Bill Text: PA HB1052 | 2011-2012 | Regular Session | Amended

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Bill Title: Establishing an independent informal dispute resolution process for long-term care nursing facilities to dispute Department of Health survey deficiencies; and providing for the powers and duties of the Department of Health.

Spectrum: Moderate Partisan Bill (Republican 19-3)

Status: (Passed) 2011-12-22 - Act No. 128 [HB1052 Detail]

Download: Pennsylvania-2011-HB1052-Amended.html

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SENATE AMENDED
PRIOR PRINTER'S NOS. 1138, 2588 PRINTER'S NO. 2822
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 1052 Session of2011
INTRODUCED BY GINGRICH, BEAR, CALTAGIRONE, COHEN, CREIGHTON, CUTLER, DAY, DENLINGER, GEIST, HARHART, HESS, KAUFFMAN, MILNE, MOUL, MYERS, RAPP, SWANGER, TAYLOR, VULAKOVICH, MURT, GILLESPIE AND HICKERNELL, MARCH 14, 2011
SENATOR WARD, AGING AND YOUTH, IN SENATE, AS AMENDED, DECEMBER 6, 2011
AN ACT
Establishing an independent informal dispute resolution process
for long-term care nursing facilities to dispute Department
of Health survey deficiencies; and providing for the powers
and duties of the Department of Health.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Long-Term
Care Nursing Facility Independent Informal Dispute Resolution
Act.
Section 2. Purpose and intent.
The purpose of this act is to establish an informal review
process for long-term care nursing facilities to dispute
Department of Health survey findings using an independent agent.
This informal review process is intended to ensure that a
statement of deficiencies, as maintained in Federal and State
data systems, accurately identifies a long-term care nursing
facility's actual state of compliance with applicable
regulations by providing nursing facilities with the opportunity
to redress grievances arising during the survey process prior to
the entry of the survey results in the Federal data system and
without need to engage in formal litigation.
Section 3. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Deficiency." A long-term care nursing facility's alleged
noncompliance with a requirement of the Social Security Act (42
U.S.C. § 301 et seq.), 42 CFR Pt. 483 Subpt. B (relating to
requirements for long term care facilities), the act of July 19,
1979 (P.L.130, No.48), known as the Health Care Facilities Act,
or 28 Pa. Code Pt. IV Subpt. C (relating to long-term care
facilities).
"Department." The Department of Health of the Commonwealth.
"Facility." A long-term care nursing facility.
"Independent IDR." An appeal process conducted by an
independent IDR agent, in compliance with 42 CFR 488.331
(relating to informal dispute resolution), by which a long-term
care facility may challenge deficiencies cited during a survey
and certification inspection by the Department of Health.
"Independent IDR agent." The entity designated by the
Department of Health to conduct an independent IDR on its
behalf.
"Informal dispute resolution" or "IDR." An appeal process
within the Department of Health, in compliance with 42 CFR
488.331 (relating to informal dispute resolution), by which a
long-term care facility may challenge deficiencies cited during
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a survey and certification inspection by the Department of
Health.
"Plan of correction." A facility's response to deficiencies
that explain:
(1) The manner by which corrective action will be
accomplished.
(2) The manner by which the facility will identify other
residents who might be affected by the deficient practice.
(3) The measures that will be used or systemic changes
that will be made by the facility to ensure that the
deficient practice will not recur.
(4) The manner by which the facility will monitor its
operations to ensure that corrective actions are sustained.
"QIO." A federally designated Medicare quality improvement
organization.
"State Operations Manual." The Centers for Medicare and
Medicaid Services State Operations Manual.
"Statement of deficiencies." Written notice by the
Department of Health to a facility specifying the items of
noncompliance found upon completion of a survey.
"Survey." An inspection of a facility conducted by
representatives of the Department of Health in accordance with
procedures outlined in Chapter 7 of the Centers for Medicare and
Medicaid Services State Operations Manual, relating to survey
and enforcement process for skilled nursing facilities and
nursing facilities.
Section 4. Informal dispute resolution process.
(a) Establishment of an independent IDR process.--
(1) The department shall establish an IDR process to
determine whether a cited deficiency contained in a statement
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of deficiencies against a facility should be upheld.
(2) (i) The department shall designate Pennsylvania's
QIO as the independent IDR agent.
(ii) In the event that Pennsylvania's QIO is unable
to serve as the independent IDR agent, the department, in
consultation with the Health Policy Board, shall
designate the QIO of another state that has experience in
conducting informal dispute resolutions for a state
survey agency as the independent IDR agent.
(iii) If no other QIO is available to serve as the
IDR agent, the department, in consultation with the
Health Policy Board, shall designate as the IDR agent an
independent review organization that is accredited by the
Utilization Review Accreditation Commission.
(iv) Notwithstanding any other provision of the law
to the contrary, the department shall enter into a sole
source contract with the independent IDR agent as
necessary to implement the provisions of this act.
(3) The department shall obtain all necessary approvals
from the Centers for Medicare and Medicaid Services to
establish contract with the independent IDR process. <--
(4) The independent IDR agent shall offer facilities
that provide the independent IDR process a choice of the
following levels of review:
(i) desk review;
(ii) telephone review; or
(iii) in-person review, including the utilization of
video conferencing.
(5) The independent IDR process may not replace or be a
substitute for the existing informal dispute resolution
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process conducted by the department, but shall be an optional
process that can be selected by facilities on a fee-for-
service basis.
(6) The fee for the independent IDR process shall be
established by the independent IDR agent, provided that the
fees are approved by the department and consistent with law.
(7) Independent IDR recommendations made by the
independent IDR agent shall be subject to final review and
approval by the department.
(b) Minimum requirements of the independent IDR process.--
The department shall establish written policies and procedures
governing the independent IDR process that comply with the
provisions of 42 CFR 488.331 (relating to informal dispute
resolution) and the State Operations Manual regarding the
informal dispute resolution process. The independent IDR
procedures shall include, but are not limited to, the following:
(1) Within ten business days of the end of the survey,
the department shall, by certified mail or by the intranet of
the department, if the facility is connected to the intranet,
transmit to the facility a statement of alleged deficiencies.
(2) A facility that may request an informal dispute
resolution review be conducted by either department staff not
associated with the survey at no charge or an independent IDR
by the independent IDR agent designated by the department on
a fee-for-service basis. A facility may select only one
method of review. A facility must submit its request for an
independent IDR review and indicate its selection of the type
of review and level of review in writing within the same ten-
day period applicable to the facility for submission of the
plan of correction.
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(3) (i) Within 45 days of receipt of the request for an
independent IDR by a facility, the independent IDR agent
shall issue a written decision to the facility based upon
its review of the facts, survey findings, State
Operations Manual and applicable law.
(ii) If the independent IDR agent sustains the
deficiency, the independent IDR agent's written
determination shall include the rationale for its
decision and provide recommended action that the facility
can implement to achieve compliance.
(iii) If the department disagrees with an
independent IDR agent's determination that reverses a
deficiency, the department shall provide a written
explanation for its decision to nullify the independent
IDR agent's report to the independent IDR agent and to
the facility.
Section 5. Data collection.
The department shall collect and maintain the following data:
(1) The total number of review requests received on an
annual basis, including the number of independent IDR
requests and the number of State informal dispute resolution
review requests.
(2) The total number of independent IDRs completed,
including the number of reviews that resulted in the removal
of a deficiency, the number of reviews that resulted in the
downgrade of a deficiency and the number of reviews that
upheld a deficiency.
(3) The total number of State informal dispute
resolution reviews completed, including the number of reviews
that resulted in the removal of a deficiency, the number of
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reviews that resulted in the downgrade of a deficiency and
the number of reviews that upheld a deficiency.
Section 6. Liability and responsibility. <--
Except as otherwise provided in this act, nothing in this act
is intended to affect common law or statutory liability and
responsibility of licensees.
Section 6 7. Effective date. <--
This act shall take effect in 120 days.
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