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SECOND REGULAR SESSION
SENATE BILL NO. 1528
103RD GENERAL ASSEMBLY
INTRODUCED BY SENATOR BURGER.
6228S.01I KRISTINA MARTIN, Secretary
AN ACT
To repeal sections 198.073 and 335.081, RSMo, and to enact in lieu thereof two new sections
relating to health care providers.
Be it enacted by the General Assembly of the State of Missouri, as follows:
Section A. Sections 198.073 and 335.081, RSMo, are 1
repealed and two new sections enacted in lieu thereof, to be 2
known as sections 198.073 and 335.081, to read as follows:3
198.073. 1. A residential care facility shall admit 1
or retain only those persons who are capable mentally and 2
physically of negotiating a normal path to safety using 3
assistive devices or aids when necessary, and who may need 4
assisted personal care within the limitations of such 5
facilities, and who do not require hospitalization or 6
skilled nursing care. 7
2. Notwithstanding the provisions of subsection 1 of 8
this section, those persons previously qualified for 9
residence who may have a temporary period of incapacity due 10
to illness, surgery, or injury, which period does not exceed 11
forty-five days, may be allowed to remain in a residential 12
care facility or assisted living facility if approved by a 13
physician. 14
3. Any facility licensed as a residential care 15
facility II on August 27, 2006, shall be granted a license 16
as an assisted living facility, as defined in section 17
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198.006, on August 28, 2006, regardless of the laws, rules, 18
and regulations for licensure as an assisted living facility 19
as long as such facility continues to meet all laws, rules, 20
and regulations that were in place on August 27, 2006, for a 21
residential care facility II. At such time that the average 22
total reimbursement, not including residents' cost-of-living 23
increases in their benefits from the Social Security 24
Administration after August 28, 2006, for the care of 25
persons eligible for Medicaid in an assisted living facility 26
is equal to or exceeds forty-one dollars per day, all 27
facilities with a license as an assisted living facility 28
shall meet all laws, rules, and regulations for licensure as 29
an assisted living facility. Nothing in this section shall 30
be construed to allow any facility that has not met the 31
requirements of subsections 4 and 6 of this section to care 32
for any individual with a physical, cognitive, or other 33
impairment that prevents the individual from safely 34
evacuating the facility. 35
4. Any facility licensed as an assisted living 36
facility, as defined in section 198.006, except for 37
facilities licensed under subsection 3 of this section, may 38
admit or retain an individual for residency in an assisted 39
living facility only if the individual does not require 40
hospitalization or skilled nursing placement, and only if 41
the facility: 42
(1) Provides for or coordinates oversight and services 43
to meet the needs of the resident as documented in a written 44
contract signed by the resident, or legal representative of 45
the resident; 46
(2) Has twenty-four-hour staff appropriate in numbers 47
and with appropriate skills to provide such services; 48
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(3) Has a written plan for the protection of all 49
residents in the event of a disaster, including keeping 50
residents in place, evacuating residents to areas of refuge, 51
evacuating residents from the building if necessary, or 52
other methods of protection based on the disaster and the 53
individual building design; 54
(4) Completes a pre-move-in screening with 55
participation of the prospective resident; 56
(5) Completes for each resident a community-based 57
assessment, as defined in subdivision (7) of section 198.006: 58
(a) Upon admission; 59
(b) At least semiannually; and 60
(c) Whenever a significant change has occurred in the 61
resident's condition which may require a change in services; 62
(6) Based on the assessment in subsection 7 of this 63
section and subdivision (5) of this subsection, develops an 64
individualized service plan in partnership with the 65
resident, or legal representative of the resident, that 66
outlines the needs and preferences of the resident. The 67
individualized service plan will be reviewed with the 68
resident, or legal representative of the resident, at least 69
annually, or when there is a significant change in the 70
resident's condition which may require a change in 71
services. The signatures of an authorized representative of 72
the facility and the resident, or the resident's legal 73
representative, shall be contained on the individualized 74
service plan to acknowledge that the service plan has been 75
reviewed and understood by the resident or legal 76
representative; 77
(7) Makes available and implements self-care, 78
productive and leisure activity programs which maximize and 79
encourage the resident's optimal functional ability; 80
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(8) Ensures that the residence does not accept or 81
retain a resident who: 82
(a) Has exhibited behaviors that present a reasonable 83
likelihood of serious harm to himself or herself or others; 84
(b) Requires physical restraint; 85
(c) Requires chemical restraint. As used in this 86
paragraph, the following terms mean: 87
a. "Chemical restraint", a psychopharmacologic drug 88
that is used for discipline or convenience and not required 89
to treat medical symptoms; 90
b. "Convenience", any action taken by the facility to 91
control resident behavior or maintain residents with a 92
lesser amount of effort by the facility and not in the 93
resident's best interest; 94
c. "Discipline", any action taken by the facility for 95
the purpose of punishing or penalizing residents; 96
(d) Requires skilled nursing services as defined in 97
subdivision (23) of section 198.006 for which the facility 98
is not licensed or able to provide; 99
(e) Requires more than one person to simultaneously 100
physically assist the resident with any activity of daily 101
living, with the exception of bathing and transferring; 102
(f) Is bed-bound or similarly immobilized due to a 103
debilitating or chronic condition; and 104
(9) Develops and implements a plan to protect the 105
rights, privacy, and safety of all residents and to protect 106
against the financial exploitation of all residents; 107
(10) Complies with the training requirements of 108
subsection 7 of section 192.2000. 109
5. Exceptions to paragraphs (d) to (f) of subdivision 110
(8) of subsection 4 of this section shall be made for 111
residents on hospice, provided the resident, designated 112
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representative, or both, and the assisted living provider, 113
physician, and licensed hospice provider all agree that such 114
program of care is appropriate for the resident. 115
6. If an assisted living facility accepts or retains 116
any individual with a physical, cognitive, or other 117
impairment that prevents the individual from safely 118
evacuating the facility with minimal assistance, the 119
facility shall: 120
(1) Have sufficient staff present and awake twenty- 121
four hours a day to assist in the evacuation; 122
(2) Include an individualized evacuation plan in the 123
service plan of the resident; and 124
(3) Take necessary measures to provide residents with 125
the opportunity to explore the facility and, if appropriate, 126
its grounds; and 127
(4) Use a personal electronic monitoring device for 128
any resident whose physician recommends the use of such 129
device. 130
7. An individual admitted or readmitted to the 131
facility shall have an admission physical examination by a 132
licensed physician, advanced practice registered nurse, or 133
physician assistant. Documentation should be obtained prior 134
to admission but shall be on file not later than ten days 135
after admission and shall contain information regarding the 136
individual's current medical status and any special orders 137
or procedures that should be followed. If the individual is 138
admitted directly from a hospital or another long-term care 139
facility and is accompanied on admission by a report that 140
reflects his or her current medical status, an admission 141
physical shall not be required. 142
8. Facilities licensed as an assisted living facility 143
shall disclose to a prospective resident, or legal 144
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representative of the resident, information regarding the 145
services the facility is able to provide or coordinate, the 146
costs of such services to the resident, and the resident 147
conditions that will require discharge or transfer, 148
including the provisions of subdivision (8) of subsection 4 149
of this section. 150
9. After January 1, 2008, no entity shall hold itself 151
out as an assisted living facility or advertise itself as an 152
assisted living facility without obtaining a license from 153
the department to operate as an assisted living facility. 154
Any residential care facility II licensed under this chapter 155
that does not use the term assisted living in the name of 156
its licensed facility on or before May 1, 2006, shall be 157
prohibited from using such term after August 28, 2006, 158
unless such facility meets the requirements for an assisted 159
living facility in subsection 4 of this section. Any 160
facility licensed as an intermediate care facility prior to 161
August 28, 2006, that provides the services of an assisted 162
living facility, as described in paragraphs (a), (b), and 163
(c) of subdivision (6) of section 198.006, utilizing the 164
social model of care, may advertise itself as an assisted 165
living facility without obtaining a license from the 166
department to operate as an assisted living facility. 167
10. The department of health and senior services shall 168
promulgate rules to ensure compliance with this section. 169
Any rule or portion of a rule, as that term is defined in 170
section 536.010, that is created under the authority 171
delegated in this section shall become effective only if it 172
complies with and is subject to all of the provisions of 173
chapter 536 and, if applicable, section 536.028. This 174
section and chapter 536 are nonseverable and if any of the 175
powers vested with the general assembly pursuant to chapter 176
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536 to review, to delay the effective date, or to disapprove 177
and annul a rule are subsequently held unconstitutional, 178
then the grant of rulemaking authority and any rule proposed 179
or adopted after August 28, 2006, shall be invalid and void. 180
335.081. So long as the person involved does not 1
represent or hold himself or herself out as a nurse licensed 2
to practice in this state, no provision of sections 335.011 3
to 335.096 shall be construed as prohibiting: 4
(1) The practice of any profession for which a license 5
is required and issued pursuant to the laws of this state by 6
a person duly licensed to practice that profession; 7
(2) The services rendered by technicians, nurses' 8
aides or their equivalent trained and employed in public or 9
private hospitals and licensed long-term care facilities 10
except the services rendered in licensed long-term care 11
facilities shall be limited to administering medication, 12
excluding the administration of medication by an injectable 13
route other than: 14
(a) Insulin; and 15
(b) Subcutaneous injectable medications, provided that 16
any such medication was prescribed by the physician for the 17
long-term care facility resident who receives the medication; 18
(3) The providing of nursing care by friends or 19
members of the family of the person receiving such care; 20
(4) The incidental care of the sick, aged, or infirm 21
by domestic servants or persons primarily employed as 22
housekeepers; 23
(5) The furnishing of nursing assistance in the case 24
of an emergency situation; 25
(6) The practice of nursing under proper supervision: 26
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(a) As a part of the course of study by students 27
enrolled in approved schools of professional nursing or in 28
schools of practical nursing; 29
(b) By graduates of accredited nursing programs 30
pending the results of the first licensing examination or 31
ninety days after graduation, whichever first occurs; 32
(c) A graduate nurse who is prevented from attending 33
the first licensing examination following graduation by 34
reason of active duty in the military may practice as a 35
graduate nurse pending the results of the first licensing 36
examination scheduled by the board following the release of 37
such graduate nurse from active military duty or pending the 38
results of the first licensing examination taken by the 39
graduate nurse while involved in active military service 40
whichever comes first; 41
(7) The practice of nursing in this state by any 42
legally qualified nurse duly licensed to practice in another 43
state whose engagement requires such nurse to accompany and 44
care for a patient temporarily residing in this state for a 45
period not to exceed six months; 46
(8) The practice of any legally qualified nurse who is 47
employed by the government of the United States or any 48
bureau, division or agency thereof, while in the discharge 49
of his or her official duties or to the practice of any 50
legally qualified nurse serving in the Armed Forces of the 51
United States while stationed within this state; 52
(9) Nonmedical nursing care of the sick with or 53
without compensation when done in connection with the 54
practice of the religious tenets of any church by adherents 55
thereof, as long as they do not engage in the practice of 56
nursing as defined in sections 335.011 to 335.096; 57
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(10) The practice of any legally qualified and 58
licensed nurse of another state, territory, or foreign 59
country whose responsibilities include transporting patients 60
into, out of, or through this state while actively engaged 61
in patient transport that does not exceed forty-eight hours 62
in this state. 63
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