HBA-LJP S.B. 1593 77(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 1593 By: Moncrief Human Services 5/16/2001 Engrossed BACKGROUND AND PURPOSE The surveying of certain long-term care facilities is a contentious process. This uncooperative environment between providers and regulators may contribute to lower-quality care for residents in these institutions. Senate Bill 1593 increases educational and training requirements for surveyors and providers, increases evaluation and review processes, and creates an early warning system and rapid response teams to monitor long-term care facilities. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 2 (Section 531.058, Government Code) and to the commissioner of health and human services in SECTION 4 of this bill. ANALYSIS Senate Bill 1593 amends the Government and Human Resources codes relating to nursing institutions assisted living facilities and immediate care facilities for the mentally retarded. The bill requires the Texas Department of Human Services (department) to require a surveyor to complete a basic training program before the surveyor inspects, surveys, or investigates a long-term care facility. The training must include observation of a facility for a minimum of 10 working days within a 14-day period. The bill requires the department semiannually to provide training for surveyors and providers on subjects that address at least one of the 10 most common violations by long-term care facilities under federal or state law. The bill also sets forth provisions relating to the required continuing education credits of a surveyor who is a licensed health care professional or pharmacist in gerontology or care for individuals with cognitive or physical disabilities (Sec. 22.037, Human Resources Code). The bill requires the Health and Human Services Commission (HHSC) to adopt procedures to review citations or penalties assessed for a violation of a rule or law against an institution or facility licensed or certified as a long-term care facility and the performance of duties by employees and agents of the department or another state agency responsible for licensing, inspecting, surveying, or investigating longterm care facilities. The bill also requires HHSC to annually report to the speaker of the house of representatives, the lieutenant governor, and the governor on the findings of the review (Sec. 531.056, Government Code). The bill requires HHSC to establish an early warning system to detect conditions that could be detrimental to the health, safety, and welfare of residents, including an analysis of financial and quality-care indicators that would predict the need for HHSC to take action. The bill requires HHSC to establish regional offices with one or more quality-of-care monitors based on the number of long-term care facilities in the region. The HHSC is required to establish regional offices with one or more quality-of-care monitors, based on the number of long-term facilities in the region, to monitor the facilities in the region on a regular, unannounced, aperiodic basis, including nights, evenings, weekends, and holidays. The bill provides that priority for monitoring visits is required to be given to long-term care facilities with a history of patient care deficiencies. The bill sets forth provisions regarding the deployment, the assessment, confidentiality, findings, and recommendations of quality-of-care monitors, and observations of quality-of-care monitors of conditions at long-term care facilities that create a threat to the health or safety of a resident. The bill also sets forth provisions regarding the admissibility of testimony and evidence related to information gathered or reviewed by a quality-of-monitor in any civil or administrative action related to a long-term care facility. The bill requires HHSC to create rapid response teams composed of health care experts that can visit longterm care facilities identified through the early warning system. The bill authorizes rapid response teams to visit long-term care facilities that request the assistance of HHSC and prohibits the deployment of rapid response teams for the purpose of helping a long-term care facility prepare for a regular inspection or survey (Sec. 531.057, Government Code). The bill requires HHSC by rule to establish an informal dispute resolution process that provides for adjudication by an appropriate disinterested person of disputes relating to a proposed enforcement action or related proceeding regarding certain long-term care facilities of the department. The bill requires HHSC to adopt rules to adjudicate claims in contested cases, including claims unresolved by the informal dispute resolution process of HHSC. The bill prohibits HHSC from delegating its responsibility to administer the informal dispute resolution process to another state agency (Secs. 32.021, Human Resources Code and 531.058, Government Code). The bill requires the commissioner of HHSC, not later than January 1, 2002, to adopt any rules necessary to implement the review and survey process in certain institutions and facilities, a quality assurance early warning system for certain long-term care facilities, and an informal dispute resolution process for certain long-term care facilities (SECTION 4). The bill requires the department, no later than January 1, 2002, to develop training necessary to implement the training and continuing education for investigating certain long-term care facilities. The bill provides for the transfer, effective January 1, 2002, of all property and records in the custody of the department and any rules or forms adopted by the department to HHSC (SECTIONS 5 and 6). EFFECTIVE DATE September 1, 2001.