE) 2 GOVERNMENT_____ 3 NONPROFIT _____ 4 FOR-PROFIT_____ 5 NAME OF MULTIFACILITY SYSTEM IF ANY______________________________ 6 ADDRESS OF MULTIFACILITY SYSTEM__________________________________ 7 _________________________________________________________________ 8 SIGNATURE OF ADMINISTRATOR: _____________________________________ 9 TITLE OF ADMINISTRATOR:__________________________________________ 10 LICENSE STATUS: 11 CURRENT LICENSE STATUS:_____________________________________ 12 PAST LICENSE STATUS: INDICATE HERE IF THE NURSING HOME HAS 13 EVER BEEN ASSIGNED ANY OF THE FOLLOWING LICENSE STATUSES AND THE 14 TIME PERIODS COVERED: 15 PROVISIONAL___________________________ DATES_____________ 16 BAN ON ADMISSIONS_____________________ DATES_____________ 17 SUSPENDED_____________________________ DATES_____________ 18 REVOKED_______________________________ DATES_____________ 19 RECEIVER APPOINTED____________________ DATES_____________ 20 NURSING STAFFING: SHOWN HERE ARE AVERAGE NURSING STAFFING LEVELS 21 FOR THE REPORTING PERIOD. NURSING HOURS PER PATIENT DAY ARE COM- 22 PARED TO MINIMUM STAFFING REQUIREMENTS AND COUNTY AVERAGES. IN 23 ADDITION TO A MINIMUM HOUR STANDARD, THIS STATE REQUIRES THAT 24 STAFFING RATIOS OF NURSING PERSONNEL TO PATIENTS OF 1:8 DURING 25 THE DAY SHIFT, 1:12 DURING THE AFTERNOON SHIFT, AND 1:15 DURING 26 THE NIGHT SHIFT, BE MET EACH SHIFT OF EACH DAY. 00795'97 a 3 1 1. AVERAGE NURSING HOURS PER PATIENT DAY DURING REPORTING 2 PERIOD___________________________________________________________ 3 2. REQUIRED NURSING HOURS PER PATIENT DAY_______________________ 4 3. AVERAGE NURSING HOURS PER PATIENT DAY IN_____________________ 5 COUNTY. 6 NURSING TURNOVER: TURNOVER IS A MEASURE OF THE NUMBER STAFF 7 LEAVING THEIR POSITION FOR ANY REASON DURING THE REPORTING 8 PERIOD, SHOWN AS A PERCENTAGE OF THE NORMAL NUMBER OF STAFF ON 9 STATUS. 10 4. TURNOVER RATE DURING THE REPORTING PERIOD____________________ 11 WORKER INJURY RATES: WORKER INJURY RATES ARE SHOWN AS THE NUMBER 12 OF REPORTED INJURIES PER 100 FULL-TIME WORKERS PER REPORTING 13 PERIOD. 14 5. ANNUAL OSHA INJURY RATE PER 100 FULL-TIME WORKERS____________ 15 6. ANNUAL WORKERS' DISABILITY COMPENSATION INJURY RATE PER 100 16 FULL-TIME WORKERS________________________________________________ 17 PROFITS: PRESETTLEMENT NET INCOME REPORTED HERE MAY INCREASE OR 18 DECREASE SOMEWHAT DEPENDING ON FINAL SETTLEMENT WITH THIS STATE. 19 7. NET INCOME FOR PERIOD________________________________________ 20 8. NET INCOME PER PATIENT DAY___________________________________ 21 COMPUTATION OF FIGURES FOR DISCLOSURE FORM 22 "REPORTING PERIOD" SHOULD BE MOST RECENT FISCAL YEAR OR PORTION 23 OF FISCAL YEAR THE NURSING HOME IS OPERATIONAL. 24 "MULTIFACILITY SYSTEM" REFERS TO ANY ENTITY THAT OPERATES OTHER 25 NURSING FACILITIES IN ANY STATE THAT OWNS THE REPORTING NURSING 26 HOME OR WITH WHICH THE REPORTING NURSING HOME IS FORMALLY 27 AFFILIATED. 00795'97 a 4 1 "LICENSE STATUS" REFERS TO THE CURRENT STATUS OF THE NURSING 2 HOME'S LICENSE AS ASSIGNED BY THE DEPARTMENT. 3 ENTER "FULL," "PROVISIONAL," "BAN ON ADMISSIONS," "SUSPENDED," 4 "REVOKED," OR "RECEIVER APPOINTED," AS APPLICABLE. 5 LINES 1-3: 6 1A. ENTER TOTAL FLOOR HOURS WORKED BY NURSING PER- 7 SONNEL DURING REPORTING PERIOD ___________ 8 1B. ENTER TOTAL PATIENT DAYS PER PERIOD ___________ 9 1C. DIVIDE 1A BY 1B (ENTER ON LINE 1, PAGE 1) ___________ 10 LINE 4: 11 2A. ENTER NUMBER OF NURSING PERSONNEL LEAVING 12 ACTIVE STATUS FOR ANY REASON DURING REPORTING PERIOD ___________ 13 2B. ENTER NUMBER OF NURSING PERSONNEL ON ACTIVE 14 STATUS ON LAST DAY OF FISCAL YEAR ___________ 15 2C. DIVIDE 2A BY 2B ___________ 16 2D. MULTIPLY 2C TIMES 100% (ENTER ON LINE 4) ___________ 17 LINES 5-6: 18 3A. ENTER TOTAL NUMBER OF HOURS WORKED BY ALL NURS- 19 ING PERSONNEL DURING REPORTING PERIOD ___________ 20 3B. DIVIDE LINE 3A BY 2080 HOURS ___________ 21 3C. ENTER NUMBER OF INJURIES AND ILLNESS REPORTED 22 ON OSHA RECORDKEEPING FORMS DURING REPORTING PERIOD ___________ 23 3D. DIVIDE 3C BY 3B (ENTER ON LINE 5) ___________ 24 3E. ENTER NUMBER OF INJURIES AND ILLNESSES REPORTED 25 TO THE BUREAU OF WORKERS' DISABILITY COMPENSATION ___________ 26 3F. DIVIDE 3E BY 3B (ENTER ON LINE 6) ___________ 00795'97 a 5 1 LINES 7-8: 2 4A. ENTER PRESETTLEMENT NET INCOME OR EXCESS FROM 3 MEDICAID COST REPORT, SCHEDULE D, LINE 30A (ENTER ON 4 LINE 7) ___________ 5 4B. DIVIDE 4A BY 1B (ENTER ON LINE 8) _________________". 6 Enacting section 1. This amendatory act takes effect upon 7 the expiration of 60 days after the date of its enactment. 8 Enacting section 2. This amendatory act does not take 9 effect unless Senate Bill No. _____ or House Bill No. _____ 10 (request no. 00795'97) of the 89th Legislature is enacted into 11 law. 00795'97 a Final page. CPD