HB-4441, As Passed Senate, May 25, 2011

SUBSTITUTE FOR

HOUSE BILL NO. 4441

     A bill to amend 1978 PA 368, entitled

"Public health code,"

by amending sections 22208 and 22210 (MCL 333.22208 and 333.22210),

section 22208 as amended by 1993 PA 88 and section 22210 as amended

by 2006 PA 195.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

     Sec. 22208. (1) "Short-term nursing care" means nursing care

provided in a hospital to a patient who has been discharged or is

ready for transfer from a licensed hospital bed other than a

hospital long-term care unit bed and cannot be placed in a nursing

home bed, county medical care facility bed, or hospital long-term

care unit bed located within a 50-mile radius of the patient's

residence.

(1) (2) "Title XVIII" means title XVIII of the social security

act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2,

1395c to 1395i, 1395-2 to 1395i-4, 1395j to 1395t, 1395u to 1395w-

2, 1395w-4 to 1395zz, and 1395bbb to 1395ccc 42 USC 1395 to

1395kkk-1.

(2) (3) "Title XIX" means title XIX of the social security

act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i

to 1396u 42 USC 1396 to 1396w-5.

     Sec. 22210. (1) A Subject to this section, a hospital that

applies to the department for a certificate of need and meets all

of the following criteria shall be granted a certificate of need

for a short-term nursing an extended care services program with up

to 10 licensed hospital beds:

     (a) Is eligible to apply for certification as a provider of

swing-bed extended care services through the use of swing beds

under section 1883 of title XVIII, 42 USC 1395tt.

     (b) Subject to subsection (2), has fewer than 100 licensed

beds not counting beds excluded under section 1883 of title XVIII,

42 USC 1395tt.

     (c) Does not have uncorrected licensing, certification, or

safety deficiencies for which the department or the bureau of fire

services created in section 1b of the fire prevention code, 1941 PA

207, MCL 29.1b, or both, has not accepted a plan of correction.

     (d) Provides evidence satisfactory to the department that the

hospital has had difficulty in placing patients in skilled nursing

home beds during the 12 months immediately preceding the date of

the application.

     (2) After October 1, 1990, the criteria set forth in

subsection (1)(b) may be modified by the commission, using the

procedure set forth in section 22215(3). The department shall not

charge a fee for processing a certificate of need application to

initiate a short-term nursing an extended care services program.

     (3) A hospital that is granted a certificate of need for a

short-term nursing an extended care services program under

subsection (1) shall comply with all of the following:

     (a) Not charge for or otherwise attempt to recover the cost of

a length of stay for a patient in the short-term nursing extended

care services program that exceeds the length of time allowed for

post-hospital extended care under title XVIII.

     (b) Admit patients to the short-term nursing extended care

services program only pursuant to an admissions contract approved

by the department.

     (c) Not Subject to subdivision (f), not discharge or transfer

a patient from a licensed hospital bed other than a hospital long-

term care unit bed and admit that patient to the short-term nursing

extended care services program unless the discharge or transfer and

admission is determined medically appropriate by the attending

physician.

     (d) Permit access to a representative of an organization

approved under section 21764 to patients admitted to the short-term

nursing extended care services program, for all of the purposes

described in section 21763.

     (e) Subject to subsection (8), not Not allow the number of

patient days for the short-term nursing extended care services

program to exceed the equivalent of 1,825 patient days for a single

state fiscal year.

     (f) Transfer a patient in the short-term nursing care program

to an appropriately certified nursing home bed, county medical care

facility bed, or hospital long-term care unit bed located within a

50-mile radius of the patient's residence within 5 business days

after the hospital has been notified, either orally or in writing,

that a bed has become available.Not provide extended care services

in a swing bed if the hospital owns or operates a hospital long-

term care unit that has beds available.

     (g) Not charge or collect from a patient admitted to the

short-term nursing extended care services program, for services

rendered as part of the short-term nursing extended care services

program, an amount in excess of the reasonable charge for the

services as determined by the United States secretary of the United

States department of health and human services under title XVIII.

     (h) Assist a patient who has been denied coverage for services

received in a short-term nursing an extended care services program

under title XVIII to file an appeal with the medicare recovery

project operated by the office of services to the aging.

     (i) Operate the short-term nursing extended care services

program in accordance with pursuant to this section and the

requirements of the swing bed provisions of section 1883 of title

XVIII, 42 USC 1395tt, that are applicable to the extended care

services program.

     (j) Provide data to the department considered necessary by the

department to evaluate the short-term nursing extended care

services program. The data shall include, but is are not limited

to, all of the following:

     (i) The total number of patients admitted to the hospital's

short-term nursing extended care services program during the period

specified by the department.

     (ii) The total number of short-term nursing extended care

services patient days for the period specified by the department.

     (iii) Information identifying the type of care to which patients

in the short-term extended care nursing services program are

released.

     (k) As part of the hospital's policy describing the rights and

responsibilities of patients admitted to the hospital, as required

under section 20201, incorporate all of the following additional

rights and responsibilities for patients in the short-term nursing

extended care services program:

     (i) A copy of the hospital's policy shall be provided to each

short-term nursing extended care services patient upon admission,

and the staff of the hospital shall be trained and involved in the

implementation of the policy.

     (ii) Each short-term nursing extended care services patient may

associate and communicate privately with persons of his or her

choice. Reasonable, regular visiting hours, which shall take into

consideration the special circumstances of each visitor, shall be

established for short-term nursing extended care services patients

to receive visitors. A short-term nursing An extended care services

patient may be visited by the patient's attorney or by

representatives of the departments named in section 20156 during

other than established visiting hours. Reasonable privacy shall be

afforded for visitation of a short-term nursing an extended care

services patient who shares a room with another short-term nursing

extended care services patient. Each short-term nursing extended

care services patient shall have reasonable access to a telephone.

     (iii) A short-term nursing An extended care services patient is

entitled to retain and use personal clothing and possessions as

space permits, unless medically contraindicated, as documented by

the attending physician in the medical record.

     (iv) A short-term nursing An extended care services patient is

entitled to the opportunity to participate in the planning of his

or her medical treatment, including the development of the

discharge plan under subdivision (m). A short-term nursing An

extended care services patient shall be fully informed by the

attending physician of the short-term nursing extended care

services patient's medical condition, unless medically

contraindicated, as documented by a physician in the medical

record. Each short-term nursing extended care services patient

shall be afforded the opportunity to discharge himself or herself

from the short-term nursing extended care services program.

     (v) A short-term nursing An extended care services patient is

entitled to be fully informed either before or at the time of

admission, and during his or her stay, of services available in the

hospital and of the related charges for those services. The

statement of services provided by the hospital shall be in writing

and shall include those services required to be offered on an as

needed basis.

     (vi) A patient in a short-term nursing an extended care

services program or a person authorized in writing by the patient

may, upon submission to the hospital of a written request, inspect

and copy the patient's personal or medical records. The hospital

shall make the records available for inspection and copying within

a reasonable time, not exceeding 7 days, after the receipt of the

written request.

     (vii) A short-term nursing An extended care services patient

has the right to have his or her parents, if the short-term nursing

extended care services patient is a minor, or his or her spouse,

next of kin, or patient's representative, if the short-term nursing

extended care services patient is an adult, stay at the facility

hospital 24 hours a day if the short-term nursing extended care

services patient is considered terminally ill by the physician

responsible for the short-term nursing extended care services

patient's care.

     (viii) Each short-term nursing extended care services patient

shall be provided with meals that meet the recommended dietary

allowances for that patient's age and sex and that may be modified

according to special dietary needs or ability to chew.

     (ix) Each short-term nursing extended care services patient has

the right to receive a representative of an organization approved

under section 21764, for all of the purposes described in section

21763.

     (l) Achieve and maintain medicare certification under title

XVIII.

     (m) Establish a discharge plan for each extended care services

patient who is admitted to the extended care services program. In

the discharge plan, the hospital shall emphasize patient choice in

receiving extended care services in the most appropriate and least

restrictive setting. The hospital shall provide to the patient or

his or her authorized representative a copy of the discharge plan

not later than 3 days after the patient is admitted to the extended

care services program.

     (4) A hospital or the owner, administrator, an employee, or a

representative of the hospital shall not discharge, harass, or

retaliate or discriminate against a short-term nursing an extended

care services patient because the short-term nursing extended care

services patient has exercised a right described in subsection

(3)(k).

     (5) In the case of a short-term nursing an extended care

services patient, the rights described in subsection (3)(k)(iv) may

be exercised by the patient's representative, as defined in section

21703(2).

     (6) A short-term nursing An extended care services patient

shall be fully informed, as evidenced by the short-term nursing

extended care services patient's written acknowledgment, before or

at the time of admission and during stay, of the rights described

in subsection (3)(k). The written acknowledgment shall provide that

if a short-term nursing an extended care services patient is

adjudicated incompetent and not restored to legal capacity, the

rights and responsibilities set forth in subsection (3)(k) shall be

exercised by a person designated by the short-term nursing extended

care services patient. The hospital shall provide proper forms for

the short-term nursing extended care services patient to provide

for the designation of this person at the time of admission.

     (7) Subsection (3)(k) does not prohibit a hospital from

establishing and recognizing additional rights for short-term

nursing extended care services patients.

     (8) Upon application, the department may grant a variation

from the maximum number of patient days established under

subsection (3)(e), to an applicant hospital that demonstrates to

the satisfaction of the department that there is an immediate need

for skilled nursing beds within a 100-mile radius of the hospital.

A variation granted under this subsection shall be valid for not

more than 1 year after the date the variation is granted. The

department shall promulgate rules to implement this subsection

including, at a minimum, a definition of immediate need and the

procedure for applying for a variation.

(8) (9) A hospital that violates subsection (3) is subject to

the penalty provisions of section 20165.

(9) (10) A person shall not initiate a short-term nursing an

extended care services program without first obtaining a

certificate of need under this section.

     (10) As used in this section:

     (a) "Extended care services program" means a program by a

hospital to provide extended care services to a patient through the

use of swing beds under section 1883 of title XVIII, 42 USC 1395tt.

     (b) "Hospital long-term care unit" means that term as defined

in section 20106.

     Enacting section 1. This amendatory act takes effect 180 days

after the date it is enacted into law.