Bill 251

                    Current Status

Bill Number:               251
Ratification Number:       260
Act Number                 184
Introducing Body:          Senate
Subject:                   Nursing Home Licensing Act of 1987

(A184, R260, S251)

AN ACT TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976, BY ADDING ARTICLE 2 TO CHAPTER 7 OF TITLE 44 SO AS TO ENACT THE "NURSING HOME LICENSING ACT OF 1987"; TO AMEND SECTION 44-7-130, RELATING TO THE STATE HOSPITAL CONSTRUCTION AND FRANCHISING ACT, SO AS TO SUBSTITUTE NURSING HOMES FOR NURSING CARE AND INTERMEDIATE FACILITIES WITHIN THE DEFINITIONS OF "HOSPITAL" AND "HEALTH CARE FACILITY"; AND TO AMEND SECTION 44-7-320, RELATING TO THE FRANCHISING APPLICATION REQUIRED BY A HEALTH CARE FACILITY, SO AS TO PROVIDE THAT IF A CERTIFICATE OF NEED HAS BEEN ISSUED WITH SPECIAL CONDITIONS OR RESTRICTIONS ATTACHED, THE DEPARTMENT MAY REMOVE THESE CONDITIONS OR RESTRICTIONS WITHOUT REQUIRING A NEW FRANCHISING APPLICATION; AND TO AMEND CHAPTER 6, TITLE 44, RELATING TO THE STATE HEALTH AND HUMAN SERVICES FINANCE COMMISSION, BY ADDING SECTION 44-6-220 SO AS TO REQUIRE ALL APPLICATIONS FOR ADMISSION TO A NURSING HOME TO CONTAIN A NOTICE SIGNED BY THE APPLICANT WHICH STATES THE ELIGIBILITY QUALIFICATIONS FOR MEDICAID-SPONSORED LONG-TERM CARE SERVICES.

Be it enacted by the General Assembly of the State of South Carolina:

Medicaid nursing home permits

SECTION 1. Chapter 7 of Title 44 of the 1976 Code is amended by adding:

"Article 2

Medicaid Nursing Home Permits

Section 44-7-80. For the purposes of this article:

(1) 'Nursing home' means a facility with an organized nursing staff to maintain and operate organized facilities and services to accommodate two or more unrelated persons over a period exceeding twenty-four hours, which is operated either in connection with a hospital or as a freestanding facility for the express or implied purpose of providing intermediate or skilled nursing care for persons who are not in need of hospital care.

(2) 'Medicaid nursing home permit' means a permit to serve Medicaid patients in an appropriately certified nursing home.

(3) 'Medicaid patient' means a person who is eligible for Medicaid (Title XIX) sponsored long-term care services.

(4) 'Medicaid patient day' means a day of nursing home care for which a nursing home receives Medicaid reimbursement.

(5) 'Department' means the Department of Health and Environmental Control.

Section 44-7-82. No nursing home may provide care to Medicaid patients without first obtaining a permit in the manner provided in this article.

Section 44-7-84. (A) In the annual appropriations act, the General Assembly shall establish the maximum number of Medicaid patient days for which the department is authorized to issue Medicaid nursing home permits.

(B) Based on a method the department develops for determining the need for nursing home care for Medicaid patients in each area of the State, the department shall determine the distribution of Medicaid patient days for which Medicaid nursing home permits can be issued. The department shall promulgate by regulation the method and criteria it will use to choose among competing applications if there are applications for more Medicaid patient days than allocated to an area of the State. These criteria shall give preference to nursing homes seeking to renew their Medicaid nursing home permits. The number of Medicaid patient days allocated to a nursing home must not be decreased from the previous year's allocation unless requested by the nursing home. However, if the maximum number of Medicaid patient days authorized by the General Assembly is decreased, the nursing home may be required to absorb a proportionate decrease in its Medicaid patient days' allocation.

(C) Within sixty days of the effective date of the annual appropriations act, all nursing homes desiring to serve Medicaid patients must apply to the department for a Medicaid nursing home permit. The application must state the specific number of Medicaid patient days the nursing home will provide.

Section 44-7-88. Nursing home patients may not be involuntarily discharged or transferred due to their Medicaid status. If no Medicaid patients are waiting for admission to the nursing home, or if for some other reason a nursing home anticipates the possibility that the home cannot satisfy the Medicaid nursing home permit requirements, the home may request a waiver of the permit requirements from the department.

Section 44-7-90. (A) Based on reports from the State Health and Human Services Finance Commission, the department shall determine each nursing home's compliance with its Medicaid nursing home permit. Violations of this article include:

(1) a nursing home exceeding by more than ten percent the number of Medicaid patient days stated in its permit;

(2) a nursing home failing to provide at least ten percent fewer days than the number stated in its permit;

(3) the provisions of any Medicaid patient days by a home without a Medicaid nursing home permit.

(B) Each Medicaid patient day above or below the allowable range is considered a separate violation. The department may levy a fine not to exceed the average rate per Medicaid patient day times each violation. Appeals from this action must comply with the appropriate provisions of Chapter 23 of Title 1."

Definition - hospital

SECTION 2. Item (4) of Section 44-7-130 of the 1976 Code is amended to read:

"(4) 'Hospital' includes public health centers and general, tuberculosis, mental, chronic disease, and other types of hospital and related facilities such as outpatient facilities, nursing homes, state health laboratories, nurses' training facilities,

facilities for persons with developmental disabilities (formerly facilities for the mentally retarded), community mental health centers, including facilities for alcoholics and narcotic addicts, and residential care facilities providing care for nonambulatory persons."

Definition - health care facility

SECTION 3. Item (9) of Section 44-7-130 of the 1976 Code is amended to read:

"(9) 'Health care facility' includes hospitals, psychiatric hospitals, tuberculosis hospitals, nursing homes, kidney disease treatment centers, including freestanding hemodialysis centers, ambulatory surgical facilities, rehabilitation facilities, health maintenance organizations except as exempted by regulation, and any other project for which certificate of need review is required under the federal act."

Department may remove conditions or restrictions

SECTION 4. Section 44-7-320 of the 1976 Code is amended by adding the following paragraph:

"If a certificate of need has been issued with special conditions or restrictions attached, the department may permanently remove these conditions or restrictions or waive them on an annual basis without requiring a new franchising application."

Applications must contain notice

SECTION 5. Chapter 6 of Title 44 of the 1976 Code is amended by adding:

"Section 44-6-220. All applications for admission to a nursing home must contain a notice, to be signed by the applicant, stating:

'Eligibility for Medicaid-sponsored long-term care services is based on income and medical necessity. To qualify for assistance through the Medicaid program, a nursing home patient must need intermediate or skilled nursing care as determined through an assessment conducted by Medicaid program staff. The fact that a patient has already been admitted to a nursing home is not considered in this determination. It is possible that a patient could exhaust all other means of paying for nursing home care and meet Medicaid income criteria but still be denied assistance due to the lack of medical necessity.

It is recommended that all persons seeking admission to a nursing home be assessed by the Medicaid program prior to admission. This assessment will provide information about the level of care needed and the viability of community services as an alternative to admission. The commission may charge a fee, not to exceed the cost of the assessment, to persons not eligible for Medicaid-sponsored long-term care services.'"

Time effective

SECTION 6. Sections 1, 2, 3, and 5 of this act take effect July 1, 1988. Section 4 of this act takes effect July 1, 1987.