GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	1
HOUSE BILL 1265
     

 
Short Title:	Quality Support/Skilled Nursing Facilities.	()	
Sponsors:	Representatives Wright and Earle (Primary Sponsors).	
Referred to:	Appropriations.	
April 12, 2001

A BILL TO BE ENTITLED
AN ACT TO DIRECT THE Department of Health and Human Services TO ESTABLISH A QUALITY IMPROVEMENT CONSULTATION PROJECT; TO CONVENE A QUALITY STANDARDS WORK GROUP TO EXPLORE ALTERNATIVES TO OVERSIGHT AND SURVEY PRACTICES; AND PERTAINING TO SURVEY TEAM MEMBERS OF THE Department of Health and Human Services IN REVIEWING NURSING HOME PROVIDER COMPLIANCE WITH STATE AND FEDERAL LAW. 

The General Assembly of North Carolina enacts:
SECTION 1.(a)  The Department of Health and Human Services shall establish a Quality Improvement Consultation Project to assist providers in the development of quality improvement plans for each long-term care facility and program that offers skilled nursing services to the public.  In order to avoid conflict with federal regulations, the Department shall locate the project in a section of the Division of Facility Services other than the Licensure and Certification Section.  Project staff shall include nurses who have previous experience in long-term care. Staff shall be available to all licensed nursing facilities and, upon request of the facility, shall provide on-site consultation in the following areas:
(1)	Analysis of recent survey results in order to assist the facility with its efforts to correct problems or deficiencies identified by the survey.
(2)	Training for in-house quality improvement programs.
(3)	Specific area or issues of concern raised by the facility.
(4)	Best practices information.
The Department may contract with a private entity to assist in the implementation of the project.
SECTION 1.(b)  There is appropriated from the General Fund to the Department of Health and Human Services the sum of one million two hundred sixty thousand dollars ($1,260,000) for the 2001-2002 fiscal year and the sum of one million two hundred sixty thousand dollars ($1,260,000) for the 2002-2003 fiscal year to develop and implement the Quality Improvement Consultation Project pursuant to subsection (a) of this section.
SECTION 2.(a)  The Department of Health and Human Services shall offer joint training of survey team members and nursing home providers.  The training shall be offered not less than two times per year, and subject matter of the training should be based on one or more of the 10 deficiencies cited most frequently in the State during the immediately preceding calendar year.  The joint training shall be designed to reduce inconsistencies experienced by providers in the survey process, to increase objectivity by survey team members in conducting surveys, and to promote a higher degree of understanding between facility staff and survey team members in what is expected during the survey process.
SECTION 2.(b)  The Department of Health and Human Services shall require survey team members who have no previous nursing home experience to spend part of their basic training in a nursing home observing operations of the nursing home. On-site training should be designed to provide the survey team member with experience in the actual operation of a nursing facility outside of the survey process, and to achieve a general understanding of the following facility functions: administration, nursing, personal care services, and dietary services. On-site training requirement shall be for a minimum of three days and must be completed before the survey team member assumes survey work or oversight responsibilities.  In addition to on-site training, at least fifty percent (50%) of the annual continuing education requirement of survey team members shall be in the subject area of geriatric care.
SECTION 2.(c)  There is appropriated from the General Fund to the Department of Health and Human Services, Division of Facility Services, the sum of one hundred forty-eight thousand eight hundred dollars ($148,800) for the 2001-2002 fiscal year and the sum of one hundred forty-eight thousand eight hundred dollars ($148,800) for the 2002-2003 fiscal year to implement the requirements of this section.
SECTION 3.  The Department of Health and Human Services shall convene a Quality of Standards Work Group to explore alternatives to existing oversight and survey practices that will ensure quality in skilled nursing facilities.  The Work Group shall do the following:
(1)	Clarify and provide guidance on terms applicable in the survey and oversight process to ensure uniformity. Terms that should be clarified include 'immediate jeopardy', 'harm', 'potential harm', 'avoidable', and 'unavoidable'. The Department shall ensure that clarification of terms is included in basic and continuing survey training.
(2)	Identify rules that impede the direct care of patients and develop a proposal for repeal of those rules, including any necessary repeal of, or amendment to, current law that is the basis for the rule.
(3)	Examine possible incentives for providers such as extended survey period, increased reimbursement rates, accreditation, and deemed status. The Work Group shall consider all available quality measurements in developing recommendations for incentives.  The Work Group shall also identify changes in current law necessary to implement incentives.
(4)	Explore aspects of quality assessment/monitoring that should be changed to facilitate improvements and determine if a waiver from the Health Care Financing Administration is necessary to implement innovative approaches to the delivery and monitoring of long-term care in this State.
The Work Group shall consist of representatives of the Division of Facility Services, the North Carolina Health Care Facilities Association, and the Long-Term Care Ombudsman office.
SECTION 4.  The Department of Health and Human Services shall report to the Joint Legislative Health Care Oversight Committee and the North Carolina Study Commission on Aging on the status of implementation of this act.  The report shall be submitted on October 1, 2001, and March 1, 2002.
SECTION 5.  This act becomes effective July 1, 2001.