Health Facility Committee MeetingMinutes

November 18, 2015

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9:00am – 12:00pm
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3760 S. HIghland dr.
suite 200, slc
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Room 241
members present / Brent Jones, Bruce Davis, Bryan Erickson, Dale Johns, DaNece Fickett,Jim Sheets, Scott Monson, & Todd Cope
members absent / Dr. Earl Leeman, Lou Jean Flint, Steve Sabins
staff present / Joel Hoffman,Kimberlee Jessop
special guests / Scott Horne
welcome / Jim Sheets
Review and Approval of amended Minutes from September 9, 2015.Mr. Davis motioned to approve the minutes. Mr. Monson seconded the motion.

OLD BUSINESS

UPDATE
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rule updates
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joel hoffman
Discussion / The Alternate Remedies for Nursing Facilities Rule was effective September 29, 2015. This rule was moved from Medicaid to the bureau.
UPDATE / rule updates / joel hoffman
Some changes were made to the Assisted Living Facilities Rule (R432-270) and presented to the committee for feedback and possible approval. The changes are listed below (strike out old information, underlined new information).
R432-270-10 Admissions
(4)(a)(iv) do not require total assistance from staff or others with more than [two] three ADLS.
(5)(a) require total assistance from staff or others in more than [two] three ADLS, provided that:
R432-270-12 Resident Assessment
(3)The resident assessment must accurately reflect the resident’s status at the time of assessment.
(4) The resident assessment must include a statement signed by the licensed health care professional completing the resident assessment that the resident meets the admission and level of assistance criteria for the facility.
([4] 5) The facility shall use a resident assessment form that is approved and reviewed by the Department to document the resident assessments.
([5] 6) The facility shall revise and update each resident’s assessment when there is a significant change in the resident’s cognitive, medical, physical, or social condition and update the resident’s service plan to reflect the change in condition.
R432-270-19 Medication Administration
(2) Each resident’s medication program must be administered by means of one of the methods described in (a) through ([e] f) in this section:
(e) Residents may independently administer their own personal insulin injections if they have been assessed to be independent in that process. This may be done in conjunction with the administration of medication in methods (a) through (d) of this section.
(f)home health or hospice agency staff may provide medication administration to facility residents exclusively, or in conjunction with (a) through (e) of this section.
R432-270-21 Facility Records
(6) There shall be written incident and injury reports to document consumer death, injuries, elopement, fights or physical confrontations, situations which require the use of passive physical restraint, suspected abuse or neglect, and other situations or circumstances affecting the health, safety or wellbeing of residents. The reports shall be kept on file.
R432-270-24 Laundry Services
(1)The facility shall provide laundry services to meet the needs of the residents[, including sufficient linen supply to permit a change in bed linens for the total number of licensed beds, plus an additional fifty percent of the licensed bed capacity].
(4) The facility shall make available for resident use at least one washing machine and one clothes dryer [, the following:
(a) at least one washing machine and one clothes dryer; and
(b) at least one iron and ironing board].
Approval of suggested changes to be moved forward. Mr. Cope motioned to approve the changes. Ms. Fickett seconded the motion.
UPDATE / hospital designated caregiver new rule / joel hoffman
This rule was discussed during our September meeting. A couple of things have changed or been amended (in red). The rule as written is approved by the Hospital Association, AARP and other committees.
R432-100-12. Patient Designated Caregiver
(1)The hospital shall give a patient admitted to the hospital the opportunity to designate a caregiver who will assist the patient with continuing care after discharge from the hospital.
(a)A caregiver is an individual designated by an inpatient of the hospital to assist with continuing care that can be given in the patient’s residence after discharge;
(b)The hospital shall document the designated caregiver in the patient record and include contact information; and
(c)If the patient declines to designate a caregiver, the hospital shall document the patient’s choice in the medical record.
(2)The hospital shall notify the designated caregiver as soon as practicable before any of the following circumstances occur:
(a)The patient is transferred to another health facility;
(b)The patient is discharged back to their own residence.
(3)If the hospital is unable to contact the designated caregiver when changes occur, the lack of contact shall not interfere with, delay or otherwise affect the medical care provided to the patient or the transfer or discharge of the patient.
(4)The hospital shall document all attempts to contact the designated caregiver in the patient record, to include dates and times attempted.
(5)The patient may give written consent to allow the hospital to release medical information to the designated caregiver, pursuant to the hospital’s established procedures for the release of personal health information.
(6)Prior to the patient being discharged, the hospital shall provide a written discharge plan for continuing care needs to the patient and designated caregiver, which shall include:
(a)The name and contact information of the designated caregiverand relation to the patient;
(b)A description of continuing care tasks that the patient requires, in a culturally competent manner; and
(c)Contact information for any other health care resources necessary to meet the needs of the patient.
(7)Prior to the patient being discharged, the hospital shall provide the designated caregiver with an opportunity for instruction in continuing care tasks outlined in the discharge plan, which shall include:
(a)Demonstration of the continuing care tasks by hospital personnel; and
(b)Opportunity for the patient and designated caregiver to ask questions and receive answers regarding the continuing care tasks; and
(c)Education and counseling about medications, including dosing and proper use of delivery devices.
(8)The hospital shall document the instruction given to the patient and designated caregiver in the patient record, to include the date, time and contents of the instructions.
Approval of new rule with changes. Ms. Fickett motioned to approve. Mr. Monson seconded the motion.
update / continuing care retirement community / joel hoffman
Representative Tanner is presenting this bill to a committee this morning to outline how these communities will be regulated in the state. Mr. Hoffman has not seen the bill language yet but when he finds out he will share the information with the committee as well as Long Term Care and Assisted Living providers. This type of communityallows a resident to reside in a retirement community, then move into other levels of care as needed - Assisted Living and/or Nursing care. He also stated that they originally wanted one license to cover all areas in the community, however, each facility type in the community will need to have it’s own license. Mr. Hoffman will continue to keep the committee updated.
update / Freestanding emergency departments / joel hoffman
The EPIC Group (Emergency Physicians Integrated Care) contacted Mr. Hoffman to talk about their concerns regarding Freestanding Emergency Departments. They are concerned about the necessity of this type of service. Mr. Hoffman and Craig Stout from the EPIC Group do not feel like this is an access issue. Scott feels like it’s a good investment for physicians. Physicians are attracted to this type of system based on how they are operated, however, the rates tend to be higher at these types of facilities. The group from Texas that met with Mr. Hoffman a few months back talked about bringing in a boutique hospital (4-5 beds) and then adding a number of satellite emergency departments. This would most likely been in urban areas where there is more of a market for this type of care. They stated they would probably pick higher income areas. Mr. Hoffman stated that in the future if we get a request to look at this type of service we will have to say that we will only accept an application for a freestanding ED if it is connected as a satellite to an existing hospital. Right now our rules do not limit the amount of satellites that can be operated from a single parent facility. Mr. Hoffman stated that we might want to consider limiting the amount of freestanding emergency departments a hospital can have as a group. We need to consider access to safe and necessary care. In this case, there is not enough information to support that. Mr. Sheets feels that Urgent Care clinics are a better option. Mr. Sheets supports Joel and Carmen bringing a proposed rule limiting the number of hospital satellites to review at our next meeting in February. Mr. Sheets does not feel that Freestanding Emergency Rooms are a good solution. The question was asked about a mileage limit for satellites – the bureau does not have a mileage limit in rule for satellites. Mr. Hoffman stated that the committee can look at that as well, however, if we limit the hospitals to one satellite, mileage might not be an issue anyway.
NEW BUSINESS
update / five year rule reviews / carmen richins
Five-year reviews and their associated statements of continuation are to be filed once every five years, on or before the fiver-year anniversary of the enactment or last five-year review of a rule.
If the Bureau does not file a five-year review, or a five-year review extension, the Division is required to remove the rule from the administrative code.
A five-year review is filed by the Bureau once it has been determined there is a need to continue the rule.
The following five-year rule reviews were completed on november 9, 2015:
R432-100 general hospital standards
R432-101 specialty hospital-psychiatric
r432-102 specialty hospital-chemical dependency/substance abuse
r432-103 specialty hospital-rehabilitation
r432-104 specialty hospital-long term acute care
r432-105 specialty hospital-orthopedic
r432-106 specialty hospital-critical access
r432-500 freestanding ambulatory surgical center rules
r432-550 birthing centers
r432-600 abortion clinic rule
UPDATE / government shut down / joel hoffman
Discussion / Just a quick notification. There have been threats of a Federal shutdown. In case there is a government shutdown, we have to have a plan in place. Federal shutdown stops all Medicare funding which effects all facilities that have Medicare funding. Mr. Hoffman stated that the Bureau would shift staff to focus on Medicaid facilities and Licensing facilities.
During the last government shutdown, the Bureau was able to make it 10-12 days before running out of resources. Mr. Hoffman stated that they had to furlough employees for one day however the staff were paid back when budgets were restored.
This will be the same plan for the Bureau if there is another Federal shutdown in December.
Update / licensing sanctions / joel hoffman
  • On September 9, 2015, Superior Assisted Living of Centerville was issued a $1,000.00 Civil Money Penalty and a four month Conditional License based on a complaint investigation that identified and cited the facility for failure to ensure residents were free from abuse and retaining a hospice resident who was unable to evacuate without assistance and failed to assign a person to assist.
  • On October 28, 2015, Latter Days Assisted Living was issued a$200.00 Civil Money Penalty based on a relicensure investigation that identified and cited the facility for failure to ensure safe hot water temperatures.
  • On November 4, 2015, Tender Care Hospice was issued an additional $200.00 Civil Money Penalty and a four month Conditional License based on the facilities failure to file the required immunization report and pay original Civil Money Penalty issued April 2, 2015.
  • On May 8, 2015, Laurel Groves Assisted Living Center was issued a $1,000.00 Civil Money Penalty and a four month Conditional License based on a recertification investigation that identified and cited the facility for actual harm and imminent danger which included eight conditions being determined as significantly out of compliance.

Update / nursing facility census reporting rule proposal / joel hoffman
Discussion / Long Term Care facilities are currently asked by the Bureau to report the number of residents they have on the last day of every month. The Bureau gives each facility until the 15th of the following month to report their information. The facilities can fax, e-mail or call their information in.
This requirement is currently not in rule therefore if a facility does not report the information the Bureau can’t enforce the requirement. The Bureau would like to add the following language to rule R432-150-8so they will have the ability to cite the facility if they do not report their information. See below for proposed changes to the rule (strikeout old information, underlined new information).
R432-150-8 Administrator
(2)(a) complete, submit, and file [all records and reports required by the Department];
(i) a monthly facility census report to the Department by the 15th of the following month; and
(ii) all other records and reports required by the Department.
Mr. Erickson would like to take this information to the committees he is on to inform and educate others in the field. He feels some Administrators might not understand why the Department is requesting the information.

OTHER BUSINESS

Discussion / Mr. Sheets got a call this morning from Sen. Henderson, a representative from Spanish Fork asking about the rule for Birthing Centers. She is interested and wants us to consider revisiting the Birthing Center Rule. Right now if you want to have a Birthing Center with two or more rooms, you have to be licensed by that State,however, in order to be licensed you are required to have a Transfer Agreement in place with a full service hospital. For legal reasons all hospitals in the State have refused to sign. All Birthing Centers currently operating in Utah only have one room. Sen. Henderson feels that there should be some sort of rule in place for one bed centers. She questions why DOPL and Licensing requirements don’t match up. If a problem occurs at one of the Birthing Centers the patient ends up being brought to the hospital to be treated so some people question why the transfer agreement is necessary. A lot of people go to Birthing Centers because they are cheaper or because they don’t have insurance. Sen. Henderson feels that it’s not safe to operate without a license.
Mr. Jones suggested that the committee invite Sen. Henderson as a guest to our next meeting in February 2016 and also send her copies of the minutes from the last time this was discussed before we add the topic to our agenda which opens up the discussion to the public. Mr. Hoffman can see her point of view regarding increased measures for patient safety however that brings up other issues, one being staffing for surveys. We only have four licensing staff. Sen. Henderson sees it as a big choice issue for women and she feels that we are limiting women’s choices. She is also interested in the representatives of the Health Facility Committee. She asked if there was a Birthing Center Rep on the committee and Mr. Hoffman informed her that Birthing Centers are not currently a category that is appointed a representative on the committee. Sen. Henderson is going to look into the appointments for the committee. Mr. Hoffman suggested that he could invite Sen. Henderson to come and meet with Mr. Sheets and himself just to give her a little more background. If this issue does end up being on the February agenda, we will send out the rule to all committee members so they can be informed. Sen. Henderson is also looking at the Health Facility Committee By-Laws.
Mr. Davis moved to adjourn the meeting. Mr. Johns seconded it.
2016
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UPCOMING MEETINGS
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udoh
February 10, 2016 Room 241
May 11, 2016 Room 241
September 14, 2016 Room 241
November 9, 2016 Room 241