DAR File No. 43002

Health, Family Health and Preparedness, Licensing

Rule R432-270

Assisted Living Facilities

Notice of Proposed Rule

(Amendment)

DAR File No.: 43002
Filed: 06/15/2018 10:09:19 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to modify this rule regulating the new discharge notification process for licensed assisted living facilities. The Health Facility Committee reviewed and approved this rule amendment on 05/09/2018. This amendment was required by H.B. 263 from the 2018 General Session.

Summary of the rule or change:

This amendment is to modify this rule to include the new discharge Ombudsman notification process for licensed assisted living facilities. This amendment was required by H.B. 263 (2018).

Statutory or constitutional authorization for this rule:

• Title 26, Chapter 21

Anticipated cost or savings to:

the state budget:

The state government assisted living facility survey process was thoroughly reviewed. This proposed rule amendment could lead to increased health care facility deficiencies, however, with all the variables within the survey process, and the facility practices, this is an inestimable benefit.

local governments:

Local government city business licensing requirements were considered. This proposed rule amendment should not impact local governments revenues or expenditures.

small businesses:

After conducting a thorough analysis, it was determined that this rule amendment could lead to increased costs for small business licensed assisted living facilities as it may result in increased man hours and sanctions, however, with all the variables within the survey process, and the facility practices, this is an inestimable cost. There are 141 small businesses (NAICS codes used - Homes for the Elderly 623312).

persons other than small businesses, businesses, or local governmental entities:

After conducting a thorough analysis, it was determined that this rule amendment will not result in a fiscal impact to persons because this amendment modifies health care facility requirements and therefore, would not add any costs for other persons.

Compliance costs for affected persons:

After conducting a thorough analysis, it was determined that this proposed rule amendment will not result in a fiscal impact to affected persons because this amendment modifies health care facility requirements and therefore, would not add any compliance costs.

Comments by the department head on the fiscal impact the rule may have on businesses:

There may be a fiscal impact to businesses if there is an increase in sanctions for violation of this rule.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office of Administrative Rules, or at:

Health
Family Health and Preparedness, Licensing
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Joel Hoffman at the above address, by phone at 801-273-2804, by FAX at 801-274-0658, or by Internet E-mail at [email protected]
• Carmen Richins at the above address, by phone at 801-273-2802, by FAX at 801-274-0658, or by Internet E-mail at [email protected]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/31/2018

This rule may become effective on:

08/07/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2019	FY 2020	FY 2021
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$0	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$0	$0
Total Fiscal Benefits:	$0	$0	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

There are four non-small business (NAICS codes used - Homes for the Elderly 623312).

 

After conducting a thorough analysis, it was determined that this rule amendment could lead to increased costs for non-small business licensed health care facilities as it may result in increased man hours and sanctions, however, with all the variables within the survey process, and the facility practices, this is an inestimable cost.

 

The Department of Health Executive Director Joseph K. Miner, MD, has reviewed and approved this fiscal analysis.

 

 

R432. Health, Family Health and Preparedness, Licensing.

R432-270. Assisted Living Facilities.

R432-270-3. Definitions.

(1) The terms used in these rules are defined in R432-1-3.

(2) In addition:

(a) "Assessment" means documentation of each resident's ability or current condition in the following areas:

(i) memory and daily decision making ability;

(ii) ability to communicate effectively with others;

(iii) physical functioning and ability to perform activities of daily living;

(iv) continence;

(v) mood and behavior patterns;

(vi) weight loss;

(vii) medication use and the ability to self-medicate;

(viii) special treatments and procedures;

(ix) disease diagnoses that have a relationship to current activities of daily living status, behavior status, medical treatments, or risk of death;

(x) leisure patterns and interests;

(xi) assistive devices; and

(xii) prosthetics.

(b) "Activities of daily living (ADL)":

(i) means those personal functional activities required for an individual for continued well-being, including:

(A) personal grooming, including oral hygiene and denture care;

(B) dressing;

(C) bathing;

(D) toileting and toilet hygiene;

(E) eating/nutrition;

(F) administration of medication; and

(G) transferring, ambulation and mobility.

(ii) are divided into the following levels:

(A) "Independent" means the resident can perform the ADL without help.

(B) "Assistance" means the resident can perform some part of an ADL, but cannot do it entirely alone.

(C) "Dependent" means the resident cannot perform any part of an ADL; it must be done entirely by someone else.

(c) Certification in Cardiopulmonary Resuscitation (CPR) refers to certification issued after completion of a course that is consistent with the most current version of the American Heart Association Guidelines for Health Care Provider CPR.

(d) "Home-like" as used in statute and this rule means a place of residence which creates an atmosphere supportive of the resident's preferred lifestyle. Home-like is also supported by the use of residential building materials and furnishings.

(e) "Hospice patient" means an individual who is admitted to a hospice program or agency.

(f) "Legal representative" means an individual who is legally authorized to make health care decisions on behalf of another individual.

(g) "Monitoring device":

(i) means a video surveillance camera or a microphone or other device that captures audio; and

(ii) does not include:

(A) a device that is specifically intended to intercept wire, electronic, or oral communication without notice to or the consent of a party to the communication; or

(B) a device that is connected to the Internet or that is set up to transmit data via an electronic communication.

(h) "Licensed health care professional" means a registered nurse, physician assistant, advanced practice registered nurse, or physician licensed by the Utah Department of Commerce who has education and experience to assess and evaluate the health care needs of the resident.

(i) "Responsible person" means an individual who:

(i) is designated in writing by a resident to receive communication on behalf of the resident; or

(ii) a legal representative.

(j) "Self-direct medication administration" means the resident can:

(i) recognize medications offered by color or shape; and

(ii) question differences in the usual routine of medications.

([j]k) "Service Plan" means a written plan of care for services which meets the requirements of R432-270-13.

([k]l) "Services" means activities which help the residents develop skills to increase or maintain their level of psycho-social and physical functioning, or which assist them in activities of daily living.

([l]m) "Significant change" means a major change in a resident's status that is self-limiting or impacts on more than one area of the resident's health status.

([m]n) "Significant assistance" means the resident is unable to perform any part of an ADL and is dependent upon staff or others to accomplish the ADL as defined in R432-270-3(2)(b).

([n]o) "Social care" means:

(i) providing opportunities for social interaction in the facility or in the community; or

(ii) providing services to promote independence or a sense of self-direction.

([o]p) "Unit" means an individual living space, including living and sleeping space, bathroom, and optional kitchen area.

 

R432-270-11. Transfer or Discharge Requirements.

(1) A resident may be discharged, transferred, or evicted for one or more of the following reasons:

(a) The facility is no longer able to meet the resident's needs because the resident poses a threat to health or safety to self or others, or the facility is not able to provide required medical treatment.

(b) The resident fails to pay for services as required by the admission agreement.

(c) The resident fails to comply with written policies or rules of the facility.

(d) The resident wishes to transfer.

(e) The facility ceases to operate.

(2) Prior to a facility initiated transfer[ring] or discharg e[ing] of a resident, the facility shall serve a transfer or discharge notice upon the resident and the resident's responsible person.

(a) The notice shall be either hand-delivered or sent by certified mail.

(b) The notice shall be made at least 30 days before the day on which the facility plans to transfer or discharge the resident, unless;

(i) [except that the ]notice for a shorter period of time is necessary to protect[may be made as soon as practicable before transfer or discharge if]:

([i]A) the safety [or health ]of individuals in the facility from endangerment due to the medical or behavioral status of the resident[persons in the facility is endangered];[or]

([ii]B) the health of the individuals in the facility from endangerment due to the resident's continued residency;

(C) an immediate transfer or discharge is required by the resident's urgent medical needs[.]; or

(D) the resident has not resided in the facility for at least 30 days.

(3) The notice of transfer or discharge shall:

(a) be in writing with a copy placed in the resident file;

(b) be phrased in a manner and in a language that is most likely to be understood by the resident and the resident's responsible person[can understand];

(c) detail the reasons for transfer or discharge;

(d) state the effective date of transfer or discharge;

(e) state the location to which the resident will be transferred or discharged, if known;

(f) state that the resident may request a conference to discuss the transfer or discharge; and

(g) contain the following information:

(i) [for facility residents who are 60 years of age or older,] the name, mailing address, email address and telephone number of the State Long Term Care Ombudsman;

(ii) for facility residents with developmental disabilities, the mailing address and telephone number of the agency responsible for the protection and advocacy of developmentally disabled individuals established under part C of the Developmental Disabilities Assistance and Bill of Rights Act; and

(iii) for facility residents who are mentally ill, the mailing address and telephone number of the agency responsible for the protection and advocacy of mentally ill individuals established under the Protection and Advocacy for Mentally Ill Individuals Act.

(4) The facility shall:

(i) update the transfer or discharge notice as soon as practicable before the transfer or discharge if information in the notice changes before the transfer or discharge;

(ii) orally explain to the resident, the services available through the ombudsman and the contact information for the ombudsman;

(iii) send a copy, in English, of the notice described in Subsection (2) to the State Long Term Care Ombudsman:

(A) on the same day on which the facility delivers the notice described in Subsection (2) to the resident and the resident's responsible person; and

(B) provide the notice described in Subsection (2) at least 30 days before the day on which the resident is transferred or discharged, unless notice for a shorter period of time is necessary to protect the safety of individuals in the facility from endangerment due to the medical or behavioral status of the resident.

(5) The facility shall provide and document the provisions of[sufficient] preparation and orientation, in a language and manner the resident is most likely to understand, for [to ]a resident to ensure a safe and orderly transfer or discharge from the facility.

([5]6) The resident or the resident's responsible person may contest a transfer or discharge. If the transfer or discharge is contested, the facility shall provide an informal conference, except where undue delay might jeopardize the health, safety, or well-being of the resident or others.

(a) The resident or the resident's responsible person must request the conference within five calendar days of the day of receipt of notice of discharge to determine if a satisfactory resolution can be reached.

(b) Participants in the conference shall include the facility representatives, the resident or the resident's responsible person, and any others requested by the resident or the resident's responsible person.

([6]7) In the event of a facility closure, provide written notification of the closure to the State Long Term Care Ombudsman, each resident of the facility, and each resident's responsible person.

(8) The facility may not discharge a resident for the sole reason that the resident or the resident's legal representative requests to install or operate a monitoring device in the individual's room in accordance with UCA Section 26-21-304.

 

KEY: health care facilities

Date of Enactment or Last Substantive Amendment: [November 1, 2017]2018

Notice of Continuation: April 10, 2014

Authorizing, and Implemented or Interpreted Law: 26-21-5; 26-21-1