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First Substitute H.B. 62

Representative Rebecca D. Lockhart proposes the following substitute bill:





Sponsor: Rebecca D. Lockhart

             7      LONG TITLE
             8      General Description:
             9          This bill amends the Nursing Care Facility Assessment Act to include intermediate care
             10      facilities for the mentally retarded.
             11      Highlighted Provisions:
             12          This bill:
             13          .    amends the definition of nursing care facility to include intermediate care facilities
             14      for the mentally retarded;
             15          .    clarifies the rulemaking authority of the department in setting the uniform rate
             16              for intermediate care facilities for the mentally retarded; and
             17          .    makes conforming amendments in the definitions for health care facilities.
             18      Monies Appropriated in this Bill:
             19          None
             20      Other Special Clauses:
             21          This bill takes effect on July 1, 2005.
             22      Utah Code Sections Affected:
             23      AMENDS:
             24          26-21-2, as last amended by Chapter 1, Laws of Utah 2000
             25          26-35a-103, as enacted by Chapter 284, Laws of Utah 2004

             26      ENACTS:
             27          26-35a-108, Utah Code Annotated 1953
             29      Be it enacted by the Legislature of the state of Utah:
             30          Section 1. Section 26-21-2 is amended to read:
             31           26-21-2. Definitions.
             32          As used in this chapter:
             33          (1) "Abortion clinic" means a facility, other than a general acute or specialty hospital,
             34      that performs abortions and provides abortion services during the second trimester of
             35      pregnancy.
             36          (2) "Activities of daily living" means essential activities including:
             37          (a) dressing;
             38          (b) eating;
             39          (c) grooming;
             40          (d) bathing;
             41          (e) toileting;
             42          (f) ambulation;
             43          (g) transferring; and
             44          (h) self-administration of medication.
             45          (3) "Ambulatory surgical facility" means a freestanding facility, which provides
             46      surgical services to patients not requiring hospitalization.
             47          (4) "Assistance with activities of daily living" means providing of or arranging for the
             48      provision of assistance with activities of daily living.
             49          (5) (a) "Assisted living facility" means:
             50          (i) a type I assisted living facility, which is a residential facility that provides assistance
             51      with activities of daily living and social care to two or more residents who:
             52          (A) require protected living arrangements; and
             53          (B) are capable of achieving mobility sufficient to exit the facility without the
             54      assistance of another person; and
             55          (ii) a type II assisted living facility, which is a residential facility with a home-like
             56      setting that provides an array of coordinated supportive personal and health care services

             57      available 24 hours per day to residents who have been assessed under department rule to need
             58      any of these services.
             59          (b) Each resident in a type I or type II assisted living facility shall have a service plan
             60      based on the assessment, which may include:
             61          (i) specified services of intermittent nursing care;
             62          (ii) administration of medication; and
             63          (iii) support services promoting residents' independence and self sufficiency.
             64          (6) "Birthing center" means a freestanding facility, receiving maternal clients and
             65      providing care during pregnancy, delivery, and immediately after delivery.
             66          (7) "Committee" means the Health Facility Committee created in Section 26-1-7 .
             67          (8) "Consumer" means any person not primarily engaged in the provision of health care
             68      to individuals or in the administration of facilities or institutions in which such care is provided
             69      and who does not hold a fiduciary position, or have a fiduciary interest in any entity involved in
             70      the provision of health care, and does not receive, either directly or through his spouse, more
             71      than 1/10 of his gross income from any entity or activity relating to health care.
             72          (9) "End stage renal disease facility" means a facility which furnishes staff-assisted
             73      kidney dialysis services, self-dialysis services, or home-dialysis services on an outpatient basis.
             74          (10) "Freestanding" means existing independently or physically separated from another
             75      health care facility by fire walls and doors and administrated by separate staff with separate
             76      records.
             77          (11) "General acute hospital" means a facility which provides diagnostic, therapeutic,
             78      and rehabilitative services to both inpatients and outpatients by or under the supervision of
             79      physicians.
             80          (12) "Governmental unit" means the state, or any county, municipality, or other
             81      political subdivision or any department, division, board, or agency of the state, a county,
             82      municipality, or other political subdivision.
             83          (13) (a) "Health care facility" means general acute hospitals, specialty hospitals, home
             84      health agencies, hospices, nursing care facilities, residential-assisted living facilities, birthing
             85      centers, ambulatory surgical facilities, small health care facilities, abortion clinics, facilities
             86      owned or operated by health maintenance organizations, end stage renal disease facilities, and
             87      any other health care facility which the committee designates by rule.

             88          (b) "Health care facility" does not include the offices of private physicians or dentists,
             89      whether for individual or group practice.
             90          (14) "Health maintenance organization" means an organization, organized under the
             91      laws of any state which:
             92          (a) is a qualified health maintenance organization under 42 U.S.C. Sec. 300e-9; or
             93          (b) (i) provides or otherwise makes available to enrolled participants at least the
             94      following basic health care services: usual physician services, hospitalization, laboratory, x-ray,
             95      emergency, and preventive services and out-of-area coverage;
             96          (ii) is compensated, except for copayments, for the provision of the basic health
             97      services listed in Subsection (14)(b)(i) to enrolled participants by a payment which is paid on a
             98      periodic basis without regard to the date the health services are provided and which is fixed
             99      without regard to the frequency, extent, or kind of health services actually provided; and
             100          (iii) provides physicians' services primarily directly through physicians who are either
             101      employees or partners of such organizations, or through arrangements with individual
             102      physicians or one or more groups of physicians organized on a group practice or individual
             103      practice basis.
             104          (15) (a) "Home health agency" means an agency, organization, or facility or a
             105      subdivision of an agency, organization, or facility which employs two or more direct care staff
             106      persons who provide licensed nursing services, therapeutic services of physical therapy, speech
             107      therapy, occupational therapy, medical social services, or home health aide services on a
             108      visiting basis.
             109          (b) "Home health agency" does not mean an individual who provides services under
             110      the authority of a private license.
             111          (16) "Hospice" means a program of care for the terminally ill and their families which
             112      occurs in a home or in a health care facility and which provides medical, palliative,
             113      psychological, spiritual, and supportive care and treatment.
             114          (17) "Nursing care facility" means a health care facility, other than a general acute or
             115      specialty hospital, constructed, licensed, and operated to provide patient living
             116      accommodations, 24-hour staff availability, and at least two of the following patient services:
             117          (a) a selection of patient care services, under the direction and supervision of a
             118      registered nurse, ranging from continuous medical, skilled nursing, psychological, or other

             119      professional therapies to intermittent health-related or paraprofessional personal care services;
             120          (b) a structured, supportive social living environment based on a professionally
             121      designed and supervised treatment plan, oriented to the individual's habilitation or
             122      rehabilitation needs; or
             123          (c) a supervised living environment that provides support, training, or assistance with
             124      individual activities of daily living.
             125          (18) "Person" means any individual, firm, partnership, corporation, company,
             126      association, or joint stock association, and the legal successor thereof.
             127          (19) "Resident" means a person 21 years of age or older who:
             128          (a) as a result of physical or mental limitations or age requires or requests services
             129      provided in an assisted living facility; and
             130          (b) does not require intensive medical or nursing services as provided in a hospital or
             131      nursing care facility.
             132          (20) "Small health care facility" means a four to sixteen bed facility that provides
             133      licensed health care programs and services to residents [who generally do not need continuous
             134      nursing care or supervision].
             135          (21) "Specialty hospital" means a facility which provides specialized diagnostic,
             136      therapeutic, or rehabilitative services in the recognized specialty or specialties for which the
             137      hospital is licensed.
             138          (22) "Substantial compliance" means in a department survey of a licensee, the
             139      department determines there is an absence of deficiencies which would harm the physical
             140      health, mental health, safety, or welfare of patients or residents of a licensee.
             141          Section 2. Section 26-35a-103 is amended to read:
             142           26-35a-103. Definitions.
             143          As used in this chapter:
             144          (1) (a) "Nursing care facility" means:
             145          (i) a nursing care facility described in Subsection 26-21-2 (17)[.];
             146          (ii) beginning January 1, 2006, a designated swing bed in:
             147          (A) a general acute hospital as defined in Subsection 26-21-2 (11); and
             148          (B) a critical access hospital which meets the criteria of 42, U.S.C.
             149      1935i-4(c)(2)(1998); and

             150          (iii) an intermediate care facility for the mentally retarded that is licensed under Section
             151      26-21-13.5 .
             152          (b) "Nursing care facility" does not include:
             153          (i) the Utah State Developmental Center;
             154          (ii) the Utah State Hospital;
             155          (iii) a general acute hospital, specialty hospital, or small health care facility as defined
             156      in Section 26-21-2 ; or
             157          [(iv) an intermediate care facility for the mentally retarded that is licensed under
             158      Section 26-21-13.5 ; or]
             159          [(v)] (iv) the Utah State Veteran's Home.
             160          (2) "Patient day" means each calendar day in which an individual patient is admitted to
             161      the nursing care facility during a calendar month, even if on a temporary leave of absence from
             162      the facility.
             163          Section 3. Section 26-35a-108 is enacted to read:
             164          26-35a-108. Intermediate care facilities for the mentally retarded -- Uniform rate.
             165          An intermediate care facility for the mentally retarded is subject to all the provisions of
             166      this chapter, except that the department shall establish a uniform rate for intermediate care
             167      facilities for the mentally retarded that:
             168          (1) is based on the same formula specified for nursing care facilities under the
             169      provisions of Subsection 26-35a-104 (1)(b); and
             170          (2) may be different than the uniform rate established for other nursing care facilities.
             171          Section 4. Effective date.
             172          This bill takes effect on July 1, 2005.

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