HOUSE BILL No. 4152 February 7, 2001, Introduced by Reps. Wojno, Hansen, Mans and Rich Brown and referred to the Committee on Senior Health, Security and Retirement. A bill to amend 1978 PA 368, entitled "Public health code," by amending section 20155 (MCL 333.20155), as amended by 2000 PA 171. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 20155. (1) Except as otherwise provided in this sec- 2 tion, the department of consumer and industry services shall make 3 annual and other visits to each health facility or agency 4 licensed under this article for the purposes of survey, evalu- 5 ation, and consultation. A visit made pursuant to a complaint 6 shall be unannounced. Except for a county medical care facility, 7 a home for the aged, a nursing home, or a hospice residence, the 8 department shall determine whether the visits that are not made 9 pursuant to a complaint are announced or unannounced. IN 10 ADDITION TO VISITS MADE PURSUANT TO A COMPLAINT INVESTIGATION, 00746'01 * CPD 2 1 THE DEPARTMENT SHALL ANNUALLY MAKE AT LEAST 2 UNANNOUNCED VISITS 2 TO EACH COUNTY MEDICAL CARE FACILITY AND HOSPICE RESIDENCE. 3 Beginningupon the expiration of 12 months after the effective4date of the amendatory act that added this sentenceJUNE 20, 5 2001, the department shall assure that each newly hired nursing 6 home surveyor, as part of his or her basic training, is assigned 7 full-time to a licensed nursing home for at least 10 days within 8 a 14-day period to observe actual operations outside of the 9 survey process before the trainee begins oversight 10 responsibilities. A member of a survey team shall not be 11 employed by a licensed nursing home or a nursing home management 12 company doing business in this state at the time of conducting a 13 survey under this section. The department shall not assign an 14 individual to be a member of a survey team for purposes of a 15 survey, evaluation, or consultation visit at a nursing home in 16 which he or she was an employee within the preceding 5 years. 17 (2) The department of consumer and industry services shall 18 make at least a biennial visit to each licensed clinical labora- 19 tory, each nursing home,and each hospice residence for the 20 purposes of survey, evaluation, and consultation. IN ADDITION TO 21 VISITS MADE PURSUANT TO COMPLAINT INVESTIGATIONS, AT LEAST TWICE 22 ANNUALLY MAKE UNANNOUNCED VISITS TO AND INSPECT EACH NURSING HOME 23 LICENSED UNDER THIS ARTICLE, REGARDLESS OF WHETHER THE NURSING 24 HOME IS CERTIFIED UNDER TITLE XVIII OR TITLE XIX. The department 25 of consumer and industry services shall semiannually provide for 26 joint training with nursing home surveyors and providers on at 27 least 1 of the 10 most frequently issued federal citations in 00746'01 * 3 1 this state during the past calendar year. The department of 2 consumer and industry services shall develop a protocol for the 3 review of citation patterns compared to regional outcomes and 4 standards and complaints regarding the nursing home survey 5 process. The review will result in a report provided to the 6 legislature. Except as otherwise provided in this subsection, 7 beginning with his or her first full relicensure period after 8the effective date of the amendatory act that added this9sentenceJUNE 20, 2001, each member of a department of consumer 10 and industry services nursing home survey team who is a health 11 professional licensee under article 15 shall earn not less than 12 50% of his or her required continuing education credits, if any, 13 in geriatric care. If a member of a nursing home survey team is 14 a pharmacist licensed under article 15, he or she shall earn not 15 less than 30% of his or her required continuing education credits 16 in geriatric care. 17 (3) The department of consumer and industry services shall 18 make a biennial visit to each hospital for survey and evaluation 19 for the purpose of licensure. Subject to subsection (6), the 20 department may waive the biennial visit required by this subsec- 21 tion if a hospital, as part of a timely application for license 22 renewal, requests a waiver and submits both of the following and 23 if all of the requirements of subsection (5) are met: 24 (a) Evidence that it is currently fully accredited by a body 25 with expertise in hospital accreditation whose hospital accredit- 26 ations are accepted by the United States department of health and 00746'01 * 4 1 human services for purposes of section 1865 of part C of 2 title XVIII of the social security act, 42 U.S.C. 1395bb. 3 (b) A copy of the most recent accreditation report for the 4 hospital issued by a body described in subdivision (a), and the 5 hospital's responses to the accreditation report. 6 (4) Except as provided in subsection (8), accreditation 7 information provided to the department of consumer and industry 8 services under subsection (3) is confidential, is not a public 9 record, and is not subject to court subpoena. The department 10 shall use the accreditation information only as provided in this 11 section and shall return the accreditation information to the 12 hospital within a reasonable time after a decision on the waiver 13 request is made. 14 (5) The department of consumer and industry services shall 15 grant a waiver under subsection (3) if the accreditation report 16 submitted under subsection (3)(b) is less than 2 years old and 17 there is no indication of substantial noncompliance with licen- 18 sure standards or of deficiencies that represent a threat to 19 public safety or patient care in the report, in complaints 20 involving the hospital, or in any other information available to 21 the department. If the accreditation report is 2 or more years 22 old, the department may do 1 of the following: 23 (a) Grant an extension of the hospital's current license 24 until the next accreditation survey is completed by the body 25 described in subsection (3)(a). 26 (b) Grant a waiver under subsection (3) based on the 27 accreditation report that is 2 or more years old, on condition 00746'01 * 5 1 that the hospital promptly submit the next accreditation report 2 to the department. 3 (c) Deny the waiver request and conduct the visits required 4 under subsection (3). 5 (6) This section does not prohibit the department from 6 citing a violation of this part during a survey, conducting 7 investigations or inspections pursuant to section 20156, or con- 8 ducting surveys of health facilities or agencies for the purpose 9 of complaint investigations or federal certification. This sec- 10 tion does not prohibit the state fire marshal from conducting 11 annual surveys of hospitals, nursing homes, and county medical 12 care facilities. 13 (7) At the request of a health facility or agency, the 14 department of consumer and industry services may conduct a con- 15 sultation engineering survey of a health facility and provide 16 professional advice and consultation regarding health facility 17 construction and design. A health facility or agency may request 18 a voluntary consultation survey under this subsection at any time 19 between licensure surveys. The fees for a consultation engineer- 20 ing survey are the same as the fees established for waivers under 21 section 20161(10). 22 (8) If the department of consumer and industry services 23 determines that substantial noncompliance with licensure stan- 24 dards exists or that deficiencies that represent a threat to 25 public safety or patient care exist based on a review of an 26 accreditation report submitted pursuant to subsection (3)(b), the 27 department shall prepare a written summary of the substantial 00746'01 * 6 1 noncompliance or deficiencies and the hospital's response to the 2 department's determination. The department's written summary and 3 the hospital's response are public documents. 4 (9) The department of consumer and industry services or a 5 local health department shall conduct investigations or inspec- 6 tions, other thaninspectionsAN INSPECTION of financial 7 records, of a county medical care facility, home for the aged, 8 nursing home, or hospice residence without prior notice to the 9 health facility or agency. An employee of a state agency charged 10 with investigating or inspecting the health facility or agency or 11 an employee of a local health department who directly or indi- 12 rectly gives prior notice regarding an investigation or an 13 inspection, other than an inspection of the financial records, to 14 the health facility or agency or to an employee of the health 15 facility or agency, is guilty of a misdemeanor.Consultation16visits that areA CONSULTATION VISIT THAT IS not for the purpose 17 of annual or follow-up inspection or survey may be announced. 18 (10) The department of consumer and industry services shall 19 maintain a record indicating whether a visit and inspection is 20 announced or unannounced. Information gathered at each visit and 21 inspection, whether announced or unannounced, shall be taken into 22 account in licensure decisions. 23 (11) The department of consumer and industry services shall 24 require periodic reports and a health facility or agency shall 25 give the department access to books, records, and other documents 26 maintained by a health facility or agency to the extent necessary 27 to carry out the purpose of this article and the rules 00746'01 * 7 1 promulgated under this article. The department shall respect the 2 confidentiality of a patient's clinical record and shall not 3 divulge or disclose the contents of the records in a manner that 4 identifies an individual except under court order. The depart- 5 ment may copy health facility or agency records as required to 6 document findings. 7 (12) The department of consumer and industry services may 8 delegate survey, evaluation, or consultation functions to another 9 state agency or to a local health department qualified to perform 10 those functions. However, the department shall not delegate 11 survey, evaluation, or consultation functions to a local health 12 department that owns or operates a hospice or hospice residence 13 licensed under this article. The delegation shall be by cost 14 reimbursement contract between the department and the state 15 agency or local health department. Survey, evaluation, or con- 16 sultation functions shall not be delegated to nongovernmental 17 agencies, except as provided in this section. The department may 18 accept voluntary inspections performed by an accrediting body 19 with expertise in clinical laboratory accreditation under part 20 205 if the accrediting body utilizes forms acceptable to the 21 department, applies the same licensing standards as applied to 22 other clinical laboratories and provides the same information and 23 data usually filed by the department's own employees when engaged 24 in similar inspections or surveys. The voluntary inspection 25 described in this subsection shall be agreed upon by both the 26 licensee and the department. 00746'01 * 8 1 (13) If, upon investigation, the department of consumer and 2 industry services or a state agency determines that an individual 3 licensed to practice a profession in this state has violated the 4 applicable licensure statute or the rules promulgated under that 5 statute, the department, state agency, or local health department 6 shall forward the evidence it has to the appropriate licensing 7 agency. 8 (14) The department of consumer and industry services shall 9 report to the appropriations subcommittees, the senate and house 10 of representatives standing committees having jurisdiction over 11 issues involving senior citizens, and the fiscal agencies on 12 March 1 of each year on the initial and follow-up surveys con- 13 ducted on all nursing homes in this state. The report shall 14 include all of the following information: 15 (a) The number of surveys conducted. 16 (b) The number requiring follow-up surveys. 17 (c) The number referred to the Michigan public health insti- 18 tute for remediation. 19 (d) The number of citations per nursing home. 20 (e) The number of night and weekend complaints filed. 21 (f) The number of night and weekend responses to complaints 22 conducted by the department. 23 (g) The average length of time for the department to respond 24 to a complaint filed against a nursing home. 25 (h) The number and percentage of citations appealed. 26 (i) The number and percentage of citations overturned or 27 modified, or both. 00746'01 * 9 1 (15) The department of consumer and industry services shall 2 report annually to the standing committees on appropriations and 3 the standing committees having jurisdiction over issues involving 4 senior citizens in the senate and the house of representatives on 5 the percentage of nursing home citations that are appealed and 6 the percentage of nursing home citations that are appealed and 7 amended through the informal deficiency dispute resolution 8 process. 9 (16) The department of consumer and industry services in 10 consultation with nursing home provider groups, the American med- 11 ical directors association, the department of community health, 12 the state long-term care ombudsman, and the federal health care 13 finance administration shall clarify the following terms as those 14 terms are used in title XVIII and title XIX and applied by the 15 department to provide more consistent regulation of nursing homes 16 in Michigan: 17 (a) Immediate jeopardy. 18 (b) Harm. 19 (c) Potential harm. 20 (d) Avoidable. 21 (e) Unavoidable. 22 (17) The department of consumer and industry services shall 23 instruct and train the surveyors in the use of the clarifications 24 described in subsection (16) in citing deficiencies. 25 (18) A nursing home shall post the nursing home's survey 26 report in a conspicuous place within the nursing home for public 27 review. 00746'01 * 10 1 (19) As used in this section: 2 (a) "Title XVIII" means title XVIII of the social security 3 act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 4 1395b-6 to 1395b-7, 1395c to 1395i, 1395i-2 to 1395i-5, 1395j to 5 1395t, 1395u to 1395w, 1395w-2 to 1395w-4, 1395w-21 t0 1395w-28, 6 1395x to 1395yy, and 1395bbb to 1395ggg. 7 (b) "Title XIX" means title XIX of the social security act, 8 chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to1396f, 1396g-1 to9 1396r-6,and 1396r-8 to 1396v. 00746'01 * Final page. 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