HOUSE BILL No. 4785 May 14, 1997, Introduced by Reps. Quarles, DeHart, Varga, Curtis, LaForge, Brewer, Cherry, Rison, Murphy, Bogardus, Schermesser, Godchaux, Parks, Hale, Scott and Martinez and referred to the Committee on Health Policy. A bill to amend 1978 PA 368, entitled "Public health code," by amending section 22210 (MCL 333.22210), as amended by 1993 PA 88. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 22210. (1) A hospital that applies to the department 2 for a certificate of need and meets all of the following criteria 3 shall be granted a certificate of need for a short-term nursing 4 care program with up to 10 licensed hospital beds: 5 (a) Is eligible to apply for certification as a provider of 6 swing-bed services under section 1883 of title XVIII, 7 42 U.S.C. 1395tt. 8 (b) Subject to subsection (2), has fewer than 100 licensed 9 beds not counting beds excluded under section 1883 of title XVIII 10 of the social security act. 01256'97 CPD 2 1 (c) Does not have uncorrected licensing, certification, or 2 safety deficiencies for which the department or the state fire 3 marshal, or both, has not accepted a plan of correction. 4 (d) Provides evidence satisfactory to the department that 5 the hospital has had difficulty in placing patients in skilled 6 nursing home beds during the 12 months immediately preceding the 7 date of the application. 8 (2) After October 1, 1990, the criteria set forth in 9 subsection (1)(b) may be modified by the commission, using the 10 procedure set forth in section22215(3)22215. The department 11 shall not charge a fee for processing a certificate of need 12 application to initiate a short-term nursing care program. 13 (3) A hospital that is granted a certificate of need for a 14 short-term nursing care program under subsection (1) shall comply 15 with all of the following: 16 (a) Not charge for or otherwise attempt to recover the cost 17 of a length of stay for a patient in the short-term nursing care 18 program that exceeds the length of time allowed for post-hospital 19 extended care under title XVIII. 20 (b) Admit patients to the short-term nursing care program 21 only pursuant to an admissions contract approved by the 22 department. 23 (c) Not discharge or transfer a patient from a licensed hos- 24 pital bed other than a hospital long-term care unit bed and admit 25 that patient to the short-term nursing care program unless the 26 discharge or transfer and admission is determined medically 27 appropriate by the attending physician. 01256'97 3 1 (d) Permit access to a representative of an organization 2 approved under section 21764 to patients admitted to the 3 short-term nursing care program, for all of the purposes 4 described in section 21763. 5 (e) Subject to subsection (8), not allow the number of 6 patient days for the short-term nursing care program to exceed 7 the equivalent of 1,825 patient days for a single state fiscal 8 year. 9 (f)TransferEXCEPT AS OTHERWISE PROVIDED IN THIS SUBDIVI- 10 SION, TRANSFER a patient in the short-term nursing care program 11 to an appropriately certified nursing home bed, county medical 12 care facility bed, or hospital long-term care unit bed located 13 within a 50-mile radius of the patient's residence within 5 busi- 14 ness days after the hospital has been notified, either orally or 15 in writing, that a bed has become available. IF THE AVAILABLE 16 NURSING HOME BED, COUNTY MEDICAL CARE FACILITY BED, OR HOSPITAL 17 LONG-TERM CARE UNIT BED WITHIN THE 50-MILE RADIUS IS LOCATED IN 18 ANOTHER STATE OR COUNTRY, THE HOSPITAL MAY WAIT TO TRANSFER THE 19 PATIENT UNDER THIS SUBDIVISION UNTIL A BED DESCRIBED IN THIS SUB- 20 DIVISION WITHIN THE 50-MILE RADIUS AND LOCATED IN THIS STATE 21 BECOMES AVAILABLE. 22 (g) Not charge or collect from a patient admitted to the 23 short-term nursing care program, for services rendered as part of 24 the short-term nursing care program, an amount in excess of the 25 reasonable charge for the services as determined by the United 26 States secretary of health and human services under title XVIII. 01256'97 4 1 (h) Assist a patient who has been denied coverage for 2 services received in a short-term nursing care program under 3 title XVIII to file an appeal with the medicare recovery project 4 operated by the office of services to the aging. 5 (i) Operate the short-term nursing care program in accord- 6 ance with this section and the requirements of the swing bed pro- 7 visions of section 1883 of title XVIII, 42 U.S.C. 1395tt. 8 (j) Provide data to the department considered necessary by 9 the department to evaluate the short-term nursing care program. 10 The data shall include, but is not limited to, all of the 11 following: 12 (i) The total number of patients admitted to the hospital's 13 short-term nursing care program during the period specified by 14 the department. 15 (ii) The total number of short-term nursing care patient 16 days for the period specified by the department. 17 (iii) Information identifying the type of care to which 18 patients in the short-term care nursing program are released. 19 (k) As part of the hospital's policy describing the rights 20 and responsibilities of patients admitted to the hospital, as 21 required under section 20201, incorporate all of the following 22 additional rights and responsibilities for patients in the 23 short-term nursing care program: 24 (i) A copy of the hospital's policy shall be provided to 25 each short-term nursing care patient upon admission, and the 26 staff of the hospital shall be trained and involved in the 27 implementation of the policy. 01256'97 5 1 (ii) Each short-term nursing care patient may associate and 2 communicate privately with persons of his or her choice. 3 Reasonable, regular visiting hours, which shall take into consid- 4 eration the special circumstances of each visitor, shall be 5 established for short-term nursing care patients to receive 6 visitors. A short-term nursing care patient may be visited by 7 the patient's attorney or by representatives of the departments 8 named in section 20156 during other than established visiting 9 hours. Reasonable privacy shall be afforded for visitation of a 10 short-term nursing care patient who shares a room with another 11 short-term nursing care patient. Each short-term nursing care 12 patient shall have reasonable access to a telephone. 13 (iii) A short-term nursing care patient is entitled to 14 retain and use personal clothing and possessions as space per- 15 mits, unless medically contraindicated, as documented by the 16 attending physician in the medical record. 17 (iv) A short-term nursing care patient is entitled to the 18 opportunity to participate in the planning of his or her medical 19 treatment. A short-term nursing care patient shall be fully 20 informed by the attending physician of the short-term nursing 21 care patient's medical condition, unless medically contraindi- 22 cated, as documented by a physician in the medical record. Each 23 short-term nursing care patient shall be afforded the opportunity 24 to discharge himself or herself from the short-term nursing care 25 program. 26 (v) A short-term nursing care patient is entitled to be 27 fully informed either before or at the time of admission, and 01256'97 6 1 during his or her stay, of services available in the hospital and 2 of the related charges for those services. The statement of 3 services provided by the hospital shall be in writing and shall 4 include those services required to be offered on an as needed 5 basis. 6 (vi) A patient in a short-term nursing care program or a 7 person authorized in writing by the patient may, upon submission 8 to the hospital of a written request, inspect and copy the 9 patient's personal or medical records. The hospital shall make 10 the records available for inspection and copying within a reason- 11 able time, not exceeding 7 days, after the receipt of the written 12 request. 13 (vii) A short-term nursing care patient has the right to 14 have his or her parents, if the short-term nursing care patient 15 is a minor, or his or her spouse, next of kin, or patient's rep- 16 resentative, if the short-term nursing care patient is an adult, 17 stay at the facility 24 hours a day if the short-term nursing 18 care patient is considered terminally ill by the physician 19 responsible for the short-term nursing care patient's care. 20 (viii) Each short-term nursing care patient shall be pro- 21 vided with meals that meet the recommended dietary allowances for 22 that patient's age and sex and that may be modified according to 23 special dietary needs or ability to chew. 24 (ix) Each short-term nursing care patient has the right to 25 receive a representative of an organization approved under 26 section 21764, for all of the purposes described in section 27 21763. 01256'97 7 1 (l) Achieve and maintain medicare certification under title 2 XVIII. 3 (4) A hospital or the owner, administrator, an employee, or 4 a representative of the hospital shall not discharge, harass, or 5 retaliate or discriminate against a short-term nursing care 6 patient because the short-term nursing care patient has exercised 7 a right described in subsection (3)(k). 8 (5) In the case of a short-term nursing care patient, the 9 rights described in subsection (3)(k)(iv) may be exercised by the 10 patient's representative, as defined in section 21703(2). 11 (6) A short-term nursing care patient shall be fully 12 informed, as evidenced by the short-term nursing care patient's 13 written acknowledgment, before or at the time of admission and 14 during stay, of the rights described in subsection (3)(k). The 15 written acknowledgment shall provide that if a short-term nursing 16 care patient is adjudicated incompetent and not restored to legal 17 capacity, the rights and responsibilities set forth in subsection 18 (3)(k) shall be exercised by a person designated by the 19 short-term nursing care patient. The hospital shall provide 20 proper forms for the short-term nursing care patient to provide 21 for the designation of this person at the time of admission. 22 (7) Subsection (3)(k) does not prohibit a hospital from 23 establishing and recognizing additional rights for short-term 24 nursing care patients. 25 (8) Upon application, the department may grant a variation 26 from the maximum number of patient days established under 27 subsection (3)(e), to an applicant hospital that demonstrates to 01256'97 8 1 the satisfaction of the department that there is an immediate 2 need for skilled nursing beds within a 100-mile radius of the 3 hospital. IF PART OF THE 100-MILE RADIUS IS LOCATED IN ANOTHER 4 STATE OR COUNTRY, THE APPLICANT HOSPITAL NEED ONLY DEMONSTRATE TO 5 THE SATISFACTION OF THE DEPARTMENT THAT THERE IS AN IMMEDIATE 6 NEED FOR SKILLED NURSING BEDS WITHIN THAT PART OF THE 100-MILE 7 RADIUS LOCATED IN THIS STATE. A variation granted under this sub- 8 section shall be valid for not more than 1 year after the date 9 the variation is granted. The department shall promulgate rules 10 to implement this subsection including, at a minimum, a defini- 11 tion of immediate need and the procedure for applying for a 12 variation. 13 (9) A hospital that violates subsection (3) is subject to 14 the penalty provisions of section 20165. 15 (10) A person shall not initiate a short-term nursing care 16 program without first obtaining a certificate of need under this 17 section. 01256'97 Final page. CPD